1
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Batra H, Bose PSC, Ding Y, Dai A, Chen H, Albarracin CT, Sun H, Sahin AA, Yang F, Wistuba II, Raso MG. MYB expression by immunohistochemistry is highly specific and sensitive for detection of solid variant of adenoid cystic carcinoma of the breast among all triple-negative breast cancers. Histopathology 2024; 85:503-509. [PMID: 38973399 DOI: 10.1111/his.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/26/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Adenoid cystic carcinoma is a rare subtype of triple-negative breast carcinoma. These low-grade tumours, which are treated by simple mastectomy and have an excellent prognosis compared to other triple-negative breast carcinomas. Solid-variant adenoid cystic carcinomas have basaloid features and are difficult to distinguish morphologically from other triple-negative breast cancers. Breast adenoid cystic carcinoma exhibits MYB protein overexpression, which can be detected by immunohistochemistry (IHC). AIM We compared the IHC expression of MYB in solid-variant adenoid cystic carcinoma with that in other triple-negative breast cancers. METHODS We conducted IHC staining of 210 samples of triple-negative breast cancers, including solid-variant adenoid cystic carcinoma (n = 17), metaplastic breast carcinoma (n = 44), basaloid triple-negative breast cancer (n = 21), and other triple-negative invasive ductal carcinoma (n = 128). We classified nuclear staining of MYB as diffuse/strong (3+), focal moderate (2+), focal weak (1+), or none (0). RESULTS All 17 solid/basaloid adenoid cystic carcinoma cases exhibited 3+ MYB expression. Of the 21 solid/basaloid triple-negative breast cancers, one (5%) had 2+ expression, seven (33%) 1+ expression, and 13 (62%) 0 expression. Of the 44 metaplastic carcinoma cases, 39 cases (89%) had no (0) staining, and the other five cases had focal weak (1+) or moderate (2+) staining. Among the 128 triple-negative invasive ductal carcinoma cases, 92 cases (72%) had no (0) staining, 36 cases (28%) exhibited focal weak (1+) or moderate (2+) staining. CONCLUSIONS Our study revealed diffuse/strong MYB staining (3+) only in solid/basaloid adenoid cystic carcinomas. Thus, we recommend routine MYB IHC staining in triple-negative breast carcinoma with solid/basaloid morphology to improve diagnostic accuracy.
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Affiliation(s)
- Harsh Batra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya S C Bose
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yang Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alan Dai
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Constance T Albarracin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hongxia Sun
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fei Yang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria G Raso
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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2
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Ch'ng ES. Prognosis of primary breast salivary gland-type carcinoma: a propensity score-matching analysis with invasive carcinoma of no special type based on the SEER database for years 2010-2020. Breast Cancer 2024; 31:496-506. [PMID: 38546966 DOI: 10.1007/s12282-024-01564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Primary breast salivary gland-type carcinoma has weak evidence to support its management due to its rare occurrence and limited data regarding its clinicopathological features and prognosis. Therefore, this study aimed to assess clinicopathological features and prognosis for this type of carcinoma diagnosed over the past decade and compared those to the common breast invasive carcinoma of no special type (NST). METHODS This study used the Surveillance, Epidemiology, and End Results (SEER) database to extract data regarding primary breast salivary gland-type carcinoma. Using a propensity score-matching approach, the prognosis was compared with invasive carcinoma, NST. RESULTS This study included 488 cases of salivary gland-type carcinoma and 375,660 cases of invasive carcinoma, NST, giving an occurrence ratio of 1 to 770. Adenoid cystic carcinoma (81%) formed the majority of salivary gland-type carcinoma, followed by secretory carcinoma (13%). For salivary gland-type carcinoma, acinic cell carcinoma histological type, tumor grade 3, HER2-overexpressed status, and higher AJCC stage groups were significant worse prognostic factors for breast cancer-specific survival in univariate analyses (p < 0.05). Nonetheless, tumor grade 3 and higher AJCC stage groups remained as significant independent prognostic factors in multivariate analysis (p < 0.05). The apparent better breast cancer-specific survival of salivary gland-type carcinoma as compared to that of invasive carcinoma, NST, was diminished following adjustment for differences in baseline clinicopathological features and treatment-related variables. CONCLUSIONS This study suggests that when managing primary breast salivary gland-type carcinoma, greater emphasis should be given to the tumor grade and AJCC stage group in addition to acinic cell carcinoma histological type and HER2 overexpression. Conventional prognostic factors are important as salivary gland-type carcinoma had similar prognosis as invasive carcinoma, NST, following adjustment for confounding variables.
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Affiliation(s)
- Ewe Seng Ch'ng
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia.
- Cancer Research Malaysia, Selangor, Malaysia.
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3
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Salem A, Wu Y, Ding Q, Middleton LP. Impact of NOTCH1 expression in primary breast adenoid cystic carcinoma. J Clin Pathol 2024:jcp-2023-209325. [PMID: 38471758 DOI: 10.1136/jcp-2023-209325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
AIMS Adenoid cystic carcinoma (AdCC) originates from salivary-type like glands in the head and neck, lung, and breast. AdCC shows chromosomal translocation, resulting in MYB::NFIB fusion and overexpression of MYB. Recently, NOTCH1 pathway alteration has been recognised in a subset of patients with salivary gland AdCC and has been shown to be associated with poor survival. In this study, we investigated the correlation of NOTCH1 pathway alteration with the clinical outcome of patients with primary breast AdCC by examining NOTCH1 immunoreactivity in attempts to better predict clinical outcomes. METHODS We identified 25 cases of breast AdCC, reviewed the clinical outcome and performed immunohistochemical (IHC) staining for NOTCH1 on FFPE sections. RESULTS IHC evaluation of NOTCH1 expression in 25 cases of primary breast AdCCs revealed a positive correlation between NOTCH1 expression and primary tumour size. All cases with NOTCH1 expression were greater than 15 mm in size at presentation but only 50% of NOTCH1 negative tumours were greater than 15 mm. We demonstrated a positive correlation between NOTCH1 positive AdCCs and recurrence/metastases. 63.6% of NOTCH1 positive AdCCs had either metastases or recurrence. On the contrary, only 21.5% of NOTCH1 negative AdCCs had recurrence or metastases. AdCCs with NOTCH1 positivity correlated with inferior relapse free survival (median 33 vs 129 months). CONCLUSIONS Our study demonstrates that in patients with breast AdCC, overexpression of NOTCH1 ≥20% is associated with larger tumour size and aggressive clinical outcomes. Importantly, NOTCH1 inhibitors may have potential therapeutic effect in patients with breast AdCC.
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Affiliation(s)
- Alireza Salem
- Pathology, The University of Texas, Houston, Texas, USA
- Columbia University Medical Center, New York, New York, USA
| | - Yun Wu
- Pathology, The University of Texas, Houston, Texas, USA
| | - Qingqing Ding
- Pathology, The University of Texas, Houston, Texas, USA
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4
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Grabenstetter A, D'Alfonso TM. The Role of Novel Immunohistochemical Markers for Special Types of Breast Carcinoma. Adv Anat Pathol 2023; 30:374-379. [PMID: 37746900 DOI: 10.1097/pap.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Some histologic special types of breast carcinoma harbor specific recurrent genetic alterations that are not seen in other types of breast carcinoma (no special type), namely adenoid cystic carcinoma, secretory carcinoma, and tall cell carcinoma with reversed polarity. These tumors have unique morphologic features, are triple-negative, that is, do not express hormone receptors or HER2, and are generally associated with a favorable prognosis. Adenoid cystic carcinoma, like its counterpart in other organs, shows a MYB-NFIB fusion gene that is the result of a recurrent t(6;9)(q22-23;p23-24) translocation. Other MYB alterations have been described that result in overexpression of MYB . Secretory carcinoma is characterized by an ETV6-NTRK3 gene fusion that is the result of recurrent (12;15);(p13;q25) translocation, which is also seen in mammary analog secretory carcinoma of the salivary gland. Tall cell carcinoma with reversed polarity shows IDH2 p.Arg172 hotspot mutations. Immunohistochemical antibodies have emerged that identify the underlying genetic alterations in these tumors and serve as useful diagnostic tools. This review will provide an update on the molecular features and diagnostic immunohistochemical markers that have become increasingly popular to aid in diagnosing these uncommon triple-negative breast tumors.
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Affiliation(s)
- Anne Grabenstetter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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Hmidi A, Houcine Y, Naija L, Mansour HB, Driss M. Solid-basaloid variant of adenoid cystic carcinoma of the breast unresponsive to neoadjuvant chemotherapy: Case report. Int J Surg Case Rep 2023; 111:108858. [PMID: 37757737 PMCID: PMC10539882 DOI: 10.1016/j.ijscr.2023.108858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Adenoid cystic carcinoma (ACC) is a rare triple-negative breast cancer, accounting for only 0.1 % of all primary breast carcinomas. At variance with the classic variant, the solid-basaloid variant of ACC (SB-ACC) is clinically more aggressive and has different molecular features. There is, currently, no consensus regarding the treatment of SB-ACC of the breast, especially the use of neoadjuvant chemotherapy. CASE PRESENTATION Here, we present a rare case of SB-ACC in an elderly female patient, with no history of breast carcinoma, who presented with a 4.5 cm central round mass invading the nipple. Given the locally advanced triple negative breast cancer and the invasion of the nipple-areolar complex, the patient has received neoadjuvant chemotherapy followed by surgical treatment. On histopathological examination, the diagnosis of SB-ACC, non-responsive to neoadjuvant chemotherapy, with absence of rearrangement of the MYB gene was retained. The patient received adjuvant radiation therapy and was ambulatory followed without recurrence at the 12-month follow-up. DISCUSSION/CONCLUSION This case provided direct evidence that SB-ACC of the breast wasn't responsive to neoadjuvant chemotherapy but cannot allow for definitive conclusions on chemotherapy recommendations. For this reason, more data must be published to investigate the real value of neoadjuvant chemotherapy in SB-ACC.
