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Zhang D, Li L, Ma F. Prognosis stratification and postoperative radiation therapy utilization in adenoid cystic carcinoma of the breast. Breast 2022; 66:40-48. [PMID: 36113374 PMCID: PMC9483639 DOI: 10.1016/j.breast.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Adenoid cystic carcinoma of the breast (ACCB) is a rare malignancy with a favorable prognosis. Little information exists regarding the impact of postoperative radiation therapy (RT) on survival outcome in patients with ACCB. This study aimed to evaluate the clinical significance of postoperative RT in ACCB. METHODS Data of patients with ACCB were extracted from the Surveillance, Epidemiology, and End Results database (2000-2019). Univariate and multivariable Cox regression analyses were performed to identify prognostic factors. In addition, a nomogram model was constructed and internally validated for discrimination and calibration. The value of postoperative RT was respectively accessed in each risk subgroup according to nomogram-deduced individualized score. RESULTS A total of 689 eligible patients were included in the analysis. Partial mastectomy was associated with an increased risk of death compared with partial mastectomy plus postoperative RT (P = 0.020), but total mastectomy with or without postoperative RT was comparable (P = 0.624). Then, in-depth analysis was performed for patients receiving breast-conserving therapy (n = 485, the training set vs. the testing set = 340 vs. 145). Age at diagnosis, histological grade, and T stage were identified as prognostic factors for overall survival (OS) (All P < 0.05). A nomogram was constructed to provide predictive accuracy toward individual OS rates of ACCB and to divide patients into different risk subgroups. Notably, compared with non-RT, postoperative RT significantly improved OS in the high-risk subgroup (P = 0.006 for the training set, and P = 0.013 for the overall population) but not in the low-risk subgroup (P = 0.807 for the training set, and P = 0.293 for the overall population), suggesting that these patients may be able to exempt from postoperative RT. CONCLUSION A robust and effective nomogram was developed to predict prognosis and assist in treatment decisions in patients with ACCB undergoing partial mastectomy.
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Treatment of adenoid cystic carcinoma of the breast: Is postoperative radiation getting its due credit? Breast 2021; 59:358-366. [PMID: 34411836 PMCID: PMC8377486 DOI: 10.1016/j.breast.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/17/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The role of postoperative radiation (PR) in treating mammary ACC is poorly defined. This study evaluated the impact of PR on survival outcomes for mammary ACC and the extent of utilization. Methods Patients who underwent surgery for mammary ACC from 2005 to 2015 in SEER database were analyzed. KM analyses of OS and DSS were done for PR versus no PR. Cox hazard regression models were used to determine predictors of OS and DSS. Results Of the 488 patients, 244 underwent PR. The PR group was younger, but other variables were similar between the 2 groups. OS was better for PR (p = 0.029). 10-year DSS was better for PR group by an absolute value of 6 % but did not reach statistical significance (p = 0.537). Age, radiation, nodal metastasis, and grade III/IV were independent predictors of OS while grade III/IV and AJCC stage III/IV independently predicted DSS. Conclusion PR improves OS for mammary ACC, but this study did not show increased utilization. Radiation should be considered after surgery for mammary ACC, particularly for patients with independent predictors of OS. The role of postoperative radiation (PR) in the management of mammary adenoid cystic carcinoma (ACC) is still poorly defined. Postoperative radiation improves OS for mammary ACC. Despite previous studies demonstrating benefits of PR, this study did not show increased use of the treatment modality. PR should be considered for mammary ACC, particularly for patients with negative independent predictors of OS.
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Hogan KO, Fan F. Diagnosis of metastatic adenoid cystic carcinoma of the breast on pleural fluid cytology in a 60-year-old male. Diagn Cytopathol 2020; 49:E172-E174. [PMID: 33035408 DOI: 10.1002/dc.24636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
Adenoid cystic carcinoma (AdCC) is a rare triple-negative breast cancer with a favorable prognosis, although cases of distant metastases have been reported. Less than 10 cases of AdCC of the breast in males have been reported. We report a unique presentation of pleural fluid metastasis diagnosed by cytologic evaluation of pleural fluid in a 60-year-old male patient with AdCC of the breast. Careful surveillance and cytologic evaluation of effusion specimens can detect metastases with the aid of cellblock preparations and immunohistochemical stains.
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Affiliation(s)
- Keenan O Hogan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Fang Fan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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4
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Slodkowska E, Xu B, Kos Z, Bane A, Barnard M, Zubovits J, Iyengar P, Faragalla H, Turbin D, Williams P, Barnes PJ, Mulligan AM. Predictors of Outcome in Mammary Adenoid Cystic Carcinoma: A Multi-Institutional Study. Am J Surg Pathol 2020; 44:214-223. [PMID: 31567278 DOI: 10.1097/pas.0000000000001378] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mammary adenoid cystic carcinoma (ACC) is a rare subtype of breast cancer with a favorable prognosis. Here we report on predictors of outcome based on a detailed morphologic review and analysis of 108 mammary ACC. Sixty-four tumors (59.2%) were pure conventional ACC, 23 (21.3%) were pure basaloid ACC. Follow-up was available for 87 patients (median: 51 mo). Eighteen patients (20.7%) developed recurrence: 7 (8%) had local recurrence and 14 (16%) had distant metastasis. Two patients died of disease, 1 died of an unrelated cause, 14 were alive with disease (including 8 in palliative care), and 70 (80.5%) were alive with no evidence of disease. Of 90 patients with known lymph node (LN) status 9 (10%) had nodal involvement (all with basaloid ACC). Distant metastases in patients with predominantly basaloid ACC compared with pure conventional ACC were more common (40% vs. 7.7%) and occurred earlier (22 vs. 84 mo). The following factors were found to be predictive of recurrence-free survival: positive margin, Nottingham grade, neovascularization, basaloid component, perineural invasion, lymphovascular invasion, >30% solid growth, necrosis and LN involvement; the first 3 remained statistically significant on multivariate analysis. Factors predictive of distant disease-free survival were neovascularization, Nottingham grade, lymphovascular invasion, solid component >50%, LN involvement, basaloid component >50%, tumor necrosis, perineural invasion, and final margin. Only neovascularization remained statistically significant on multivariate analysis. Basaloid ACC is an aggressive variant of mammary ACC with more frequent nodal involvement and higher incidence of distant spread. LN staging should be performed for all mammary basaloid ACC.
