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Noh JM, Lee E, Ahn YC, Oh D, Kim YD, Woo KI, Ko YH, Kim S. Clinical significance of post-surgical residual tumor burden and radiation therapy in treating patients with lacrimal adenoid cystic carcinoma. Oncotarget 2018; 7:60639-60646. [PMID: 27372060 PMCID: PMC5312407 DOI: 10.18632/oncotarget.10259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022] Open
Abstract
Retrospective analyses were done on 19 lacrimal adenoid cystic carcinoma (ACC) patients who underwent curative treatment between 1997 and 2013. Nine patients (47.4%) had T1-2 disease and ten (52.6%) had T4 disease. Surgical procedures were globe-preserving tumor resection in 11 patients (57.9%), incisional biopsy in five (26.3%), and orbital exenteration was undertaken in three (15.8%). Residual tumor burdens were R0/1 in 12 patients (63.2%) and R2 in seven (36.8%). Radiation therapy (RT) was recommended to all patients, and 16 (84.2%) completed RT (median 60 Gy). After median follow-up of 57.5 months, seven (36.8%) developed progression and three (15.8%) died. Local recurrence occurred in four patients (21.1%), distant metastasis in one (5.3%), and combined local recurrence and distant metastasis in two (10.5%). Progression-free survival and overall survival rates at 5-years were 64.5% and 82.6%, respectively. Among 12 patients following R0/1 resection, two (16.7%) developed local recurrence and none died, while among seven following R2 resection, five (71.4%) developed progression and three (42.9%) died. RT following R0/R1 resection could reduce progression. Globe-preserving surgery and RT seemed optimal strategy for T1-2 disease. Careful attention should to be paid to minimize residual tumor burden at surgery and effort for safe radiation dose escalation would be desired.
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Affiliation(s)
- Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eonju Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seokhwi Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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52
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Zhao S, Ma D, Xiao Y, Jiang YZ, Shao ZM. Clinicopathologic features and prognoses of different histologic types of triple-negative breast cancer: A large population-based analysis. Eur J Surg Oncol 2018; 44:420-428. [PMID: 29429597 DOI: 10.1016/j.ejso.2017.11.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/05/2017] [Accepted: 11/21/2017] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To examine the clinicopathologic characteristics and survival outcomes of different histologic types of triple-negative breast cancer (TNBC). METHODS We used the SEER database to identify patients with TNBC diagnosed between 2010 and 2014. Our analysis focused on the seven most prevalent histologic types. Differences were compared between invasive carcinoma of no special type (NST) and the other six types. RESULTS Significant differences were observed in age at diagnosis, tumor grade, size, nodal status and treatment. As tumor size increased, the number of positive lymph nodes increased markedly in invasive lobular carcinoma (ILC) and mixed NST and lobular carcinoma (NST-ILC), while in metaplastic carcinoma the number only increased slightly. In multivariate survival analyses, compared with patients with invasive carcinoma NST, breast cancer-specific survival (BCSS) and overall survival (OS) were worse for those with NST-ILC (BCSS: hazard ratio [HR] 1.81, P < .001; OS: HR 1.56, P = .005) or metaplastic carcinoma (BCSS: HR 1.95, P < .001; OS: HR 1.73, P < .001). By contrast, patients with medullary (HR 0.40, P = .010) or apocrine carcinoma (HR 0.27, P = .008) showed better BCSS. Time-dependent receiver operating characteristic (ROC) analyses indicated that T category in ILC and N category in metaplastic carcinoma were of less prognostic value. CONCLUSIONS According to the histologic classification of TNBC, this heterogeneous disease can be divided into several entities with different clinicopathologic features and prognoses. In the era of molecular subtyping of breast cancer, the histologic classification of TNBC is still of considerable clinical significance.
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Affiliation(s)
- Shen Zhao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Ding Ma
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Yi Xiao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Yi-Zhou Jiang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China.
| | - Zhi-Ming Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China; Institutes of Biomedical Sciences, Fudan University, Shanghai, PR China.
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53
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Adenoid cystic carcinoma of the breast, high grade with basal phenotype, literature review. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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54
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Abstract
Breast cancer is the most common cancer among women and represents one of the top five leading causes of cancer-related mortality. Inherited and acquired genetic mutations as well as epigenetic aberrations are known to be important contributors to the development and progression of breast cancer. Recent developments in high-throughput technologies have increased our understanding of the molecular changes in breast cancer, leading to the identification of distinctive genetic and epigenetic modifications in different breast cancer molecular subtypes. These genetic and epigenetic changes in luminal A, luminal B, ERBB2/HER2-enriched, basal-like, and normal-like breast cancer subtypes are discussed in this chapter. Furthermore, recent epigenome studies provided more information about further stratification of breast cancer subtypes, with essential role in the appropriate diagnosis and treatment of breast cancer. Thus, the inclusion of both genetic and epigenetic information in breast cancer clinical care could provide critical scientific base for precision medicine in breast cancer.
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Liao HY, Zhang WW, Sun JY, Li FY, He ZY, Wu SG. The Clinicopathological Features and Survival Outcomes of Different Histological Subtypes in Triple-negative Breast Cancer. J Cancer 2018; 9:296-303. [PMID: 29344276 PMCID: PMC5771337 DOI: 10.7150/jca.22280] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/11/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose: To determine the clinicopathological features and survival outcomes of triple-negative breast cancer (TNBC) according to different histological subtypes. Methods: Using the Surveillance, Epidemiology, and End Results database, we included TNBC cases in 2010-2013. The effect of histological subtype on breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed using univariate and multivariate analyses. Results: A total of 19,900 patients were identified. Infiltrating ductal carcinoma not otherwise specified accounted for 91.6% of patients, followed by metaplastic carcinoma (2.7%), medullary carcinoma (1.4%), mixed lobular-ductal carcinoma (1.4%), lobular carcinoma (1.3%), apocrine carcinoma (1.0%), and adenoid cystic carcinoma (0.6%). Medullary carcinoma was more frequently poorly/undifferentiated. Significantly more lobular carcinoma, mixed lobular-ductal carcinoma, and metaplastic carcinoma patients had larger tumors. Adenoid cystic carcinoma, metaplastic carcinoma, medullary carcinoma, and apocrine carcinoma were more frequently node-negative. Lobular carcinoma (16.0%) and mixed lobular-ductal carcinoma (10.4%) more frequently had distant stage at initial diagnosis. Histologic subtype was an independent prognostic factor of BCSS and OS. Compared with infiltrating ductal carcinoma, medullary carcinoma and apocrine carcinoma had better BCSS and OS, while mixed lobular-ductal carcinoma and metaplastic carcinoma had worse survival. Adenoid cystic carcinoma survival was not significantly different from that of infiltrating ductal carcinoma. Conclusions: TNBC histological subtypes have different clinicopathological characteristics and survival outcomes. Medullary carcinoma and apocrine adenocarcinoma have excellent prognosis; mixed lobular-ductal carcinoma and metaplastic carcinoma are the most aggressive subtypes.
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Affiliation(s)
- Hong-Ye Liao
- Department of Breast Surgery, Xiamen Maternity and Child Care Hospital, Xiamen 361003, People's Republic of China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
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56
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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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58
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Genomic profiling of breast secretory carcinomas reveals distinct genetics from other breast cancers and similarity to mammary analog secretory carcinomas. Mod Pathol 2017; 30:1086-1099. [PMID: 28548128 DOI: 10.1038/modpathol.2017.32] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 12/23/2022]
Abstract
Secretory carcinomas of the breast are rare tumors with distinct histologic features, recurrent t(12;15)(p13;q25) translocation resulting in ETV6-NTRK3 gene fusion and indolent clinical behavior. Mammary analog secretory carcinomas arising in other sites are histopathologically similar to the breast tumors and also harbor ETV6-NTRK3 fusions. Breast secretory carcinomas are often triple (estrogen and progesterone receptor, HER2) negative with a basal-like immunophenotype. However, genomic studies are lacking, and whether these tumors share genetic features with other basal and/or triple negative breast cancers is unknown. Aside from shared ETV6-NTRK3 fusions, the genetic relatedness of secretory carcinomas arising in different sites is also uncertain. We immunoprofiled and sequenced 510 cancer-related genes in nine breast secretory carcinomas and six salivary gland mammary analog secretory carcinomas. Immunoprofiles of breast and salivary gland secretory carcinomas were similar. All the tumors showed strong diffuse MUC4 expression (n=15), and SOX10 was positive in all nine breast and in five out of six salivary gland tumors. All breast secretory carcinomas were triple negative or weakly ER-positive, and all tumors at both the sites expressed CK5/6 and/or EGFR, consistent with a basal-like phenotype. Sequencing revealed classic ETV6-NTRK3 fusion genes in all cases, including in carcinoma in situ of one breast tumor. Translocations were reciprocal and balanced in six out of nine breast and three out of six salivary gland tumors and were complex in three others. In contrast to most breast basal carcinomas, the mutational burden of secretory carcinomas was very low, and no additional pathogenic aberrations were identified in genes typically mutated in breast cancer. Five (56%) breast and two (33%) salivary gland tumors had simple genomes without copy number changes; the remainder had very few changes, averaging 1.3 per tumor. The ETV6-NTRK3 derivative chromosome was duplicated in one breast and one salivary gland tumor, and was the only copy number change in the latter. The findings highlight breast secretory carcinoma as a subtype more closely related to mammary analog secretory carcinoma than to basal/triple negative breast cancers of no special type. Lack of pathogenic mutations in common cancer-related genes suggests that ETV6-NTRK3 alone may suffice to drive these tumors and likely helps explain their indolent behavior.
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59
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Wang H, Liu F, Gu R, Li Y, Su F. Rare imaging appearance of adenoid cystic carcinoma of the breast: A case report. Mol Clin Oncol 2017; 7:473-475. [PMID: 28781820 DOI: 10.3892/mco.2017.1322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/26/2017] [Indexed: 01/15/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare tumor comprising <0.1% of all breast malignancies. The present study reports the case of a 66-year-old woman who underwent multiple imaging techniques, including mammography, ultrasonography and magnetic resonance imaging (MRI). The patient reported gradual enlargement of a mass in the left breast. Mammography identified a high-density, irregular mass, with nipple retraction. Ultrasonography revealed an irregular, complex cystic and solid mass with an unclear margin in the subareolar region. The internal vascularity was seen on Doppler examination. The lesion on MRI was also mixed cystic and solid, with an irregular shape and irregular margins. The solid part of the lesion appeared heterogeneously isointense on T1-weighted imaging (WI) and a slightly high signal on T2WI, and exhibited internal septations with a low signal on T2WI. Following injection of contrast agent, the enhancement of the solid part was rapid and heterogeneous. The cystic parts of lesion appeared as high-signal on T1WI and T2WI. The tumor infiltrated the left nipple and adjacent skin. The patient underwent a left modified radical mastectomy with axillary lymph node dissection. The pathological examination confirmed the tumor as ACC of the left breast. The axillary lymph nodes were negative for tumor metastasis. Therefore, the differential diagnosis of mixed cystic and solid breast masses with unclear margins and internal septations on T2WI exhibiting delayed enhancement, must include ACC.
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Affiliation(s)
- Hongli Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Fengtao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Ran Gu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Yong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510288, P.R. China
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60
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MYB Labeling by Immunohistochemistry Is More Sensitive and Specific for Breast Adenoid Cystic Carcinoma than MYB Labeling by FISH. Am J Surg Pathol 2017; 41:973-979. [DOI: 10.1097/pas.0000000000000878] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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61
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Welsh JL, Keeney MG, Hoskin TL, Glazebrook KN, Boughey JC, Shah SS, Hieken TJ. Is axillary surgery beneficial for patients with adenoid cystic carcinoma of the breast? J Surg Oncol 2017; 116:690-695. [PMID: 28608456 DOI: 10.1002/jso.24702] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Adenoid cystic carcinoma (ACC) is a rare, typically triple-negative, breast cancer reported to have a favorable prognosis and low rate of nodal metastasis. No consensus guidelines exist for axillary staging and treatment. METHODS We identified all patients with ACC evaluated at our institution from January 1994 to August 2016. Patient, tumor, and treatment variables were abstracted and analyzed. RESULTS We identified 20 pure ACCs (0.13% of all invasive breast cancers) with size range 0.2-4.8 cm, in 19 women, median age 59 years. Preoperative axillary ultrasound was normal in 10/13 women and suspicious in 3/13 who had a subsequent negative lymph node fine needle aspiration (FNA). Fifteen patients (75%) had sentinel lymph node surgery and were pathologically node-negative, while the remaining five had no axillary surgery. With 3.6 years median follow-up (range 0.2-38.6 years), three patients experienced an in-breast recurrence at 2, 16, and 17 years, respectively, while none recurred in regional nodes. CONCLUSIONS We observed no cases of nodal metastasis in 20 consecutive cases of ACC of the breast. Preoperative axillary ultrasound with FNA of suspicious nodes accurately predicted pathologic nodal stage. These data suggest axillary surgery might be omitted safely in patients with pure ACC and a clinically negative axilla.
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Affiliation(s)
| | | | - Tanya L Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sejal S Shah
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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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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63
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Huang M, Jiang T, Zhao Q, You Q, Tian G, Wang B. Breast adenoid cystic carcinoma: report of a case with emphasis on routine sonographic findings and shear wave elastography. J Med Ultrason (2001) 2017; 45:181-184. [PMID: 28382475 DOI: 10.1007/s10396-017-0786-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/13/2017] [Indexed: 01/31/2023]
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare malignant tumor. Its sonographic characteristics have been described in some reports, but there are few such reports available that describe the sonoelastographic findings of this tumor and provide additional information about the nature of the lesion. In this case report, we describe the routine sonographic findings and shear wave elastography findings of a breast adenoid cystic carcinoma in a 53-year-old woman.
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Affiliation(s)
- Min Huang
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Tian'an Jiang
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Qiyu Zhao
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Qihan You
- Department of Pathology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Baohua Wang
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
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Foschini MP, Morandi L, Asioli S, Giove G, Corradini AG, Eusebi V. The morphological spectrum of salivary gland type tumours of the breast. Pathology 2017; 49:215-227. [DOI: 10.1016/j.pathol.2016.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 12/16/2022]
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65
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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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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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67
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Childhood neuroendocrine tumours: a descriptive study revealing clues for genetic predisposition. Br J Cancer 2016; 116:163-168. [PMID: 27959889 PMCID: PMC5243994 DOI: 10.1038/bjc.2016.408] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neuroendocrine tumours (NETs) are rare in children and limited data are available. We aimed to specify tumour and patient characteristics and to investigate the role of genetic predisposition in the aetiology of paediatric NETs. METHODS Using the Dutch Pathology Registry PALGA, we collected patient- and tumour data of paediatric NETs in the Netherlands between 1991 and 2013 (N=483). RESULTS The incidence of paediatric NETs in the Netherlands is 5.40 per one million per year. The majority of NETs were appendiceal tumours (N=441;91.3%). Additional surgery in appendiceal NETs was indicated in 89 patients, but performed in only 27 of these patients. Four out of five patients with pancreatic NETs were diagnosed with Von Hippel-Lindau disease (N=2) and Multiple Endocrine Neoplasia type 1 (N=2). In one patient with an appendiceal NET Familial Adenomatous Polyposis was diagnosed. On the basis of second primary tumours or other additional diagnoses, involvement of genetic predisposition was suggestive in several others. CONCLUSIONS We identified a significant number of patients with a confirmed or suspected tumour predisposition syndrome and show that paediatric pancreatic NETs in particular are associated with genetic syndromes. In addition, we conclude that treatment guidelines for appendiceal paediatric NETs need revision and improved implementation.
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68
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Adjuvant radiation therapy and survival for adenoid cystic carcinoma of the breast. Breast 2016; 31:214-218. [PMID: 27915203 DOI: 10.1016/j.breast.2016.11.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/21/2016] [Accepted: 11/20/2016] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The assess the clinical value of different types of surgical procedures and further analyze the effect of adjuvant radiation therapy (RT) for adenoid cystic carcinoma (ACC) of the breast. METHODS Patients with ACC of the breast were identified using a population-based national registration database (Surveillance, Epidemiology, and End Results, SEER). The Kaplan-Meier method and Cox regression models were performed to determine the impact of the surgical procedures and adjuvant RT associated with cause-specific survival (CSS) and overall survival (OS). RESULTS A total of 478 patients with ACC of the breast were identified. The median follow-up was 59 months. The 10-year CSS and OS were 87.5% and 75.3%, respectively. For the Kaplan-Meier analysis, the 5-year CSS were 96.1%, 91.8%, 90.2%, and 94.1% in patients that received lumpectomy + adjuvant RT, lumpectomy alone, mastectomy alone, and mastectomy + adjuvant RT, respectively (p = 0.026). In the multivariate Cox analyses, lumpectomy + adjuvant RT was an independent prognostic factor for CSS and OS. Patients that received lumpectomy + adjuvant RT had better survival rates than patients that underwent lumpectomy only (CSS, p = 0.018; OS, p = 0.031) and mastectomy only (CSS, p = 0.010; OS, p = 0.004). CONCLUSION ACC of the breast has an excellent prognosis. Breast-conserving surgery is a reasonable alternative for patients with ACC of the breast, and adjuvant RT after lumpectomy improved survival rates.
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69
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Fusco N, Geyer FC, De Filippo MR, Martelotto LG, Ng CKY, Piscuoglio S, Guerini-Rocco E, Schultheis AM, Fuhrmann L, Wang L, Jungbluth AA, Burke KA, Lim RS, Vincent-Salomon A, Bamba M, Moritani S, Badve SS, Ichihara S, Ellis IO, Reis-Filho JS, Weigelt B. Genetic events in the progression of adenoid cystic carcinoma of the breast to high-grade triple-negative breast cancer. Mod Pathol 2016; 29:1292-1305. [PMID: 27491809 PMCID: PMC5083185 DOI: 10.1038/modpathol.2016.134] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 01/01/2023]
Abstract
Adenoid cystic carcinoma of the breast is a rare histological type of triple-negative breast cancer with an indolent clinical behavior, often driven by the MYB-NFIB fusion gene. Here we sought to define the repertoire of somatic genetic alterations in two adenoid cystic carcinomas associated with high-grade triple-negative breast cancer. The different components of each case were subjected to copy number profiling and massively parallel sequencing targeting all exons and selected regulatory and intronic regions of 488 genes. Reverse transcription PCR and fluorescence in situ hybridization were employed to investigate the presence of the MYB-NFIB translocation. The MYB-NFIB fusion gene was detected in both adenoid cystic carcinomas and their associated high-grade triple-negative breast cancer components. Although the distinct components of both cases displayed similar patterns of gene copy number alterations, massively parallel sequencing analysis revealed intratumor genetic heterogeneity. In case 1, progression from the trabecular adenoid cystic carcinoma to the high-grade triple-negative breast cancer was found to involve clonal shifts with enrichment of mutations affecting EP300, NOTCH1, ERBB2 and FGFR1 in the high-grade triple-negative breast cancer. In case 2, a clonal KMT2C mutation was present in the cribriform adenoid cystic carcinoma, solid adenoid cystic carcinoma and high-grade triple-negative breast cancer components, whereas a mutation affecting MYB was present only in the solid and high-grade triple-negative breast cancer areas and additional three mutations targeting STAG2, KDM6A and CDK12 were restricted to the high-grade triple-negative breast cancer. In conclusion, adenoid cystic carcinomas of the breast with high-grade transformation are underpinned by the MYB-NFIB fusion gene and, akin to other forms of cancer, may be constituted by a mosaic of cancer cell clones at diagnosis. The progression from adenoid cystic carcinoma to high-grade triple-negative breast cancer of no special type may involve the selection of neoplastic clones and/or the acquisition of additional genetic alterations.
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Affiliation(s)
- Nicola Fusco
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
- Division of Pathology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Felipe C Geyer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pathology, Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa, São Paulo, Brazil
| | - Maria R De Filippo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Charlotte K Y Ng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Elena Guerini-Rocco
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pathology, European Institute of Oncology, Milan, Italy
| | - Anne M Schultheis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Lu Wang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathleen A Burke
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raymond S Lim
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Masamichi Bamba
- Department of Pathology and Laboratory Medicine, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan
| | - Suzuko Moritani
- Division of Diagnostic Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Sunil S Badve
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN
| | - Shu Ichihara
- Department of Pathology, Nagoya National Hospital, Nagoya, Japan
| | - Ian O Ellis
- Department of Pathology, University of Nottingham, Nottingham, UK
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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70
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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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71
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Kocaay AF, Celik SU, Hesimov I, Eker T, Percinel S, Demirer S. Adenoid Cystic Carcinoma of the Breast: A Clinical Case Report. Med Arch 2016; 70:392-394. [PMID: 27994304 PMCID: PMC5136425 DOI: 10.5455/medarh.2016.70.392-394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/29/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction: Adenoid cystic carcinoma (ACC) is an uncommon tumor of the breast, accounting for approximately 0.1% to 1% of all breast cancers. It is characterized by rare lymph node involvement and distant metastasis, and associated with a favorable prognosis with excellent survival, despite its triple-negative status. In the current state of knowledge, results of breast-conserving treatment with postoperative radiotherapy seem to be equivalent to mastectomy alone, with respect to survival for ACC of the breast. Due to its rarity, there is no consensus on optimal treatment for patients with ACC. Otherwise, the role of chemotherapy and hormonal therapy remains controversial. Further clinical studies are required to compare treatment options for ACC. But, a long-term follow-up is very important and mandatory for affected patients, due to the late onset of local relapse and occurrence of distant metastasis. Case report: Here, we report the case of a patient who presented with a palpable breast mass in the left breast that turned out to be an ACC of the breast.
