Giant Infarcted Lactating Adenoma Mimicking Inflammatory Breast Carcinoma: A First Case Report from Somalia

Abstract

A lactating adenoma is a rare and benign breast tumor that usually occurs during pregnancy or lactation period for women. These adenomas are typically small, <3 centimeters, well circumscribed, mobile, and lobulated masses, and are most commonly witnessed in primiparous women (those having their first child) between the ages of 20 and 40 years during the third trimester of their pregnancies due to hormonal changes. In this case report, we describe an unusual variant of lactating adenoma that is characterized by the ischemic infarction of breast tissue and its giant dimensions, surpassing 16 centimeters. The case in question had poorly defined margins in addition to chronic mastitis, which can make differentiating from standard lactating adenoma presentations quite difficult clinically. Infarction associated with chronic mastitis serves to complicate the distinction, and tends to mimic inflammatory breast carcinoma. This case report emphasizes how these rare and unusual presentations of lactating adenomas can mimic a highly aggressive malignancy, leading to diagnostic confusion and potentially unnecessary interventions. Inflammatory breast carcinoma is a rapidly progressive malignancy requiring aggressive oncological management, unlike infarcted lactating adenomas, which are benign and can be effectively treated with surgical excision alone. This case adds an important dimension to the medical literature, particularly given its context of occurrence in Somalia, where resources and access to advanced diagnostic tools are limited. By detailing this unique instance, the study not only contributes to the understanding of breast pathology but also emphasizes the necessity for keen clinical acumen in achieving appropriate therapeutic interventions in diverse health-care settings.

Keywords: breast; breast neoplasms; lactation disorders.

Figure 1

Photomicrograph of the core biopsy. (A) Lactating adenoma, closely packed and intermixed with delicate fibrous stroma (H&E, 10×). (B) Microscopic appearance of grossly chalk-like area demonstrating coagulative necrosis. Some viable acini with cytoplasmic vacuolization and lumina containing eosinophilic secretions (H&E, 20×).

Figure 2

Photomicrograph of the surgical excision. (A) Lactating adenoma, closely packed and intermixed with delicate fibrous stroma. (H&E, 10×). (B) Microscopic appearance of viable acini with cytoplasmic vacuolization, prominent nuclear hobnailing with bulbous nuclear projections into the lumina, and eosinophilic secretions in the lumen (H&E, 40×).