title: Recurrence of breast carcinoma as Paget disease of the skin at a prior core needle biopsy site: Case report and review of the literature.
abstract: BACKGROUND
  Core needle biopsy has become the preferred method of diagnosing breast carcinomas prior to definitive surgery. The possibility of displacing tumor cells into the needle track is a concern.
  
  
  METHODS
  A 38 year old woman was diagnosed with right breast ductal carcinoma in situ (DCIS) with microinvasion by core needle biopsy. Bilateral skin sparing mastectomies with immediate autologous reconstruction were performed. One and a half years later the patient noted erythema and a scaling crust on the skin of the right breast that progressed over several months. Punch biopsy revealed Paget disease restricted to the epidermis. Subsequent comparison to initial clinical photographs confirmed the cancer was associated with the skin puncture site of the needle biopsy. The patient underwent complete excision with skin grafting and remains free of disease three years later.
  
  
  CONCLUSIONS
  Only 13 cases of needle track recurrences have been reported. The majority presented as invasive carcinoma forming a subcutaneous mass. In the current case, detection was delayed due to not initially noting that a skin lesion was at the puncture site of the original needle biopsy. This is the only case of recurrence as tumor limited to the epidermis.
  
  
  CONCLUSIONS
  Although recurrence in a needle track occurs very infrequently, clinicians should be aware of this phenomenon and investigate any changes, particularly when occurring at a needle biopsy site. Recording the skin puncture site can aid in early detection of recurrences. Recognition of a recurrence is important for prompt treatment and optimal prognosis.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Katherina Zabicki
authors.initials: KZ
authors.lastname: Calvillo
authors.affiliation: Department of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, MA, United States.
authors.forename: Lifei
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Valerie
authors.initials: V
authors.lastname: Brostrom
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.affiliation: Brigham and Women's Faulkner Hospital, Boston, MA, United States.
authors.forename: Xuefei
authors.initials: X
authors.lastname: Hong
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Sughra
authors.initials: S
authors.lastname: Raza
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States. Electronic address: slester@partners.org.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Lester
keywords: Breast cancer; Needle biopsy; Needle track recurrence; Paget disease