Microglandular Adenosis With Transition Into Adenoid Cystic Carcinoma of the Breast (original) (raw)
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MOH Journal of Medical Case Reports, 2024
Microglandular adenosis (MGA) is a benign breast tumor, but it is considered a non-obligate precursor to invasive breast carcinoma. MGA has a few different morphological variations, including microglandular adenosis (MGA), atypical microglandular adenosis (AMGA), and breast carcinoma-associated microglandular adenosis (BCMGA). Initially, with the identification of MGA, it was classified as a benign lesion; however, recent molecular studies have demonstrated an association between MGA, AMGA, and BCMGA. As a precancerous tumor, a definitive diagnosis of MGA is essential, including reporting the degree of atypia if present. We present the case of a 39-year-old woman whose routine mammogram revealed an irregular density, leading to her diagnosis of AMGA. We provide a brief review of the pertinent literature, including diagnosis, differential diagnosis, molecular studies, management, and outcome of MGA.
The American Journal of Surgical Pathology, 2008
Microglandular adenosis (MGA) of the breast is widely known as a benign lesion that can mimic invasive carcinoma. In situ and invasive carcinomas have been described as arising in MGA, but which cases of MGA will progress to carcinoma is unclear. Criteria for distinguishing uncomplicated MGA, MGA with atypia (AMGA), and carcinoma arising in MGA (MGACA) are not standardized. The primary objective of this study was to illustrate the clinical, histopathologic, and immunophenotypical characteristics of MGA, AMGA, and MGACA in an effort to provide criteria for distinguishing the 3 types. We retrospectively identified 108 cases seen at M.D. Anderson Cancer Center between 1983 and 2007 that had a diagnosis of MGA. Of the 108 cases, 65 cases had available material for review. Inclusion criteria were glands of MGA expressing S-100 protein and lacking myoepithelial layer (smooth muscle actin negative). Eleven out of 65 cases qualified to have an MGA component; myoepithelial layer was detected in the remaining 54 cases and were classified as adenosis. Out of the 11 MGA patients, there were 3 patients with uncomplicated MGA, 2 had AMGA, and 6 had MGACA. Staining indices for the cell cycle markers p53 and Ki-67 were used to compare the 3 tumor categories. Additional staining for other tumor markers [estrogen and progesterone receptors, HER2, epidermal growth factor receptor (EGFR), c-kit, CK5/6, and CK18] were performed. Patient demographics, tumor radiologic features, and clinical follow-up data were collected for all cases. Multiple invasive histologic components were identified in each of the MGACA cases. All invasive MGACAs had a duct-forming component. In addition, basal-like component was present in 2 cases, aciniclike in 2, matrix producing in 4, sarcomatoid in 1, and adenoid cystic in 1. All tumors had strong and diffuse CK8/ 18 and EGFR expression but no estrogen receptor, progesterone receptor, HER2 (ie, triple negative), or CK5/6 expression. C-kit was focally expressed in 2 of the MGACAs. Ki-67 and p53 labeling indices was <3% in all MGAs, 5% to 10% in the AMGAs, and >30% in MGACAs. In a follow-up ranging from 14 days to 8 years, none of the MGA cases recurred. One of the AMGA cases recurred as invasive carcinoma in a background of AMGA after 8 years following incomplete excision of the lesion. Three out of 6 MGACA cases (50%) required multiple consecutive resections ending up with mastectomy due to involved margins by invasive or in situ carcinoma. Two out of 6 MGACA cases (34%) developed metastasis and died of disease. Our data showed that Ki-67 and p53 expression, in conjunction with the morphologic features, could be a reliable marker to distinguish MGA from AMGA and MGACA. Although 11 tumors were only included in our study, 64% of the tumors were carcinomas arising in MGA. This high incidence of MGACA may not represent the actual frequency of MGAs progressing into carcinoma and is likely due to referral bias in our institution. Nonetheless, the high association of carcinoma with MGA necessitates complete excision of MGA to rule out invasion. Although all the MGACA cases were triple negative and express EGFR (basallike features), all the cases in our study showed a luminal type of differentiation by CK8/18 expression, indicating that MGACA may not fit well into the current proposed molecular classification of breast cancer.
Adenoid Cystic Carcinoma of the Breast
American Journal of Roentgenology, 2010
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.
