International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 09 Issue 24, December, 2017

Pages: 32-34

Date of Publication: 26-Dec-2017


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Post Burn Ductal Carcinoma of Breast- A Rare Case Report

Author: Juhi Khanna, Nandita P. Mehta, Hansa M. Goswami

Category: Healthcare

Abstract:Objective: A 25 years old female presented to outpatient department of General Surgery of Civil Hospital with breast lump. The objective was to investigate and diagnose the case.
Material and Methods: The case was clinically examined in General surgery department. FNAC was done to diagnose swelling. The resected tissue was sent to histopathology for confirmation of the diagnosis. Histological analysis and Immunohistochemical staining was done in Pathology department.
Results: On FNAC-Infiltrating Ductal Carcinoma of breast. The patient was operated and tumor was resected. On gross examination, growth identified measures 4x3.5x2.5cm3, Cut surface
is whitish solid, well defined and firm to hard. On histological examination tumor was diagnosed to be Poorly Differentiated Ductal Carcinoma of Breast. Immuno-histo-chemical
staining revealed that the cells were positive for Estrogen receptor and Progesterone receptor. This case was to be Post burn Ductal Carcinoma of breast.
Conclusion: Malignancy arising from Burn scar is rare, Squamous cell Carcinoma is most common Burn scar neoplasia and adenocarcinoma is extremely rare. So such cases should be thoroughly examined and followed.

Keywords: Post burn, Ductal Carcinoma

DOI: 10.7324/IJCRR.2017.9246

Full Text:

INTRODUCTION:

Malignancy arising from burn scar is extremely rare. Squamous cell carcinoma is the most common, type, other types are basal cell carcinoma, malignant melanoma and rarely sacrcoma. Adenocarcinoma is extremely rare and only 4 cases have been reported till date and only one case of infiltrating Ductal carcinoma of breast has been reported. We report a care case of post burn carcinoma in a young woman.

Case Report:

A 25 years old female presented to outpatient department of General Surgery of Civil Hospital with breast lump. She had sustained thermal burns 14 years back, involving the right side of  chest wall, arm and trunk. The burns where left to heal secondarily and no skin grafting was done. On examination, the burn scar was seen at right mammary area, axilla and arm. The right breast was deformed, nipple and areolar region was also unremarkable. Underneath the burn scar a large firm lump measuring4x3cm2 was seen in lower inner quadrant of right breast. The lump was adherent to chest wall but overlying skin was free. In the right axilla no lymph node where palpated. Left breast and axilla were unremarkable.

The patient was referred for fine needle aspiration (FNAC) from the lump which was performed as per standard technique. FNA from the lump yielded  blood mixed aspirated which was processed as air-dried, hematoxylin and eosin stained smears where prepared.FNA smears show moderate cellularity with ductal  cells arranged as irregular clusters and single cells(loss of cohesion). No myoepithelial cells seen. Ductal cells show moderated to severe nuclear atypia, enlargement, pleomorphism with evidence of occasional bizarre forms, irregular nuclear membrane and chromatin. The cytomorphology is of malignant breast lesion-Ductal carcinoma (DC)of breast-Robinsons cytological grade II.[Figure 1]

Patient underwent surgery and the specimen was received for histopathological examination.

Gross examination: Received specimen measured 22x15x2.5cm3.nipple areola was grossly not identified. One growth measuring 4x3.5x2.5cm3was identified. Cut section was whitish, solid, well defined and firm to hard in consistency. Growth is 3 cm away from superior margin,3 cm away from inferior argin,2 cm away from medial margin ,5 cm away from lateral margin,1.5 cm from base. Total 12 lymph nodes where resected size ranging from 0.3x0.2cm2 to 0.8x0.5cm2.

Microscopic examination: Sections showed histology of Poorly differentiated Ductal Carcinoma of Breast [Figure 2,3] with lymphovascular permeation by tumor cells. Stroma showed desmoplasia, lymphoplasmacytic infiltration, hemorrhage and necrosis. Surrounding breast showed fibrocystic changes. Section from all resected 12 lymph node does not show evidence of metastasis with histology of sinus histiocytosis. Section from resected surgical margin(superior, lateral, medial and inferior ) and base do not show evidence of tumor cells.