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Affiliation(s)
- Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Bin Xu
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Zuzana Kos
- Department of Anatomic Pathology, The Ottawa Hospital and University of Ottawa, Ottawa
| | - Anita Bane
- Department of Anatomic Pathology, Cambridge Memorial Hospital, Cambridge
| | - Maja Barnard
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
- Department of Anatomic Pathology, North York General Hospital
| | - Judit Zubovits
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
- Department of Anatomic Pathology, Scarborough Health Network, Scarborough
| | - Pratibha Iyengar
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
- Department of Anatomic Pathology, Trillium Health Partners, Mississauga
| | - Hala Faragalla
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
- Department of Anatomic Pathology, St. Michael's Hospital
| | - Dmitry Turbin
- Department of Anatomic Pathology, St. Paul's Hospital, Vancouver, BC
| | - Phillip Williams
- Department of Anatomic Pathology, Juravinski Hospital and McMaster University, Hamilton, ON
| | - Penny J Barnes
- Department of Anatomic Pathology, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada
| | - Anna Marie Mulligan
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
- Department of Anatomic Pathology, University Health Network, Toronto
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Yiğit S, Etit D, Hayrullah L, Atahan MK. Androgen Receptor Expression in Adenoid Cystic Carcinoma of Breast: A Subset of Seven Cases. Eur J Breast Health 2019; 16:44-47. [PMID: 31912013 DOI: 10.5152/ejbh.2019.5068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/15/2019] [Indexed: 12/26/2022]
Abstract
Objective Adenoid cystic carcinoma (ACC) of the breast is an uncommon salivary type of breast carcinoma. It is a triple negative breast carcinoma with a basal-like phenotype that behaves in an indolent manner. Herein, we aimed to document clinicopathologic findings and hormone receptor status of ACC in the breast diagnosed in our institution during an eleven-year period. Materials and Methods Medical data of cases diagnosed as adenoid cystic carcinoma in the breast between January 2006 and December 2016 were retrospectively reviewed from hospital data base. Paraffin blocks of seven cases were retrieved from the archive of Pathology Department and androgen receptor (AR) immunohistochemistry was applied to each case. Results All of the cases diagnosed as ACC were females with a mean age 56.2. Solid growth pattern was present in two cases. P63 was constantly expressed in the whole group, and at least one additional myoepithelial marker (calponin, caldesmon, etc.) was co-expressed in tumors. While weak estrogen receptor expression was detected only in one patient, AR was strikingly expressed in majority (%85.7) of the tumors. Conclusion To our knowledge, our series is the first to report such high levels of AR expression. This new finding, in turn, suggests considering hormonal therapy as an option in the management of ACC of the breast.
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Affiliation(s)
- Seyran Yiğit
- Department of Pathology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Demet Etit
- Department of Pathology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Leyla Hayrullah
- Department of Pathology, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Murat Kemal Atahan
- Department of General Surgery, İzmir Katip Celebi University Atatürk Training and Research Hospital, İzmir, Turkey
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Abdelwahed A, Ahmed M. Rare epithelial breast cancer: surgery and adjuvant therapy. Transl Cancer Res 2019; 8:S479-S492. [PMID: 35117126 PMCID: PMC8797705 DOI: 10.21037/tcr.2019.05.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 01/30/2023]
Abstract
Breast cancer is a heterogenous disease, exhibiting a wide range of morphological phenotypes shaping its prognosis and clinical course. However, optimal management of rarer breast cancer subtypes is often undefined and controversial in literature due to the lack of large studies and randomised trials. This review aims to discuss the treatment of 13 rare epithelial subtypes, focussing on surgery and adjuvant therapies.
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Affiliation(s)
| | - Muneer Ahmed
- King's College London, Division of Cancer, Research Oncology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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Abstract
Only a few breast cancer histologic subtypes harbor distinct genetic alterations that are associated with a specific morphology (genotype-phenotype correlation). Secretory carcinomas and adenoid cystic carcinomas are each characterized by recurrent translocations, and invasive lobular carcinomas frequently have CDH1 mutations. Solid papillary carcinoma with reverse polarity is a rare breast cancer subtype with a distinctive morphology and recently identified IDH2 mutations. We review the clinical and pathologic features and underlying genetic alterations of those breast cancer subtypes with established genotype-phenotype correlations and discuss the phenotypes associated with germline mutations in genes associated with hereditary breast cancer.
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Affiliation(s)
- Jonathan D Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, One Rope Ferry Road, Hanover, NH 03755-1404, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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8
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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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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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10
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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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11
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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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12
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Foschini MP, Rizzo A, De Leo A, Laurino L, Sironi M, Rucco V. Solid Variant of Adenoid Cystic Carcinoma of the Breast. Int J Surg Pathol 2015; 24:97-102. [DOI: 10.1177/1066896915606973] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a low-grade malignancy “triple negative” breast tumor. ACC of the breast can present a great variety of morphological features having a prognostic impact. Recently, cases of ACC having solid-basaloid features (SBACC) have been described. In the present study, 6 cases of SBACC have been reported. All the cases affected female patients aged 47 to 69 years (mean = 54 years). Two patients had metastases to the axillary lymph nodes, and 2 patients experienced local recurrences. No deaths due to the tumor were observed. A review of the literature on breast SBACC showed that local recurrences and lymph node metastases are more frequent than in the ACC conventional type; nevertheless, no deaths due to the tumor are registered at the moment. On the contrary, cases of ACC with features of malignant transformation are on record. Therefore, a new grading system on breast ACC is proposed.
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Affiliation(s)
- Maria P. Foschini
- Section of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences of the University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Antonio Rizzo
- Operative Unit of Anatomic Pathology, S. Giacomo Hospital, Castelfranco Veneto, Italy
| | - Antonio De Leo
- Section of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences of the University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Licia Laurino
- Operative Unit of Anatomic Pathology, Treviso General Hospital, Treviso, Italy
| | - Maria Sironi
- Operative Unit of Anatomic Pathology, Department of General Pathology, ASL4 Chiavarese, Sestri Levante, Genoa
| | - Vittorio Rucco
- Operative Unit of Anatomic Pathology, ASL5 Arzignano (VI) ULSS5-Ovest Vicentino
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13
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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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14
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Rakha EA, Varga Z, Elsheik S, Ellis IO. High-grade encapsulated papillary carcinoma of the breast: an under-recognized entity. Histopathology 2014; 66:740-6. [DOI: 10.1111/his.12591] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/17/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Emad A Rakha
- Division of Cancer and Stem Cells; University of Nottingham and Nottingham University Hospitals NHS Trust; City Hospital Campus; Nottingham UK
| | - Zsuzsanna Varga
- Institute of Surgical Pathology; University Hospital Zurich; Zurich Switzerland
| | - Somaia Elsheik
- Division of Cancer and Stem Cells; University of Nottingham and Nottingham University Hospitals NHS Trust; City Hospital Campus; Nottingham UK
| | - Ian O Ellis
- Division of Cancer and Stem Cells; University of Nottingham and Nottingham University Hospitals NHS Trust; City Hospital Campus; Nottingham UK
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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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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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17
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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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18
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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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Wang S, Ji X, Wei Y, Yu Z, Li N. Adenoid cystic carcinoma of the breast: Review of the literature and report of two cases. Oncol Lett 2012. [PMID: 23205086 DOI: 10.3892/ol.2012.818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In this study, we report two cases of adenoid cystic carcinoma (ACC) of the breast. Two women presented to our hospital with a tender lump in the breast. Mammography and ultrasonography both revealed an ill-defined mass in the breast. We performed modified radical mastectomies on the patients, and pathological assessment following surgery showed ACC of the breast. Both patients received chemotherapy following surgery, have been followed up to date and remain in good health. In this study, we report these two rare cases and review the existing literature regarding ACC of the breast.
