title: Breast cancer metastatic to the vulva after local recurrence occurring on a rectus abdominis myocutaneous flap: a case report and review of the literature.
abstract: BACKGROUND
  Vulvar metastases are the third largest group of malignant tumors of the vulva. We report the tenth case of breast cancer vulvar metastases arising 11 years after the primary diagnosis of breast ductal carcinoma and the first occurring eight years after a local recurrence on a rectus abdominis myocutaneous flap.
  
  
  METHODS
  A 49-year-old woman presented with a voluminous lump of the left labium majus and enlargement of the ipsilateral inguinal lymph nodes. The mass was removed together with the ipsilateral inguinal lymph nodes. Microscopic evaluation of the removed lump revealed massive carcinomatous infiltration. No in situ lesions nor normal breast tissue were identified.
  
  
  CONCLUSIONS
  Unusual breast cancer metastases sites should not be ruled out. Our case differs from the preceding cases because this patient underwent plastic surgery with reconstruction of the breast with a rectus abdominis myocutaneous flap one year after mastectomy and developed a local recurrence three years thereafter. It can be hypothesized that lymphatic spread through newly formed lymphatics occurred.
authors.affiliation: Department of Obstetrics and Gynecology, University of Genoa, San Martino Hospital, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Valenzano Menada
authors.forename: A
authors.initials: A
authors.lastname: Papadia
authors.forename: P
authors.initials: P
authors.lastname: Lorenzi
authors.forename: E
authors.initials: E
authors.lastname: Fulcheri
authors.forename: N
authors.initials: N
authors.lastname: Ragni
mesh_terms: D000009:Abdominal Muscles / Q000637:transplantation; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D013524:Surgical Flaps / Q000473:pathology*; D014846:Vulvar Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery