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Joyon N, Mathieu MC, Rouleau E, Roulot-Paumelle A, Scoazec JY, Suciu V. Diagnostic Challenges and Pitfalls of Mammary Pleomorphic Adenoma Illustrated by a Case Report. Int J Surg Pathol 2022; 31:472-477. [PMID: 35635223 DOI: 10.1177/10668969221102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mammary pleomorphic adenoma is a biphasic tumor, characterized by epithelial-myoepithelial components with myxochondroid stroma, resembling the prototypic pleomorphic adenoma of the salivary glands. We report the multiple diagnostic pitfalls raised by a mammary pleomorphic adenoma, initially diagnosed as mucinous carcinoma on fine-needle aspiration (FNA) cytology and invasive carcinoma on needle core biopsy. The final diagnosis was made on the surgical specimen. As the term “pleomorphic” suggests, this tumor can present various phenotypes, some of which might be misleading on both FNA cytology or needle core biopsy. Rearrangements in PLAG1 and HMGA2 genes have not been detected in our patient. Mammary pleomorphic adenoma is considered a benign tumor, despite rare local recurrence and malignant behavior. Its correct identification, despite the difficulties, is essential to avoid unnecessary aggressive treatment.
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Affiliation(s)
- Natacha Joyon
- Department of Pathology, Gustave Roussy, Villejuif, France
| | | | - Etienne Rouleau
- Department of Tumor Genetics, Gustave Roussy, Villejuif, France
| | | | - Jean-Yves Scoazec
- Department of Pathology, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Voichita Suciu
- Department of Pathology, Gustave Roussy, Villejuif, France
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A case of pleomorphic adenoma of the breast on dynamic contrast-enhanced MR imaging. Radiol Case Rep 2022; 17:1158-1162. [PMID: 35169420 PMCID: PMC8829531 DOI: 10.1016/j.radcr.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022] Open
Abstract
Pleomorphic adenoma commonly develops in the salivary gland, but rarely in the breast. The dynamic contrast-enhanced MR imaging findings of pleomorphic adenoma of the breast have not been well described. We report a 43-year-old woman with pleomorphic adenoma of the left breast. The imaging findings, including those on dynamic contrast-enhanced MR imaging, included an oval mass with a smooth margin, which consisted of solid and cystic components. The solid component was hypo-intense on T1-weighted imaging, hyper-intense on short tau inversion recovery imaging, with no apparent restricted diffusion, and had heterogeneous enhancement with dark internal septation and a fast/plateau dynamic contrast enhancement pattern. The cystic component was slightly hyper-intense on T1-weighted imaging, slightly hypo-intense on short tau inversion recovery imaging and had no apparent restricted diffusion or contrast enhancement. Together with its rarity, the similarities of imaging findings and the pathologic findings of pleomorphic adenoma of the breast to those of other tumors make accurate preoperative diagnosis difficult. Therefore, through this case report, awareness of pleomorphic adenoma of the breast on dynamic contrast-enhanced MR imaging will facilitate appropriate surgery and postoperative observation based on an accurate diagnosis.
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Boac BM, Centeno BA. Pleomorphic adenoma of the breast with cytologic atypia on cytopathology: A potential diagnostic pitfall and literature review. Diagn Cytopathol 2022; 50:265-269. [PMID: 35100498 DOI: 10.1002/dc.24933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/05/2022]
Abstract
Pleomorphic adenoma of the salivary gland is a well-established and recognized diagnosis; however, pleomorphic adenomas of the breast are rare and can be difficult to diagnose on cytology or intraoperatively. We report a case that was misdiagnosed on a fine needle aspiration and frozen section. The pitfalls, differential diagnoses, and current management are discussed.
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Affiliation(s)
- Bernadette M Boac
- Department of Pathology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Barbara A Centeno
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Harada J, Horiguchi SI, Ishiba T, Kubota H, Ichida M, Sakurai N, Arai H, Motoi T, Aruga T, Hishima T. A Case of Adenomyoepithelioma With a Pleomorphic Adenoma-Like Component of the Male Breast. Int J Surg Pathol 2020; 29:538-542. [PMID: 33289419 DOI: 10.1177/1066896920978824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Adenomyoepithelioma (AME) of the male breast is a rare tumor characterized by biphasic proliferation of gland epithelial cells and myoepithelial cells. Though pleomorphic adenoma (PA) is also known to be an epithelial-myoepithelial tumor in the breast, and these tumors are considered to exist on the same spectrum by some authors, to the best of our knowledge, there have been no reports of a clear transition from AME to PA in the male breast. Therefore, the case of an 85-year-old man with AME with PA-like components is presented.
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Affiliation(s)
| | | | | | | | - Miyu Ichida
- Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | | | - Hideo Arai
- Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Toru Motoi
- Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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Aydin H, Guner B, Bostanci IE, Ciledag N, Bulut MB, Bozgul M, Dilek GB, Aribas BK. Radiologic Findings of a Rare Subtype of Invasive Breast Cancer with Poor Prognosis: Metaplastic Carcinoma of the Breast. Curr Med Imaging 2020; 15:338-348. [PMID: 31989886 DOI: 10.2174/1573405614666180813120227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to evaluate the mammographic, sonographic and MRI findings of metaplastic breast carcinoma. METHODS In this retrospective review study, we analyzed the medical files of 9600 patients who were treated for invasive breast cancers. Clinical information, histopathologic and radiologic findings of 65 patients were included in this study. All existing radiologic images and medical reports were reviewed retrospectively. Thirty-three patients had MG, 58 patients had US and 7 patients had MRI imaging results. RESULTS Mammographically, the most frequent presentations of MPBC were round shape, microlobulated margin and high density masses. Calcifications with or without masses were not a frequent finding. The most common sonographic findings were round shape, partially indistinct angular margin, hypoechoic and heterogeneous echo patterns and no posterior feature masses. All lesions were presented as masses rather than non-mass enhancements on magnetic resonance imaging. Features of masses had more malignant feature on MRI than other modalities in all 7 patients. CONCLUSION Metaplastic breast carcinoma is one of the rarest poorly differentiated invasive breast carcinomas. Interestingly, these aggressive tumors demonstrate benign or moderately malign features on imaging methods. This appearance of MPBC can cause it to be misdiagnosed as a benign breast lesion especially in young women. MPBC should be kept in mind in the differential diagnosis of large palpable breast masses. Therefore, follow-up at short intervals and/or multimodality imaging studies which include breast MRI are important for the diagnosis of MPBC.
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Affiliation(s)
- Hale Aydin
- Department of Radiology, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Bahar Guner
- Department of Radiology, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Isil Esen Bostanci
- Department of Radiology, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Nazan Ciledag
- Department of Radiology, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Melda Boyacioglu Bulut
- Department of Pathology, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Mustafa Bozgul
- Department of General Surgery, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Gulay Bilir Dilek
- Department of Pathology, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Bilgin Kadri Aribas
- Department of Radiology, Dr. AY Ankara Oncology Research and Training Hospital, Ankara, Turkey
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Saad ESA, Lam JSY, Al-Khan AA, Tayebi M, Day MJ, Richardson SJ, Danks JA. A Comparative Review of Mixed Mammary Tumors in Mammals. J Mammary Gland Biol Neoplasia 2019; 24:125-137. [PMID: 30488318 DOI: 10.1007/s10911-018-9422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 11/21/2018] [Indexed: 11/30/2022] Open
Abstract
Mixed tumors are characterized by the histological identification of two or more cell types. Commonly, a mixture of epithelial and myoepithelial cells is included in abundant stroma, which can consist of myxoid, chondroid or bony matrices. Spontaneously arising mixed tumors are rare lesions in the human breast but are common in human salivary glands and canine mammary glands. Subtle histopathological characteristics and overlapping attributes of malignant lesions with other benign lesions can lead to a diagnostic challenge. Mixed tumors can present as benign or malignant. While malignant mixed tumors are quite rare in the human breast they have a poor prognosis. Benign mixed mammary tumors occur more frequently in female dogs than in humans and are usually associated with a good prognosis. This review will provide a comprehensive overview of mixed mammary tumors, across various mammalian species.
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Affiliation(s)
- Eman S A Saad
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Jacqueline S Y Lam
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- Laverty Pathology, Macquarie Park, Sydney, Australia
| | - Awf A Al-Khan
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Mourad Tayebi
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Michael J Day
- School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
| | - Samantha J Richardson
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Janine A Danks
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.
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Takahashi K. Diagnosis of an extremely rare pleomorphic adenoma of the breast with core needle biopsy: A case report. Ann Med Surg (Lond) 2018; 36:242-245. [PMID: 30510762 PMCID: PMC6258873 DOI: 10.1016/j.amsu.2018.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Pleomorphic adenoma (PA) rarely originates in the mammary gland. This tumor is a benign mixed tumor and is commonly found in the salivary glands, but rarely shows findings similar to those of breast cancer. The tumor is misdiagnosed in 30-50% of the patients, including overdiagnosis of malignancy preoperatively, leading to unnecessary surgery for breast cancer. CASE PRESENTATION The present patient was a 45-year-old woman who exhibited no subjective symptoms. She visited the Takahashi Breast and Gastroenterology Clinic for breast cancer screening. A mass measuring 1.5 cm was palpated in the E region of the left breast. Mammography (MMG) showed a tumor shadow in the left S region. There was a high-density area inside the tumor, suggesting bone or cartilage formation, and a diagnosis of category 3 on MMG was made. Ultrasonography (US) revealed a poorly demarcated tumor measuring 14.3 × 14.8 × 10.7 mm with relatively smooth margins and inhomogeneous high-echo content. Core needle biopsy (CNB) was performed, which led to the diagnosis of PA. The tumor showed proliferation of small cells forming glandular duct-like structures or anastomosed funicular structures. Moreover, the cells in the basilar portion were spindle shaped and transitioned to the stroma. Cartilaginous metaplasia, calcification, and ossification were observed in some areas. Intraductal papilloma was also observed in some areas. CONCLUSION PA may be diagnosed based on the histological findings of CNB. Thus, unnecessary surgery for breast cancer may be avoided.
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Rakha EA, Aleskandarany MA, Samaka RM, Hodi Z, Lee AHS, Ellis IO. Pleomorphic adenoma-like tumour of the breast. Histopathology 2015; 68:405-10. [DOI: 10.1111/his.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/05/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Emad A Rakha
- Department of Histopathology and Division of Cancer and Stem Cells; School of Medicine; The University of Nottingham and Nottingham University Hospitals NHS Trust; Nottingham City Hospital; Nottingham UK
| | - Mohammed A Aleskandarany
- Department of Histopathology and Division of Cancer and Stem Cells; School of Medicine; The University of Nottingham and Nottingham University Hospitals NHS Trust; Nottingham City Hospital; Nottingham UK
| | - Rehab M Samaka
- Department of Pathology; Faculty of Medicine; Menoufia University; Shebin ElKom Egypt
| | - Zsolt Hodi
- Department of Histopathology and Division of Cancer and Stem Cells; School of Medicine; The University of Nottingham and Nottingham University Hospitals NHS Trust; Nottingham City Hospital; Nottingham UK
| | - Andrew H S Lee
- Department of Histopathology and Division of Cancer and Stem Cells; School of Medicine; The University of Nottingham and Nottingham University Hospitals NHS Trust; Nottingham City Hospital; Nottingham UK
| | - Ian O Ellis
- Department of Histopathology and Division of Cancer and Stem Cells; School of Medicine; The University of Nottingham and Nottingham University Hospitals NHS Trust; Nottingham City Hospital; Nottingham UK
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Pleomorphic adenoma of breast: a radiological and pathological study of a common tumor in an uncommon location. Case Rep Pathol 2015; 2015:172750. [PMID: 25830053 PMCID: PMC4373341 DOI: 10.1155/2015/172750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/07/2015] [Indexed: 11/18/2022] Open
Abstract
Pleomorphic adenoma occurs commonly in the major salivary glands but is uncommonly encountered in the breast. In both of these locations, the tumor is typically grossly circumscribed and has a “mixed” histological appearance, being composed of myoepithelial and epithelial components amid a myxochondroid matrix. Herein, we report a case of pleomorphic adenoma of the breast which was preoperatively thought to represent a fibroadenoma on clinical and radiological grounds. It is the rarity of the tumor in the breast, rather than its histological appearance, that causes diagnostic difficulty.