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Affiliation(s)
- Akin Firat Kocaay
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Suleyman Utku Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Ilkin Hesimov
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Tevfik Eker
- Department of General Surgery, Famagusta Medical Center Hospital, Gazimagusa, Turkish Republic of Northern Cyprus
| | - Sibel Percinel
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Seher Demirer
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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72
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Spiliopoulos D, Mitsopoulos G, Kaptanis S, Halkias C. Axillary lymph node metastases in adenoid cystic carcinoma of the breast. A rare finding. G Chir 2016; 36:209-13. [PMID: 26712257 DOI: 10.11138/gchir/2015.36.5.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare malignant salivary-type neoplasm that has a good prognosis and represents less than 1% of all breast cancers. It is a triple negative carcinoma that presents as a painful mass. The mean age at the time of diagnosis is 50-60 years old. The solid variant of this type of tumour with basaloid features and presence of nodal metastases is very rare and considered to have a more aggressive clinical course. We present a case with presence of axillary lymph node metastases that was successfully treated with no evidence of recurrence one year after the diagnosis and review the literature.
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Abstract
Basaloid carcinoma of the breast (BCB) is a rare, triple-negative aggressive primary breast tumor that can closely mimic cutaneous basal cell carcinoma (BCC), neuroendocrine tumors, adnexal neoplasms, and other primary breast tumors. Accurate diagnosis of this tumor is critical for appropriate clinical management. We add to the literature 2 female patients with BCB presenting with a nipple mass. Histopathologic findings from both patients showed dermal nests and cords of atypical basaloid cells with epidermal involvement, closely resembling cutaneous BCC. A panel of immunohistochemical stains, including the novel use of CK17, is essential for differentiating BCB from mimickers. BCB is a rare primary breast tumor that follows an aggressive clinical course and closely mimics many basaloid neoplasms, including cutaneous BCC clinicopathologically. Increased awareness of BCB among dermatologists and dermatopathologists is critical for accurate diagnosis and patient care.
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74
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Aihara T, Toyama T, Takahashi M, Yamamoto Y, Hara F, Akabane H, Fujisawa T, Ishikawa T, Nagai S, Nakamura R, Tsurutani J, Ito Y, Mukai H. The Japanese Breast Cancer Society Clinical Practice Guideline for systemic treatment of breast cancer, 2015 edition. Breast Cancer 2016; 23:329-42. [DOI: 10.1007/s12282-016-0670-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/18/2015] [Indexed: 02/07/2023]
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75
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Romeira D, Cardoso D, Miranda H, Martins A. Adenoid cystic carcinoma: triple negative breast cancer with good prognosis. BMJ Case Rep 2016; 2016:bcr-2015-213704. [PMID: 26843221 DOI: 10.1136/bcr-2015-213704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Adenoid cystic carcinoma of the breast (ACCb) is a rare type of breast cancer. The treatment is not consensual. The authors report two cases of ACCb. Case 1: A 59-year-old woman with T1bN0M0, who went for lumpectomy and adjuvant radiation therapy (RT) (60 Gy in 30 fractions); Case 2: A 43-year-old woman, who went for modified radical mastectomy with T3N1M0, and underwent adjuvant chemotherapy, and a sequential regimen with antracyclin and taxane, prior to adjuvant RT (50 Gy/25 fractions).
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Affiliation(s)
- Daniel Romeira
- Department of Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Débora Cardoso
- Department of Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Helena Miranda
- Department of Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ana Martins
- Department of Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Abstract
We report the case of a 65-year-old woman with a history of adenoid cystic carcinoma (ACC) of the breast. Fifteen years after mastectomy, the patient underwent a right upper lobectomy for a lung mass, and biopsy indicated ACC metastasis. Ten years after lobectomy, an F-FDG PET/CT was performed for restaging to rule out further metastases. We observed intense FDG uptake in enlarged polylobulated kidneys, which was biopsy proven as ACC metastasis.
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77
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Rakha EA, Lee AHS, Sheeran R, Abbosh C, Hodi Z, Merchant W, Ellis IO, Shaaban AM. Breast Neoplasms with Dermal Analogue Differentiation (Mammary Cylindroma): Report of 3 Cases and a Proposal for a New Terminology. Pathobiology 2015; 82:172-8. [PMID: 26330358 DOI: 10.1159/000433600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Salivary gland-like and dermal analogue tumours of the breast are rare lesions that can be diagnostically challenging for pathologists. Data on the clinical behaviour and molecular characterisation of these mammary tumours are limited and their designation is mainly based on similar salivary gland or skin lesions. In this study, we present three cylindromatous breast tumours. These lesions were located within the breast, had ill-defined margins and were composed of nests containing a dual population of cytologically bland cells, surrounded at least partially by basement membrane-like material. The lack of cytological atypia and absence of mitoses led to the diagnosis of benign mammary cylindroma in 1 case. The expression of oestrogen receptor, focal absence of basement membrane material and the focal infiltrative nature together with patchy absence of peripheral basement membrane supported the diagnosis of malignancy in the other 2 cases. We discuss the morphological criteria, immunohistochemical profile and diagnostic pitfalls of these tumours. We also review the literature including previously reported cases of mammary cylindroma and differential diagnoses to be considered before making a diagnosis. We propose the term 'mammary tumours with cylindromatous differentiation', implying their uncertain malignant nature, and propose management strategies.
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Affiliation(s)
- Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, and Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
Breast carcinoma is a heterogenous disease. Carcinomas lacking expression of estrogen, progesterone, and HER2/neu receptors by immunohistochemistry and Her2 amplification are designated as triple negative. This group of carcinomas comprises approximately 10% to 20% of all breast carcinomas and is characterized by an aggressive nature with shorter rates of disease-free and overall survival. This aggressive behavior is further compounded by the lack of available targeted therapies. Patients receive cytoxic chemotherapy regimens. Although tumors are initially sensitive to this therapy, drugs are toxic and ineffective in maintaining long-term response thereby providing limited benefit. Much effort is being spent on this group of cancers for the identification of appropriate molecular targets, an effort that is proving challenging due to the presence of marked heterogeneity, both at the morphologic and molecular levels. An understanding of the advances in this field is crucial for developing targeted therapies and tailored patient management protocols. This report summarizes the pathologic subtypes of breast cancer that are commonly of a triple-negative immunophenotype and recent molecular advances in this field.