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Affiliation(s)
- Shaohua Wang
- Department of General Surgery, Nanjing Jinling Hospital, Nanjing University, Nanjing, Jiangsu 210002, P.R. China
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20
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Cadoo KA, McArdle O, O'Shea AM, Power CP, Hennessy BT. Management of unusual histological types of breast cancer. Oncologist 2012; 17:1135-45. [PMID: 22826373 DOI: 10.1634/theoncologist.2012-0134] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
There is increased understanding of the heterogeneity of breast tumors, with greater emphasis now being placed on histological and molecular profiles and, in particular, their implications for prognosis and therapy. This review addresses breast cancers of unusual histological subtype with an approximate incidence ≤1%. Given the rarity of these tumors, the literature contains primarily case reports, small series, and population-based studies. Data are heterogeneous and almost entirely retrospective, frequently gathered over long time periods, in the context of changing pathological techniques and reporting. In addition, our understanding of the disease biology and therapeutic context has also evolved significantly over this time. There is often limited information about the specific therapies used and the rationale for choosing such an approach. Meaningful comparisons of treatment modalities are not feasible and it is not possible to define management guidelines. Instead, this review correlates the available information to give an impression of how each subgroup behaves-of the favored surgical technique, responses to therapy, and prognosis-as well as the emerging molecular data, highlighting new research areas for potential target in clinical trials. Each tumor subtype described represents a small but real cohort of patients with breast cancer, and although inferences may be made from this review, we are mindful of the paucity of data. The management of each patient must be considered in the context of their unique clinical presentation and correlated with the evidence-based principles that apply to more common breast cancer histologies.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Breast Neoplasms/classification
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma/diagnosis
- Carcinoma/pathology
- Carcinoma/therapy
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Female
- Humans
- Prognosis
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Affiliation(s)
- Karen A Cadoo
- Evelyn H. Lauder Breast Center, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
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Boujelbene N, Khabir A, Boujelbene N, Jeanneret Sozzi W, Mirimanoff RO, Khanfir K. Clinical review--breast adenoid cystic carcinoma. Breast 2011; 21:124-7. [PMID: 22154460 DOI: 10.1016/j.breast.2011.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/12/2011] [Accepted: 11/16/2011] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To review the published literature on the diagnosis and management of adenoid cystic carcinoma (ACC) of the breast. MATERIALS AND METHODS Papers were identified by searching PubMed using the terms « adenoid cystic carcinoma » and « breast ». Additional papers were identified by reviewing references of relevant articles. RESULTS ACC of the breast is a rare tumour comprising less than 0.1% of breast malignancies. Its cellular origin in the breast remains unclear. The histological characteristics of ACC in the breast are similar to those of ACC of the salivary glands. However the prognosis of ACC of the breast is better than that of other localizations with prolonged survival. Breast-conserving treatment including postoperative radiotherapy seems to be equivalent to mastectomy alone with respect to survival. The value of adjuvant systemic therapies is not established. Late relapses can occur, so long-term follow-up is mandatory for these patients. CONCLUSIONS ACC of the breast has a favourable prognosis. An accurate diagnosis and appropriate treatment are therefore important.
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Affiliation(s)
- N Boujelbene
- Department of Radiation Oncology, Hôpital de Sion, CHCVs, Grand-Champsec 80, CH-1950 Sion, Switzerland.
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22
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Khanfir K, Kallel A, Villette S, Belkacémi Y, Vautravers C, Nguyen T, Miller R, Li YX, Taghian AG, Boersma L, Poortmans P, Goldberg H, Vees H, Senkus E, Igdem S, Ozsahin M, Jeanneret Sozzi W. Management of adenoid cystic carcinoma of the breast: a Rare Cancer Network study. Int J Radiat Oncol Biol Phys 2011; 82:2118-24. [PMID: 21570212 DOI: 10.1016/j.ijrobp.2010.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/24/2010] [Accepted: 12/08/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mammary adenoid cystic carcinoma (ACC) is a rare breast cancer. The aim of this retrospective study was to assess prognostic factors and patterns of failure, as well as the role of radiation therapy (RT), in ACC. METHODS Between January 1980 and December 2007, 61 women with breast ACC were treated at participating centers of the Rare Cancer Network. Surgery consisted of lumpectomy in 41 patients and mastectomy in 20 patients. There were 51(84%) stage pN0 and 10 stage cN0 (16%) patients. Postoperative RT was administered to 40 patients (35 after lumpectomy, 5 after mastectomy). RESULTS With a median follow-up of 79 months (range, 6-285), 5-year overall and disease-free survival rates were 94% (95% confidence interval [CI], 88%-100%) and 82% (95% CI, 71%-93%), respectively. The 5-year locoregional control (LRC) rate was 95% (95% CI, 89%-100%). Axillary lymph node dissection or sentinel node biopsy was performed in 84% of cases. All patients had stage pN0 disease. In univariate analysis, survival was not influenced by the type of surgery or the use of postoperative RT. The 5-year LRC rate was 100% in the mastectomy group versus 93% (95% CI, 83%-100%) in the breast-conserving surgery group, respectively (p = 0.16). For the breast-conserving surgery group, the use of RT significantly correlated with LRC (p = 0.03); the 5-year LRC rates were 95% (95% CI, 86%-100%) for the RT group versus 83% (95% CI, 54%-100%) for the group receiving no RT. No local failures occurred in patients with positive margins, all of whom received postoperative RT. CONCLUSION Breast-conserving surgery is the treatment of choice for patients with ACC breast cancer. Axillary lymph node dissection or sentinel node biopsy might not be recommended. Postoperative RT should be proposed in the case of breast-conserving surgery.
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Vranic S, Frkovic-Grazio S, Lamovec J, Serdarevic F, Gurjeva O, Palazzo J, Bilalovic N, Lee LMJ, Gatalica Z. Adenoid cystic carcinomas of the breast have low Topo IIα expression but frequently overexpress EGFR protein without EGFR gene amplification. Hum Pathol 2010; 41:1617-23. [PMID: 20688355 DOI: 10.1016/j.humpath.2010.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/24/2010] [Accepted: 04/30/2010] [Indexed: 01/11/2023]
Abstract
Adenoid cystic carcinoma of the breast is a rare subtype of breast cancer with basal-like features. Published studies on breast adenoid cystic carcinoma are limited, resulting in relatively scarce information on the value of predictive tumor markers. We studied 20 primary cases of adenoid cystic carcinoma of the breast for expression of estrogen receptor, progesterone receptor, androgen receptor, epidermal growth factor receptor, HER-2/neu, and topoisomerase IIα using immunohistochemistry and fluorescent in situ hybridization methods. Estrogen and progesterone receptor expression were detected in 1 case each. All tumors were uniformly negative for Her-2/neu expression. Androgen receptor and topoisomerase IIα expression were weakly positive in three cases and 7 cases, respectively. Epidermal growth factor receptor overexpression was detected in 13 cases (65% of all cases). Amplification of TOP2A or HER-2/neu gene was not detected in any of the cases. Our study shows that the majority of adenoid cystic carcinomas of the breast do not overexpress Her-2/neu, topoisomerase IIα, or estrogen receptor, and thus, they are unlikely to respond to therapies targeting these proteins. However, these tumors frequently over-express epidermal growth factor receptor, indicating a potential benefit from anti-epidermal growth factor receptor therapy for patients with advanced adenoid cystic carcinomas of the breast.
