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Case Report
A 38-year old female patient was hospitalized on the 10th of December, 2006 as she had noted a lump in her right breast for 3 months. Her past medical history indicated that, because of a left-breast carcinoma complex, she had undergone a radical operation for a left-sided mastocarcinoma on the 20th, October, 2002, in Xiangya Hospital, Chasha. She received 5-course postoperative chemotherapy (i.e. CAF regimen), and one course of radiotherpy on the left supraclavicular and left parasternal region. There was no medical record of breast cancer in her family.
Physical examination of the right breast showed that there was no red swelling of the skin, no orange-peel appearance and the nipple was not inverted. Lumps of sizes of 5×3 cm and 3×2 cm could be felt at the lower inner quadrant and the upper external quadrant of the right breast, with an irregular tumor form, a little rigid texture, rough surface, blurry margin, poor mobility and absence of tenderness. Two lymph nodes, one 1.5×1 cm and the other 1×1 cm in size, could be felt at the right axilla, with a rigid texture, a limpid border and an acceptable mobility. A supersonic B examination indicated separate, slightly low-echo areas of 4.1× 1.3 cm and of 2.6×1.5 cm at the lower inner quadrant and the upper external quadrant of the right breast. SPECT radionuclide imaging suggested a slight radionuclide concentration at the lumps of the right breast, with a more evident delayed imaging compared to an early imaging. Upon fine-needle aspiration, cancer cells were found in the lumps of the right breast, using a cytological examination. Clinical diagnosis demonstrated that it was a rightsided breast cancer (T2N1MX).
After completing the preoperative preparation, a radical operation of the right-sided mastocarcinoma was conducted on the 13th of December, 2006. Pathological examination showed that there were separated cancerous nodi at the lower inner quadrant and the upper external quadrant of the right breast, with sizes 5×3×3 cm and of 3×2×2 cm. The cancerous nodi had no membrane, a rigid texture and a buff cross section. Microscopically the cancer cells were big, round or oval, and foamy, with a rich and lucent cytoplasm and visible vacuoles in part of the cells. Lipid staining showed that the cancerous cytoplasm was filled with a great quantity of lipid. Pathological diagnosis revealed a right infiltrated lipid-rich carcinoma of the breast, with metastasis of the axillary nodes (13/15). An immunohistochemical assay showed the following: PR(-), ER (+++), CerbB-2 (-), E-cadherin (+++). The surgical procedure went smoothly and postoperative recovery was satisfactory. Two courses of radiotherapy and chemotherapy were performed, resulting in a present good general state of health.
Lipid-rich breast carcinoma of this case, H&E × 400.
Discussion
Lipid-rich carcinoma of breast, also called sebaceous breast cancer, is a rare mammary cancer of a special type. First reported by Aboumrad[1] in 1963, it was formally named following a report of 13 cases by Ramos et al.[2] in 1974. This breast carcinoma has a rather low incidence. After consulting the literature in China and at overseas, less than 100 cases of this disease have been confirmed up to now.
Based on the diagnostic criteria on bilateral primary breast cancer[3], our case is in accord with a diagnosis of heterochronic bilateral primary breast cancer. However, this case of unilateral lipid-rich breast carcinoma is especially unusual as it occurred in a patient with bilateral primary breast cancer. To our knowledge no similar case has been reported in the literature before. In this case, there were two mutually-separated cancerous nodi in the homolateral breast, which is consistent with a multicentric lipidrich mammary carcinoma. Its etiological factors and pathogenesis require further investigation.
The pathologic features of a lipid-rich breast carcinoma include large cancer cells, transparent or foamy cytoplasm, that is full of a medium or considerable amount of neutral lipid and strongly-positive lipid staining. No specific clinical manifestations have been found to relate to this disease, so a final diagnosis of the disease relies on pathological examination and lipid staining. The tumor shows very high malignancy, strong invasivenes, rapid progression and a poor prognosis. An early axillary-node metastasis may occur and then the tumor may spread all over the body via a hematogenous route, even with a tendency for eyelid metastasis. It has been reported that half of the patients die within 2 years after their first visit to the doctor[2].
- Received March 25, 2007.
- Accepted June 18, 2007.
- Copyright © 2007 by Tianjin Medical University Cancer Institute & Hospital and Springer
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