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79
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Expression of miRNAs in adenoid cystic carcinomas of the breast and salivary glands. Virchows Arch 2015; 467:551-62. [DOI: 10.1007/s00428-015-1827-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/30/2015] [Accepted: 08/06/2015] [Indexed: 12/19/2022]
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80
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Terando AM, Agnese DM, Holmes DR. Treatment and Prognosis of Rare Breast Cancers. Ann Surg Oncol 2015; 22:3225-9. [DOI: 10.1245/s10434-015-4748-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Indexed: 01/30/2023]
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81
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Ilkay TM, Gozde K, Ozgur S, Dilaver D. Diagnosis of adenoid cystic carcinoma of the breast using fine-needle aspiration cytology: A case report and review of the literature. Diagn Cytopathol 2015; 43:722-6. [PMID: 26183224 DOI: 10.1002/dc.23272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/27/2014] [Accepted: 03/20/2015] [Indexed: 01/25/2023]
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and is associated with an excellent prognosis. ACC accounts for 0.1% of all breast carcinomas. It has favorable biological characteristics and an excellent prognosis. A 77-year-old woman presented with a lump in the right breast. Ultrasonography and mammography showed a 12-mm, well-defined, lobulated mass in the retroareolar region of the right breast. The lump was diagnosed as ACC on the basis of immunohistochemical staining results for c-kit (CD117), muscle-specific actin, p63, estrogen receptor, and progesterone receptor using a fine-needle aspiration cytology (FNAC) specimen. This diagnosis was subsequently confirmed by excision biopsy. To the best of our knowledge, this is the first case of ACC of the breast to date to be diagnosed on the basis of immunohistochemical staining of an FNAC cell block material. From our experience, we recommend the usage of cell block material for immunohistochemical studies to accurately diagnose ACC of the breast.
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Affiliation(s)
- Tosun M Ilkay
- Department of Pathology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Kir Gozde
- Department of Pathology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Sarica Ozgur
- Department of Radiology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Demirel Dilaver
- Department of Pathology, GATA Haydarpasa Education Hospital, Istanbul, Turkey
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82
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Kumar BR, Padmanabhan N, Bose G, Paneer V. A Case Report of Adenoid Cystic Carcinoma of Breast- So Close Yet So Far from Triple Negative Breast Cancer. J Clin Diagn Res 2015; 9:XD01-XD03. [PMID: 26393191 DOI: 10.7860/jcdr/2015/14283.6164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/04/2015] [Indexed: 02/02/2023]
Abstract
Adenoid cystic carcinoma (ACC) of breast is a rare tumour with a low malignant potential. Though negative for oestrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (Her2/neu), it is different from triple negative breast cancer (TNBC); ACC has an indolent course with a good prognosis.We present a case of a 40 year old premenopausal female initially diagnosed with ductal carcinoma in situ (DCIS) on core needle biopsy. She underwent breast-conserving surgery (BCS) and her final histopathological diagnosis was ACC. She subsequently underwent adjuvant external beam radiotherapy. The patient is on follow-up for more than a year with no recurrence till date.
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Affiliation(s)
- Barath Raj Kumar
- Registrar, Department of Surgical Oncology, Apollo Speciality Hospital , Chennai, India
| | - Naveen Padmanabhan
- Registrar, Department of Surgical Oncology, Apollo Speciality Hospital , Chennai, India
| | - Gajasaraj Bose
- Registrar, Department of Surgical Oncology, Apollo Speciality Hospital , Chennai, India
| | - Venkat Paneer
- Consultant, Department of Surgical Oncology, Apollo Speciality Hospital , Chennai, India
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83
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Ng CE, Angamuthu N, Fasih T. Rare breast malignancies and review of literature: A single centres experience. Int J Surg Case Rep 2015; 11:11-17. [PMID: 25898336 PMCID: PMC4446669 DOI: 10.1016/j.ijscr.2015.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/04/2015] [Indexed: 12/01/2022] Open
Abstract
Lymphoma of the breast is best managed with chemotherapy rather than surgery. Supradiaphragmatic metastases of ovarian cancer to breast can significantly alter prognosis. Osteosarcoma requires total excision with adequate margins in order to determine tumour size which is a valuable prognostic factor for survival. Immunohistochemistry is helpful to distinguish metaplastic carcinoma which are aggressive and are associated with poor outcomes. Adenoid cystic carcinoma of the breast are associated with favourable prognosis that only require surgery.
Introduction Breast cancer is a heterogeneous condition, with variants which are less common but still very well defined by the World Health Organization (WHO) classification. With the small number of cases each year large trials are difficult to perform. This series aims to discuss the rare breast malignancies encountered within a breast department and the evidence based approached to their management. Method Literature search of electronic databases via PubMed and the search engines Google/Google Scholar were used. Emphasis on keywords: breast cancer and the type of histology used to limit search. Searches were screened and those articles suitable had full text versions retrieved. The references to all retrieved texts were searched for further relevant studies. Conclusion Due to the rarity of some of these breast cancers, systematic evaluation of patient with detailed histopathology will aid accurate diagnosis and management. The series hopes to add the existing understanding of this small percentage of cases.
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Affiliation(s)
- Cho Ee Ng
- Surgical Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX, United Kingdom.
| | - Nithia Angamuthu
- Surgical Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX, United Kingdom.
| | - Tarannum Fasih
- Surgical Department, Queen Elizabeth Hospital, Gateshead, NE9 6SX, United Kingdom.
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84
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Gene-expression molecular subtyping of triple-negative breast cancer tumours: importance of immune response. Breast Cancer Res 2015; 17:43. [PMID: 25887482 PMCID: PMC4389408 DOI: 10.1186/s13058-015-0550-y] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/10/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Triple-negative breast cancers need to be refined in order to identify therapeutic subgroups of patients. Methods We conducted an unsupervised analysis of microarray gene-expression profiles of 107 triple-negative breast cancer patients and undertook robust functional annotation of the molecular entities found by means of numerous approaches including immunohistochemistry and gene-expression signatures. A triple-negative external cohort (n = 87) was used for validation. Results Fuzzy clustering separated triple-negative tumours into three clusters: C1 (22.4%), C2 (44.9%) and C3 (32.7%). C1 patients were older (mean = 64.6 years) than C2 (mean = 56.8 years; P = 0.03) and C3 patients (mean = 51.9 years; P = 0.0004). Histological grade and Nottingham prognostic index were higher in C2 and C3 than in C1 (P < 0.0001 for both comparisons). Significant event-free survival (P = 0.03) was found according to cluster membership: patients belonging to C3 had a better outcome than patients in C1 (P = 0.01) and C2 (P = 0.02). Event-free survival analysis results were confirmed when our cohort was pooled with the external cohort (n = 194; P = 0.01). Functional annotation showed that 22% of triple-negative patients were not basal-like (C1). C1 was enriched in luminal subtypes and positive androgen receptor (luminal androgen receptor). C2 could be considered as an almost pure basal-like cluster. C3, enriched in basal-like subtypes but to a lesser extent, included 26% of claudin-low subtypes. Dissection of immune response showed that high immune response and low M2-like macrophages were a hallmark of C3, and that these patients had a better event-free survival than C2 patients, characterized by low immune response and high M2-like macrophages: P = 0.02 for our cohort, and P = 0.03 for pooled cohorts. Conclusions We identified three subtypes of triple-negative patients: luminal androgen receptor (22%), basal-like with low immune response and high M2-like macrophages (45%), and basal-enriched with high immune response and low M2-like macrophages (33%). We noted out that macrophages and other immune effectors offer a variety of therapeutic targets in breast cancer, and particularly in triple-negative basal-like tumours. Furthermore, we showed that CK5 antibody was better suited than CK5/6 antibody to subtype triple-negative patients. Electronic supplementary material The online version of this article (doi:10.1186/s13058-015-0550-y) contains supplementary material, which is available to authorized users.
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85
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Tang P, Yang S, Zhong X, Yao J, Zhang Y, Dong H, Li G. Breast adenoid cystic carcinoma in a 19-year-old man: a case report and review of the literature. World J Surg Oncol 2015; 13:19. [PMID: 25885366 PMCID: PMC4329652 DOI: 10.1186/s12957-015-0442-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 01/07/2015] [Indexed: 12/27/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is very rare in males. There have been only eight previous articles published on breast ACC in males. Here, we will report on the first case of this type of tumor in the Chinese province of Hainan. The patient was a 19-year-old male, and he underwent a radical mastectomy (RM) with axillary lymph node dissection. The histopathological examination specimen revealed that surgical margins were negative; none of the 41 axillary lymph nodes excised were positive for malignancy. The patient is alive and well 67 months after radical mastectomy. In the present study, we discuss the diagnosis and treatment options for male breast ACC based on previous English publications.
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Affiliation(s)
- Peng Tang
- Department of Breast surgery, Hainan Province People's Hospital, NO.19, Xiuhua Road, Xiuying District, Haikou, Hainan, 570311, China.
| | - Shiping Yang
- Department of Radiation Oncology, Hainan Province People's Hospital, NO.19, Xiuhua Road, Xiuying District, Haikou, Hainan, 570311, China.
| | - Xiaojie Zhong
- Department of Breast surgery, Hainan Province People's Hospital, NO.19, Xiuhua Road, Xiuying District, Haikou, Hainan, 570311, China.
| | - Jia Yao
- Department of Breast surgery, Hainan Province People's Hospital, NO.19, Xiuhua Road, Xiuying District, Haikou, Hainan, 570311, China.
| | - Yu Zhang
- Department of Breast surgery, Hainan Province People's Hospital, NO.19, Xiuhua Road, Xiuying District, Haikou, Hainan, 570311, China.
| | - Huaying Dong
- Department of Breast surgery, Hainan Province People's Hospital, NO.19, Xiuhua Road, Xiuying District, Haikou, Hainan, 570311, China.
| | - Guanqiao Li
- Department of Breast surgery, Hainan Province People's Hospital, NO.19, Xiuhua Road, Xiuying District, Haikou, Hainan, 570311, China.
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86
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Tang W, Peng WJ, Gu YJ, Zhu H, Jiang TT, Li C. Imaging Manifestation of Adenoid Cystic Carcinoma of the Breast. J Comput Assist Tomogr 2015; 39:523-30. [DOI: 10.1097/rct.0000000000000236] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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87
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Miyai K, Schwartz MR, Divatia MK, Anton RC, Park YW, Ayala AG, Ro JY. Adenoid cystic carcinoma of breast: Recent advances. World J Clin Cases 2014; 2:732-41. [PMID: 25516849 PMCID: PMC4266822 DOI: 10.12998/wjcc.v2.i12.732] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/03/2014] [Accepted: 09/18/2014] [Indexed: 02/05/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare special subtype of breast cancer characterized by the presence of a dual cell population of luminal and basaloid cells arranged in specific growth patterns. Most breast cancers with triple-negative, basal-like breast features (i.e., tumors that are devoid of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression, and express basal cell markers) are generally high-grade tumors with an aggressive clinical course. Conversely, while ACCs also display a triple-negative, basal-like phenotype, they are usually low-grade and exhibit an indolent clinical behavior. Many discoveries regarding the molecular and genetic features of the ACC, including a specific chromosomal translocation t(6;9) that results in a MYB-NFIB fusion gene, have been made in recent years. This comprehensive review provides our experience with the ACC of the breast, as well as an overview of clinical, histopathological, and molecular genetic features.
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Breast- and Salivary Gland-Derived Adenoid Cystic Carcinomas: Potential Post-Transcriptional Divergencies. A Pilot Study Based on miRNA Expression Profiling of Four Cases and Review of the Potential Relevance of the Findings. Pathol Oncol Res 2014; 21:29-44. [DOI: 10.1007/s12253-014-9770-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 03/25/2014] [Indexed: 12/18/2022]
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89
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D'Alfonso TM, Mosquera JM, MacDonald TY, Padilla J, Liu YF, Rubin MA, Shin SJ. MYB-NFIB gene fusion in adenoid cystic carcinoma of the breast with special focus paid to the solid variant with basaloid features. Hum Pathol 2014; 45:2270-80. [PMID: 25217885 DOI: 10.1016/j.humpath.2014.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 02/01/2023]
Abstract
Adenoid cystic carcinomas (ACCs) from various anatomical sites harbor a translocation t(6;9)(q22-23;p23-24), resulting in MYB-NFIB gene fusion. This gene fusion is not well studied in mammary ACCs, and there are no studies examining this abnormality in solid variant of ACC with basaloid features (SBACC), a high-grade variant thought to behave more aggressively than ACCs with conventional histologic growth. Our aim was to investigate the frequency of MYB-NFIB gene fusion in mammary ACCs with a focus paid to SBACC. MYB rearrangement and MYB-NFIB fusion were assessed by fluorescence in situ hybridization and reverse-transcription polymerase chain reaction, respectively. Histologic features and the presence of MYB rearrangement were correlated with clinical outcome. MYB rearrangement was present in 7 (22.6%) of 31 mammary ACCs (5/15 [33.3%] ACCs with conventional growth; 2/16 [12.5%] SBACCs). One patient with conventional ACC developed distant metastasis, and no patients had axillary lymph node involvement by ACC (mean follow-up, 34 months; range, 12-84 months). Two patients with SBACC had axillary lymph node involvement at initial surgery, and 2 additional patients experienced disease recurrence (1 local, 1 distant; mean follow-up, 50 months; range, 9-192 months). MYB-NFIB fusion status did not correlate with clinical outcome in studied patients. We confirm that MYB-NFIB gene fusion is observed in mammary ACCs and that a subset lacks this abnormality. This study is the first to confirm the presence of MYB rearrangement in SBACC. Additional validation with long-term follow-up is needed to determine the relationship, if any, between MYB-NFIB gene fusion and clinical outcome.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065.
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065; Institute for Precision Medicine of Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY 10065
| | - Theresa Y MacDonald
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Jessica Padilla
- Institute for Precision Medicine of Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY 10065
| | - Yi-Fang Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
| | - Mark A Rubin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065; Institute for Precision Medicine of Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY 10065
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065
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Anderson WF, Rosenberg PS, Prat A, Perou CM, Sherman ME. How many etiological subtypes of breast cancer: two, three, four, or more? J Natl Cancer Inst 2014; 106:dju165. [PMID: 25118203 PMCID: PMC4148600 DOI: 10.1093/jnci/dju165] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 05/01/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is a heterogeneous disease, divisible into a variable number of clinical subtypes. A fundamental question is how many etiological classes underlie the clinical spectrum of breast cancer? An etiological subtype reflects a grouping with a common set of causes, whereas a clinical subtype represents a grouping with similar prognosis and/or prediction. Herein, we review the evidence for breast cancer etiological heterogeneity. We then evaluate the etiological evidence with mRNA profiling data. A bimodal age distribution at diagnosis with peak frequencies near ages 50 and 70 years is a fundamental characteristic of breast cancer for important tumor features, clinical characteristics, risk factor profiles, and molecular subtypes. The bimodal peak frequencies at diagnosis divide breast cancer overall into a "mixture" of two main components in varying proportions in different cancer populations. The first breast cancer tends to arise early in life with modal age-at-diagnosis near 50 years and generally behaves aggressively. The second breast cancer occurs later in life with modal age near 70 years and usually portends a more indolent clinical course. These epidemiological and molecular data are consistent with a two-component mixture model and compatible with a hierarchal view of breast cancers arising from two main cell types of origin. Notwithstanding the potential added value of more detailed categorizations for personalized breast cancer treatment, we suggest that the development of better criteria to identify the two proposed etiologic classes would advance breast cancer research and prevention.
