![]() Various proposed theories to explain the etiopathogenesis of tumors in BS include chronic irritation (Virchow), misplaced epithelial cells (Ribbet), release of toxins by autolysis and heterolysis from tissue (Treves and Pack), repeated trauma and loss of skin elasticity resulting in ulceration, hence provoking malignant transformation (Gibbin). Malignant transformation rarely occurs in grafted skin, and hence rapid epithelization and prompt skin grafting should be promoted. The published literature provides very little information about the possible link between old thermal scars and development of duct carcinoma breast.Ī review of literature suggests that severe burns which are allowed to heal without skin grafting (as in the present case), are especially prone to develop cancer. To the best of our knowledge, this is the first case of an IDC breast developing in post-BS. However none of these was reported as IDC breast. An extensive literature search revealed four cases of AC arising in burn scars, out of which one was a metastatic AC in a burnt arm from a lung primary, while three were reported as AC arising in the previously burnt breast/mammary area. Adenocarcinoma arising in post-BS is extremely rare. There are rare case reports of malignant fibrous histiocytoma, dermatofibrosarcoma protuberans, pleomorphic liposarcoma and verrucous carcinoma in post-burn patients. Squamous cell carcinoma is the commonest tumor arising in old BS (71%) followed by basal cell carcinoma (6%), malignant melanoma (5%) and sarcomas (4%). The average latent period for development of a post-burn malignancy is 30 years. The patient declined surgery and was lost to follow-up.Ĭancers arising in old BS are rare. Thus histological features and IHC were compatible with a high-grade IDC (NOS, grade 3). ![]() On immunohistochemistry (IHC), few tumor cells stained positive for HER-2/neu. There was marked desmoplastic reaction in the surrounding stroma. Thus a cytological diagnosis of duct carcinoma breast was suggested.Ī 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). FNAC from the supraclavicular node revealed similar features, suggestive of metastasis. ![]() Immunocytochemistry for HER-2/neu was performed on the cell-block sections, the cells showed focal weak positivity for the marker. The cells showed moderate pleomorphism with high nuclear-cytoplasmic ratio, coarse chromatin, prominent 1-2 nucleoli and moderate amount of pale blue cytoplasm. FNA smears showed moderate cellularity, comprising singly scattered and loosely cohesive clusters of round to oval cells forming a glandular pattern at places. 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. ![]() The patient was referred for fine needle aspiration cytology (FNAC) from the lump and supraclavicular lymph node which was performed as per the standard technique. (a) Clinical photograph showing extensive burn scar involving right mammary area, chest and arm (b) FNA smears from breast showing malignant epithelial cells arranged in clusters and glandular pattern (Giemsa stain, ×300) (c) Biopsy from breast lump showing features of infiltrating duct carcinoma breast (H and E, ×300)
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