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Affiliation(s)
- Amira Hmidi
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia.
| | - Yoldez Houcine
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Lamia Naija
- Surgical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | | | - Maha Driss
- Pathology Department, Salah Azaiez Institute, Tunis, Tunisia
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6
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Huang T, Fang Q, Niu L, Wang L, Sun X. Optimal surgical procedure for treating early-stage adenoid cystic carcinoma of the breast. Sci Rep 2023; 13:10222. [PMID: 37353590 PMCID: PMC10290055 DOI: 10.1038/s41598-023-36644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/07/2023] [Indexed: 06/25/2023] Open
Abstract
To explore the superiority of breast conservation surgery (BCS) to mastectomy in treating early-stage adenoid cystic carcinoma of the breast (BACC). Patients with surgically treated stage I/II BACC were enrolled between 2000 and 2019 in the SEER database; they were divided into the BCS and mastectomy groups. Overall survival (OS) and disease-specific survival (DSS) were compared between the two groups, and Cox hazard regression models were used to determine the independent predictors. Of the 583 patients in the study, 386 were included in the BCS group. The 10-year OS rates for the BCS and mastectomy groups were 78% (95% CI: 74-82%) and 76% (95% CI: 70-82%), respectively, but the difference was not statistically significant (p = 0.968). The 10-year DSS rates for the BCS and mastectomy groups were 95% (95% CI: 93-97%) and 89% (95% CI: 85-93%), respectively, and the difference was statistically significant (p = 0.002). Pathological examination of regional lymph nodes and adjuvant treatment were not associated with improved OS or DSS, but age, disease grade, and lymph node metastasis were independent prognostic factors. For stage I/II BACC, BCS can achieve more satisfactory 10-year OS and DSS than mastectomy.
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Affiliation(s)
- Tao Huang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Qigen Fang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, People's Republic of China
| | - Lianjie Niu
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Lina Wang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Xianfu Sun
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, People's Republic of China.
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7
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Nguyen L, Van Hoeck A, Cuppen E. Machine learning-based tissue of origin classification for cancer of unknown primary diagnostics using genome-wide mutation features. Nat Commun 2022; 13:4013. [PMID: 35817764 PMCID: PMC9273599 DOI: 10.1038/s41467-022-31666-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/23/2022] [Indexed: 12/25/2022] Open
Abstract
Cancers of unknown primary (CUP) origin account for ∼3% of all cancer diagnoses, whereby the tumor tissue of origin (TOO) cannot be determined. Using a uniformly processed dataset encompassing 6756 whole-genome sequenced primary and metastatic tumors, we develop Cancer of Unknown Primary Location Resolver (CUPLR), a random forest TOO classifier that employs 511 features based on simple and complex somatic driver and passenger mutations. CUPLR distinguishes 35 cancer (sub)types with ∼90% recall and ∼90% precision based on cross-validation and test set predictions. We find that structural variant derived features increase the performance and utility for classifying specific cancer types. With CUPLR, we could determine the TOO for 82/141 (58%) of CUP patients. Although CUPLR is based on machine learning, it provides a human interpretable graphical report with detailed feature explanations. The comprehensive output of CUPLR complements existing histopathological procedures and can enable improved diagnostics for CUP patients.
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Affiliation(s)
- Luan Nguyen
- University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Arne Van Hoeck
- University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Edwin Cuppen
- University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
- Hartwig Medical Foundation, Science Park 408, 1098 XH, Amsterdam, The Netherlands.
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8
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Wan D, Zhou H, Zhang Y. Adenoid Cystic Carcinoma of the Breast in a Male Patient: A Case Report and Literature Review. Front Oncol 2022; 12:905997. [PMID: 35875113 PMCID: PMC9300960 DOI: 10.3389/fonc.2022.905997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast (breast ACC) is a rare tumor, especially in men, with only 17 cases reported in the literature. Owing to this rarity, male breast ACC is susceptible to missed or incorrect diagnoses, and data on treatment options and prognosis is also scarce. Herein, we report a case of a male patient with primary breast ACC and performed a detailed clinicopathological analysis of the 17 cases reported in the literature. A 38-year-old Chinese man patient developed right-sided breast nipple retraction in 2013 and presented to our hospital in 2015 with a palpable mass in the right breast for four days. B-scan ultrasound indicated the presence of a solid space-occupying lesion in the right breast. Breast Imaging Reporting and Data System (BI-RADS) classified the lesion as category 4B, and mammography showed a right breast nodule classified as BI-RADS 4C. Modified radical mastectomy for breast cancer was performed on the right breast. Microscopic examination of the excised tissue revealed diffuse tumor invasion of the subcutaneous fibers and adipose tissue, with tumor cells arranged in cribriform, tubular, and microcystic patterns. Immunohistochemical staining indicated that the glandular epithelial cells were positive for CD117, CK7, and Ki67 (approximately 30%) and negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, while the myoepithelial/basal cells were positive for P63, CK5/6 and S-100. Moreover, basement membrane materials were positive for collagen type IV. Molecular pathology analysis by fluorescence in situ hybridization revealed that the tumor was negative for MYB rearrangements. The patient was followed up for 82 months with no tumor recurrence or metastasis. According to the current literature, mastectomies have a better prognosis than lumpectomy. Accurately identifying the diagnosis of male breast ACC and considering the surgery of mastectomy may be the key factors for patients to obtain a good prognosis based on the microscopic characteristics of the tumor.
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9
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Distinct clinicopathological and genomic features in solid and basaloid adenoid cystic carcinoma of the breast. Sci Rep 2022; 12:8504. [PMID: 35590093 PMCID: PMC9120443 DOI: 10.1038/s41598-022-12583-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/21/2022] [Indexed: 12/16/2022] Open
Abstract
Adenoid cystic carcinoma (AdCC) of the breast is a rare indolent carcinoma of salivary gland-type tumors, frequently associated with MYB genetic alteration. Solid and basaloid adenoid cystic carcinoma (SB-AdCC) is considered a sparse variant of AdCC. This study sought to search for clinicopathological and genomic features in SB-AdCC. Registered clinicopathological data on a cohort of 13 AdCC of the breast cases, including six conventional adenoid cystic carcinoma (C-AdCC) cases and seven SB-AdCC cases, were collected. MYB gene rearrangement via fluorescent in situ hybridization was investigated and MYB protein expression was evaluated by immunohistochemistry. Compared with C-AdCC, we found that the distribution of SB-AdCC cases were shifted to older age and were more frequently distant metastasis. Moreover, metastasis cases also showed a high (exceed 30%) Ki-67 index. Both groups showed MYB rearrangements and MYB protein expression, but they were less frequent in SB-AdCC than C-AdCC. To conclude, our results suggest that SB-AdCC is an aggressive variant of mammary AdCC with a higher incidence of distant metastases compared with C-AdCC, though they share common molecular features. A high Ki-67 index may be an adverse prognostic factor for metastasis.
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10
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Reyes NM, Gorji L, Huish G, Archer A. Adenoid Cystic Carcinoma of the Breast: A Case Report. Cureus 2022; 14:e25131. [PMID: 35747058 PMCID: PMC9206188 DOI: 10.7759/cureus.25131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/05/2022] Open
Abstract
Adenoid cystic carcinoma (ACC), characterized by proliferating glands and stromal and basement membrane elements, is a tumor most commonly occurring in the salivary glands; very rarely does this tumor present as a primary tumor in the breast. We present the case of a 53-year-old female who presented with a breast mass noted to be concerning on imaging and confirmed to be ACC on biopsy. The mass was amenable to surgical excision with referrals to medical and radiation oncology. Due to the rarity of the disease, there is no consensus regarding the optimal treatment strategy for the pathology, including the use of chemotherapy and radiation. Long-term follow-up is, however, recommended in order to monitor for recurrence.
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Affiliation(s)
- Nicole M Reyes
- Department of Surgery, Kettering Health Network, Dayton, USA
| | - Leva Gorji
- Department of Surgery, Kettering Health Network, Dayton, USA
| | - Grant Huish
- Department of Surgery, Kettering Health Network, Dayton, USA
| | - Andrew Archer
- Department of Surgery, Kettering Health Network, Dayton, USA
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11
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Gordillo C, Chukus A. Adenoid cystic carcinoma: A case of rare breast cancer. Radiol Case Rep 2022; 17:690-692. [PMID: 35003461 PMCID: PMC8715290 DOI: 10.1016/j.radcr.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
Adenoid cystic carcinoma is a rare form of breast cancer accounting for 0.1%-1.0% of all mammary malignancies. It is characterized by an indolent clinical course and favorable prognosis, contrary to other breast cancers. Diagnostic mammogram and breast ultrasound play a pivotal role in the early detection and diagnosis of breast adenoid cystic carcinoma. Treatment may consist of lumpectomy and radiation therapy vs mastectomy alone. Even though rare, late disease recurrence and metastasis has been reported in the literature thus long-term surveillance is of utmost importance for these patients. We will review the literature and discuss the case of a 52-year-old female who presented with a palpable lump of the right breast, which was pathologically proven to be adenoid cystic carcinoma of the breast.
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Affiliation(s)
- Claudia Gordillo
- Aventura Hospital and Medical Center Diagnostic Radiology Residency Program, Aventura FL, USA
- Corresponding author.
| | - Anjeza Chukus
- Faculty of Diagnostic Radiology Residency Program at Aventura Hospital and Medical Center in Aventura, FL, USA
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12
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Liu Z, Wang M, Wang Y, Shen X, Li C. Diagnosis of adenoid cystic carcinoma in the breast: a case report and literature review. Arch Med Sci 2022; 18:279-283. [PMID: 35154549 PMCID: PMC8826839 DOI: 10.5114/aoms/144321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Zihui Liu
- Department of Pathology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Minghui Wang
- Department of Breast Surgery, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Yan Wang
- Department of Pathology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Xingbin Shen
- Department of Pathology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Chunhui Li
- Department of Pathology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
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13
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Accardo G, Capobianco AM, Torre GL, Thodas A, Marino G, Sisti LG, Vita G. Adenoid cystic carcinoma of the breast and intraoperative electron radiotherapy: single case report and review of literature. Future Oncol 2021; 18:871-881. [PMID: 34904444 DOI: 10.2217/fon-2021-0860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a very rare neoplasm. It presents a triple-negative phenotype in most cases, but its prognosis is generally considered to be better than other breast cancers with the same immunohistochemical pattern. Due to its controversial features, no data are available in the literature regarding a consensus approach for ACC treatment, especially for subtypes with worse prognosis like solid basaloid ACC. We present for the first time a rare case of ACC with multifocal presentation treated with breast-conservative surgery and intraoperative electron radiotherapy, thus supporting this treatment of ACC in selected patients like young women affected by the solid basaloid variant who commonly present a worse prognosis. In this case, no local or systemic recurrence was detected after 30 months of follow-up.
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Affiliation(s)
- Giuseppe Accardo
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Alba Ml Capobianco
- Head of Multidisciplinary Oncology Unit, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Giuseppe La Torre
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Alexios Thodas
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Graziella Marino
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Leuconoe Grazia Sisti
- Center for Global Health Research and studies and Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Giulia Vita
- Department of Pathology, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
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14
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Li JX, Zhang XM, Xiao YX, Tang ZM, Huang T, Ming J. Male Adenoid Cystic Carcinoma of the Breast. J Med Cases 2021; 12:503-510. [PMID: 34970375 PMCID: PMC8683108 DOI: 10.14740/jmc3790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast, a rare malignancy that makes up less than 0.1% of all breast malignancies, is much rarer in males than in females. Due to the rarity of this disease, an optimal treatment strategy for male breast ACC has not been established, and therapy for male patients is currently based on guidelines for female patients. According to previous reported cases, some authors believe that male breast ACC may have higher invasive potential than female breast ACC and the prognoses in male patients may be worse than those in female patients. Therefore, a more proactive diagnosis and treatment regimen may be required. However, the clinical feature of our case is inconsistent with this view. Herein we report the case of a 24-year-old male without any antecedent medical or family history who presented with a slow-growing lump on his left chest wall for 5 years. The patient initially underwent lumpectomy, and the mass was pathologically diagnosed as breast ACC. Systemic examination was performed, and no evidence of distant metastasis was found. Then, he received modified radical mastectomy and ipsilateral axillary lymph node dissection. The mastectomy pathological examination revealed that no cancerous tissue was detected around the primary tumor bed, and all 22 axillary lymph nodes were negative. The patient did not receive postoperative chemotherapy, radiotherapy or endocrine therapy and remained well after 28 months of follow-up. In this study, we review the literature and summarize the clinical manifestations, imaging and histopathological characteristics, treatments and outcomes of male breast ACC. We share our experience in the hopes that this evidence will aid in the development of better therapeutics.
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Affiliation(s)
- Jie Xiao Li
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Xi Meng Zhang
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yun Xiao Xiao
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Zi Mei Tang
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
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15
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An JK, Woo JJ, Kim EK, Kwak HY. Breast adenoid cystic carcinoma arising in microglandular adenosis: A case report and review of literature. World J Clin Cases 2021; 9:7579-7587. [PMID: 34616829 PMCID: PMC8464440 DOI: 10.12998/wjcc.v9.i25.7579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/13/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast adenoid cystic carcinoma (AdCC) is a rare invasive carcinoma composed of epithelial and myoepithelial cells. Microglandular adenosis (MGA) is a rare benign proliferative lesion consisting of small, uniform, and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer. MGA may progress to atypical MGA and carcinoma arising in MGA. Among various invasive carcinomas from MGA, AdCC has been rarely reported. Here, we report a case of AdCC arising in MGA.
CASE SUMMARY A 59-year-old woman was diagnosed with a newly developed density on a routine mammogram. The density was similar to or slightly lower than that of the breast parenchyma. Sonography showed an irregular mass with a slightly higher echo than that of fat. Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma. The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern. Microscopically, the tumor was composed of invasive AdCC, in situ AdCC, and MGA. AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets, or haphazardly scattered small cribriform or tubular glands. MGA showed small glands with a single epithelial lining and retained lumen. S-100 staining was strongly positive in MGA area. The patient underwent breast-conserving surgery with sentinel lymph node biopsy.
CONCLUSION Breast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.
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Affiliation(s)
- Jin Kyung An
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Jeong Joo Woo
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Eun Kyung Kim
- Department of Pathology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Hee Yong Kwak
- Department of Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
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16
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Zhang W, Fang Y, Zhang Z, Wang J. Management of Adenoid Cystic Carcinoma of the Breast: A Single-Institution Study. Front Oncol 2021; 11:621012. [PMID: 33791208 PMCID: PMC8005703 DOI: 10.3389/fonc.2021.621012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of our study was to analyze the clinicopathologic features and surgical and oncological outcomes of adenoid cystic carcinoma (ACC) of the breast and to provide the basis for a clinical therapeutic schedule. Methods A total of 14 patients with primary breast adenoid cystic carcinoma treated at Cancer Hospital of the Chinese Academy of Medical Sciences from January 2000 to December 2017 were included. Data on clinical presentation, treatment strategy, and outcome, as well as the pathological features of ACC, were reviewed and analyzed. Results Fourteen patients were diagnosed with ACC of the breast, out of 23205 total patients treated for breast cancer (0.06%). All but three patients were postmenopausal, with a median age at diagnosis of 60.5 years (range, 39–73 years). The most common clinical presentation was a palpable mass (85.7%), and the imaging characteristics of all patients on color Doppler ultrasound and mammography were nonspecific. Six patients (42.9%) were suspected of having ACC by fine-needle aspiration cytology (FNAC) and were confirmed by postoperative histology and immunohistochemistry. All 14 patients underwent surgery, and no patient had a positive lymph node status. Median tumor size was 1.75 cm (range, 1–3 cm). Eight/14 (57.1%) patients were hormone receptor negative (HR−) and HER-2/neu (−) (HER2−). The remaining patients were hormone receptor positive (HR+). There was no significant difference in clinicopathological characteristics between the HR+ group and the HR- group (P>0.05). The mean follow-up period was 57 months. Local recurrence occurred in 14.3% of patients, 1.7% of patients had distant metastasis, all patients with local recurrence or distant metastasis were in the HR (-) group, and all patients were alive at the last follow-up. Conclusion ACC of the breast cannot be simply summarized as triple-negative breast cancer because it also includes a small number of hormone receptor-positive breast cancers. Establishing a preoperative diagnosis is difficult on the basis of clinical imaging examination, FNAC may be useful tool in the diagnosis. the final diagnosis can only be assessed based on the results of the histopathological and immunohistochemical examination. Breast-conserving surgery may be an alternative treatment strategy, and axillary lymph node dissection or sentinel node biopsy may not be necessary in some cases.
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Affiliation(s)
- Wenxiang Zhang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihui Zhang
- Cytology Section Department of Pathology, National Cancer Centre/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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Adenoid cystic carcinoma of the breast - an uncommon malignancy with unpredictable clinical behaviour. A case series of three patients. Contemp Oncol (Pozn) 2021; 24:263-265. [PMID: 33531875 PMCID: PMC7836279 DOI: 10.5114/wo.2020.99025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/09/2020] [Indexed: 11/17/2022] Open
Abstract
Adenoid cystic carcinoma (AdCC) is a common tumour of the minor salivary gland, rarely seen in other anatomical locations. In particular, AdCC of the breast accounts for < 0.1% of patients diagnosed with breast cancer. Here we report our institutional experience with three cases of breast AdCC diagnosed between 2009 and 2017. Mean age of women included in the report was 53 (range from 41 to 62). One case was of no special subtype, two were solid variants and one presented with a component of invasive ductal carcinoma. At diagnosis in all cases neither lymph node involvement nor distal metastases were detected. All patients underwent surgical resection of the tumour - mastectomy or lumpectomy, followed by either adjuvant radiotherapy and chemotherapy (one case), chemotherapy without radiotherapy (one case) or no treatment (one case). Two patients were reported to develop metastatic disease. No deaths were recorded. In contrast to other anatomical locations AdCC of the breast is regarded as a rare tumour with low malignant potential. However, as shown in our case series, it can present as an aggressive disease with distal metastases, which calls for deep awareness among both pathologists and clinicians involved in the process of diagnosis and therapy.
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18
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Gillie B, Kmeid M, Asarian A, Xiao P. Adenoid cystic carcinoma of the breast with distant metastasis to the liver and spleen: a case report. J Surg Case Rep 2020; 2020:rjaa483. [PMID: 33274045 PMCID: PMC7697849 DOI: 10.1093/jscr/rjaa483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare malignancy, accounting for 0.1–1% of breast cancers. Histologically breast ACC is similar to ACC’s found in salivary tissue and is a triple-negative breast cancer with an uncharacteristically favorable prognosis and low incidence of metastasis. Most cases present as a painful, palpable mass; however, asymptomatic cases found on screening mammograms have also been noted. Core needle biopsy or excisional biopsy is necessary for definitive diagnosis of breast ACC. Immunohistochemistry of these cancers can differentiate breast ACC from masses with similar histology, such as invasive cribriform carcinoma and collagenous spherulosis. There is no well-established treatment guideline for ACC; however, it has been noted that reoccurrence and metastasis are noted more in cases of local resection than mastectomy.
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Affiliation(s)
- Breanne Gillie
- Department of Medicine, St George's University School of Medicine, True Blue, Grenada, WI, USA
| | - Michael Kmeid
- Department of Medicine, St George's University School of Medicine, True Blue, Grenada, WI, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA
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19
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Fernández de Los Reyes I, Córdoba Iturriagagoitia A, Chouza Sanin M, Aguiar Losada B, Larrea Ramirez A, Ruíz de Azúa Ciria Y. [Adenoid cystic carcinoma of the breast, 22 years of experience]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 53:206-212. [PMID: 33012489 DOI: 10.1016/j.patol.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/24/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adenoid cystic carcinoma (ACC) is an uncommon neoplasm in the breast (less than 0.1%). ACC is typically triple negative with a favourable prognosis. Its low frequency and indolent course cause difficulties in the agreement of the evaluation and therapeutic consensus, as well as the use of the sentinel node excision in these carcinomas. OBJECTIVE Our goal is to provide a new series of cases from the Complejo Hospitalario de Navarra, through retrospective review over a period of 22 years. MATERIAL AND METHODS Every case of breast ACC diagnosed between 1998-2020 is reviewed. We analyze the clinical and pathological characteristics, and compare them with the literature. RESULTS We identified twelve cases of ACC, from a total of 18,241 patients diagnosed with breast carcinoma, with an average tumor size of 23.8mm and mean of 63.5 years. All of them were in a stage I-II at diagnosis. One case presented a lymph node micrometastases. One of them presented local recurrences and one case presented metastases 5 months after diagnosis (93.5 months of mean follow-up). According to Nottingham Histological Score, eight cases had a grade 1, two grade 2 and two grade 3. According to the classification of Ro et al., three were grade 1, four grade 2 and five grade 3. One case was ER positive (10%). No case presents positivity for BRAF-V600E in immunohistochemistry. CONCLUSION The management and prognosis ACC of breast, within benignity, remains uncertain, with more studies being needed to understand the clinical evolution and perform adequate therapeutic management.
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Affiliation(s)
| | | | - Mateo Chouza Sanin
- Departamento de Anestesiología y Reanimación, Complejo Hospitalario de Navarra, Pamplona, España
| | - Begoña Aguiar Losada
- Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Alba Larrea Ramirez
- Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, España
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20
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Tummidi S, Prasad S, Joshi D, Tandon A, Mohan A, Saxena P, Kapoor N. Adenoid Cystic Carcinoma Breast: a Rare Entity. Indian J Surg Oncol 2020; 11:226-231. [PMID: 33364705 PMCID: PMC7732897 DOI: 10.1007/s13193-020-01106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/22/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
| | - Shubhra Prasad
- Department of Pathology & Lab Medicine, AIIMS, Bhopal, MP India
| | - Deepti Joshi
- Department of Pathology & Lab Medicine, AIIMS, Bhopal, MP India
| | - Ashwani Tandon
- Department of Pathology & Lab Medicine, AIIMS, Bhopal, MP India
| | - Anjaly Mohan
- Department of General Surgery, AIIMS, Bhopal, MP India
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21
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Kim J, Kim JY, Lee HB, Lee YJ, Seong MK, Paik N, Park WC, Park S, Jung SP, Bae SY. Characteristics and prognosis of 17 special histologic subtypes of invasive breast cancers according to World Health Organization classification: comparative analysis to invasive carcinoma of no special type. Breast Cancer Res Treat 2020; 184:527-542. [PMID: 32794061 DOI: 10.1007/s10549-020-05861-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breast cancer is a heterogeneous disease with various histopathologic subtypes. Except for invasive carcinoma of no special type (NST), other subtypes are rare with limited data. The purpose of this study was to analyze the characteristics and prognosis of special histopathologic subtypes of breast cancer compared to NST. METHODS A total of 136,140 patients were analyzed using the Korean Breast Cancer Society Registry database between January 1996 and March 2019. The clinicopathologic features and survival outcomes of special type breast carcinoma were compared with those of NST. RESULTS The prevalence of special subtypes other than NST was 13.7% (n = 18,633). Compared to NST, patients with lobular, medullary, metaplastic, and micropapillary carcinoma had larger tumors (p < 0.001). Patients with mucinous, tubular, medullary, metaplastic, and cribriform carcinoma presented with less node metastasis (p < 0.001), contrary to patients with micropapillary carcinoma. Patients with lobular, mucinous, tubular, papillary, and cribriform carcinoma presented as luminal A subtype much more often (p < 0.001). Micropapillary carcinoma included more luminal B subtype (p < 0.001). Typically, medullary and metaplastic carcinoma included more triple-negative subtypes (p < 0.001). In survival analysis, only medullary (Hazard Ratio (HzR) 0.542, 95% CI 0.345 to 0.852, p = 0.008) and metaplastic carcinoma (HzR 1.655, 95% CI 1.317 to 2.080, p < 0.001) showed significantly different overall survival from NST by multivariate analysis. CONCLUSION Breast cancer had distinct clinicopathologic features according to histopathologic subtype. However, special types of breast cancer had similar survival outcomes compared to NST when adjusting for other prognostic factors, except for metaplastic carcinoma and medullary carcinoma.
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Affiliation(s)
- Jiyoung Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, South Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Young Joo Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Namsun Paik
- Ewha Womans University Cancer Center Hospital for Women, Seoul, South Korea
| | - Woo-Chan Park
- Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sungmin Park
- Department of Breast Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si, Republic of Korea
| | - Seung Pil Jung
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Soo Youn Bae
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
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22
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Unusual Presentations of Primary and Metastatic Adenoid Cystic Carcinoma Involving the Skin. Am J Dermatopathol 2020; 42:967-971. [PMID: 32618709 DOI: 10.1097/dad.0000000000001730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adenoid cystic carcinoma (ACC) is most commonly seen in the salivary glands but may occur at other sites. Primary or metastatic involvement of the skin is unusual. We report 2 cases of ACC with unusual presentation. In the first case, a 55-year-old woman presented with a cutaneous lesion on the right shin, and final pathology showed ACC. An extracutaneous origin was excluded by clinical and imaging studies. In the second case, a 49-year-old woman presented with a nodule on the breast, and biopsy confirmed high-grade ACC (>30% solid areas). She underwent lumpectomy and subsequent mastectomy after recurrence. Sixteen months after the initial diagnosis of ACC of the breast, distant metastases at multiple sites, including the skin, were identified. This report will increase awareness of these rare presentations of cutaneous ACC and allow correct diagnosis and appropriate management of such cases.
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23
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Ginter PS, Tang X, Shin SJ. A review of mucinous lesions of the breast. Breast J 2020; 26:1168-1178. [PMID: 32419267 DOI: 10.1111/tbj.13878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
Mucinous lesions of the breast include a variety of benign and malignant epithelial processes that display intracytoplasmic or extracellular mucin, including mucocele-like lesions, mucinous carcinoma, solid papillary carcinoma, and other rare subtypes of mucin-producing carcinoma. The finding of free-floating or stromal mucin accumulations is a diagnostic challenge of which the significance depends on the clinical, radiologic, and pathologic context. This article emphasizes the differential diagnosis between benign and malignant mucin-producing lesions, with a brief consideration of potential mimics, such as biphasic and mesenchymal lesions with associated with mucinous, myxoid, or matrix material.
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Affiliation(s)
- Paula S Ginter
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Xiaoyu Tang
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY, USA
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24
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Naeem M, Zulfiqar M, Ballard DH, Billadello L, Cao G, Winter A, Lowdermilk M. "The unusual suspects"-Mammographic, sonographic, and histopathologic appearance of atypical breast masses. Clin Imaging 2020; 66:111-120. [PMID: 32470708 DOI: 10.1016/j.clinimag.2020.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/16/2020] [Accepted: 04/30/2020] [Indexed: 01/23/2023]
Abstract
Breast malignancy is the second most common cause of cancer death in women. However, less common breast masses can mimic carcinoma and can pose diagnostic challenges. This case-based review describes a spectrum of rare breast neoplastic and non-neoplastic masses ranging from malignant to benign entities. Malignant masses in this review include adenoid cystic carcinoma, spindle cell lipoma, granular cell tumor, angiosarcoma, glomus tumor, adenosquamous carcinoma, and myofibroblastoma. Benign masses include sarcoidosis, diabetic mastopathy, and cat scratch disease. Demographics and, when relevant, clinical presentation are summarized. Breast imaging appearance on mammography and ultrasound are highlighted along with radiology-pathology correlation with the appearance and characteristics of the histopathological specimen of these rare masses.
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Affiliation(s)
- Muhammad Naeem
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America.
| | - Maria Zulfiqar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America.
| | - Laura Billadello
- Department of Radiology, St Louis University School of Medicine, United States of America.
| | - Guihua Cao
- Department of Pathology, SSM Health St Mary's Hospital, United States of America.
| | - Andrea Winter
- Department of Radiology, St Louis University School of Medicine, United States of America
| | - Mary Lowdermilk
- Department of Radiology, St Louis University School of Medicine, United States of America.
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25
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Kutasovic JR, McCart Reed AE, Sokolova A, Lakhani SR, Simpson PT. Morphologic and Genomic Heterogeneity in the Evolution and Progression of Breast Cancer. Cancers (Basel) 2020; 12:E848. [PMID: 32244556 PMCID: PMC7226487 DOI: 10.3390/cancers12040848] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/13/2022] Open
Abstract
: Breast cancer is a remarkably complex and diverse disease. Subtyping based on morphology, genomics, biomarkers and/or clinical parameters seeks to stratify optimal approaches for management, but it is clear that every breast cancer is fundamentally unique. Intra-tumour heterogeneity adds further complexity and impacts a patient's response to neoadjuvant or adjuvant therapy. Here, we review some established and more recent evidence related to the complex nature of breast cancer evolution. We describe morphologic and genomic diversity as it arises spontaneously during the early stages of tumour evolution, and also in the context of treatment where the changing subclonal architecture of a tumour is driven by the inherent adaptability of tumour cells to evolve and resist the selective pressures of therapy.
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Affiliation(s)
- Jamie R. Kutasovic
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane 4029, Australia; (J.R.K.); (A.E.M.R.); (A.S.); (S.R.L.)
- QIMR Berghofer Medical Research Institute, Herston 4006, Australia
| | - Amy E. McCart Reed
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane 4029, Australia; (J.R.K.); (A.E.M.R.); (A.S.); (S.R.L.)
- QIMR Berghofer Medical Research Institute, Herston 4006, Australia
| | - Anna Sokolova
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane 4029, Australia; (J.R.K.); (A.E.M.R.); (A.S.); (S.R.L.)
- Pathology Queensland, The Royal Brisbane & Women’s Hospital, Herston, Brisbane 4029, Australia
| | - Sunil R. Lakhani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane 4029, Australia; (J.R.K.); (A.E.M.R.); (A.S.); (S.R.L.)
- Pathology Queensland, The Royal Brisbane & Women’s Hospital, Herston, Brisbane 4029, Australia
| | - Peter T. Simpson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Brisbane 4029, Australia; (J.R.K.); (A.E.M.R.); (A.S.); (S.R.L.)
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26
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Noda Y, Nakanishi Y, Nishimae A, Takahashi H, Oshiro C, Inaji H, Yamasaki M. Fine-needle aspiration cytology for the diagnosis of solid basaloid adenoid cystic carcinoma of the breast: Its role, limitation, and perspective. Diagn Cytopathol 2020; 48:652-656. [PMID: 32181598 DOI: 10.1002/dc.24414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
Solid basaloid adenoid cystic carcinoma (SB-AdCC) is a subtype of breast AdCC which shows more aggressive clinical behavior than other subtypes. Fine-needle aspiration (FNA) cytology is a useful diagnostic tool for breast malignancies. However, most of the diagnostic cytological characteristics of AdCC are not present in SB-AdCC and cytomorphological studies of this subtype are limited. Here, we evaluated the utility of FNA in the diagnosis of SB-AdCC of the breast. A search of the pathology archives of our institutions for FNA specimens of histologically confirmed SB-AdCC between 2012 and 2019 identified four patients with SB-AdCC of the breast. All patients were female and the average age was 60 years. Cytologically, one case was classified as malignant, two as indeterminate, and one as unsatisfactory. Smears had low to moderate cellularity. All smears showed ribbon-like material surrounding the clusters and a vertical nuclear arrangement toward the peripheral rim. Hyaline globules appeared only in one case. Cells in all cases showed an oval, angular, and spindle shape hyperchromatic nuclei with mild to severe atypia, and also dispersed naked nuclei similar to the cells of the clusters were detected in one case. In histological sections, these cytological findings were compatible with the histological findings and divergent histological differentiation was detected. Diagnosing of few cellular smears of SB-AdCC is difficult whereas the features of peripheral rim of the clusters, naked nuclei, and the divergent differentiation may be important for diagnosing SB-AdCC of the breast.
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Affiliation(s)
- Yuri Noda
- Department of Diagnostic Pathology, Kaizuka City Hospital, Osaka, Japan
| | - Yuko Nakanishi
- Department of Clinical Laboratory, Kaizuka City Hospital, Osaka, Japan
| | - Ayaka Nishimae
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Hiroyo Takahashi
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Chiya Oshiro
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Hideo Inaji
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Masaru Yamasaki
- Department of Diagnostic Pathology, Kaizuka City Hospital, Osaka, Japan
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27
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Singla G, Singla T, Das S, Arora R, Singla S. A rare type of breast carcinoma. Cytojournal 2020; 17:4. [PMID: 32256670 PMCID: PMC7111540 DOI: 10.25259/cytojournal_84_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 12/21/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gaurav Singla
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tanisha Singla
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumanta Das
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rashmi Arora
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Swati Singla
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Yiğit S, Etit D, Hayrullah L, Atahan MK. Androgen Receptor Expression in Adenoid Cystic Carcinoma of Breast: A Subset of Seven Cases. Eur J Breast Health 2019; 16:44-47. [PMID: 31912013 DOI: 10.5152/ejbh.2019.5068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/15/2019] [Indexed: 12/26/2022]
Abstract
Objective Adenoid cystic carcinoma (ACC) of the breast is an uncommon salivary type of breast carcinoma. It is a triple negative breast carcinoma with a basal-like phenotype that behaves in an indolent manner. Herein, we aimed to document clinicopathologic findings and hormone receptor status of ACC in the breast diagnosed in our institution during an eleven-year period. Materials and Methods Medical data of cases diagnosed as adenoid cystic carcinoma in the breast between January 2006 and December 2016 were retrospectively reviewed from hospital data base. Paraffin blocks of seven cases were retrieved from the archive of Pathology Department and androgen receptor (AR) immunohistochemistry was applied to each case. Results All of the cases diagnosed as ACC were females with a mean age 56.2. Solid growth pattern was present in two cases. P63 was constantly expressed in the whole group, and at least one additional myoepithelial marker (calponin, caldesmon, etc.) was co-expressed in tumors. While weak estrogen receptor expression was detected only in one patient, AR was strikingly expressed in majority (%85.7) of the tumors. Conclusion To our knowledge, our series is the first to report such high levels of AR expression. This new finding, in turn, suggests considering hormonal therapy as an option in the management of ACC of the breast.
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Affiliation(s)
- Seyran Yiğit
- Department of Pathology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Demet Etit
- Department of Pathology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Leyla Hayrullah
- Department of Pathology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Murat Kemal Atahan
- Department of General Surgery, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
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29
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Abdelwahed A, Ahmed M. Rare epithelial breast cancer: surgery and adjuvant therapy. Transl Cancer Res 2019; 8:S479-S492. [PMID: 35117126 PMCID: PMC8797705 DOI: 10.21037/tcr.2019.05.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 01/30/2023]
Abstract
Breast cancer is a heterogenous disease, exhibiting a wide range of morphological phenotypes shaping its prognosis and clinical course. However, optimal management of rarer breast cancer subtypes is often undefined and controversial in literature due to the lack of large studies and randomised trials. This review aims to discuss the treatment of 13 rare epithelial subtypes, focussing on surgery and adjuvant therapies.
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Affiliation(s)
| | - Muneer Ahmed
- King's College London, Division of Cancer, Research Oncology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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30
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Mackenzie J, Douglas C. Gynecomastia or rare malignancy? A young man with an unremarkable history proves to have adenoid cystic carcinoma of the breast. Breast J 2019; 26:502-504. [PMID: 31493308 DOI: 10.1111/tbj.13534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Jack Mackenzie
- Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Charles Douglas
- The Breast and Endocrine Centre, Gateshead, NSW, Australia.,The University of Newcastle, Callaghan, NSW, Australia
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31
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Adenoid Cystic Carcinoma of the Bartholin's Gland: A Diagnostic Dilemma. Case Rep Obstet Gynecol 2019; 2019:1784949. [PMID: 31531253 PMCID: PMC6720055 DOI: 10.1155/2019/1784949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022] Open
Abstract
Adenoid cystic carcinomas of the Bartholin's gland are extremely rare and are often misdiagnosed. There are currently no definite treatment guidelines. This article describes the case of a 33-year-old female who was managed at our centre for adenoid cystic carcinoma of the Bartholin's gland. She presented with a prolonged history of a vulvar lesion which was eventually diagnosed as adenoid cystic carcinoma of the Bartholin's gland. She was subsequently treated with wide local excision of the primary and inguinal lymph node dissection followed by adjuvant radiotherapy and chemotherapy. She had gross perineural invasion on MRI imaging. The present case highlights the diagnostic dilemma in this extremely rare cancer and the literature further explores the natural history and treatment options.
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32
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Pang W, Wang Z, Jin X, Zhang Q. Adenoid cystic carcinoma of the breast in a male: A case report. Medicine (Baltimore) 2019; 98:e16760. [PMID: 31393393 PMCID: PMC6708915 DOI: 10.1097/md.0000000000016760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/06/2019] [Accepted: 07/16/2019] [Indexed: 01/27/2023] Open
Abstract
RATIONALE Adenoid cystic carcinoma (ACC) of the breast is an infrequent neoplasm, and the occurrence in males is rare. Therefore, diagnostic and therapeutic challenges are inevitable. PATIENT CONCERNS Herein, we present a case of a 44-year-old man with a tumor on his right breast that he had known about for 6 years. DIAGNOSES The patient underwent a lumpectomy, and the histological examination confirmed a diagnosis of ACC. INTERVENTIONS Modified radical mastectomy was subsequently conducted in the patient. No positive lymph nodes were observed in the postoperative pathological examination. Following the surgery, the patient received adjuvant chemotherapy. OUTCOMES The patient remained recurrence-free at 26 months. LESSONS Compared to female breast ACC, male breast ACC may behave differently biologically and have a different prognosis. Our case will provide more diagnostic and treatment experience to deal with this disease.
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33
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Nozoe T, Nozoe E, Ohga T, Ezaki T, Sueishi K. A case of adenoid cystic carcinoma of the breast. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 65:289-291. [PMID: 30282876 DOI: 10.2152/jmi.65.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An 85-year old woman who had a large tumor in the left breast came to our out-patient clinic. Computed tomography showed multiple lung tumors in addition to a huge tumor in the left breast. A needle biopsy brought about a histological diagnosis of ductal carcinoma. A simple mastectomy was performed and a histological examination using the resected specimen demonstrated a coexistence of an adenoid structure and a false ductal structure according the histologic characteristics of adenoid cystic carcinoma, which is quite rare among breast tumors. J. Med. Invest. 65:289-291, August, 2018.
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Affiliation(s)
- Tadahiro Nozoe
- Department of Surgery, Fukuoka Higashi Medical Center.,Department of Breast Surgery, Saiseikai Fukuoka General Hospital
| | - Emiko Nozoe
- Department of Breast Surgery, Saiseikai Fukuoka General Hospital
| | - Takefumi Ohga
- Department of Surgery, Fukuoka Higashi Medical Center
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34
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Thomas DN, Asarian A, Xiao P. Adenoid cystic carcinoma of the breast. J Surg Case Rep 2019; 2019:rjy355. [PMID: 30697408 PMCID: PMC6344919 DOI: 10.1093/jscr/rjy355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/28/2018] [Accepted: 01/09/2019] [Indexed: 12/18/2022] Open
Abstract
Adenoid cystic carcinoma of the breast (ACC) is a rare tumor, comprising <0.1% of all breast cancers. It has a unique dual-cell pattern and is indistinguishable from ACC arising from salivary tissue. It is a low-grade tumor with favorable prognosis, and rare metastasis, with unique features. It is more commonly seen in older women with a mean age at diagnosis of 63, with Caucasian women being at greatest risk. Most cases present as a painful, palpable mass in the outer quadrants of the breast, and must be diagnosed via core needle biopsy or surgical excisional biopsy. Although few other cancers resemble ACC it is commonly misdiagnosed. Given the rarity of this cancer, treatment guidelines have yet to be well established. Current treatment is focused around surgical resection, however, there are not specific recommendations for the extent of resection due to the lack of cases to draw from.
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Affiliation(s)
- Devon N Thomas
- Department of Surgery, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA
| | - Armand Asarian
- Department of Surgery, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA
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35
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Krucoff KB, Shammas RL, Stoecker M, Tolnitch LA. Rare breast metastasis from adenoid cystic carcinoma of the submandibular gland. BMJ Case Rep 2018; 2018:bcr-2017-223345. [PMID: 30068574 DOI: 10.1136/bcr-2017-223345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adenoid cystic carcinomas (ACCs) are rare malignant neoplasms of exocrine glands, most commonly found in salivary glands. This report describes a 67-year-old woman with metastatic ACC to the breast, only the third reported case of its kind. The salivary gland ACC was first diagnosed 5 years prior. Routine mammogram identified a Breast Imaging and Reporting Systems (BIRADS) 4 lesion. Core breast biopsy demonstrated findings consistent with metastatic ACC to the breast. The patient ultimately underwent local excision but suffered a recurrence of disease less than 2 months later despite chemotherapy. She passed away 15 months after excision due to complications associated with a small bowel obstruction and decompensated respiratory status from pulmonary metastases. While metastatic salivary ACC to the breast is rare, it is important to be able to distinguish metastatic salivary ACC to the breast from primary ACC of the breast as the treatment considerations for the two disease processes differ significantly.
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Affiliation(s)
| | | | - Maggie Stoecker
- Department of Pathology, Duke Raleigh Hospital, Raleigh, North Carolina, USA
| | - Lisa Anne Tolnitch
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
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36
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Andreasen S, Tan Q, Agander TK, Steiner P, Bjørndal K, Høgdall E, Larsen SR, Erentaite D, Olsen CH, Ulhøi BP, von Holstein SL, Wessel I, Heegaard S, Homøe P. Adenoid cystic carcinomas of the salivary gland, lacrimal gland, and breast are morphologically and genetically similar but have distinct microRNA expression profiles. Mod Pathol 2018; 31:1211-1225. [PMID: 29467480 DOI: 10.1038/s41379-018-0005-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 12/13/2022]
Abstract
Adenoid cystic carcinoma is among the most frequent malignancies in the salivary and lacrimal glands and has a grave prognosis characterized by frequent local recurrences, distant metastases, and tumor-related mortality. Conversely, adenoid cystic carcinoma of the breast is a rare type of triple-negative (estrogen and progesterone receptor, HER2) and basal-like carcinoma, which in contrast to other triple-negative and basal-like breast carcinomas has a very favorable prognosis. Irrespective of site, adenoid cystic carcinoma is characterized by gene fusions involving MYB, MYBL1, and NFIB, and the reason for the different clinical outcomes is unknown. In order to identify the molecular mechanisms underlying the discrepancy in clinical outcome, we characterized the phenotypic profiles, pattern of gene rearrangements, and global microRNA expression profiles of 64 salivary gland, 9 lacrimal gland, and 11 breast adenoid cystic carcinomas. All breast and lacrimal gland adenoid cystic carcinomas had triple-negative and basal-like phenotypes, while salivary gland tumors were indeterminate in 13% of cases. Aberrations in MYB and/or NFIB were found in the majority of cases in all three locations, whereas MYBL1 involvement was restricted to tumors in the salivary gland. Global microRNA expression profiling separated salivary and lacrimal gland adenoid cystic carcinoma from their respective normal glands but could not distinguish normal breast adenoid cystic carcinoma from normal breast tissue. Hierarchical clustering separated adenoid cystic carcinomas of salivary gland origin from those of the breast and placed lacrimal gland carcinomas in between these. Functional annotation of the microRNAs differentially expressed between salivary gland and breast adenoid cystic carcinoma showed these as regulating genes involved in metabolism, signal transduction, and genes involved in other cancers. In conclusion, microRNA dysregulation is the first class of molecules separating adenoid cystic carcinoma according to the site of origin. This highlights a novel venue for exploring the biology of adenoid cystic carcinoma.
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Affiliation(s)
- Simon Andreasen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark. .,Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.
| | - Qihua Tan
- Department of Clinical Research, Unit of Human Genetics, University of Southern Denmark, Odense, Denmark
| | | | - Petr Steiner
- Department of Pathology, Faculty of Medicine, Charles University in Prague, Pilsen, Czech Republic.,Bioptic Laboratory Ltd, Molecular Pathology Laboratory, Pilsen, Czech Republic
| | - Kristine Bjørndal
- Department of ORL-Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Estrid Høgdall
- Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | - Daiva Erentaite
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Sarah Linéa von Holstein
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.,Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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37
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Co-inhibition of mTORC1, HDAC and ESR1α retards the growth of triple-negative breast cancer and suppresses cancer stem cells. Cell Death Dis 2018; 9:815. [PMID: 30050079 PMCID: PMC6062597 DOI: 10.1038/s41419-018-0811-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
Abstract
Triple-negative breast cancer (TNBC) is the most refractory subtype of breast cancer. It causes the majority of breast cancer-related deaths, which has been largely associated with the plasticity of tumor cells and persistence of cancer stem cells (CSCs). Conventional chemotherapeutics enrich CSCs and lead to drug resistance and disease relapse. Development of a strategy capable of inhibiting both bulk and CSC populations is an unmet medical need. Inhibitors against estrogen receptor 1, HDACs, or mTOR have been studied in the treatment of TNBC; however, the results are inconsistent. In this work, we found that patient TNBC samples expressed high levels of mTORC1 and HDAC genes in comparison to luminal breast cancer samples. Furthermore, co-inhibition of mTORC1 and HDAC with rapamycin and valproic acid, but neither alone, reproducibly promoted ESR1 expression in TNBC cells. In combination with tamoxifen (inhibiting ESR1), both S6RP phosphorylation and rapamycin-induced 4E-BP1 upregulation in TNBC bulk cells was inhibited. We further showed that fractionated CSCs expressed higher levels of mTORC1 and HDAC than non-CSCs. As a result, co-inhibition of mTORC1, HDAC, and ESR1 was capable of reducing both bulk and CSC subpopulations as well as the conversion of fractionated non-CSC to CSCs in TNBC cells. These observations were partially recapitulated with the cultured tumor fragments from TNBC patients. Furthermore, co-administration of rapamycin, valproic acid, and tamoxifen retarded tumor growth and reduced CD44high/+/CD24low/− CSCs in a human TNBC xenograft model and hampered tumorigenesis after secondary transplantation. Since the drugs tested are commonly used in clinic, this study provides a new therapeutic strategy and a strong rationale for clinical evaluation of these combinations for the treatment of patients with TNBC.
