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Gou WB, Yang YQ, Song BW, He P. Solid basal adenoid cystic carcinoma of the breast: A case report and literature review. Medicine (Baltimore) 2024; 103:e37010. [PMID: 38241532 PMCID: PMC10798743 DOI: 10.1097/md.0000000000037010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024] Open
Abstract
RATIONALE Adenoid cystic carcinoma (AdCC) is a rare malignancy of the breast with a low Ki-67 index and good prognosis. Owing to the rarity of breast AdCC, the misdiagnosis rate is as high as 50%, and there is no consensus or recognized guidelines for the treatment of this disease. Therefore, it is necessary to conduct a detailed clinical and pathological analysis in combination with a literature review to improve our understanding, diagnosis, and treatment of the disease. METHODS A 68-year-old woman sought medical attention due to a recently increasing mass in the breast. The left breast mass was 1.3 cm × 1 cm in size. We analyzed the morphology, immunohistochemistry, and molecular characteristics of the tumor removed by surgery, and reviewed relevant literature. DIAGNOSES Solid basal AdCC of the breast. INTERVENTIONS We performed biopsy, immunohistochemistry and molecular testing on surgical resection specimens. OUTCOMES Combining morphological and immunohistochemical features, it is consistent with solid basal AdCC of the breast, and Fish detected MYB gene break. LESSONS Due to the high misdiagnosis rate of AdCC, accurate histopathological diagnosis is particularly important. At present, breast conserving surgery and local tumor resection are mainly used for the treatment of breast AdCC, and postoperative adjuvant radiotherapy is feasible.
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Affiliation(s)
- Wen Bin Gou
- Department of Pathology, People’s Hospital of Wanning, Wanning, Hainan, China
| | - Yong Qiang Yang
- Department of Endoscopy, People’s Hospital of Wanning, Wanning, Hainan, China
| | - Bei Wen Song
- Department of Endoscopy, People’s Hospital of Wanning, Wanning, Hainan, China
| | - Pei He
- Department of Clinical laboratory, Xinjiang Production and Construction Corps Sixth Division Hospital, Wujiaqu, Xinjiang, China
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2
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Histoséminaire : ouf, c’est positif ! De l’usage salvateur des biomarqueurs en pathologie mammaire : cas no 5. Ann Pathol 2022; 42:313-316. [DOI: 10.1016/j.annpat.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/01/2022] [Indexed: 11/19/2022]
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3
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Hara Y, Yamaguchi R, Yano H, Iwasaki K. Adenoid Cystic Carcinoma, Solid-Basaloid Subtype of the Breast: A Case Report. Int J Surg Pathol 2022; 31:460-463. [PMID: 35635208 DOI: 10.1177/10668969221102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a rare tumor of adenoid cystic carcinoma, solid-basaloid subtype of the breast. Solid-basaloid adenoid cystic carcinoma may have a worse prognosis than classical adenoid cystic carcinoma. A 70-year-old woman presented with a mass in her left breast. Malignancy was suspected on imaging and confirmed via core needle biopsy. Left breast partial mastectomy and sentinel lymph node biopsy were performed. Histologically, the tumor was composed of basaloid cells with hyperchromatic nuclei and frequent mitotic figures, as are small-cell neuroendocrine carcinomas. Immunohistochemical analysis of the tumor cells showed high expression of KIT and CD10 and focal expression of keratin 7. Synaptophysin, chromogranin A, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 were not expressed. This patient should be followed up carefully for distant metastases and recurrences.