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Affiliation(s)
- Semir Vranic
- Department of Pathology, Clinical Center of the University of Sarajevo, Bosnia and Herzegovina
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24
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Ghabach B, Anderson WF, Curtis RE, Huycke MM, Lavigne JA, Dores GM. Adenoid cystic carcinoma of the breast in the United States (1977 to 2006): a population-based cohort study. Breast Cancer Res 2010; 12:R54. [PMID: 20653964 PMCID: PMC2949643 DOI: 10.1186/bcr2613] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 07/11/2010] [Accepted: 07/23/2010] [Indexed: 01/11/2023] Open
Abstract
Introduction Adenoid cystic carcinoma of the breast (breast-ACC) is a rare and special type of basal-like tumor for which scant population-based descriptive data exist. We sought to provide new population-based information on breast-ACC incidence, relative survival, and associated cancer risk in the United States. Methods Using data from the Surveillance, Epidemiology and End Results Program, we calculated age-adjusted incidence rates (IRs), IR ratios (IRRs), and relative survival for breast-ACC, and standardized incidence ratios (SIRs) for other cancers. Results Overall 338 women (IR = 0.92/1 million person-years) were diagnosed with breast-ACC during 1977 to 2006. Blacks had 39% lower IRs than Whites (IRR = 0.61, 95% confidence interval = 0.37 to 0.96), and IRs remained constant over the 30-year period. Ninety-five percent of cases presented with localized stage (n = 320; IR = 0.87), and the highest IRs were observed for estrogen receptor (ER)-negative/progesterone receptor (PR)-negative tumors (IR = 0.56). Like other typically ER-negative tumors, age-specific IRs increased until midlife and then plateaued. Five-year, 10-year, and 15-year relative survival was 98.1%, 94.9%, and 91.4%, respectively. The risk of female breast cancer was not increased following (SIR = 0.89, 95% confidence interval = 0.43 to 1.64) or preceding (SIR = 0.71, 95% confidence interval = 0.28 to 1.46) breast-ACC. Similarly, no association was observed for breast-ACC and risk of all other cancers combined, solid tumors, or lymphohematopoietic malignancies. Conclusions Breast-ACC among women is characterized by ER-negative/PR-negative expression, rare regional lymph node involvement, a favorable prognosis with excellent survival, and absence of associated cancers. These findings reinforce the importance of tailored treatments for breast-ACC and lend credence to the apparent heterogeneity of basal-like breast cancers.
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Affiliation(s)
- Bassam Ghabach
- Department of Veterans Affairs Medical Center, Medical Service (111), 921 NE 13th Street, Oklahoma City, OK 73104, USA.
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25
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Abstract
OBJECTIVE The purpose of our study was to describe the imaging findings in adenoid cystic carcinoma (ACC) of the breast, with pathologic and clinical correlation. MATERIALS AND METHODS We retrospectively searched our surgical database from January 1994 through December 2008 for cases of pathologically proven ACC of the breast. Of approximately 15,000 breast biopsies, 11,250 were malignant. Eleven cases of ACC (0.1% of all malignancies), all with imaging available for review, were included in the study. RESULTS Mammographically (n = 10), tumors appeared as developing asymmetric densities or irregular masses. Sonographically (n = 9), they appeared as irregular, heterogeneous, or hypoechoic masses with minimal vascularity on color Doppler imaging. MRI (n = 5)--because of better soft-tissue contrast and dedicated, multiplanar breast sequences--helped show the extent of the tumor, particularly if dense breast tissue obscured the mass on CT. Two cases with subtle sonographic findings were better delineated on MRI because of tumor enhancement. The solid variant showed increased signal intensity on T2-weighted imaging. ACC showed variable enhancement kinetics ranging from persistent enhancement to washout kinetics in the larger lesions. On molecular breast imaging (n = 1), the tumors showed avid uptake of radiotracer but did not always show activity on PET (n = 1). CT (n = 2) showed areas of rapid, nodular enhancement. CONCLUSION Recognition of ACC is important to avoid delay in diagnosis because this tumor has a good prognosis with rare metastases to axillary lymph nodes. Axillary nodal sampling by fine-needle aspiration or core biopsy is rarely indicated.
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26
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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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27
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Hodgson NC, Lytwyn A, Bacopulos S, Elavathil L. Adenoid cystic breast carcinoma: high rates of margin positivity after breast conserving surgery. Am J Clin Oncol 2010; 33:28-31. [PMID: 19730354 DOI: 10.1097/coc.0b013e31819fdfc8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Adenoid cystic carcinoma of the breast (ACCB) is a rare malignancy with favorable prognosis: axillary lymph node involvement, distant metastases, and death due to disease are uncommon. ACCB may recur locally many years after primary surgical excision and may be substantially higher if primary procedure is lumpectomy rather than mastectomy. METHODS Pathology database searched to identify patients diagnosed with ACCB between 1988 and 2007 at Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.Two pathologists independently reviewed histology to confirm diagnosis of ACCB, and documented surgical procedure, tumor size, tumor grade, surgical margin, and lymph node status. Immunohistochemistry was performed on representative blocks and independently reviewed by 2 pathologists. Clinical and radiologic data were retrospectively reviewed. RESULTS Fifteen cases of ACCB were identified and pathology slides were available for 12. The median age was 62 years. Seven patients presented with a palpable mass and breast pain was described in 3. Positive surgical margins were identified in 5 patients (42%). Only 3 patients had postoperative radiation therapy. CONCLUSIONS Our series shows frequent resection margin involvement in ACCB. Neither clinical nor mammographic examination consistently delineated full tumor extent preoperatively. Future use of magnetic resonance imaging in preoperative assessment may prevent high positive margin rate when lumpectomy is planned. Histologic assessment of tumor extent may be difficult, but immunohistochemistry may be helpful in this regard.
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Affiliation(s)
- Nicole C Hodgson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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28
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Defaud-Hénon F, Tunon-de-Lara C, Fournier M, Marty M, Velasco V, de Mascarel I, MacGrogan G. [Adenoid cystic carcinoma of the breast: clinical, histological and immunohistochemical characterization]. Ann Pathol 2010; 30:7-16. [PMID: 20223349 DOI: 10.1016/j.annpat.2010.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 01/09/2010] [Accepted: 01/13/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adenoid cystic carcinoma (ACC) of the Breast is a rare tumour (less than 1 % of all breast carcinomas). The aim of this study was to determine the clinical, histological and immunohistochemical characteristics of these tumours. METHODS From the database of the Bergonié Institute of Bordeaux, 30 cases of ACC were identified. The clinical and histological features of these carcinomas were characterized. An immunohistochemical study was performed with the following antibodies: ER, PR, HER-2-neu, Vimentin, EGFR, P63, SMA, CK5/6, CK8/18, CK14, cKIT, MIB1, CD44 and CD24. RESULTS Thirty patients were included (median age 60.7 years). The 10 axillary lymph node dissections and two sentinel lymph procedures were negative. The architecture was frequently of a mixed type (26/30) and less often solid (4/30). Among the 23 patients for whom follow up was available (median follow-up: 84 months [2-288]), there were three local recurrences and three metastatic events. The tumors with recurrence and metastasis showed more necrosis, a mitotic count greater than 4/10hpf, and in one case perineural infiltration. All the tumours were ER, PR and Her-2-neu negative. Morphological and immunophenotypical analysis disclosed in each tumor, a basaloid and a luminal cell population with divergent immunophenotypical patterns. CONCLUSIONS The mammary ACC is made of two cell types and is of good prognosis despite its triple negative phenotype, similar to the basal-like infiltrating carcinoma NOS. Axillary lymph node dissection is not recommended. Good local control by at least large lumpectomy with long-term follow-up is necessary.
