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Richardson ET, Jo VY, Schnitt SJ. Salivary Gland-like Tumors of the Breast. Arch Pathol Lab Med 2023; 147:1014-1024. [PMID: 37651394 DOI: 10.5858/arpa.2023-0038-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 09/02/2023]
Abstract
CONTEXT The World Health Organization classification of tumors of the breast recognizes several special type carcinomas and benign lesions with features comparable to those of salivary gland tumors. OBJECTIVE To discuss the histologic, immunophenotypic, molecular, and clinical features of salivary gland-like carcinomas of the breast. These breast tumors are often negative for hormone receptors and human epidermal growth factor receptor 2 (HER2), that is, triple-negative, but they generally have a much better prognosis than triple-negative breast carcinomas of no special type. We compare the immunophenotypic, molecular, and clinical features of these breast tumors with their salivary gland counterparts, highlighting similarities and differences. We also discuss benign salivary gland-like breast tumors. Finally, we highlight recent developments in understanding the molecular pathogenesis of these breast tumors and novel ancillary studies that can be used to support their diagnosis. DATA SOURCES A literature review was conducted, and papers were selected for further analysis and discussion by the authors of this review based on their novelty, applicability, and impact in the field. CONCLUSIONS Breast tumors that exhibit morphologic overlap with salivary gland tumors have been recognized by pathologists for decades, but the similarities and differences in their molecular pathogenesis have not been understood until more recently. These developments have led to novel diagnostic tools and further knowledge of these rare breast lesions.
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Affiliation(s)
- Edward T Richardson
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- The Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vickie Y Jo
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- The Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stuart J Schnitt
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- The Dana-Farber Cancer Institute, Boston, Massachusetts
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Ahmad M, Naumaan A, Munoz Zuluaga C, Yoon E. Pleomorphic Adenoma of the Breast: A Rare Benign Lesion Masquerading as a Metaplastic Breast Carcinoma on Core-Needle Biopsy. Cureus 2023; 15:e38827. [PMID: 37250610 PMCID: PMC10219638 DOI: 10.7759/cureus.38827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
We report a rare case of pleomorphic adenoma (benign mixed tumor) of the breast in a 66-year-old female. A 5.5 cm hypoechoic mass with lobulated margins was noted on ultrasound. A biopsy showed an atypical cartilaginous lesion, leading to a subsequent segmental mastectomy, which was initially interpreted as metaplastic breast carcinoma. On the second review at our tertiary care center, a diagnosis of a pleomorphic adenoma was favored due to the circumscription and the benign epithelial component. Due to unfamiliarity with this entity, this neoplasm has occasionally been misdiagnosed clinically and even been overcalled on core needle biopsies. Careful clinical, radiological, and pathological correlation is required to avoid unnecessarily aggressive surgery, and a differential diagnosis of pleomorphic adenoma must be included in cases of well-demarcated breast masses showing myxoid or cartilaginous changes on core-needle biopsy.
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Affiliation(s)
- Muhammad Ahmad
- Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, USA
- Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York City, USA
| | - Anam Naumaan
- Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, USA
| | - Carlos Munoz Zuluaga
- Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York City, USA
| | - Esther Yoon
- Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, USA
- Pathology and Laboratory Medicine, Cleveland Clinic Florida, Weston, USA
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3
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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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Ma S, Zhao D, Liu Y, Rohr J, Zhang F, Ma Y, Gong L, Shi H, Wang Y, Fan L, Qin J, Wang Z, Guo S. Some Pleomorphic Adenomas of the Breast Share PLAG1 Rearrangements with the Analogous Tumor of the Salivary Glands. Histopathology 2021; 79:1030-1039. [PMID: 34292619 DOI: 10.1111/his.14461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023]
Abstract
AIMS Pleomorphic adenoma (PA) of the breast, and especially its malignant transformation, is extremely rare and represents a diagnostic pitfall. Molecular alterations in this entity have not been investigated. We aimed to examine the clinicopathologic features of our breast PAs and perform molecular analysis. METHODS Seven cases of breast PA including two cases of carcinoma ex PA were analyzed. PLAG1 and HMGA2 gene rearrangements were assayed by FISH and RNA-Seq, respectively. RT-PCR and Sanger sequencing were used to verify RNA sequencing results. RESULTS All seven cases of breast PA occurred in women. The histological features were similar to the analogous tumor in salivary glands, including a dual epithelial-myoepithelial component and negativity of ER, PR, and HER2 by immunohistochemistry. Of the two cases with carcinoma ex PA, one demonstrated minimal invasion and one was extensively invasive. PLAG1 rearrangements were identified in two cases (28.6%), but no rearrangements of HMG2A were found. A novel fusion product in PAs, TRPS1-PLAG1, was identified in one case. No patients had recurrence or metastasis with a follow-up period of 6 to 158 months. CONCLUSIONS Breast PA is rare, but it is an important differential diagnosis of breast pathology with the potential to develop carcinoma ex PA. We reported a novel TRPS1-PLAG1 fusion gene in breast PA.
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Affiliation(s)
- Shirong Ma
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Danhui Zhao
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Yixiong Liu
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Joseph Rohr
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, 68105, NE, USA
| | - Fan Zhang
- Department of Pathology, the First Affiliated Hospital of Wannan Medical College, Anhui Province, Wuhu City, 241001, China
| | - Ying Ma
- Department of Pathology, Shengjing Hospital of China Medical University, Liao Ning Province, Shen Yang, 110004, China
| | - Li Gong
- Department of Pathology, the Second Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Huijuan Shi
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guanggong Province, Guangzhou, 510080, China
| | - Yingmei Wang
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Linni Fan
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Junhui Qin
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Zhe Wang
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
| | - Shuangping Guo
- Department of Pathology, the Basic Medicine Science and the First Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shaan Xi Province, 710032, China
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5
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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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6
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Srinivasamurthy BC, Bhat RV, Gopal SV. A rare benign tumor of breast masquerading on fine needle aspiration cytology: A case report. Breast Dis 2017; 37:105-107. [PMID: 28655120 DOI: 10.3233/bd-170270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pleomorphic adenoma is a common tumor encountered in major salivary gland and very rarely seen in breast. This matrix producing tumor can be confused with fibroadenoma, phyllodes tumor and metaplastic carcinoma on fine needle aspiration cytology(FNAC). Pre-operative diagnosis of pleomorphic adenoma helps in preventing surgical over or under treatment of the disease. We present an extremely rare case of pleomorphic adenoma of breast diagnosed on FNAC with histopathological confirmation.
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Rakha EA, Badve S, Eusebi V, Reis-Filho JS, Fox SB, Dabbs DJ, Decker T, Hodi Z, Ichihara S, Lee AHS, Palacios J, Richardson AL, Vincent-Salomon A, Schmitt FC, Tan PH, Tse GM, Ellis IO. Breast lesions of uncertain malignant nature and limited metastatic potential: proposals to improve their recognition and clinical management. Histopathology 2016; 68:45-56. [PMID: 26348644 DOI: 10.1111/his.12861] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are classified traditionally into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey zone between benign and malignant, as their behaviour cannot be predicted reliably. Defined pathological categorization of such lesions is challenging, and for some entities is recognized to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over- or undertreatment. The rarity of these lesions makes the acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision-making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification and behaviour, and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential, such as low-grade adenosquamous carcinoma, low-grade fibromatosis-like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions of uncertain malignant nature remain, such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of (1) breast lesions of uncertain malignant nature and (2) breast lesions of limited metastatic potential are proposed with details of which histological entities could be included in each category, and their management implications are discussed.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Sunil Badve
- Departments of Pathology and Internal Medicine, Clarian Pathology Laboratory of Indiana University, Indianapolis, IN, USA
| | - Vincenzo Eusebi
- Sezione Anatomia Istologia e Citologia Patologica 'M. Malpighi', Università-ASL Ospedale Bellaria, Bologna, Italy
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Fox
- Pathology Department, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia
| | - David J Dabbs
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thomas Decker
- German Breast-Screening Program, Reference Centres Berlin and Muenster, Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany
| | - Zsolt Hodi
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Shu Ichihara
- Department of Pathology, Nagoya Medical Center, Nagoya, Japan
| | - Andrew H S Lee
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - José Palacios
- Department of Pathology, Hospital Universitario Ramón y Cajal, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | - Fernando C Schmitt
- Department of Medicine and Pathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Puay-Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ian O Ellis
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
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8
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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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