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Affiliation(s)
- Yuki Hara
- Department of Breast Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Hiroshi Yano
- Department of Breast Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Keisuke Iwasaki
- Department of Pathology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
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4
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Massé J, Truntzer C, Boidot R, Khalifa E, Pérot G, Velasco V, Mayeur L, Billerey-Larmonier C, Blanchard L, Charitansky H, Soubeyran I, Iggo R, Arnould L, MacGrogan G. Solid-type adenoid cystic carcinoma of the breast, a distinct molecular entity enriched in NOTCH and CREBBP mutations. Mod Pathol 2020; 33:1041-1055. [PMID: 31857685 DOI: 10.1038/s41379-019-0425-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
Adenoid cystic carcinoma (ACC) of the breast with a predominant solid pattern is difficult to diagnose with certainty and differentiate from more common triple-negative breast cancers (TNBCs) of basal-phenotype. To better characterize solid ACC, we performed a clinical, morphological, immunohistochemical, and molecular comparative analysis of 33 ACCs of the breast comprising 17 solid variant ACCs and 16 conventional ACCs. Solid ACCs displayed basaloid morphology with an exclusive or predominant epithelial cell population associated with decreased myoepithelial differentiation, while demonstrating MYB protein overexpression similar to the more common type of ACC. Strong and diffuse MYB expression by immunochemistry was observed in 14/17 (82%) of solid ACCs while MYB rearrangements were detected by break apart fluorescence in situ hybridization (FISH) in only 3/16 (19%) of solid ACCs. Conversely, weak MYB immunohistochemical expression was observed in only 7/204 (3%) of TNBC. Solid ACCs displayed a transcriptomic profile distinct from conventional ACCs with 549 genes showing a highly significant differential expression between conventional and solid ACC [false discovery rate (FDR) < 0.01; log2FC > |1|]. EnrichR and Kegg Pathway analyses identified PI3K-Akt and focal adhesion signaling pathways as significantly overexpressed in conventional ACCs compared with solid ACCs which significantly overexpressed the nitrogen metabolism pathway. CREBBP mutations and NOTCH activating gene mutations were only present in solid ACCs, concerning 5/16 (31%) of cases for each gene. Tumors with NOTCH activating mutations displayed a strong diffuse nuclear NICD1 staining, an established marker of Notch pathway activation. Solid ACCs also differed from basal-type TNBC, with fewer TP53 mutations and a more stable genomic profile on array comparative genomic hybridization (CGH). In summary, solid-type ACC of the breast is a distinct molecular entity within the ACC family and is different from common basal-type TNBC. MYB is a diagnostically useful biomarker of solid ACC and NOTCH could be a novel potential therapeutic target in 30% of cases.
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Affiliation(s)
- Julie Massé
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France.,University of Bordeaux, F-33076, Bordeaux, France
| | - Caroline Truntzer
- Department of Tumor Biology and Pathology, Centre Georges-François Leclerc, Comprehensive Cancer Centre, F-21000, Dijon, France
| | - Romain Boidot
- Department of Tumor Biology and Pathology, Centre Georges-François Leclerc, Comprehensive Cancer Centre, F-21000, Dijon, France
| | - Emmanuel Khalifa
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France
| | - Gaëlle Pérot
- INSERM U1037, Cancer Research Center Toulouse (CRCT), F-31000, Toulouse, France.,Department of Pathology, Institut Claudius Regaud, IUCT-Oncopole, F-31000, Toulouse, France
| | - Valérie Velasco
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France
| | - Laétitia Mayeur
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France
| | - Claire Billerey-Larmonier
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France
| | - Larry Blanchard
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France
| | - Hélène Charitansky
- Department of Surgical oncology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France
| | - Isabelle Soubeyran
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France
| | - Richard Iggo
- University of Bordeaux, F-33076, Bordeaux, France.,INSERM U1218, F-33076, Bordeaux, France
| | - Laurent Arnould
- Department of Tumor Biology and Pathology, Centre Georges-François Leclerc, Comprehensive Cancer Centre, F-21000, Dijon, France
| | - Gaëtan MacGrogan
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33076, Bordeaux, France. .,INSERM U1218, F-33076, Bordeaux, France.