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Affiliation(s)
- William F Anderson
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP).
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
| | - Aleix Prat
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
| | - Charles M Perou
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
| | - Mark E Sherman
- Division of Cancer Epidemiology and Genetics Biostatistics Branch (WFA, PSR), and Division of Cancer Prevention (MES), National Cancer Institute, National Institutes of Health, Bethesda, MD; Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain (AP); Department of Genetics and Pathology & Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (CMP)
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Malignant adenomyoepithelioma combined with adenoid cystic carcinoma of the breast: a case report and literature review. Diagn Pathol 2014; 9:148. [PMID: 25056281 PMCID: PMC4222729 DOI: 10.1186/1746-1596-9-148] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/07/2014] [Indexed: 01/22/2023] Open
Abstract
Background Malignant adenomyoepithelioma and adenoid cystic carcinoma are both rare malignant epithelial-myoepithelial tumors of the breast. We report a very rare case with a malignant adenomyoepithelioma combining with adenoid cystic carcinoma in a single mass. Case presentation A 61-year-old female presented with a palpable painless mass in the right breast. Mammography revealed a large irregular dense shadow without obvious internal calcification. A simple lumpectomy was performed, and a 1.6cm well-circumscribed pale-tan nodule was presented. Histologically, the nodule was composed of two obscure lobules. One exhibited typical histological image of adenoid cystic carcinoma, the other one showed the image of epithelial-myoepithelial carcinoma of salivary gland, and support the diagnosis of biphasic malignant adenomyoepithelioma. Transition between the two lobules was gradual. Immunohistochemically, CK18 and P63 highlighted the epithelial and myoepithelial cells respectively in both lesions. CD117 was positive in the epithelial cells of adenoid cystic carcinoma, but was totally negative in malignant adenomyoepithelioma. Conclusion This report is, to our knowledge, the first case that combines these two tumors in a single mass. In addition, we present a review of the literature. The histogenesis of these tumors is also discussed. Virtual Slides The virtual slide(s) for this article can be found here: http://med.motic.com/MoticGallery/Slide?id=D562817E-23C2-4F72-9823-86EF6DA40005&user=2C69F0D6-A478-4A2B-ABF0-BB36763E8025 and http://med.motic.com/MoticGallery/Slide?id=38BB7126-6FFB-4B66-A208-B8C0F528DCA8&user=2C69F0D6-A478-4A2B-ABF0-BB36763E8025
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92
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Dieci MV, Orvieto E, Dominici M, Conte P, Guarneri V. Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist 2014; 19:805-13. [PMID: 24969162 DOI: 10.1634/theoncologist.2014-0108] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Breast cancer encompasses a collection of different diseases characterized by different biological and pathological features, clinical presentation, response to treatments, clinical behavior, and outcome. On the basis of cell morphology, growth, and architecture patterns, breast cancer can be classified in up to 21 distinct histological types. Breast cancer special types, including the classic lobular invasive carcinoma, represent 25% of all breast cancers. The histological diversity of breast carcinomas has relevant prognostic implications. Indeed, the rare breast cancer group includes subtypes with very different prognoses, ranging from the tubular carcinoma, associated with an indolent clinical course, to metaplastic cancer, whose outcome is generally unfavorable. New approaches based on gene expression profiling allow the identification of molecularly defined breast cancer classes, with distinct biological features and clinical behavior. In clinical practice, immunohistochemical classification based on the expression of human epidermal growth factor receptor 2 and Ki67 is applied as a surrogate of the intrinsic molecular subtypes. However, the identification of intrinsic molecular subtypes were almost completely limited to the study of ductal invasive breast cancer. Moreover, some good-prognosis triple-negative histotypes, on the basis of gene expression profiling, can be classified among the poor-prognosis group. Therefore, histopathological classification remains a crucial component of breast cancer diagnosis. Special histologies can be very rare, and the majority of information on outcome and treatments derives from small series and case reports. As a consequence, clear recommendations about clinical management are still lacking. In this review, we summarize current knowledge about rare breast cancer histologies.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Biomarkers, Tumor/biosynthesis
- Breast Neoplasms/classification
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Prognosis
- Rare Diseases/genetics
- Rare Diseases/pathology
- Receptor, ErbB-2/biosynthesis
- Receptors, Estrogen/metabolism
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Affiliation(s)
- Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Orvieto
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Dominici
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; and Istituto Oncologico Veneto IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Padova, Italy; Department of Pathology, University Hospital of Padova, Padova, Italy; Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
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93
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Underusage of radiotherapy and a lack of socio-economic disparity in treatment outcome: a population-based study on adenoid cystic carcinomas. JOURNAL OF RADIOTHERAPY IN PRACTICE 2014. [DOI: 10.1017/s1460396913000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis study used receiver operating characteristic curve to analyse a long list of biological, treatment and socio-economic predictors of adenoid cystic carcinoma treatment outcome. Anatomical staging was found to be the most predictive factor of outcome.PurposeThis study used receiver operating characteristic curve (ROC) to analyse surveillance, epidemiology and end results (SEER) adenoid cystic carcinoma data to identify predictive models and potential disparity in outcome.Materials and methodsFor the risk modelling, each factor was fitted by a generalised linear model to predict the cause-specific survival. The area under the ROC was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate the modelling errors. Risk of adenoid cystic carcinoma death was computed for the predictors for comparison.ResultsThere were 5,947 patients diagnosed from 1973 to 2009 included in this study. The mean follow-up time (SD) was 93·8 (90·6) months. Three out of five patients were women. The mean (SD) age was 58·55 (16·01) years. SEER stage was the most predictive factor of outcome (ROC area of 0·68). Sex, radiotherapy and surgery had ROC areas of about 0·57. None of the socio-economic disparities was found for treatment outcome. Radiotherapy was underused in localised and regional stages when the intent was curative, especially in older patients.ConclusionAnatomical staging was predictive and useful in treatment selection. Understaging and underuse of radiotherapy may have contributed to poor outcomes.
