Breast-like cancer of the vulva: primary or metastatic? A case report and review of the literature

A 45-year-old white female presented a polypoid nodule in the vulva, one year after she was operated on for breast cancer. Histologic examination showed a poorly differentiated carcinoma that closely resembled the primary breast tumor. Eight similar cases have been previously described in the literature. This very rare event should be differentiated from primary adenocarcinoma of the mammary-like glands of the vulva. The recognition of such a lesion as primary or metastatic is very important, since it greatly influences management and prognosis.

Breast carcinoma; Vulva; Metastasis; Mammary-like glands

[1] Parker S.L .,T ong T., Bolden S.,W ingo P.A.: "Cancer Statistics, 1997". CA Cancer J. Clin., 1997, 47, 5.

[2] Cifuentes N., Pickren J. W.: "Metastases from carcinoma of mammary gland.A n autopsy study". J. Surg. Oncol., 1979, 11 , 193.

[3] MazurT.,H sueh S., Gersell D. J.: "Metastases to the female genital tract:A nalysis of 325 cases". 1978, Cancer, 1984, 53, 1978.

[4] Convington E. E., Brendle W. K.: " Breast carcinoma with vulvar metastases". Ohstet. Gynecol., 1964, 23, 910.

[5] Dehner L. P.: "Metastatic and secondary tumors of the vulva" Ohstet. Gynecol., 1973, 42, 47.

[6] Mader M. H., Friedrich E. G.: "Yul var metastasis of breast camnoma: a case report". J. Reprod. Med., 1982, 2, 169.

[7] Cohen R., Margolius K. A., Guidozzi F.: "Non-gynaecological metastases to the vulva and vagina". S. Afr. Med. J., 1988, 73, 159.

[8] Patsner B.: "Bartbolin's gland metastases from breast cancer: a case report". Eur. J. Gynaecol. Oneal., 1996, 17, 96.

[9] CurtinW .M .,M urthy B.:''Vulvar metastasis of breast carcinoma. A case report". J. Reprod. Med., 1997, 42, 61.

[10] Menzin A. W., De Risi D., Smilari T. F., Kalish P. E., Vinciguerra V.: "Lobular breast carcinoma metastatic to the vulva: a case report and literature review". Gynecol. Oncol., 1998, 69, 84.

[11] Porzio G., FicorellaC .,C alvisi G.,P arisI ., Ricevuto E.,M archetti P.: " Ductal breast carcinoma metastatic to the vulva: a case report". Ew: J. Gynaecol. Oneal., 2001, 22, 147.

[12] Cho D.. Buscema J., RosenheinN .B., Woodruff J.D.: "Primary breast cancer of the vulva". Obstet., Gynecol., 1985, 66 (3 Suppl), 79S.

[13] Simon K. E., Dutcher J. P., Runowicz C. D.,W iemik P. H.: "Adenocarcinoma arising in vulvar breast tissue". Cancer, 1988, 62, 2234.

[14] Levin M.,P akarakas R. M.,C hang H.A .,M aimanM ., Goldberg S. L.: "Primary breast carcinoma of the vulva: a case report and review of the literature". Gynecol. Oneal., 1995. 56, 448.

[15] Kennedy D. A., Hermina M. S., Xanos E.T., Schink J. C., Hafez G. R.: "Infiltrating ductal carcinoma of the vulva". Pathol. Res. Pract., 1997, 193, 723.

[16] Trvin W.P .,C athro H.P., Grosh W.W.. Rice L. W.,A ndersen W A.: "Primary breast carcinoma of the vulva: a case report and literature review". Gynecol. Oncol., 1999, 73, 155.

[17] Neumann I., Strauss H. G., Buchmann J., Koelbl H.: "Ectopic lobular breast cancer of the vulva". Anticancer Res., 2000, 20, 4805.

[18] Gorisek B., Zegura B., Kavalar R., But T., Kra」ncI.: "Primary breast cancer of the vulva: a case report and review of the literature". Wien Klin. Wochenschr., 2000, 112, 855.

[19] Van der Putte S. J. C.: "Mammary-like glands of the vulva and their disorders". Int. J. Gynecol. Pathol., 1994, 13. 150.

[20] Luttges J.. KalbfleischH .,P rinz P.: "Nipple involvement and multicentricity in breast cancer. A study on whole organ sections“ J Cancer Res. Clin. Oncol., 1987, 11, 481.

[21] Holland R., Yeling S.H .,M ravunacM .,H endriks J. H.: "Histologic multifocality of Tis, T l-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery". Cancer, 1985, 56, 979.

[22] UngerM .A ., Rishi M.,Clemmer V. B.,H artman J.L ., Keiper E A.. Greshock J. D. et al.: "Characterization of adjacent breast tumors using oligonucleotide microarrays“ Breast Cancer Res., 2001, 3, 336.

[23] Kim N. G.. Roh J. K., Kim J. H., ChungW. Y., Park C. S., Ktm H.: "Clonality analysis using methylation-specific polymerase chain reaction: a novel method for investigating tumor clonality" Lab. Invest., 1999. 79, 1727.

[24] ZhangL .,E pstein J.,Band P., Berean K.,H ay J.,C heng X., Rosin M. P.: "Local tumor recurrence or emergence of a new primary lesion?A molecular analysis". J. Oral Pathol. Med., 1999. 28, 381.

[25] Heim S.,T eixeira M. R., Dietrich C. U.,P andis N.: "Cytogenetic polyclonality in tumors of the breast". Cancer Genet. Cytogenet., 1997. 95, 16.

[26] Teixeira M. R.,P andis N., Bardi G.,A ndersen J. A.,Heim S.: ''Karyotypic comparisons of multiple tumorous and macroscopically normal surrounding tissue samples from patinets with breast cancer". Cancer Res., 1996, 56, 855.

[27] Pandis N., Teixeira M. R.. Adeyinka A., Rizou H., Bardi G., Mertens F. et al.: "Cytogenetic comparison of primary tumors and lymph node metastases in breast cancer patients". Genes Chromasomes Cancer, 1998, 22, 122.