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29
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Yerushalmi R, Hayes MM, Gelmon KA. Breast carcinoma--rare types: review of the literature. Ann Oncol 2009; 20:1763-70. [PMID: 19602565 DOI: 10.1093/annonc/mdp245] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Invasive breast cancer is a heterogeneous disease in its presentation, pathological classification and clinical course. However, there are more than a dozen variants which are less common but still very well defined by the World Health Organization (WHO) classification. The rarity of many of these neoplasms does not allow large or randomized studies to define the optimal treatment. Many of the descriptions of these cancers are from case reports and small series. Our review brings updated information on 16 epithelial subtypes as classified by the WHO system with a very concise histopathology description and parameters helpful in the clinic. The aim of our review is to provide a tool for breast cancer caregivers which will enable a better understanding of the disease and its optimal approach to therapy. This may also stand as a clinical framework for a future understanding of these rarer breast cancers when gene analysis work is reported.
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Affiliation(s)
- R Yerushalmi
- British Columbia Cancer Agency, Vancouver, Canada.
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30
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Trabelsi A, Chouchene O, Chtioui A, Yacoubi MT, Korbi S. Le carcinome adénoïde kystique du sein: à propos d’un cas et revue de la littérature. ONCOLOGIE 2008. [DOI: 10.1007/s10269-007-0758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Soon SR, Yong WS, Ho GH, Wong CY, Ho BCS, Tan PH. Adenoid cystic breast carcinoma: a salivary gland-type tumour with excellent prognosis and implications for management. Pathology 2008; 40:413-5. [DOI: 10.1080/00313020802036830] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Degirmenci B, Gulhan S, Acar M, Haktanir A. Large cystic infiltrating ductal carcinoma in male breast. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:102-4. [PMID: 17206728 DOI: 10.1002/jcu.20272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Cystic infiltrating ductal carcinoma is a very rare entity that, to the best of our knowledge, has not yet been reported in males. We report the sonographic and CT findings of a large cystic infiltrating ductal carcinoma in a 51-year-old man. Cystic infiltrating ductal carcinoma is a very rare entity that, to the best of our knowledge, has not yet been reported in males. We report the sonographic and CT findings of a large cystic infiltrating ductal carcinoma in a 51-year-old man.
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Affiliation(s)
- Bumin Degirmenci
- Department of Radiology, University of Kocatepe, School of Medicine, Izmir Yolu, Mavi Hastane, 03200 Afyonkarahisar, Turkey
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33
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Rabban JT, Swain RS, Zaloudek CJ, Chase DR, Chen YY. Immunophenotypic overlap between adenoid cystic carcinoma and collagenous spherulosis of the breast: potential diagnostic pitfalls using myoepithelial markers. Mod Pathol 2006; 19:1351-7. [PMID: 16810311 DOI: 10.1038/modpathol.3800658] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adenoid cystic carcinoma of the breast is a rare neoplasm whose cribriform architecture may mimic invasive cribriform carcinoma, cribriform ductal carcinoma in situ, and collagenous spherulosis. The diagnosis may be even more challenging in needle core biopsies. Immunohistochemical expression of p63 and c-kit distinguishes adenoid cystic carcinoma from invasive cribriform carcinoma and ductal carcinoma in situ. A formal comparison of the immunophenotype of adenoid cystic carcinoma to collagenous spherulosis has not been reported. Of concern is the overlap in myoepithelial markers between these two entities. Both may express S100, smooth muscle actin, and p63. This overlap may cause diagnostic confusion yet is under-emphasized in the literature. The expression profile of newer myoepithelial markers has not been studied in this setting. We evaluated smooth muscle actin, p63, calponin, smooth muscle myosin heavy chain, as well as c-kit, in nine cases of cribriform pattern adenoid cystic carcinoma of the breast in comparison to 12 cases of collagenous spherulosis. Both entities strongly expressed p63 and smooth muscle actin; in adenoid cystic carcinoma, the basaloid myoepithelial-like tumor cells expressed these markers, but the ductular epithelial cells did not. Neither calponin nor smooth muscle myosin heavy chain was expressed in adenoid cystic carcinoma but both were strongly expressed in collagenous spherulosis. Whereas the ductular epithelial cells of adenoid cystic carcinoma were positive for c-kit in all cases, collagenous spherulosis was negative for c-kit. Positive p63 expression by a cribriform breast lesion is not sufficiently specific to confirm a diagnosis of adenoid cystic carcinoma. A broader panel that includes calponin or smooth muscle myosin heavy chain and c-kit is required to exclude collagenous spherulosis in settings in which the distinctive morphologic features that separate these entities are not conspicuously present. Reliance on p63 or smooth muscle actin alone poses a potential diagnostic pitfall in evaluating cribriform breast lesions.
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Affiliation(s)
- Joseph T Rabban
- Department of Pathology, University of California, San Francisco, CA 94143, USA.
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34
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Page DL. Adenoid cystic carcinoma of breast, a special histopathologic type with excellent prognosis. Breast Cancer Res Treat 2005; 93:189-90. [PMID: 16142443 DOI: 10.1007/s10549-005-5198-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- David L Page
- Department of Pathology, Vanderbilt University Medical Center, C-3321 Medical Center North, 21st Avenue South, Nashville, TN 37232-2561, USA.
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35
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Azoulay S, Laé M, Fréneaux P, Merle S, Al Ghuzlan A, Chnecker C, Rosty C, Klijanienko J, Sigal-Zafrani B, Salmon R, Fourquet A, Sastre-Garau X, Vincent-Salomon A. KIT is highly expressed in adenoid cystic carcinoma of the breast, a basal-like carcinoma associated with a favorable outcome. Mod Pathol 2005; 18:1623-31. [PMID: 16258515 DOI: 10.1038/modpathol.3800483] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent biological studies have classified breast carcinomas into HER2-overexpressing, estrogen receptor-positive/luminal, basal- and normal-like groups. According to this new biological classification, the objectives of our study were to assess the clinical, morphologic and immunophenotypic characteristics of adenoid cystic carcinoma of the breast in order to classify this subtype of breast carcinoma. A total of 18 cases of adenoid cystic carcinoma were identified from the Institut Curie files. Clinical information was available for 16 patients with a median follow-up of 6.5 years. Morphologically, all tumors were graded according to the system defined by Kleer and Oberman (histologic and nuclear grade). Immunophenotype was assessed with anti-ER, PR, HER-2, KIT, basal (CK5/6) and luminal cytokeratins (CK8/18) and p63 antibodies. One out of 18 tumors was nuclear grade 1 (16%), nine were nuclear grade 2 (50%) and eight were nuclear grade 3 (44%). All cases were estrogen receptor, progesterone receptor and HER-2 negative. Epithelial cells were strongly positive around glandular lumina with one or both cytokeratins, identifying the coexistence of CK5/6+ cells, CK5/6 and CK8/18+ cells, CK8/18+ cells and p63+ cells. All cases (100%) were also KIT positive. In all, 15 patients were treated by surgery. Nine of them received adjuvant radiotherapy. Follow-up was available for 16 patients. In all, 14 patients were alive. Two of them, initially treated by surgery only, presented a local recurrence. Two patients died (one of them treated by radiation therapy only died from her disease). Our study shows that adenoid cystic carcinoma of the breast is a special, estrogen receptor, progesterone receptor, HER-2 negative and highly KIT-positive, basal-like breast carcinoma, associated with an excellent prognosis. This highly specific immunophenotype could be useful to differentiate adenoid cystic carcinoma of the breast from other subtypes of breast carcinoma such as cribriform carcinoma.
