Post-burn duct carcinoma breast: An unusual case report
A 27-year-old woman presented with a rapidly growing lump in the right chest wall for 3 months. She had sustained thermal burns 20 years back, involving the right side of the chest wall, arm and trunk. The burns were left to heal secondarily and skin grafting was not done. On examination, the BS involved the right mammary area, axilla, arm and upper back. Because of severe scar contractures, the upper arm was adherent to the trunk []. The right breast was completely deformed. Underneath the burn scar, there was a large, firm lump measuring 10 × 8 × 6 cm in the right mammary region. The lump was adherent to the underlying chest wall but the overlying skin was free. The right axilla could not be palpated due to severe scar contractures. A firm, mobile lymph node measuring 1.5 × 1 × 1 cm, was palpable in the right supraclavicular region. Left breast and axilla were unremarkable.\nThe patient was referred for fine needle aspiration cytology (FNAC) from the lump and supraclavicular lymph node which was performed as per the standard technique. FNA from the mammary lump yielded thick yellowish aspirate, which was processed as air-dried, Giemsa stained smears and a part of it was processed for cell-block preparation. FNA smears showed moderate cellularity, comprising singly scattered and loosely cohesive clusters of round to oval cells; forming a glandular pattern at places []. The cells showed moderate pleomorphism with high nuclear-cytoplasmic ratio, coarse chromatin, prominent 1-2 nucleoli and moderate amount of pale blue cytoplasm. The background was necrotic. Immunocytochemistry for HER-2/neu was performed on the cell-block sections, the cells showed focal weak positivity for the marker. FNAC from the supraclavicular node revealed similar features, suggestive of metastasis. Thus a cytological diagnosis of duct carcinoma breast was suggested.\nA trucut biopsy from the lump [] revealed solid nests and tubular formations of atypical round to oval cells, with moderate amount of cytoplasm, coarse chromatin with 1-2 prominent nucleoli and high mitotic activity (1-2/hpf). There was marked desmoplastic reaction in the surrounding stroma. On immunohistochemistry (IHC), few tumor cells stained positive for HER-2/neu. Thus histological features and IHC were compatible with a high-grade IDC (NOS, grade 3). The patient declined surgery and was lost to follow-up.