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Abstract
Epithelial-myoepithelial proliferations of the breast are a heterogeneous poorly defined group of lesions characterized morphologically by dual differentiation into ductal (luminal) and myoepithelial cells. They include neoplastic and non-neoplastic entities that have overlapping morphologic features that may give rise to diagnostic difficulty. Many of these entities are low grade or of uncertain malignant potential but the biology of some of these rare lesions remains to be elucidated. This article discusses the differential diagnosis of epithelial-myoepithelial lesions of the breast and highlights the morphologic features of some of these entities.
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Affiliation(s)
- Rola H Ali
- Department of Pathology, University of British Columbia and Consultant Pathologist, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Malcolm M Hayes
- Department of Pathology, University of British Columbia and Consultant Pathologist, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
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Hayes MM. Adenomyoepithelioma of the breast: a review stressing its propensity for malignant transformation. J Clin Pathol 2011; 64:477-84. [DOI: 10.1136/jcp.2010.087718] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review describes the classification, clinical presentation, pathological features and clinical behaviour of adenomyoepithelioma (AME) of the breast. It is based on an extensive review of the literature and study of a collection of cases built up over a 17-year period at the British Columbia Cancer Agency. The diversity of the morphology encountered in both benign and malignant AME is described. The behaviour of malignant AME seems to be related to the grade of the malignant component.
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Foschini MP, Krausz T. Salivary gland-type tumors of the breast: a spectrum of benign and malignant tumors including "triple negative carcinomas" of low malignant potential. Semin Diagn Pathol 2010; 27:77-90. [PMID: 20306833 DOI: 10.1053/j.semdp.2009.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Salivary gland-type neoplasms of the breast are uncommon and comprise numerous entities analogous to that more commonly seen in salivary glands. The clinicopathologic spectrum ranges from benign to malignant but there are important differences as compared with those of their salivary counterpart. In the breast, benign adenomyoepithelioma is recognized in addition to malignant one, whereas in the salivary gland a histologically similar tumor is designated as epithelial-myoepithelial carcinoma without a separate benign subgroup. Mammary adenoid cystic carcinoma is a low-grade neoplasm compared with its salivary equivalent. It is also important to appreciate that in contrast to "triple negative" conventional breast carcinomas with aggressive course, most salivary-type malignant breast neoplasms behave in a low-grade manner. Most of these tumors are capable of differentiating along both epithelial and myoepithelial lines, but the amount of each lineage-component varies from case to case, contributing to diagnostic difficulties. Well established examples of this group include pleomorphic adenoma, adenomyoepithelioma, and adenoid cystic carcinoma. Another family of salivary gland-type mammary epithelial neoplasms is devoid of myoepithelial cells. Key examples include mucoepidermoid carcinoma and acinic cell carcinoma. The number of cases of salivary gland-type mammary neoplasms in the published data is constantly increasing but some of the rarest subtypes like polymorphous low-grade adenocarcinoma and oncocytic carcinoma are "struggling" to become clinically relevant entities in line with those occurring more frequently in salivary glands.
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Affiliation(s)
- Maria P Foschini
- Department of Hematology and Oncology, Section of Anatomic Pathology at Bellaria Hospital, L. and A. Seragnoli University of Bologna, Bologna, Italy.
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Pleomorphic adenoma of the breast. ACTA ACUST UNITED AC 2008; 26:442-5. [DOI: 10.1007/s11604-008-0250-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 04/11/2008] [Indexed: 12/23/2022]
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