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Affiliation(s)
- Sandy Azoulay
- Department of Pathology, Institut Curie, Paris Cedex, France
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Abstract
This article reviews cytomorphology of rare malignant tumors of the breast: squamous carcinoma, metaplastic carcinoma, adenoid cystic carcinoma, apocrine carcinoma, secretory carcinoma, lipid-rich carcinoma, and carcinoma with choriocarcinomatous features. It is important to bear in mind the cytomorphology and diagnosis of rare malignant tumors of the breast in analysis of breast fine needle aspiration smears. Although rare, these malignant tumors can be diagnosed by the cytomorphological characteristics, and should be included in the differential diagnoses of breast neoplasms.
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Affiliation(s)
- Walid E Khalbuss
- Department of Pathology, University of Florida Health Science Center, Jacksonville, FL 32209, USA.
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Mastropasqua MG, Maiorano E, Pruneri G, Orvieto E, Mazzarol G, Vento AR, Viale G. Immunoreactivity for c-kit and p63 as an adjunct in the diagnosis of adenoid cystic carcinoma of the breast. Mod Pathol 2005; 18:1277-82. [PMID: 15846389 DOI: 10.1038/modpathol.3800423] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Adenoid cystic carcinoma of the breast represents a unique clinicopathologic entity with a variable histological appearance and a relatively indolent clinical course in most of the cases. Adenoid cystic carcinoma may be difficult to differentiate from infiltrating duct carcinomas, and in particular from tubular and cribriform carcinomas, especially in core or vacuum-assisted biopsies. We evaluated the prevalence of c-kit, p63, and e-cadherin immunoreactivity in a series of 20 adenoid cystic carcinomas, comparing the results with those obtained in a series of infiltrating tubular carcinomas and infiltrating cribriform carcinomas. The hormone receptor status, proliferation labeling index, and HER/2 immunoreactivity had been previously investigated in all the cases. Three (15%) adenoid cystic carcinomas and all infiltrating tubular and cribriform carcinomas showed estrogen receptor and/or progesterone receptor immunoreactivity (P < 0.00001 for estrogen and P = 0.00002 for progesterone receptors). Adenoid cystic carcinomas consistently lacked any immunoreactivity for HER/2, whereas three (15%) infiltrating and cribriform carcinomas showed weak and incomplete membrane staining (P = 0.23077). Membranous immunoreactivity for c-kit was found in all except one (predominantly basaloid) adenoid cystic carcinomas (95%), and in none of the infiltrating tubular and cribriform carcinomas (P < 0.00001). Nuclear immunoreactivity for p63 was found in all except three (predominantly basaloid) adenoid cystic carcinomas (85%) and in none of the infiltrating tubular and cribriform carcinomas (P < 0.00001). All infiltrating tubular and cribriform carcinomas and 18/20 (90%) adenoid cystic carcinomas showed immunoreactivity for e-cadherin (P = 0.48718). In summary, adenoid cystic carcinomas showed the following phenotype: estrogen receptor-/progesterone receptor-/c-kit+/p63+ (13 cases, 65%), estrogen receptor-/progesterone receptor/c-kit+/p63- (three cases, 15%), estrogen receptor-/progesterone receptor-/c-kit-/p63+ (one case, 5%), estrogen receptor+/progesterone receptor+/c-kit+/p63+ (two cases, 10%), and estrogen receptor+/progesterone receptor-/c-kit+/p63+ (one case). By contrast, all the infiltrating tubular and cribriform carcinomas showed the estrogen receptor+/progesterone receptor+/c-kit-/p63- phenotype. Our data provide evidence that immunoreactivity for c-kit and/or p63 may be useful in differentiating adenoid cystic carcinomas from other types of breast cancer.
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Affiliation(s)
- Mauro G Mastropasqua
- Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, School of Medicine, Milan, Italy
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38
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Millar BAM, Kerba M, Youngson B, Lockwood GA, Liu FF. The potential role of breast conservation surgery and adjuvant breast radiation for adenoid cystic carcinoma of the breast. Breast Cancer Res Treat 2005; 87:225-32. [PMID: 15528965 DOI: 10.1007/s10549-004-8693-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Adenoid cystic carcinoma (ACC) of the breast is a rare breast cancer variant and optimal management is unclear. A review of this unusual tumour was performed at our Institution, to assess the role of breast conservation in the management of this disease. METHODS AND MATERIALS A review of all cases of ACC of breast (1960-2000) treated at Princess Margaret Hospital (PMH) was undertaken. Information was collected on age at diagnosis, presenting features, tumour size and treatment modalities. Treatment outcomes were evaluated. RESULTS Eighteen female and one male patient were identified. Median age at diagnosis was 58 years (range 35-76 years). Four patients had lymph-node positive disease at presentation; the single male patient presented with metastatic disease. Surgery was either a lumpectomy (10 cases) or a simple, radical or modified radical mastectomy (9 patients). Nine of 19 patients received adjuvant radiotherapy (RT). The median follow-up time was 14 years; the recurrence rate at 10 years was 31% (95% CI 7-54%) with a range in time of recurrence from 2.3 to 11.9 years. Seven recurrences were identified (4 local, 1 regional, 2 metastatic). Two of these patients developed metastatic spread and died. Six of the 19 cases went on to develop second malignancies of whom four died. Among the 18 female patients, the 10-year overall (OS), cause-specific (CSS), and relapse free survival (RFS) rates were 75, 100, and 46% respectively. CONCLUSIONS ACC of the breast has a relatively prolonged natural history, and responds well to conservative management at presentation, with good outcome, even following local recurrence.
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Affiliation(s)
- Barbara-Ann M Millar
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, University Health Network, Ont., Canada
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Ogata K, Sakamoto G, Sakurai T. Adenoid cystic carcinoma with collagenous spherulosis-like structures in the breast: report of a case. Pathol Int 2004; 54:332-6. [PMID: 15086837 DOI: 10.1111/j.1440-1827.2004.01627.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Adenoid cystic carcinoma (ACC) is rare in breast carcinomas and has a relatively better prognosis than other histological types. Although the tumor shows various growth patterns, such as those of salivary glands or other organs, the papillary growth pattern is uncommon. Collagenous spherulosis (CS), consisting of intraluminal clusters of eosinophilic spherules situated adjacent to, or encompassed by, usually benign proliferative epithelium, is also a rare incidental microscopic finding that ACC must be distinguished from, and it has never been reported in association with ACC. We present a case of ACC arising in mammary ducts with the papillary growth pattern and CS-like structures that should not be mistaken for benign proliferative lesions, especially in the core needle-biopsy specimen, because the adenoid cystic pattern might not always be contained in the specimen. Morphologically and histochemically, the results suggest that the CS-like structures in the present case undergo a similar process to the originally described CS, which the myoepithelium is thought to be associated with. Examination of more cases are necessary to clarify the process of CS and its relationship to mammary proliferative lesions.
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Affiliation(s)
- Kentaro Ogata
- Department of Laboratory Medicine, Kawasaki Municipal Ida Hospital, Kanagawa, Japan.