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38
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Andreasen S. Molecular features of adenoid cystic carcinoma with an emphasis on microRNA expression. APMIS 2018; 126 Suppl 140:7-57. [DOI: 10.1111/apm.12828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Simon Andreasen
- Department of Otorhinolaryngology and Maxillofacial Surgery; Zealand University Hospital; Køge Denmark
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39
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Frequent NFIB-associated Gene Rearrangement in Adenoid Cystic Carcinoma of the Vulva. Int J Gynecol Pathol 2018; 36:289-293. [PMID: 27662035 DOI: 10.1097/pgp.0000000000000324] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adenoid cystic carcinoma is a rare malignant tumor that usually arises in the major and minor salivary glands and other locations containing secretory glands, including the lower female genital tract. Lower female genital tract carcinomas with adenoid cystic differentiation can be subclassified into 2 distinct groups based on the presence or absence of high-risk HPV. Cervical mixed carcinomas with some adenoid cystic differentiation are high-risk HPV-related but pure adenoid cystic carcinomas of vulvar and cervical origin appear to be unrelated to high-risk HPV. Mechanisms by which normal cells give rise to an HPV-unrelated adenoid cystic carcinoma remain largely unknown. Studies demonstrate that chromosomal translocation involving the genes encoding the transcription factors MYB and NFIB functions as a driving force of adenoid cystic carcinomas development regardless of anatomic site. The current study used fluorescence in situ hybridization with 3 different probes including MYB break-apart probe, NFIB break-apart probe, and MYB-NFIB fusion probe to assess for the presence of gene rearrangements in adenoid cystic carcinomas of the vulva. Six (66.7%) of 9 vulvar adenoid cystic carcinomas demonstrated NFIB rearrangement. Of these 6 cases with a disturbed NFIB, only 2 cases (33.3%) were positive for a MYB rearrangement that was also confirmed by a positive MYB-NFIB fusion pattern. NFIB-associated gene rearrangement is a frequent genetic event in vulvar adenoid cystic carcinomas. Chromosome translocations involving NFIB but with an intact MYB indicate the presence of novel oncogenic mechanisms for the development of adenoid cystic carcinomas of the vulva.
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40
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Cutaneous Adnexal Cylindroma of Breast: Epithelial Immunoreactivities for GATA-3, Mammaglobin, and E-Cadherin Do Not Equate to a Mammary Ductal Neoplasm. Case Rep Pathol 2018; 2018:4039545. [PMID: 29651355 PMCID: PMC5831977 DOI: 10.1155/2018/4039545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/18/2018] [Indexed: 11/18/2022] Open
Abstract
Cylindromas are benign epithelial neoplasms derived from cutaneous eccrine adnexal structures. These tumors are most commonly encountered on the head, neck, and scalp of older women. In rare instances, solitary cylindromas may arise at other body sites. In the current case, a cylindroma of the skin of the breast was diagnosed by complete excision. Immunohistochemical studies confirmed the tumor cells to be immunoreactive with cytokeratin AE1/3, cytokeratin 5/6, cytokeratin 7, p63, and SOX10. The neoplastic cells were also noted to be immunoreactive with markers typically expected to be positive in ductal epithelium of the breast including GATA3, mammaglobin, and E-cadherin. The case emphasizes the importance of correlating clinical setting, imaging studies, patient history, and careful microscopic evaluation in arriving at an accurate diagnosis. This case also illustrates the point that not all “breast” tumors that are confirmed to be positive for GATA3, mammaglobin, and E-cadherin are derived from mammary ducts.
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41
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Mukherjee A, Russell R, Chin SF, Liu B, Rueda OM, Ali HR, Turashvili G, Mahler-Araujo B, Ellis IO, Aparicio S, Caldas C, Provenzano E. Associations between genomic stratification of breast cancer and centrally reviewed tumour pathology in the METABRIC cohort. NPJ Breast Cancer 2018; 4:5. [PMID: 29532008 PMCID: PMC5841292 DOI: 10.1038/s41523-018-0056-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 12/20/2022] Open
Abstract
The integration of genomic and transcriptomic profiles of 2000 breast tumours from the METABRIC [Molecular Taxonomy of Breast Cancer International Consortium] cohort revealed ten subtypes, termed integrative clusters (IntClust/s), characterised by distinct genomic drivers. Central histopathology (N = 1643) review was undertaken to explore the relationship between these ten molecular subtypes and traditional clinicopathological features. IntClust subtypes were significantly associated with histological type, tumour grade, receptor status, and lymphocytic infiltration (p < 0.0001). Lymph node status and Nottingham Prognostic Index [NPI] categories were also significantly associated with IntClust subtype. IntClust 3 was enriched for tubular and lobular carcinomas, the latter largely accounting for the association with CDH1 mutations in this cluster. Mucinous carcinomas were not present in IntClusts 5 or 10, but did not show an association with any of the remaining IntClusts. In contrast, medullary-like cancers were associated with IntClust 10 (15/26). Hormone receptor-positive tumours were scattered across all IntClusts. IntClust 5 was dominated by HER2 positivity (127/151), including both hormone receptor-positive (60/72) and hormone receptor-negative tumours (67/77). Triple-negative tumours comprised the majority of IntClust 10 (132/159) and around a quarter of IntClust 4 (52/217). Whilst the ten IntClust subtypes of breast cancer show characteristic patterns of association with traditional clinicopathological variables, no IntClust can be adequately identified by these variables alone. Hence, the addition of genomic stratification has the potential to enhance the biological relevance of the current clinical evaluation and facilitate genome-guided therapeutic strategies.
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Affiliation(s)
- A. Mukherjee
- Department of Histopathology, Division of Cancer and Stem cells, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R. Russell
- CRUK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - Suet-Feung Chin
- CRUK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - B. Liu
- CRUK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - O. M. Rueda
- CRUK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - H. R. Ali
- CRUK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, UK
| | - G. Turashvili
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC Canada
| | - B. Mahler-Araujo
- Addenbrooke’s Hospital, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I. O. Ellis
- Department of Histopathology, Division of Cancer and Stem cells, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S. Aparicio
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC Canada
| | - C. Caldas
- CRUK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Addenbrooke’s Hospital, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E. Provenzano
- Addenbrooke’s Hospital, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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42
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Chen QX, Li JJ, Wang XX, Lin PY, Zhang J, Song CG, Shao ZM. Similar outcomes between adenoid cystic carcinoma of the breast and invasive ductal carcinoma: a population-based study from the SEER 18 database. Oncotarget 2018; 8:6206-6215. [PMID: 28008158 PMCID: PMC5351624 DOI: 10.18632/oncotarget.14052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/12/2016] [Indexed: 02/01/2023] Open
Abstract
Adenoid cystic carcinoma of the breast (breast-ACC) is a rare and indolent tumor with a good prognosis despite its triple-negative status. However, we observed different outcomes in the present study. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled a total of 89,937 eligible patients with an estimated 86 breast-ACC cases and 89,851 invasive ductal carcinoma (IDC) patients. In our study, breast-ACC among women presented with a higher proportion of triple-negative breast cancer (TNBC), which was more likely to feature well-differentiated tumors, rare regional lymph node involvement and greater application of breast-conserving surgery (BCS). Kaplan-Meier analysis revealed that patients with breast-ACC and breast-IDC patients had similar breast cancer-specific survival (BCSS) and overall survival (OS). Moreover, using the propensity score matching method, no significant difference in survival was observed in matched pairs of breast-ACC and breast-IDC patients. Additionally, BCSS and OS did not differ significantly between TNBC-ACC and TNBC-IDC after matching patients for age, tumor size, and nodal status. Further subgroup analysis of molecular subtype indicated improved survival in breast-ACC patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/Her2-) tumors compared to IDC patients with HR+/Her2- tumors. However, the survival of ACC-TNBC and IDC-TNBC patients was similar. In conclusion, ACCs have an indolent clinical course and result in similar outcomes compared to IDC. Understanding these clinical characteristics and outcomes will endow doctors with evidence to provide the same intensive treatment for ACC-TNBC as for IDC-TNBC and lead to more individualized and tailored therapies for breast-ACC patients.