Conclusion: Poorly Differentiated infiltrating ductal carcinoma(IDC) of breast with tumor free resected surgical margins and base.

Modified BR grade III, TNM STAGING:T2NOMX,AJCC Stage grouping :stage IIA.[Figure 2 and 3].

Immunohistochemistry showed positivity for Estrogen receptor and progesterone receptor.

DISCUSSION:

Cancers arising in old burn scar is rare. 30years is the average latent period for development of malignancy. Most common cancer is Squamous cell carcinoma(71%),followed by basal cell carcinoma(6%),malignant melanoma(5%) and scarcomas(4%)[1]. Also  rare case of  malignant fibrous histocytoma, dermatofibrosarcoma protuberans, pleomorphic liposarcoma and verrucous carcinoma have been reported in post burn patient [1,2,3,4]. Adenocarcinoma in burn scar is extremely rare, total 5 cases have been reported and one case out of 5 was of IDC breast. This is the second case of IDC Breast developing in post burn.[5,6,7,8]

It has been seen that majority of burn scar carcinoma occur in burns that have not been grafted. It may also arise from chronic ulceration, but 50% patient had burn scar. The relatively avascular scar tissue with no lymphatic channels in scar may then act as immunological privileged site that allow the tumor to resist the body’s usual defenses[9,10].It is speculated that a carcinogenic toxin is produced from burned tissue and cicatrical tissue which prevents mechanism from checking the new tumor formation[11,12] .

As the breast is a modified sweat gland, DC post burn scar suggest that adnexal elements and adjacent subcutaneous tissue can also show malignant change.[7]

Promotion of rapid epithelisation and early grafting are the principles of treating initial burn.[9,10]

Conclusion:

Burn scar Malignancy is rare and Adenocarcinoma can occur in the burn scar although squamous cell carcinoma is most common. So patients need to be thoroughly examined and followed up. Skin grafting should be encouraged  after burn as it might help in prevention of cancer.

References:

1.Kowal-vern,criswell BK. Burn scar neoplasm: A literature and review and statistical analysis.

2.Tanaka A, HatokoM, Tada H, Kuwahara M, lioka H, Nitsuma K Dermatofibrosarcoma protuberans arising from a burn scar of axilla. Ann  Plast Surg.2004:52:423-5

3.Nishimoto S ,Matsushita T, Matsumolo K, Adachi S . A rare case of burn scar malignancy. Burns 1996;22:497-9.

4. Hunag CY, Feng CH, HSIAO YC, Chuang SS, Yang JY. Burn Scar Carcinoma J Dermatology Treat 2010,21:350-6.

5.Losanoff JE, Konard A, Sauter ER. Breast Cancer after severe burn in injury co incidence or consequence? Breast J. 2008:14:87-9.

6.Balakrishnan C, Noorily MJ Prasad VK, Wilson RP. Metastatic adenocarcinoma in a recent in a recent burn scar. Burns 1994;20:371-2.

7.Vogelin E Feichler G, Luscher NJ .Breast cancer in previously burned skin:A Post Burn skin adenexal malignancy? Burns 1997;23:366-8.

8.Neha Singh, Seena Rao and Shyama Jain J.Cytol.2013 Apr-Jun;30(2):139-141.doi:10.4103/0970-9371.112660.

9.Futrell JW Myers GH Jr.The burn scar as an immunologically privlleged site .Surg forum 1972;23:129-131

10.Dellon AL, Potvin, Chretin PB, Rogentine CN. The immunobiology of skin cancer. Plast reconstruct surg.1975;55:341-354.

11.Kennawa EC Hieger  J. Carcinogenic substances and their fluorescence BMJ 1930:I:1044-6.

12.Castillo JL, Goldsmith HS burn Scar malignancy in possible depressed immune setting. Surg forum 1968:19511.

13.Bostwich J. Pendergrast WJ, Vasconez LO. Marjolinsulcer: An immunologically privileged tumor? Plast Reconstruc surg. 1876:57:66-9

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A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
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A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

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