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Pareja F, Bhargava R, Borges VF, Brogi E, Canas Marques R, Cardoso F, Desmedt C, Harigopal M, Lakhani SR, Lee A, Leone JP, Linden H, Lord CJ, Marchio C, Merajver SD, Rakha E, Reis-Filho JS, Richardson A, Sawyer E, Schedin P, Schwartz CJ, Tutt A, Ueno NT, Vincent-Salomon A, Weigelt B, Wen YH, Schnitt SJ, Oesterreich S. Unraveling complexity and leveraging opportunities in uncommon breast cancer subtypes. NPJ Breast Cancer 2025; 11:6. [PMID: 39856067 PMCID: PMC11760369 DOI: 10.1038/s41523-025-00719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 01/09/2025] [Indexed: 01/27/2025] Open
Abstract
Special histologic subtypes of breast cancer (BC) exhibit unique phenotypes and molecular profiles with diagnostic and therapeutic implications, often differing in behavior and clinical trajectory from common BC forms. Novel methodologies, such as artificial intelligence may improve classification. Genetic predisposition plays roles in a subset of cases. Uncommon BC presentations like male, inflammatory and pregnancy-related BC pose challenges. Emerging therapeutic strategies targeting genetic alterations or immune microenvironment are being explored.
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Affiliation(s)
- Fresia Pareja
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Virginia F Borges
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Edi Brogi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Malini Harigopal
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sunil R Lakhani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, and Pathology Queensland, Brisbane, QLD, Australia
| | - Adrian Lee
- Women's Cancer Research Center, Magee-Womens Research Institute, UPMC Hillmann Cancer Center, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jose Pablo Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Hannah Linden
- Division of Hematology and Oncology, Fred Hutchinson Cancer Center/University of Washington, Seattle, WA, USA
| | - Christopher J Lord
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Caterina Marchio
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sofia D Merajver
- Breast and Ovarian Cancer Risk Evaluation Program, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Emad Rakha
- Department of Pathology, School of Medicine, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jorge S Reis-Filho
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- AstraZeneca, Cambridge, UK
| | | | - Elinor Sawyer
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Guy's Cancer Centre, King's College London, London, UK
| | - Pepper Schedin
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Christopher J Schwartz
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Tutt
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Naoto T Ueno
- Breast Medical Oncology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Anne Vincent-Salomon
- Department of Pathology, Curie Institute, Paris Sciences Lettres University, Paris, France
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Y Hannah Wen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Steffi Oesterreich
- Women's Cancer Research Center, Magee-Womens Research Institute, UPMC Hillmann Cancer Center, Pittsburgh, PA, USA.
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.
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Alshwayyat S, Abu Al Hawa MB, Alshwayyat M, Alshwayyat TA, Sawan S, Heilat G, Hammouri HM, Mheid S, Al Shweiat B, Hanifa H. Personalized treatment strategies for breast adenoid cystic carcinoma: A machine learning approach. Breast 2025; 79:103878. [PMID: 39826386 PMCID: PMC11786111 DOI: 10.1016/j.breast.2025.103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 12/29/2024] [Accepted: 01/08/2025] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Breast adenoid cystic carcinoma (BACC) is a rare subtype of breast cancer that accounts for less than 0.1 % of all cases. This study was designed to assess the efficacy of various treatment approaches for BACC and to create the first web-based tool to facilitate personalized treatment decisions. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five Machine Learning (ML) algorithms to predict the 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of ML models. We also performed a Kaplan-Meier (K-M) survival analysis. RESULTS This study included 1212 patients. The median age was 60 years, with most tumors being localized and less than 2 cm in size. The 5-year overall survival (OS) rates were highest for surgery + radiotherapy (RT) (94.9 %) and lowest for surgery + chemotherapy (CTX) + RT (80.1 %). Positive estrogen receptor (ER) status and younger age were associated with better survival outcomes. ML models identified key predictive features for survival, including age, nodal status, and ER status. CONCLUSION Age, lymph node metastasis, and ER status are crucial prognostic indicators for BACC. Although postoperative RT enhances survival, the advantages of adjuvant CTX are uncertain, implying that it may be eschewed to avert adverse effects. Our online tool offers essential resources for prognostication and treatment optimization.
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Affiliation(s)
- Sakhr Alshwayyat
- King Hussein Cancer Center, Amman, Jordan; Princess Basma Teaching Hospital, Irbid, Jordan; Research Fellow, Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| | | | - Mustafa Alshwayyat
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan.
| | | | - Siya Sawan
- Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Ghaith Heilat
- Breast Oncoplastic and General Surgery, Department of General Surgery and Urology, Jordan University of Science & Technology, King Abdullah University Hospital, Irbid, Jordan.
| | - Hanan M Hammouri
- Department of Mathematics and Statistics, Faculty of Arts and Science, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sara Mheid
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan.
| | - Batool Al Shweiat
- Breast Imaging Fellow, Department of Radiology, King Hussein Cancer Center, Amman, Jordan.
| | - Hamdah Hanifa
- Faculty of Medicine, University of Kalamoon, Al_Nabk, Syria.
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3
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Lee SM, Jang BS, Park W, Kim YB, Song JH, Kim JH, Kim TH, Kim IA, Lee JH, Ahn SJ, Kim K, Chang AR, Kwon J, Park HJ, Shin KH. Locoregional Recurrence in Adenoid Cystic Carcinoma of the Breast: A Retrospective, Multicenter Study (KROG 22-14). Cancer Res Treat 2025; 57:150-158. [PMID: 38993091 PMCID: PMC11729329 DOI: 10.4143/crt.2024.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/11/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE This study aims to evaluate the treatment approaches and locoregional patterns for adenoid cystic carcinoma (ACC) in the breast, which is an uncommon malignant tumor with limited clinical data. MATERIALS AND METHODS A total of 93 patients diagnosed with primary ACC in the breast between 1992 and 2022 were collected from multi-institutions. All patients underwent surgical resection, including breast-conserving surgery (BCS) or total mastectomy (TM). Recurrence patterns and locoregional recurrence-free survival (LRFS) were assessed. RESULTS Seventy-five patients (80.7%) underwent BCS, and 71 of them (94.7%) received post-operative radiation therapy (PORT). Eighteen patients (19.3%) underwent TM, with five of them (27.8%) also receiving PORT. With a median follow-up of 50 months, the LRFS rate was 84.2% at 5 years. Local recurrence (LR) was observed in five patients (5.4%) and four cases (80%) of the LR occurred in the tumor bed. Three of LR (3/75, 4.0%) had a history of BCS and PORT, meanwhile, two of LR (2/18, 11.1%) had a history of mastectomy. Regional recurrence occurred in two patients (2.2%), and both cases had a history of PORT with (n=1) and without (n=1) irradiation of the regional lymph nodes. Partial breast irradiation (p=0.35), BCS (p=0.96) and PORT in BCS group (p=0.33) had no significant association with LRFS. CONCLUSION BCS followed by PORT was the predominant treatment approach for ACC of the breast and LR mostly occurred in the tumor bed. The findings of this study suggest that partial breast irradiation might be considered for PORT in primary breast ACC.
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Affiliation(s)
- Sang Min Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Tae Hyun Kim
- Department of Radiation Oncology, Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Schwartz CJ, Krings G. Salivary gland-like tumors of the breast: Histopathologic and genetic features with clinical implications. Semin Diagn Pathol 2024; 41:272-284. [PMID: 39389890 DOI: 10.1053/j.semdp.2024.10.003] [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: 10/01/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024]
Abstract
Salivary gland-like tumors of the breast are rare neoplasms that share morphologic, immunophenotypic, and/or genetic features with their salivary gland counterparts, highlighting a shared underlying histopathogenesis in most cases. Salivary gland-like carcinomas included in the World Health Organization classification of breast tumors are adenoid cystic carcinoma, secretory carcinoma, mucoepidermoid carcinoma, acinic cell carcinoma, and the exceedingly rare polymorphous adenocarcinoma. These carcinomas are usually triple negative for estrogen receptor and progesterone receptor expression and HER2 overexpression, yet generally have favorable prognosis, in contrast to high-grade triple negative carcinomas of no special type. On the other hand, a small subset, such as solid-basaloid adenoid cystic carcinoma, rare high-grade carcinomas, and those associated with transformation to other types of high-grade invasive carcinoma can behave more aggressively. Other salivary gland-like tumors of the breast, such as pleomorphic adenoma and adenomyoepithelioma, are usually benign but can rarely undergo malignant transformation. Although clinical experience with salivary gland-like breast tumors is overall limited, their recognition and accurate classification has important implications for prognosis and clinical management, especially to avoid overtreatment of salivary gland-like carcinomas. The identification of characteristic genetic alterations and/or immunohistochemical surrogates in many of these tumors has practical applications to establishing an accurate diagnosis and directing clinical management. This review highlights the histopathologic and genetic characteristics of salivary gland-like breast tumors and the implications of the diagnosis for current clinical management.