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5
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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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6
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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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7
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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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8
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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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9
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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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10
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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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11
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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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12
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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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13
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Cabibi D, Cipolla C, Maria Florena A, Fricano S, Barresi E, Vieni S, Rodolico V, Napoli L. Solid variant of mammary "adenoid cystic carcinoma with basaloid features" merging with "small cell carcinoma". Pathol Res Pract 2005; 201:705-11. [PMID: 16325513 DOI: 10.1016/j.prp.2005.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Accepted: 04/28/2005] [Indexed: 11/15/2022]
Abstract
We describe a rare case of a solid variant of a mammary adenoid cystic carcinoma with basaloid features (sbACC) and its coexistence with a "small cell" carcinoma (SCC), identified and confirmed by histological and immunohistochemical observations: the absence of glandular structures and PAS-positive globules, positivity for neuroendocrine markers (NSE, synaptophysin and chromogranin), and negativity for 34betaE12 and SMA actin were the aspects suggesting the presence of SCC. Furthermore, positivity for CD10 was found both in sbACC and in SCC, supporting the hypothesis that the two components share the same histogenetic myoepithelial origin and represent an example of dedifferentiation along neuroendocrine phenotype lines occurring in a multipotential neoplastic stem line, already committed towards a myoepithelial phenotype. To our knowledge, this is the first reported case of a solid basaloid adenoid cystic carcinoma merging with an SCC carcinoma. Furthermore, it is the first study in which CD10 was used to investigate the histogenesis of the two neoplastic components.
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MESH Headings
- Adult
- Axilla
- Biomarkers, Tumor/analysis
- Breast Neoplasms/chemistry
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Adenoid Cystic/chemistry
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/therapy
- Carcinoma, Basal Cell/chemistry
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/therapy
- Carcinoma, Small Cell/chemistry
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/therapy
- Chemotherapy, Adjuvant
- Female
- Humans
- Immunohistochemistry
- Lymph Node Excision
- Mastectomy, Segmental
- Neoplasms, Multiple Primary/chemistry
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Periodic Acid-Schiff Reaction
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Affiliation(s)
- Daniela Cabibi
- Institute of Pathology, A.O.U. Policlinico Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy.
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14
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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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Shin SJ, Rosen PP. Solid variant of mammary adenoid cystic carcinoma with basaloid features: a study of nine cases. Am J Surg Pathol 2002; 26:413-20. [PMID: 11914618 DOI: 10.1097/00000478-200204000-00002] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adenoid cystic carcinoma of the breast is a rare neoplasm that represents <1% of breast carcinomas. The tumors are histologically indistinguishable from examples in other sites, and they have a generally favorable prognosis. Several studies have investigated the possible correlation between histologic grade in adenoid cystic carcinoma (largely determined by cytology and growth pattern) and prognosis. Some earlier reports concluded that a solid variant of mammary adenoid cystic carcinoma had a more aggressive clinical course, but others did not confirm this impression. This report describes nine patients with a solid variant of mammary adenoid cystic carcinoma that has a striking basaloid appearance. All were women ranging in age from 37 to 83 years. A solitary mass was evident in all patients. Tumor size was 1.1-15 cm (mean 3.7 cm). The tumors exhibited a predominantly solid architecture comprised of basaloid appearing cells with moderate to marked nuclear atypia. Five tumors had >5 mitotic figures per 10 high power microscopic fields. Intercalated ducts were found in all tumors, being well formed in six and poorly formed in three. Immunohistochemical stains for cytokeratins, basement membranes, and vimentin were consistently positive. Surgery was performed in all cases consisting of excision in seven and mastectomy in two. Axillary lymph node metastases were found in two of six axillary dissections and four had negative lymph nodes. The lymph nodes were not examined in three patients. Follow-up information was available for seven patients. Six women had no evidence of disease after follow-up of 2-88 months (mean 32 months), one patient died of unknown causes, and one patient was lost to follow-up. It is concluded that the solid variant of mammary carcinoma with basaloid features is a histologically distinct tumor that is capable of axillary metastases. Long-term follow-up of a larger series of cases will be needed to determine whether the prognosis of these patients differs significantly from that of women with conventional adenoid cystic carcinoma. Presently, these patients are candidates for axillary staging by sentinel lymph node mapping or low axillary dissection if there is no clinical evidence of axillary metastases. Systemic adjuvant treatment would be prudent when axillary nodal metastases are present. Breast-conserving surgery with radiation is an option if negative margins can be achieved because this appears to be a unicentric form of carcinoma.
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Affiliation(s)
- Sandra J Shin
- Department of Pathology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA.
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