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94
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Gannon LM, Cotter MB, Quinn CM. The classification of invasive carcinoma of the breast. Expert Rev Anticancer Ther 2014; 13:941-54. [PMID: 23984896 DOI: 10.1586/14737140.2013.820577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The classification of invasive breast carcinoma assists diagnosis, allows for comparison of different patient groups in clinical trials and facilitates epidemiological analysis. For the individual patient, accurate tumor classification informs clinical decision-making with emphasis on assessment of prognosis and treatment formulation. Tumor grade is an independent prognostic indicator and is calculated by assessing specific tumor characteristics microscopically. The Tumor Node Metastasis staging system, produced by the American Joint Committee on Cancer Union for International Cancer Control, combines information about the primary tumor size, the status of the regional lymph nodes and the presence or absence of distant metastases at diagnosis to classify disease. In recent years, the use of gene expression profiling technology has led to the development of the molecular classification of breast cancer and has highlighted the importance of hormone receptor and HER2 oncogenic pathways, with particular reference to targeted chemotherapy. Tumor typing involves the identification of 'no special type' carcinoma with variable clinical, histological and molecular characteristics and 'special type' carcinomas that are usually associated with a particular set of prognostic and predictive indices. Some special type carcinomas have unique biological features that influence diagnostic investigation and clinical management.
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Affiliation(s)
- Louisa M Gannon
- Medical student, Health Sciences Building, University College, Dublin 4, Ireland
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Tsai JH, Hsiao TL, Chen YY, Hsiao CH, Liau JY. Endocrine mucin-producing sweat gland carcinoma occurring on extra-facial site: a case report. J Cutan Pathol 2014; 41:544-7. [DOI: 10.1111/cup.12314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/16/2013] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jia-Huei Tsai
- Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Pathology, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Tzu-Lin Hsiao
- Department of Dermatology; National Taiwan University Hospital; Taipei Taiwan
| | - Yi-Ying Chen
- Department of Dermatology; National Taiwan University Hospital; Taipei Taiwan
| | | | - Jau-Yu Liau
- Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Pathology, College of Medicine; National Taiwan University; Taipei Taiwan
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96
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Canyilmaz E, Uslu GH, Memış Y, Bahat Z, Yildiz K, Yoney A. Adenoid cystic carcinoma of the breast: A case report and literature review. Oncol Lett 2014; 7:1599-1601. [PMID: 24765184 PMCID: PMC3997715 DOI: 10.3892/ol.2014.1945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 02/04/2014] [Indexed: 01/28/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the breast that occurs in <0.1% of all patients diagnosed with breast cancer. The mean patient age at the time of diagnosis is 50–60 years. Typically, the tumor presents as a subareolar mass or as pain in the breast. While the radiological appearances of ACC are generally non-specific, the diagnosis can be made on fine-needle aspiration cytology. In the present study, a 58-year-old female patient was admitted to the Department of Radiation Oncology (Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey) with complaints of pain in the upper outer quadrant of the right breast. An excision biopsy of a lump in the upper outer quadrant revealed ACC, and perineural invasion was present. Subsequently, the patient underwent breast conservation surgery and sentinel lymph node dissection. Pathology from the second surgery depicted ACC in the form of microscopic foci around the initial surgical cavity, with two reactive sentinel lymph nodes and the closest negative margin at 2 mm. The patient was treated with radiotherapy following the surgery. No recurrence and metastasis were found after 20 months of follow-up. In conclusion, mammary ACC is a rare malignant neoplasm of the breast. Although surgery is the main treatment, the optimal adjuvant treatment of ACC of the breast has not yet been determined due to its low incidence.
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Affiliation(s)
- Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gonca Hanedan Uslu
- Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey
| | - Yahyahan Memış
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Zümrüt Bahat
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Kadriye Yildiz
- Department of Pathology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Adnan Yoney
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Kim M, Lee DW, Im J, Suh KJ, Keam B, Moon HG, Im SA, Han W, Park IA, Noh DY. Adenoid cystic carcinoma of the breast: a case series of six patients and literature review. Cancer Res Treat 2014; 46:93-7. [PMID: 24520228 PMCID: PMC3918532 DOI: 10.4143/crt.2014.46.1.93] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 03/15/2013] [Indexed: 01/09/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a very rare and indolent tumor with a favorable prognosis, despite its triple-negative status. Due to its rarity, there has been no consensus regarding treatments, and treatment guidelines have not been established. Here, we report on six patients with ACC of the breast. All of the patients initially presented with localized disease and no axillary lymph node metastases. Although some of our patients developed local recurrence or distant metastases, all patients had a favorable clinical course, and to date, none of the patients has died from complications of her disease. Here, we described the clinicopathologic features of ACC of the breast and review the current literature.
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Affiliation(s)
- Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Koung Jin Suh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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98
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Yoo SJ, Lee DS, Oh HS, Kim HJ, Kim MH, Ahn YC, Kang GH, Eom DW, Cha CH, Ahn HJ. Male breast adenoid cystic carcinoma. Case Rep Oncol 2013; 6:514-9. [PMID: 24403896 PMCID: PMC3884210 DOI: 10.1159/000356062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Adenoid cystic carcinoma (ACC) of the breast is a rare condition, and cases in male patients are even less common. CASE We describe a case of ACC of the breast with axillary lymph node metastasis, disseminated osteolytic bone metastasis and bone marrow involvement in a 41-year-old man. CONCLUSION Male breast ACC is an extremely rare malignancy; there can be difficulty in obtaining a final diagnosis. We report this case because of its rarity.
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Affiliation(s)
- Seung Jin Yoo
- Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dong Seok Lee
- Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Ho Suk Oh
- Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyun Joong Kim
- Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Moon Ho Kim
- Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Youg Chel Ahn
- Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gil Hyun Kang
- Department of Pathology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dae-Woon Eom
- Department of Pathology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Choong Hwan Cha
- Department of Laboratory Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Heui June Ahn
- Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
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99
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Kiss O, Tőkés AM, Spisák S, Szilágyi A, Lippai N, Szász AM, Kulka J. [MicroRNA-profiling in breast- and salivary gland-derived adenoid cystic carcinomas]. Orv Hetil 2013; 154:963-8. [PMID: 23774803 DOI: 10.1556/oh.2013.29643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Adenoid cystic carcinoma is a salivary gland-derived malignant tumor, but rarely it can originate from the breast, too. The salivary gland-derived form shows a very aggressive clinical outcome, while adenoid cystic carcinoma of the breast has mostly a very good prognosis. AIM The aim of the authors was to compare the miRNA-expression profile of breast- and salivary gland-derived cases. METHOD The miRNA-profiles of two salivary gland derived and two breast-derived adenoid cystic carcinoma tissues as well as one normal breast and one salivary gland tissues were analysed using the Affymetrix® Gene Chip. RESULTS The expression of some miRNAs differed in the tumor tissues compared to their controls: the let-7b was overexpressed in salivary gland-derived adenoid cystic carcinoma, while decreased in breast-derived adenoid cystic carcinoma. In addition, the miR-24 was decreased in salivary gland-derived but overexpressed in breast-derived adenoid cystic carcinomas. The miR-181a-2* was only detected in salivary gland-derived adenoid cystic carcinomas. CONCLUSIONS Through post-transcriptional regulation of the genes, the diverse expression of some miRNAs may partially explain the diverse clinical outcome of salivary gland-derived and breast-derived adenoid cystic carcinomas.
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Affiliation(s)
- Orsolya Kiss
- Semmelweis Egyetem, Általános Orvostudományi Kar, II. Patológiai Intézet, Budapest.
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100
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A review of adenoid cystic carcinoma of the breast with emphasis on its molecular and genetic characteristics. Hum Pathol 2013; 44:301-9. [DOI: 10.1016/j.humpath.2012.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/04/2012] [Accepted: 01/06/2012] [Indexed: 02/07/2023]
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