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40
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Abstract
STUDY OBJECTIVES To investigate the clinicopathologic features of primary tracheobronchial adenoid cystic carcinoma (ACC), and to examine kit protein (CD117) expression, and a possible correlation between the histologic grade and Ki-67 positivity. DESIGN Retrospective 10-year study (from 1992 to 2001). SETTING Referral center for interventional pulmonology. PATIENTS Fourteen patients referred to our institution for laser resection of tracheal or endobronchial tumors. INTERVENTIONS Twelve patients were treated primarily by laser resection via bronchoscopy with subsequent radiation therapy. The remaining two patients had tracheal resection with postoperative radiation and radiation therapy alone. RESULTS Fourteen patients (5 men and 9 women) had an average age of 44 years at diagnosis (age range, 29 to 57 years). Five of 14 patients were smokers (average smoking history, 28.5 pack-years), 8 were nonsmokers, and the smoking history was unknown in 1 patient. Major symptoms at presentation included cough (57.1%), dyspnea (71.4%), and hoarseness (14.3%). Two patients (14.3%) presented with respiratory failure. Eleven patients (78.6%) had one or more recurrences, and 4 patients (28.6%) had metastases, primarily to the lungs. The average time to either recurrence or metastasis was 4.6 years after the initial diagnosis. Five patients (35.7%), all of whom had recurrences and/or metastasis during the course of their disease, died of their disease (average time, 8.2 years). Thirteen of 13 cases stained for CD117 were positive in the tumor cell cytoplasm with membranous accentuation. Our cases included 8 grade I tumors, 4 grade II tumors, and 2 grade III tumors, which did not correlate with the degree of Ki-67 positivity. CONCLUSIONS Tracheobronchial ACCs in our study were more common in women and nonsmokers who presented with nonspecific respiratory symptoms and followed a clinical course generally comparable to that of tumors in the salivary glands. CD117 expression was present in all cases tested, and Ki-67 stain results did not correlate with the tumor grade.
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Affiliation(s)
- Elizabeth Albers
- Department of Pathology, School of Medicine, University of California San Diego, San Diego, CA, USA
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41
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Reis-Filho JS, Fulford LG, Crebassa B, Carpentier S, Lakhani SR. Collagenous spherulosis in an adenomyoepithelioma of the breast. J Clin Pathol 2004; 57:83-6. [PMID: 14693844 PMCID: PMC1770151 DOI: 10.1136/jcp.57.1.83] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Collagenous spherulosis (CS) is an incidental finding that usually occurs in association with benign proliferative and preinvasive lesions. Adenomyoepithelioma is a biphasic neoplasm of the breast, composed of both luminal epithelial and myoepithelial cells. Despite the common epimyoepithelial histogenesis, CS has never been described in association with adenomyoepithelioma. This report describes the case of a 48 year old woman who presented with CS of the breast in an adenomyoepithelioma. The combination of these two benign lesions led to diagnostic difficulties; namely, differentiation from adenoid cystic carcinoma, but also cribriform carcinoma and cylindroma of the breast. Antibodies to the oestrogen receptor, progesterone receptor, p63, and c-kit (CD117) proved to be useful adjuncts to differentiate between these lesions.
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Affiliation(s)
- J S Reis-Filho
- The Breakthrough Toby Robins Breast Cancer Research Centre, Institute of Cancer Research, London SW3 6JB UK
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42
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Nakhla H, Chandan VS, Numann PJ, Landas SK. Pathologic quiz case: a 75-year-old woman with a breast lump. Cystic carcinoma of the breast. Arch Pathol Lab Med 2003; 127:e436-7. [PMID: 14632553 DOI: 10.5858/2003-127-e436-pqcayw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hassan Nakhla
- Department of Pathology, Upstate Medical University, State University of New York-Syracuse, Syracuse, NY 13210, USA
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43
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Abstract
Salivary-type tumors occur in multiple sites in the human body, likely related to a basic structural homology between exocrine glands in these different anatomic areas. This paper reviews these salivary gland tumor types in breast tissue and lung. Salivary-type tumors of both breast and lung are relatively uncommon in comparison to their salivary gland counterparts. This may be attributable in part to lack of familiarity with these tumors in extra-salivary sites, and in part to histologic overlap with other primary and metastatic tumor types. Recognition of these entities is improving as the clinical and pathologic features are better delineated, and tumors are more accurately classified. Prediction of malignant behavior is not always possible in these unusual sites. In some instances, such as adenoid cystic carcinoma, behavior is known to differ considerably from that of analogous primary salivary gland tumors and in other instances there are simply too few reported cases to allow for adequate prognostication. In fact, more recent papers discuss the need to consider a spectrum encompassing benign and malignant lesions, in both breast and lung. Of course, some entities show clear-cut evidence of malignancy with documented potential for metastasis, others show bland features and well-reported benign behavior, and the less well-defined entities reside between these two extremes. The molecular pathology of salivary gland tumors has been reasonably well investigated in that location; however; there are few molecular studies devoted to salivary-type tumors of the breast and lung. This represents a potential area for future growth in further clarifying these tumors and their behavior.
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Affiliation(s)
- Audrey K Bennett
- Robert E. Fecuhner Division of Surgical Pathology, Department of Pathology, University of Virginia Medical Center, Charlottesville, VA 22908, USA
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44
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Acs G, Simpson JF, Bleiweiss IJ, Hugh J, Reynolds C, Olson S, Page DL. Microglandular adenosis with transition into adenoid cystic carcinoma of the breast. Am J Surg Pathol 2003; 27:1052-60. [PMID: 12883237 DOI: 10.1097/00000478-200308000-00002] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microglandular adenosis (MGA) is a well-recognized, if rare and incompletely characterized, entity in which carcinoma is rarely thought to develop. We report 17 cases in which patterns of adenoid cystic carcinoma (ACC) coexisted with MGA. Immunocharacterization with beta-catenin, E-cadherin, cytokeratins (AE1/AE3), epithelial membrane antigen, S-100 protein, smooth muscle actin, and vimentin was also performed. Most cases had areas of invasive ACC characterized by its defining dual-lumen types. Some cases of ACC appeared to have expanded glands intermingled within the MGA, whereas in other cases ACC formed a transition with the characteristic small, gland-like spaces of MGA. MGA and "atypical MGA" stained irregularly and similarly to that seen in myoepithelium with the three markers of myoepithelial cells in breast: S-100 protein, smooth muscle actin, and vimentin. These markers were also positive in the more solid elements of the ACC. Our study suggests that ACC may develop in a background of and in continuity with MGA. Altered myoepithelial cells appear to be the major neoplastic element in both ACC and "atypical MGA." "Atypical MGA" with transition to ACC may show histologic patterns and an immunohistochemical profile similar to that of ACC. These lesions might be best interpreted as ACC in situ. Both MGA and ACC of the breast grow in an expansile and diffusely infiltrative pattern without having significant metastatic capacity. Their unusual interaction with the surrounding stroma may play a role in this benign biologic behavior.
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Affiliation(s)
- Geza Acs
- Department of Pathology and Laboratory of Medicine, University of Pensilvania Medical Center, Philacelphia, Pensylvania 19104, USA.
