Characterisation of adenoid cystic carcinoma of the breast by immunohistology

A case of adenoid cystic carcinoma of the breast

An 85-year old woman who had a large tumor in the left breast came to our out-patient clinic. Computed tomography showed multiple lung tumors in addition to a huge tumor in the left breast. A needle biopsy brought about a histological diagnosis of ductal carcinoma. A simple mastectomy was performed and a histological examination using the resected specimen demonstrated a coexistence of an adenoid structure and a false ductal structure according the histologic characteristics of adenoid cystic carcinoma, which is quite rare among breast tumors. J. Med. Invest. 65:289-291, August, 2018.

Management of adenoid cystic carcinoma of the breast: a Rare Cancer Network study

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.

[Adenoid cystic carcinoma of the breast: clinical, histological and immunohistochemical characterization]

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.

KIT is highly expressed in adenoid cystic carcinoma of the breast, a basal-like carcinoma associated with a favorable outcome

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.

Salivary-type neoplasms of the breast and lung

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.

Adenoid cystic carcinoma of the breast: molecular markers, treatment, and clinical outcome

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.

Solid variant of mammary adenoid cystic carcinoma with basaloid features: a study of nine cases

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.

Immunohistochemical evaluation of estrogen and progesterone receptors in adenoid cystic carcinoma of salivary gland origin

Adenoid cystic carcinoma (ACC) is a malignant tumor of salivary gland origin, which is characterized by a high rate of local recurrence and distant metastasis even after aggressive surgical treatment. In several studies using various immunohistochemical techniques, estrogen and progesterone receptor (ER and PgR) proteins in salivary gland ACC have been identified and the possible use of endocrine therapy as a treatment modality suggested. On this basis, 27 samples of formalin-fixed paraffin-embedded salivary gland ACC were immunohistochemically evaluated for the presence of ER and PgR. ER was not detected in any of the tumors and PgR was identified in only two cases. Thus, application of hormone therapy to salivary gland ACC is not supported by the results of the present study.

Adenoid cystic carcinoma of the breast: a tumour commonly devoid of oestrogen receptors and related proteins

AIM

Adenoid cystic carcinoma (ACC) of the breast is an uncommon well-differentiated tumour with good prognosis, and sometimes difficult to distinguish from in-situ and invasive cribriform carcinoma (ICC) which are relatively more common. Recently, we encountered a case of ACC that proved to be totally oestrogen receptor (ER) negative by immunohistochemistry. We investigated the possibility that this may be a consistent feature that can help in differentiating ACC from ICC which are usually ER positive.

METHODS AND RESULTS

The immunoperoxidase technique was used to study the expression of ER and other related proteins in six cases of ACC and two cases of ICC. All ACC cases were negative for oestrogen (ER) and progesterone (PgR) receptors whereas the two ICC were strongly positive for ER and showed a variable degree of PgR positivity. In addition, ACC cases were pS2 negative and showed minimal expression of prolactin receptors (PrlR), while the two ICC showed widespread and strong staining for pS2 and PrlR. The percentages of cells staining positively for Ki67 and p27 were generally lower in ACC than in ICC. Both tumour types were c-erbB-2 negative, but p53 was weakly to moderately positive.

CONCLUSIONS

The findings suggest that a negative immunoperoxidase staining for ER would confirm the diagnosis of ACC in contrast to the positive staining which is always seen in ICC. The findings also raise the issue of the presence of a specific class of ER negative breast carcinomas which are negative not because of poor differentiation, but because of their derivation from, or differentiation along, an ER negative cell lineage.

Adenoid cystic carcinoma of the breast: utility of immunocytochemical study with collagen IV on fine-needle aspiration

A case of adenoid cystic carcinoma (ACC) of the breast in a 71-year-old woman is reported. This neoplasm accounts for about 0.1% of all breast cancers. The mammography showed a well-delineated mass without calcifications. Cytologic examination of percutaneous fine-needle aspiration (FNA) material gave the diagnostic of ACC, which was confirmed by histologic examination. This report emphasizes the utility of immunocytochemical study with collagen IV antibody on FNA material of this uncommon tumor.

Estrogen and progesterone receptors in salivary gland adenoid cystic carcinoma

Adenoid cystic carcinomas of salivary glands occur more frequently in women and bear remarkable similarity to adenoid cystic carcinomas of the breast. In addition, breast carcinomas express estrogen and progesterone receptors that impact prognostic significance. This suggests a possible role for sex steroid hormones in the development and progression of salivary gland adenoid cystic carcinoma. On this basis, 12 samples of formalin-fixed, paraffin-embedded salivary gland adenoid cystic carcinomas and 12 samples of normal salivary gland tissue were immunohistochemically evaluated for estrogen and progesterone receptor protein expression. Estrogen receptors were not detected in either group; however, a significantly higher progesterone receptor level was evident in the neoplastic group compared with normal tissue (p < 0.01). These data confirm the presence of progesterone receptors within normal and neoplastic salivary gland tissue. Progesterone receptor expression may be of possible prognostic and therapeutic value in some cases of adenoid cystic carcinoma.

Adenoid cystic carcinoma in a juvenile male breast

Adenoid cystic carcinoma of the breast is uncommon and comprises less than 1% of all mammary cancers. Its occurrence in the male breast is very rare. We describe the first case of adenoid cystic carcinoma in a juvenile male breast. The patient is alive and well 2 1/2 yrs following subcutaneous mastectomy. The details of the 4 previously reported cases of the same tumor in male breasts are reviewed.