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Affiliation(s)
- Christopher J Schwartz
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gregor Krings
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
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Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, Cardoso MJ, Carey LA, Dawood S, Del Mastro L, Denkert C, Fallenberg EM, Francis PA, Gamal-Eldin H, Gelmon K, Geyer CE, Gnant M, Guarneri V, Gupta S, Kim SB, Krug D, Martin M, Meattini I, Morrow M, Janni W, Paluch-Shimon S, Partridge A, Poortmans P, Pusztai L, Regan MM, Sparano J, Spanic T, Swain S, Tjulandin S, Toi M, Trapani D, Tutt A, Xu B, Curigliano G, Harbeck N. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:159-182. [PMID: 38101773 DOI: 10.1016/j.annonc.2023.11.016] [Citation(s) in RCA: 147] [Impact Index Per Article: 147.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- S Loibl
- GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Cancer Campus, Villejuif
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - C H Barrios
- Oncology Department, Latin American Cooperative Oncology Group and Oncoclínicas, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet and Breast Cancer Centre, Karolinska Comprehensive Cancer Centre and University Hospital, Stockholm, Sweden
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Foundation, Champalimaud Cancer Centre, Lisbon; Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - L A Carey
- Division of Medical Oncology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Dawood
- Department of Oncology, Mediclinic City Hospital, Dubai, UAE
| | - L Del Mastro
- Medical Oncology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Internal Medicine and Medical Specialities, School of Medicine, University of Genoa, Genoa, Italy
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Giessen and Marburg, Marburg
| | - E M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Gamal-Eldin
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - K Gelmon
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
| | - C E Geyer
- Department of Internal Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA
| | - M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Oncology 2 Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Martin
- Hospital General Universitario Gregorio Maranon, Universidad Complutense, GEICAM, Madrid, Spain
| | - I Meattini
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence; Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy
| | - M Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Janni
- Department of Obstetrics and Gynaecology, University of Ulm, Ulm, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - A Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - L Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - J Sparano
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - S Swain
- Medicine Department, Georgetown University Medical Centre and MedStar Health, Washington, USA
| | - S Tjulandin
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - M Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Japan
| | - D Trapani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Tutt
- Breast Cancer Research Division, The Institute of Cancer Research, London; Comprehensive Cancer Centre, Division of Cancer Studies, Kings College London, London, UK
| | - B Xu
- Department of Medical Oncology, National Cancer Centre/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Centre, Department of Obstetrics & Gynaecology and Comprehensive Cancer Centre Munich, LMU University Hospital, Munich, Germany
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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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Shamir ER, Bean GR, Schwartz CJ, Vohra P, Wang A, Allard GM, Wolsky RJ, Garcia JJ, Chen YY, Krings G. Solid-Basaloid Adenoid Cystic Carcinoma of the Breast: An Aggressive Subtype Enriched for Notch Pathway and Chromatin Modifier Mutations With MYB Overexpression. Mod Pathol 2023; 36:100324. [PMID: 37660928 DOI: 10.1016/j.modpat.2023.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/14/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