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Pia-Foschini M, Reis-Filho JS, Eusebi V, Lakhani SR. Salivary gland-like tumours of the breast: surgical and molecular pathology. J Clin Pathol 2003; 56:497-506. [PMID: 12835294 PMCID: PMC1769991 DOI: 10.1136/jcp.56.7.497] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2003] [Indexed: 01/18/2023]
Abstract
Breast glands and salivary glands are tubulo-acinar exocrine glands that can manifest as tumours with similar morphological features, but that differ in incidence and clinical behaviour depending on whether they are primary in breast or salivary glands. Salivary gland-like tumours of the breast are of two types: tumours with myoepithelial differentiation and those devoid of myoepithelial differentiation. The first and more numerous group comprises a spectrum of lesions ranging from "bona fide" benign (such as benign myoepithelioma and pleomorphic adenoma), to low grade malignant (such as adenoid cystic carcinoma, low grade adenosquamous carcinoma, and adenomyoepithelioma), to high grade malignant lesions (malignant myoepithelioma). The second group comprises lesions that have only recently been recognised, such as acinic cell carcinoma, oncocytic carcinoma of the breast, and the rare mucoepidermoid carcinoma.
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Affiliation(s)
- M Pia-Foschini
- Department of Pathology, University of Bologna, at Ospedale Bellaria, Bologna, I-40139 Italy
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46
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Abstract
Analysis of invasive breast cancers by histopathology has generally revolved around the analysis of individual characteristics such as nuclear pleomorphism and/or gland formation (grading) or categorization by specific histologic patterns (special type carcinomas). Recognition of special types of invasive breast carcinoma allows for the identification of women with an extremely good prognosis often approaching or equaling that of the general population of the same age (with unique problems for medullary). The distinguishing features of special types of breast cancer are present in complete or classic form in the pure examples of these cases, and the features recognizing these types may be present in lesser degrees in many carcinomas of no special type or not otherwise specified in which they often have important clinical correlates other than strong indicators of survival, such as recognizing the diffusely invasive feature of lobular and lobular-like cancers. Many other features have been noted as contenders for types of breast cancer (such as squamous, cystic, clear cell, histiocytoid, and lipid rich). These terms are not discussed here because they have no special clinical correlates relevant to diagnosis or prognosis. It should be reemphasized here that combined histologic grade (Nottingham system favored) with nuclear, glandular, and mitotic evaluation is expected by most authorities for clarification of diagnosis in all but rare, pure medullary cancers. (5, 13, 14, 27) The Nottingham grade 11 interacts with nodal status to produce a very strong prognostic index. The mitotic count may be the most important part of the grading system, certainly for prognosis within 5 years of diagnosis. (22, 26)
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Affiliation(s)
- David L Page
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennesee 37232, USA.
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Delanote S, Van den Broecke R, Schelfhout VRJ, Serreyn R. Adenoid cystic carcinoma of the breast in a 19-year-old girl. Breast 2003; 12:75-7. [PMID: 14659359 DOI: 10.1016/s0960-9776(02)00272-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A case of adenoid cystic carcinoma of the breast in a 19-year-old girl is presented. As this tumor has specific characteristics and diagnostic criteria, this case illustrates the importance of an accurate histological diagnosis.
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Affiliation(s)
- S Delanote
- Department of Gynaecological Oncology, Ghent University Hospital, Belgium
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Soyuer I, Soyuer S, Canoz O, Er O, Arýtap Y. Fine needle aspiration cytology of adenoid cystic carcinoma of the breast. Cytopathology 2002; 13:177-9. [PMID: 12060082 DOI: 10.1046/j.1365-2303.2002.t01-1-00381.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Abstract
BACKGROUND Adenoid cystic carcinoma is a rare type of breast cancer that is generally reported in individual case reports or as series from major referral centers. To characterize early diagnostic criteria for adenoid cystic carcinoma and to determine whether breast-preserving surgery with radiotherapy is as effective as mastectomy for eradicating the disease, we reviewed clinical records of a large series of patients treated for adenoid cystic carcinoma of the breast at a large health maintenance organization (HMO) that includes primary care facilities and referral centers. METHODS Using the data bank of the Northern California Cancer Registry of the Kaiser Permanente Northern California Region (KPNCR), we retrospectively reviewed medical records of patients treated for adenoid cystic carcinoma of the breast. Follow-up also was done for these patients. RESULTS Adenoid cystic carcinoma of the breast was diagnosed in 22 of 27,970 patients treated for breast cancer at KPNCR from 1960 through 2000. All 22 patients were female and were available for follow-up. Mean age of patients at diagnosis was 61 years (range, 37 to 94 years). In 17 (77%) of the women, a lump in the breast led to initial suspicion of a tumor; in 4 (23%) of the 22 patients, mammography led to suspicion of a tumor. Median tumor size was 20 mm. Pain was a prominent symptom. Surgical management evolved from radical and modified radical mastectomy to simple mastectomy or lumpectomy during the study period, during which time 1 patient died of previous ordinary ductal carcinoma of the contralateral breast, and 7 died of unrelated disease. At follow-up, 12 of the 13 remaining patients were free of disease; 1 patient died of the disease; and 1 patient remained alive despite late occurrence of lymph node and pulmonary metastases. CONCLUSIONS Whether breast-preserving surgery with radiotherapy is as effective as mastectomy for treating adenoid cystic carcinoma of the breast has not been determined.
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Affiliation(s)
- James H McClenathan
- Department of Surgery, Kaiser Permanente Medical Center, 900 Kiely Blvd., Santa Clara, CA 95051, USA.
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50
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Arpino G, Clark GM, Mohsin S, Bardou VJ, Elledge RM. Adenoid cystic carcinoma of the breast: molecular markers, treatment, and clinical outcome. Cancer 2002; 94:2119-27. [PMID: 12001107 DOI: 10.1002/cncr.10455] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of this study was to comprehensively characterize the clinical and biologic features of adenoid cystic carcinoma (ACC) and to assess the implications for management in a large cohort of patients. METHODS From a database of 50,000 patients, 28 were identified with ACC for which clinical follow-up and biologic information was available. The biologic features examined included estrogen receptor and progesterone receptor status, DNA ploidy, and S-phase fraction. Median follow-up was 83 months with a range of 29 to 144 months. Overall survival and disease free survival curves were drawn using Kaplan and Meier estimates and were compared by the log-rank test. RESULTS All but one patient were postmenopausal with a median age at diagnosis of 66 years (range, 40-96 years). One patient had macroscopic metastatic disease at diagnosis. Median tumor size was 1.9 cm (range, 0.5-7.0 cm). Axillary lymph node dissection was performed in 23 patients. Only 1 patient (4%) had histologic positive lymph nodes (2 of 10), and no recurrence was detected for this patient. Forty-six percent were ER positive (median, 16 fmol/mg protein; range, 5-1017 fmol/mg), and 35% were PgR positive (median, 61 fmol/mg protein; range, 6-854 fmol/mg). S-phase fraction and DNA ploidy were assessable in 24 cases. Ninety percent of tumors had low S-phase (median, 3.3%; range, 0.1-34.2%), and 92% were diploid. Simple or modified radical mastectomy was performed in 22 patients, and 6 patients were treated by lumpectomy. Five of these six patients also received radiation therapy after lumpectomy. Despite the different surgical approaches, there were no local recurrences. The 5-year disease free survival rate was 100%, and the 5-year overall survival rate was 85% (95% confidence interval, 71.7-98.6%). CONCLUSIONS Adenoid cystic carcinomas of the breast have very favorable biologic characteristics and, consistent with this, an excellent prognosis. Good local control can be achieved by lumpectomy with radiation or by simple mastectomy. Axillary lymph node dissection is not helpful in clinical management.
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Affiliation(s)
- Grazia Arpino
- Breast Center at Baylor College of Medicine, Houston, Texas 77030, USA
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