



















































Article- 07 47


Abstract

A 43-year-old woman presented with bilateral ectopic breasts in both the axillae in 

Chittagong Medical College Hospital in July 1996. She was diagnosed having carcinoma in 

the left ectopic breast. She was successfully treated with local surgical excision and regional 

lymph node dissection, adjuvant chemotherapy, loco-regional radiotherapy and hormone 

therapy. The patient continued tamoxifen for 5 years. Till last follow-up in December 2011, 

the patient was asymptomatic without any evidence of residual disease or local recurrence 

and evidence of metastases.

Key words: Ectopic accessory breasts, Adjuvant chemotherapy, Radiotherapy

                                                                                     J Enam Med Col 2013; 3(1): 47-49 

The incidence of ectopic accessory breast is 

uncertain, but it is generally found in 1-2% of 

humans.1 An alternative classification of ectopic 

breast tissue has been offered by Copeland and 

Geschickter2, in which accessory nipple formation, 

areola formation or both, with or without glandular 

breast, is termed supernumerary breast, as opposed 

to aberrant breast, referring to ectopic breast tissue 

without a nipple or areola complex. Aberrant breast 

tissue can develop with any disease that affects the 

normal breast, including breast carcinoma.3 

Carcinoma of aberrant breast tissue is rare.4 

Ectopic mammary gland includes both accessory and 

aberrant mammary glands.  Ectopic breast tissue can 

occur anywhere along the primitive embryonic milk 

line, extending from axilla to groin bilaterally. It has 

also been reported within axillary lymph nodes5 and 

along the ‘milk line’ that runs from the axilla to the 

inguinal region, the most common sites being the 

chest wall and the vulva.6 Ectopic breast parenchyma 

is  subject to changes similar to those of the 

orthotopic organ, including lactational changes, 

benign tumors and carcinoma.6 

The incidence of ectopic mammary gland is not low, 

but the development of malignancy within these 

anomalies has been scarcely reported. In view of the 

relative rarity, to remind the surgeons and 

oncologists regarding its good prognosis provided 

diagnosed early and properly treated, it was thought 
worthwhile in publishing the following case.

Case report
Mrs. Rowshan Ara, aged 43 years and mother of a 

son and two daughters, was admitted in Chittagong 

Medical College & Hospital (CMCH) on July 28, 

1996 with the complaints of a painless lump on the 

upper part of the medial wall of the left axilla for 8 

months which was gradually increasing in size.

Fig 1. Bilateral accessory breasts with carcinoma of 

the left (excised)

Introduction

 

47

Carcinoma of the Ectopic Breast

1.   Professor, Department of  Oncology, Enam Medical College & Hospital, Savar, Dhaka

2.   Former Assistant Professor, Department of Radiotherapy, Chittagong Medical College & Hospital, Chittagong

Correspondence  A. M. M. Shariful Alam, Email: nicrh2002@gmail.com

Case Report

A. M. M. Shariful Alam1, Shamima Anwar2



She had been on homeopathic treatment since 
development of the lump without any improvement. 
On admission, physical examination revealed a 
nontender, slightly mobile, palpable lump of about 5 
cm × 5 cm in size,  partly fixed to the underlying 
structures and free from overlying structures. There 
was no palpable lump in any breast and no palpable 
lymph gland could be detected either in the axillae or 
elsewhere in the body. On careful examination of the 
lump, there was small rudimentary nipple-like 
structure over the lump. The nipple-like structure of 
the same size was also found on the same site of the 
right axilla but without any lump or swelling. She 
was menopausal for the last two years and was 
hypertensive. She also observed coming out of milk 
from both these nipple-like structures of the axillae 
simultaneously during breastfeeding from original 
breasts following her every child birth. No 
abnormality was detected in her haematological 
profile, chest radiography, ultrasonogram of the 
abdomen and pelvis. She underwent local surgical 
excision and regional lymph node resection on 
16.09.1996. Histopathology revealed an invasive 
ductal carcinoma in the breast tissue, with foci of 
necrosis and moderate lymphocytic infiltration. 
Axillary lymph nodes showed reactive change. 
Estrogen and progesterone receptor positivity tests 
were performed and revealed estrogen and 
progesterone positivity. Hence the diagnosis was 
confirmed as infiltrating duct cell carcinoma of the 
left accessory breast. Then she attended the 
radiotherapy Outpatient Department (ROPD), 
CMCH on 10.10.96. Adjuvant combination 
chemotherapy including cyclophosphamide, 
adriamycin and 5-flurouracil was prescribed after 
satisfactory wound healing. This protocol was 
repeated on every 3 weeks with proper hematological 
care up to total of 6 cycles. The hematological 
parameters before each cycle of chemotherapy was 
normal and toxicity of the above cytotoxic drugs was 
on tolerable limit. 

