BACKGROUND: The two most common types of breast cancer are invasive or infiltrating ductal carcinoma (IDC) and invasive or infiltrating lobular carcinoma (ILC) (Pestalozzi et al., J. Clin. Oncol., 26, 2008, 3006). Between 5% and 15% of invasive breast carcinomas are lobular carcinomas (Pestalozzi et al., J. Clin. Oncol., 26, 2008, 3006; Dossus and Benusiglio, Breast Cancer Res., 17, 2015, 37; Braunstein et al., Breast Cancer Res. Treat., 149, 2015, 555). The paucity of data relating to recurrence rates of lobular cancers prompted this study.
METHODS: A retrospective cohort study of all cases of lobular breast carcinoma reported to the Western Australia Cancer Registry with the clinical and pathological details between 2000 and 2014.
RESULTS: Overall, 2463 subjects with a total of 2526 events of invasive lobular carcinoma of the breast. 11/2463 (0.45%) subjects met criteria for local recurrence of invasive lobular breast cancer, with an incidence of 1 in 224.
CONCLUSIONS: There are clinical implications for the management and follow-up for patients with a diagnosis of lobular cancer of the breast. Due to the low recurrence rate, now, the standard practice in our institution does not offer magnetic resonance imaging (MRI) as part of the follow-up for ILC patients. Other centres should establish local recurrence rates to aid development of appropriate management protocols.

A halo phenomenon describes a skin neoplasm that is surrounded by a hypopigmented or white halo. Halo lesions have been observed in association with an epithelial neoplasm (seborrheic keratosis), a fibrous lesion (surgical scar), a keratinocyte malignancy (basal cell carcinoma), melanocytic neoplasms, and vascular lesions. Benign lesions (café au lait macules and nevi) and malignant tumors (primary and metastatic melanoma) are melanocytic neoplasms that have developed perilesional halos. Halo nevi are a commonly occurring manifestation of a halo phenomenon; however, perilesional hypopigmented halos have also been observed around nevi in patients following treatment with antineoplastic drugs, acquisition of COVID-19 (infection and vaccine), the occurrence of a visceral tumor (including not only melanoma, but also papillary thyroid carcinoma and neuroendocrine cancer of the lung), surgery (such as the excision of a primary melanoma), and Turner syndrome. A halo phenomenon has also been observed in patients with congenital (capillary malformation-arteriovenous malformation and congenital hemangioma) or acquired (angioma, eruptive pseudoangiomatosis, infantile hemangioma, and lobular capillary hemangioma) vascular lesions. In summary, a halo phenomenon can occur in association with primary lesions of various embryologic derivations. Most commonly, they have been observed in around nevi and vascular tumors. Halo lobular capillary hemangioma can be added to the list of acquired vascular lesions with the potential to develop a halo phenomenon. The preservation of melanocytes with loss of melanin pigment expression in the reported patient suggests the possibility that a post-inflammatory etiology may be responsible for the genesis of her halo lobular capillary hemangioma.

Due to the elusive nature of invasive lobular carcinoma, mammography, ultrasound, and magnetic resonance imaging have their limitations in early detection. A 67-year-old woman presented for mammography and found retraction of breast parenchyma of the right breast. Magnetic resonance imaging and contrast mammography showed no contrast uptake in the region in question. Magnetic resonance imaging and ultrasound were found to be superior for the detection of invasive lobular carcinoma, with a sensitivity of more than 90%. On ultrasound examination, invasive lobular carcinoma may occur only with posterior acoustic shadowing. On breast magnetic resonance imaging, it is commonly described as an irregular mass and less commonly as non-mass enhancement. An additional advantage of magnetic resonance imaging is the higher detection rate of multifocal, multicentric, and contralateral breast lesions. The reason for no contrast enhancement in this particular tumor before neoadjuvant chemotherapy followed by enhancement after neoadjuvant chemotherapy is most likely at the molecular and histologic level and requires further investigation in similar cases.

We present a case of ptosis secondary to metastatic lobular carcinoma of the breast which was initially diagnosed as involutional ptosis. A 67-year-old woman previously diagnosed with lobular carcinoma of the breast presented to our clinic with mild restriction of lateral gaze and persistent droopiness of her right eyelid (associated with decreased levator function) despite recent repair of a suspected involutional ptosis. Orbital magnetic resonance imaging revealed a mass in the right orbit which was biopsied and diagnosed as lobular carcinoma of the breast. Poor levator function is rarely present in involutional ptosis. Especially in conjunction with abnormal extraocular motility, other etiologies of acquired ptosis must be considered. This case highlights the importance of patient history and ocular examination in identifying the underlying etiology of ptosis. A review of the literature to evaluate the incidence of signs and symptoms associated with metastatic breast cancer to the orbit is included.

•This is the 20th documented case of metastatic breast carcinoma to the vulva.•Greater than 21 years have passed from initial diagnosis to vulvar metastasis.•Existing literature supports long term surveillance in women with invasive lobular carcinoma of the breast.

Management of cancer patients in low-resource communities presents enormous challenges. Breast cancer is a public health problem in Cameroon and occurs mostly in elderly women. The predominant histological type is a duct carcinoma. Lobular carcinoma in teenagers is rare. In this report we present a case of bilateral invasive lobular carcinoma of the breast that was confirmed on biopsies in a 22-year-old female. We present this rare finding and review the pathological, clinical and radiographic challenges of the disease. Nodules in the breast from patients of any age should be submitted for histology. Public education is beneficial and should be intensified.