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.