The chemotherapy schedule was continued regularly 
up to 22.04.97. After completion of 6 cycles of 
chemotherapy, the patient was asymptomatic except 
some sorts of weakness and mild loss of appetite and 
on physical examination, no abnormality could be   
detected. Considering her age and menopausal status, 
tamoxifen (20 mg daily) was advised to continue it 
for 5 years. Three weeks after completion of 

chemotherapy, she was planned for radiotherapy by a 
direct field to the operated  axilla with a field size of 
12 × 12 cm and total dose given was 4000cGy in 20 
fractions up to 29.06.97. The total period of 
radiotherapy was uneventful. Six weeks after 
completion of radiotherapy, she was asymptomatic 
and there were no sign and symptom of recurrence or 
residual disease especially in the operated accessory 
breast. Opposite accessory breast and both normal 
breasts were also normal. No features of 
organomegaly and lymphadenopathy (locally or 
distant) were observed. Complete blood profile, chest 
radiography,  ultrasonogram of the abdomen and 
pelvis were normal. CT scan of the chest and 
abdomen were also normal. So all sorts of antimitotic 
treatment were stopped, except tamoxifen which was 
advised to continue for 5 years. The patient was also 
advised to come for follow-up at 6 weeks interval. 
After completion of 5-year courses of tamoxifen, the 
patient was asymptomatic. Physical examination and 
relevant investigations were normal. The patient 
underwent last follow-up examination in December 
2011. She was asymptomatic without any sign and 
symptom of recurrence or residual disease locally or 
elsewhere in the body. Relevant investigation reports 
were also normal.

Discussion
In most cases, the accessory breast tissue was either 
bilateral or confined to the right side.5 In the  present 
case, the accessory axillary breast tissue was bilateral 
and carcinoma was found only in the left ectopic 
breast. A frequency of 14% seen in one series 
appears so high that the occurrence of malignant 
changes in the accessory breast is not actually rare.7 
Although the incidence of ectopic breast tissue is 
about 1-2%8, it is more prone to develop malignant 
change than normal breast parenchyma.9 Malignant 
tumors occur more frequently than benign tumors in 
ectopic mammary glands.10 

In this article, we used the term ‘ectopic breast 
cancer’ for neoplasm developed in the left accessory 
gland. Review of Nakao et al11 showed that out of 37 
cases 33 (89%) occurred in the axilla, 2 in the 
parasternum and 2 in the inframammary region. 
Marshal7 reported that 58% of ectopic breast cancers 
were found in close proximity to the axilla. In Japan, 
ectopic breast cancer occurred more frequently in the 

 

48

J Enam Med Col  Vol 3  No 1 January 2013



49

J Enam Med Col  Vol 3  No 1 January 2013

axilla.11 In this case, cancer also occurred in the 
ectopic breast of the left axilla. Accessory breasts 
and nipples have been known to function during 
lactation.12 In this case, lactation of both the ectopic 
breasts was observed during every pregnancy. 
Accessory breast tissue responds to the hormonal 
influences of the menstrual cycle, pregnancy and 
lactation as normally situated breasts. In this case, 
response to hormonal influence and carcinoma of the 
axillary accessory breast tissue was observed. If 
ductal carcinoma is confirmed to the ectopic breast, 
the differential diagnoses of primary mammary 
carcinoma of the axilla, metastatic breast carcinoma, 
primary skin appendage carcinoma, lymphoma, 
metastatic carcinoma from other sites, eg, lung 
should be considered. A thorough metastatic workup 
should be performed, with attention directed toward 
detecting a primary site in breast by history, physical 
examination and radiological examination. 
Suspicious lesions of the breast should be evaluated 
by biopsy. If axillary mammary duct carcinoma is 
confirmed, current treatment strategy of breast 
cancer to establish a sensible management approach 
should be followed. Although the prognosis of this 
case seems to be very good, prognostic conclusions 
could not be made by studying a case only. 

Conclusion 
If accessory breast carcinoma is diagnosed earlier 
and optimal treatment can be offered, a very good 
outcome can be achieved. The patient must be 
cooperative and should be regular in follow-up 
examination to have a disease free survival. 

Acknowledgement 
We are indebted to Mrs. Rowshan Ara for allowing 
us to publish this case report. 

References
1.    Cogswell HD, Czerny EW. Carcinoma of aberrant breast 

of the axilla. Am J Surg 1961; 27: 388-390.  

2.     Copeland MM, Geschickter  CF. Diagnosis and treatment 
of premalignant lesions of the breast. Surg Clin North 
Am 1950; 30: 1717-1741.  

3.    Yerra L, Karunad AB, Votaw ML. Primary breast cancer 
in aberrant breast tissue in the axilla. South Med J 1997; 
90: 661-662. 

4.   Cheong JH, Lee BC, Lee KS. Carcinoma of the axillary 
breast.Yonsei Med J 1999; 40: 290-293. 

5.    Turner DR, Millis RR. Breast tissue inclusions in axillary 
lymph nodes. Histopathology 1980; 4: 631-663.

6.   O’Hara MF, Page DL. Adenomas of the breast and 
ectopic breast under lactational influences. Human 
Pathol1985; 16: 707-712.

7.   S p e e r t  H .  S u p e r n u m e r a r y  m a m m a c  w i t h  s p e c i a l  
reference to the rhesus monkey. Quar J 1942; 17: 59-68.

8.    Adler DD, Renber M, Pennes DR. Accessory breast tissue in 
the axilla: Mammographic appearance. Radiology 1987; 
163(3): 709-711. 

9.   Badejo OA. Fungating accessory breast carcinoma in 
Nigerian women. Trop Geogr Med 1984; 36(1): 45-49.

10.   Kanazawa K, Ishikawa K, Kusama S et al. Carcinoma of 
the axillary accessory mammary gland. Tokyo J Med Sci 
1970; 78: 99-103.

11. Nakao A, Saito S, Inoue F, Notohara K, Tanaka N. 
Ectopic breast cancer : A case report and review of the 
Japanese literature. Anticancer Research 1998; 18: 
3737-3740.

12.  Marshall MB, Moynihan JJ, Frost A, Evans SRT. Ectopic 
breast cancer: Case report and literature review. Surg 
Oncol 1994; 3: 295-304.

                                                   

 

 




