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Multiple adult myofibromas with congenital smooth muscle hamartoma

external quadrant of the left breast, which was strongly indicative of malignancy. However, the patient refused to undergo surgery. Computed tomography of the thorax and abdomen showed multiple suspicious foci in the lung and an irregularly shaped centrally necrotic tumour (size about 600 mm) ventrolaterally located in front of liver segment V. Histology of a core-needle biopsy of the tumour taken under ultrasonic guidance revealed an undifferentiated adenocarcinoma. Using immunohistochemical examination, the immunoreactive scores for oestrogen and gestagen receptors confirmed the diagnosis of breast carcinoma metastasis (Tx, Nx, M1, stage IV). Coloscopy, gastroscopy, skeletal scintigraphy, echocardiography, cranial magnetic resonance imaging, and bone-marrow biopsy did not reveal any relevant pathological findings. Laboratory investigations found high lactate dehydrogenase (609 U ⁄ L; normal range 0–246), CA-15-3 (3187 U ⁄ mL; 0–30) and alanine aminotransferase (365 U ⁄ L; 0–37). Results of tests for antineutrophil cytoplasmic, antiphospholipid, and double-stranded DNA autoantibodies, cryoglobulins and serum complement were normal or negative. The patient refused any treatment and died from widespread metastatic disease 3 months later. Cutaneous paraneoplastic syndromes such as paraneoplastic dermatomyositis have rarely been described in patients with malignancies of the breast. However, to our knowledge, the association of LR and breast carcinoma has not previously been reported. In the reported case, the investigations excluded Sneddon s syndrome and other diseases often associated with LR, including antiphospholipid syndrome and lupus erythematosus. The pathogenesis of LR in cancer patients is unclear. The vasoconstriction of LR may be induced by an interaction of antibodies (e.g. antiphospolipid antibodies) with endothelial cells or other cellular elements of vessels in a way that alters their function. A high incidence of antithyroid, centromeric protein B and SSB antibodies has been found in patients with breast cancer. It is therefore conceivable that autoimmunity might play a role in the development of LR in patients with breast cancer. LR may be considered a rare paraneoplastic syndrome in patients with breast cancer. Mucocutaneous paraneoplastic syndromes represent a group of dermatoses of variable morphology, pathology and aetiology, which can occur as idiopathic conditions or in association with a visceral malignancy. However, only a few cases of LR associated with malignancy, including renal cell carcinoma, lymphoma and multiple myeloma, have been reported. The common underlying factor in the development of LR in most malignancies has been some form of vascular obstruction. In conclusion, LR may be the presenting feature of a previously unsuspected neoplasm or the earliest sign of breast cancer. Awareness of this rare presentation of a common disorder such as breast cancer is essential to timely diagnosis and treatment.