Case Presentation:
We report a case of a 19-year-old female, from east Sudan presented 3
months after giving birth of her first healthy baby, with huge multiple
bilateral breast masses. She was very anxious about this bilateral tumor
growth in her breasts and kept thinking about cancer and death according
to that fast rapid growth, especially she is very young. This tumor
started to grow two years prior to the presentation (Age 17). Initially
the masses appeared in the right breast and shortly involved the left
one. Lumps showed a gradual course initially, but a dramatic rapid
growth was noticed during pregnancy. There was severe discomfort
especially in the left breast, due to rapid growth and inflammation. No
past history of breast trauma or family history of breast cancer. The
patient started to menstruate at age of 15 year, without reporting any
abnormal events in her breasts. She was of good internal and external
hygiene, no history of smoking, drinking or any bad habits and no
allergies. Both breasts had multiple lumps, the largest right breast
mass was measuring about 7cm x 7cm, hard and nodular with no skin
changes or evidence of deep structure involvement by clinical palpation.
The largest left breast mass was about 7cm X 5 cm with other smaller
ones occupying all 4 quadrants. There was large area of skin changes
surrounds the left large lump with a large irregular inflamed ulcer
below and lateral to the Left nipple with no elevated edges. Both
Breasts were lactating and milk discharge from the nipple was observed
with normal color.
Ultrasounds report of left breast showed multiple bilateral echogenic
breast enlargements, the largest one was about 7 cm x 7.55 cm. Also,
there was a 7cm x 4 cm well defined, turbid and cystic collection noted
beneath the ulcerated area in the left breast [figure 1]. Dilated
right breast mammary ducts were noticed. The nipple and overlying skin
were intact. Multiple enlarged bilateral axillary lymph nodes (LN) were
identified. The cytology report confirmed area of hyalinization with no
malignant changes. Patient completed six months of conservative
management locally without any signs of improvement. The size of the
tumor steadily growing, inflammation, ulceration and lymph node
enlargement were getting worse with time. Consequently, left simple
mastectomy had been done base on failure of conservative management and
infiltration of all quadrants left breast with very huge ulcerated tumor
with active surveillance of right mass. The excised specimen’s
histopathological report revealed macroscopically an exophytic growth
measuring 7cm x 6 cm lateral to normal looking nipple with skin
ulceration. Cross sectioning of the specimen showed no breast tissue,
only lobulated firm mass with central cyst behind the nipple measuring
10cm x 7cm x 5 cm in diameter. Microscopically sections showed enlarged
lobules, with complex glands composed of inner actively secreting
epithelial cells with vacuolated cytoplasm and apical cytoplasmic blebs,
and outer myoepithelial layer [Figure 2, 3]. There was no
cytological atypia and stroma was scanty. There were 2 reactive isolated
axillary lymph nodes identified during histology, the right breast
showed same histological features [Figure 4, 5]. P63 and S100 were
positive. The immunohistochemistry confirmed a diffuse tumefactive
lactating adenosis with very complicated histological picture.
Eventually, Six month follow up was arranged and overall prognosis after
surgery was satisfied.