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Affiliation(s)
- Qing-Xia Chen
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Jun-Jing Li
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Xiao Wang
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Pei-Yang Lin
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Zhang
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Chuan-Gui Song
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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43
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Mikse OR, Tchaicha JH, Akbay EA, Chen L, Bronson RT, Hammerman PS, Wong KK. The impact of the MYB-NFIB fusion proto-oncogene in vivo. Oncotarget 2017; 7:31681-8. [PMID: 27213588 PMCID: PMC5077968 DOI: 10.18632/oncotarget.9426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/11/2016] [Indexed: 11/25/2022] Open
Abstract
Recurrent fusion of the v-myb avian myelobastosis viral oncogene homolog (MYB) and nuclear factor I/B (NFIB) generates the MYB-NFIB transcription factor, which has been detected in a high percentage of individuals with adenoid cystic carcinoma (ACC). To understand the functional role of this fusion protein in carcinogenesis, we generated a conditional mutant transgenic mouse that expresses MYB-NFIB along with p53 mutation in tissues that give rise to ACC: mammary tissue, salivary glands, or systemically in the whole body. Expression of the oncogene in mammary tissue resulted in hyperplastic glands that developed into adenocarcinoma in 27.3% of animals. Systemic expression of the MYB-NFIB fusion caused more rapid development of this breast phenotype, but mice died due to abnormal proliferation in the glomerular compartment of the kidney, which led to development of glomerulonephritis. These findings suggest the MYB-NFIB fusion is oncogenic and treatments targeting this transcription factor may lead to therapeutic responses in ACC patients.
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Affiliation(s)
- Oliver R Mikse
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Ludwig Institute for Cancer, Cambridge, Massachusetts, USA
| | - Jeremy H Tchaicha
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Ludwig Institute for Cancer, Cambridge, Massachusetts, USA
| | - Esra A Akbay
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Ludwig Institute for Cancer, Cambridge, Massachusetts, USA
| | - Liang Chen
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Ludwig Institute for Cancer, Cambridge, Massachusetts, USA
| | - Roderick T Bronson
- Department of Microbiology and Immunobiology, Division of Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter S Hammerman
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,The Broad Institute, Cambridge, Massachusetts, USA
| | - Kwok-Kin Wong
- Department of Medicine, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Ludwig Institute for Cancer, Cambridge, Massachusetts, USA.,Belfer Institute for Applied Cancer Science, Boston, Massachusetts, USA
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44
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Mhamdi HA, Kourie HR, Jungels C, Aftimos P, Belbaraka R, Piccart-Gebhart M. Adenoid cystic carcinoma of the breast - an aggressive presentation with pulmonary, kidney, and brain metastases: a case report. J Med Case Rep 2017; 11:303. [PMID: 29080560 PMCID: PMC5660888 DOI: 10.1186/s13256-017-1459-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/18/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Adenoid cystic carcinoma of the breast is a rare malignant neoplasm associated with an excellent prognosis and a very rare occurrence of metastases. CASE PRESENTATION We report the case of an aggressive presentation in a 65-year-old woman, of Belgian origin, who was diagnosed as having adenoid cystic carcinoma of the breast and developed metastases to her lung, kidney, and brain. CONCLUSIONS We describe similar cases reported in the literature and discuss the molecular characteristics and treatment paradigm of this controversially aggressive disease entity.
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Affiliation(s)
- Hasnae Alaoui Mhamdi
- Department of Medical Oncology, University Hospital of Marrakech, Marrakech, Morocco.
| | - Hampig Raphael Kourie
- Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Christiane Jungels
- Department of Medical Oncology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Aftimos
- Department of Medical Oncology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Rhizlane Belbaraka
- Department of Medical Oncology, University Hospital of Marrakech, Marrakech, Morocco
| | - Martine Piccart-Gebhart
- Department of Medical Oncology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
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46
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Treitl D, Radkani P, Rizer M, El Hussein S, Paramo JC, Mesko TW. Adenoid cystic carcinoma of the breast, 20 years of experience in a single center with review of literature. Breast Cancer 2017; 25:28-33. [PMID: 28466440 DOI: 10.1007/s12282-017-0780-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/23/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adenoid cystic carcinoma (ACC) of the breast is a rare type of breast cancer, which presents inconsistencies in the optimal management strategy. METHODS A retrospective review of prospectively collected data, spanning the last 20 years, was performed using the cancer registry database at our institution. RESULTS Six patients were diagnosed with ACC of the breast, out of 5,813 total patients diagnosed with breast cancer (0.1%). Our identified patients had a median age of 66, all with the early stage cancer (Stage I/II). The average size of the breast lesion was 1.62 cm, and nodal status was negative for all cases. All patients had resection as primary therapy (partial or total mastectomy), with one patient also undergoing external beam radiation and tamoxifen hormonal therapy. Median follow-up was 85 months, with all patients being disease-free at last follow-up. CONCLUSIONS ACC of the breast has an indolent course, despite triple negative status. Our study suggests that radiation may not be warranted and confirms the rarity of axillary node metastases, indicating that sentinel node excision may also not be necessary. Ultimately, the hope is that our findings along with the reviewed literature will aid in determining the most appropriate options for management of ACC of the breast.
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Affiliation(s)
- Daniela Treitl
- Mount Sinai Medical Center, Department of Surgery, 4300 Alton Road, Miami Beach, FL, 33140, USA.
| | - Pejman Radkani
- Mount Sinai Hospital, E 101st St, New York, NY, 10029, USA
| | - Magda Rizer
- Mount Sinai Medical Center, Department of Surgery, 4300 Alton Road, Miami Beach, FL, 33140, USA
| | - Siba El Hussein
- Mount Sinai Medical Center, Department of Surgery, 4300 Alton Road, Miami Beach, FL, 33140, USA
| | - Juan C Paramo
- Mount Sinai Medical Center, Department of Surgery, 4300 Alton Road, Miami Beach, FL, 33140, USA
| | - Thomas W Mesko
- Mount Sinai Medical Center, Department of Surgery, 4300 Alton Road, Miami Beach, FL, 33140, USA
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47
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Wang S, Li W, Wang F, Niu Y, Hao C, Wang X, He L, Tong Z. 36 cases adenoid cystic carcinoma of the breast in China: Comparison with matched grade one invasive ductal carcinoma-not otherwise specified. Pathol Res Pract 2017; 213:310-315. [PMID: 28222936 DOI: 10.1016/j.prp.2017.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinicopathological characteristic of adenoid cystic carcinoma (ACC). MATERIALS AND METHODS The clininopathological features, along with relapse free survival(RFS) and overall survival(OS) of 36 patients with ACC were retrospectively investigated and compared with those of 108 grade 1 invasive ductal carcinoma not-otherwise-specified (G1-IDC-NOS) patients. RESULTS Most cases of ACC were ER, PR and HER-2 negative which was classified as triple-negative subtype. Five cases were concomitant with other pathological types of cancer. Axillary lymph node dissection(ALND) was performed in 31 patients and 2 of them with lymph nodes metastasis. Two patients died of lung metastases at 46 and 116 months after the surgery respectively. Compared with G1-IDC-NOS, ACC showed lower Ki-67 index, less lymph nodes metastasis, lower P53 expression, and higher proportion in location of upper outer quadrant of breast. There was no difference of OS and RFS between ACC and G1-IDC-NOS. CONCLUSIONS ACC of the breast was a rare disease with a good prognosis although most of them were classified as triple-negative subtype. And the value of axillary node dissection and adjuvant therapy needs to be further investigated.
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Affiliation(s)
- Shuling Wang
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Weidong Li
- Department of Breast Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Fang Wang
- Shandong Academy of Pharmaceutical Sciences, Ji Nan 250101, Shan Dong, China
| | - Yun Niu
- Department of Breast Pathology and Research Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Chunfang Hao
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Xu Wang
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Lihong He
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China
| | - Zhongsheng Tong
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy (Ministry of Education), Key Laboratory of Cancer Prevention and Therapy, Tianjin,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tianjin 300060, China.
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48
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Glover TE, Butel R, Bhuller CM, Senior EL. An unusual presentation of adenoid cystic carcinoma of the breast with metastatic disease in the clavicle. BJR Case Rep 2017; 3:20160119. [PMID: 30363306 PMCID: PMC6159263 DOI: 10.1259/bjrcr.20160119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/21/2016] [Accepted: 10/25/2016] [Indexed: 12/01/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare subtype of invasive breast cancer. Prognosis is excellent with low rates of recurrence and metastatic disease compared with other triple-negative forms of breast carcinoma and other non-breast forms of ACC. We present a case of a 63-year-old female with metastatic disease in the clavicle 13 years after excision of the breast primary. Metastasis to bone is rare, and this is the first case described in the clavicle. There are no specific radiological features of breast primaries but imaging usually reveals a circumscribed mass, often without microcalcifications. Histology is similar to that of non-breast forms of ACC. Mastectomy or wide local excision is curative in virtually all cases without lymph node involvement. However, as our case demonstrates, the presence of bone pain with a history of ACC of the breast should prompt musculoskeletal imaging. Discussion at a multidisciplinary team meeting is essential for accurate diagnosis.
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Affiliation(s)
| | - Ryan Butel
- Department of Histopathology, West Suffolk NHS Foundation Trust, Suffolk, UK
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Zhang M, Pettaway C, Vikram R, Tamboli P. Adenoid cystic carcinoma of the urethra/Cowper's gland with concurrent high-grade prostatic adenocarcinoma: a detailed clinicopathologic case report and review of the literature. Hum Pathol 2016; 58:138-144. [DOI: 10.1016/j.humpath.2016.07.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/09/2016] [Accepted: 07/20/2016] [Indexed: 02/06/2023]
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50
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Salivary gland-like breast carcinomas: An infrequent disease. Pathol Res Pract 2016; 212:1034-1038. [DOI: 10.1016/j.prp.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/15/2016] [Accepted: 09/05/2016] [Indexed: 12/28/2022]
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