Adenoid cystic carcinoma of breast: Recent advances
World Journal of Clinical Cases, 2014
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 ACC of the breast, as well as an overview of clinical, histopathological, and molecular genetic features.
Adenoid cystic carcinoma of the breast: A case report and literature review
Oncology Letters, 2014
Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the breast that occurs in <0.1% of all patients diagnosed with breast cancer. The mean patient age at the time of diagnosis is 50-60 years. Typically, the tumor presents as a subareolar mass or as pain in the breast. While the radiological appearances of ACC are generally non-specific, the diagnosis can be made on fine-needle aspiration cytology. In the present study, a 58-year-old female patient was admitted to the Department of Radiation Oncology (Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey) with complaints of pain in the upper outer quadrant of the right breast. An excision biopsy of a lump in the upper outer quadrant revealed ACC, and perineural invasion was present. Subsequently, the patient underwent breast conservation surgery and sentinel lymph node dissection. Pathology from the second surgery depicted ACC in the form of microscopic foci around the initial surgical cavity, with two reactive sentinel lymph nodes and the closest negative margin at 2 mm. The patient was treated with radiotherapy following the surgery. No recurrence and metastasis were found after 20 months of follow-up. In conclusion, mammary ACC is a rare malignant neoplasm of the breast. Although surgery is the main treatment, the optimal adjuvant treatment of ACC of the breast has not yet been determined due to its low incidence.
Adenoid Cystic Carcinoma of The breast: a Clinical Case Report
Medical Archives, 2016
Introduction: Adenoid cystic carcinoma (ACC) is an uncommon tumor of the breast, accounting for approximately 0.1% to 1% of all breast cancers. It is characterized by rare lymph node involvement and distant metastasis, and associated with a favorable prognosis with excellent survival, despite its triple-negative status. In the current state of knowledge, results of breast-conserving treatment with postoperative radiotherapy seem to be equivalent to mastectomy alone, with respect to survival for ACC of the breast. Due to its rarity, there is no consensus on optimal treatment for patients with ACC. Otherwise, the role of chemotherapy and hormonal therapy remains controversial. Further clinical studies are required to compare treatment options for ACC. But, a long-term follow-up is very important and mandatory for affected patients, due to the late onset of local relapse and occurrence of distant metastasis. Case report: Here, we report the case of a patient who presented with a palpable breast mass in the left breast that turned out to be an ACC of the breast.
Adenoid Cystic Carcinoma of Breast: A Rare Case Report
2018
Background: Adenoid cystic carcinoma (AdCC) of the breast is a rare type of invasive breast cancer, accounting for less than 1% of all breast cancer cases. It is usually a low-grade tumor that rarely metastasizes to the axillary lymph nodes and distant organs. AdCC of the breast is mostly negative for estrogen receptor, progesterone receptor, and HER2-neu. However, despite being triple-negative, it has favorable outcome, and patients with AdCC of the breast generally have a good to excellent long-term survival.Case presentation: Here we report a case of a 51-year-old female presenting with left breast mastalgia who was finally diagnosed with AdCC of the left breast. The patient underwent breast?conserving surgery and axillary staging followed by adjuvant chemoradiation.Conclusion: Because of the rarity of AdCC of the breast, it has been difficult to conduct prospective trials to determine the best treatment option. Different types of therapy, including BCS and mastectomy with or wit...
Primary Adenoid Cystic Carcinoma of the Breast
2013
Primary adenoid cystic carcinoma (ACC) of the breast is an uncommon histological form of breast cancer accounting for 0.1% of all mammary neoplasm. ACC of the breast has favorable prognosis, contrasting to the aggressive nature of the ACC at other sites like head and face especially salivary gland. It has a biological cancer of slow progression and near absence of lymph nodes metastasis. To date about 150 cases of ACC are reported in literature so far. We are presenting a case of adenoid cystic carcinoma in a 38 year old female presented with painless mass in right breast. ACC may mimic the most common form that is intraductal carcinoma on clinical, mammography and sonography. Accurate histopathological diagnosis is always warranted, in view of its rare nature but with favorable prognosis. We report this case due to its rarity with good prognostic value if proper and early diagnosed on histopathology. Article citation:-Nikumbh DB et al. Primary adenoid cystic carcinoma of the breast. Journal of pharmaceutical and biomedical sciences (J Pharm Biomed Sci.) 2013 June; 31(31): 1378-1380. Available at