Adenoid cystic carcinoma (AdCC) is a rare triple-negative breast cancer analogous to its extramammary counterparts. Diagnosis of the more aggressive solid-basaloid variant of AdCC (SB-AdCC) can be challenging due to poorly defined histopathologic and molecular features. We characterized 22 invasive and in situ basaloid carcinomas by morphology, immunohistochemistry, genetics, and MYB status using multiple platforms and assessed clinical behavior and neoadjuvant chemotherapy responses. After consensus review, 16/22 cases were classified as SB-AdCC. All SB-AdCC had predominantly solid growth and at least focal myxohyaline stroma and were immune-poor. Eosinophilic squamoid cells (69%, 11/16) and basement membrane-like secretions (69%, 11/16) were common, and intercalated ducts (31%, 5/16) were less frequent. SB-AdCC typically expressed SOX10 (100%, 16/16) and luminal markers (100%, 16/16 CK7; 88%, 14/16 CD117; 93%, 13/14 CAM5.2). SMA (40%, 6/15) expression was less common, and SMM (27%, 3/11), GATA3 (20%, 3/15), and p63 (25%, 4/16) were mostly negative. MYB protein and/or MYB RNA overexpression was universal in evaluable cases (13/13), with RNA in situ hybridization (10/10) more reliable than immunohistochemistry (10/11, plus 4 excisions inconclusive). Fluorescence in situ hybridization and/or next-generation sequencing identified MYB rearrangements (20%, 3/15) and amplifications/copy gains (60%, 9/15) but no MYB::NFIB fusions. SB-AdCC often had aberrations in Notch pathway (60%, including 40% NOTCH1 and 20% NOTCH2) and/or chromatin modifier (60%, including 33% CREBBP) genes, with relatively infrequent TP53 mutations (27%). Unclassified invasive basaloid carcinomas lacking described histologic features of SB-AdCC (n = 4) and basaloid ductal carcinoma in situ (n = 2) showed similar immunoprofiles and genetics as SB-AdCC, including Notch aberrations and MYB overexpression with MYB rearrangements/amplifications. Overall, nodal (22%) and distant (33%) metastases were common, and 23% of patients died of disease (mean follow-up, 35 months; n = 22). Responses were poor in all 7 neoadjuvant chemotherapy-treated patients, without any achieving pathologic complete response. The data highlight the histopathologic spectrum of basaloid carcinomas including SB-AdCC and reveal shared genetics and MYB activation, which can be diagnostically useful. Aggressive behavior and poor treatment responses emphasize a need for additional treatment approaches.
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Affiliation(s)
- Eliah R Shamir
- Department of Pathology, University of California San Francisco, San Francisco, California; Department of Pathology, Genentech, Inc, South San Francisco, California
| | - Gregory R Bean
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Christopher J Schwartz
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Poonam Vohra
- Department of Pathology, University of California San Francisco, San Francisco, California; Department of Pathology, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Aihui Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Grace M Allard
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Rebecca J Wolsky
- Department of Pathology, Zuckerberg San Francisco General Hospital, San Francisco, California; Department of Pathology, University of Colorado, Aurora, Colorado
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Gregor Krings
- Department of Pathology, University of California San Francisco, San Francisco, California.
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8
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Khoury T, Rosa M, Nayak A, Karabakhtsian R, Fadare O, Li Z, Turner B, Fang Y, Kumarapeli A, Li X, Numbere N, Villatoro T, Wang JG, Sadeghi S, Attwood K, George A, Bhargava R. Clinicopathologic Predictors of Clinical Outcomes in Mammary Adenoid Cystic Carcinoma: A Multi-institutional Study. Mod Pathol 2023; 36:100006. [PMID: 36853781 PMCID: PMC10952059 DOI: 10.1016/j.modpat.2022.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
Adenoid cystic carcinoma (AdCC) is an uncommon type of invasive breast carcinoma with a favorable prognosis. However, some cases are aggressive. The study aims to define the clinicopathologic predictors of outcome. Clinical, radiological, and pathologic variables were recorded for 76 AdCC cases from 11 institutions. The following histologic characteristics were evaluated by the breast pathologist in each respective institution, including Nottingham grade (NG), percentages of various growth patterns (solid, cribriform, trabecular-tubular), percentage of basaloid component, tumor borders (pushing, infiltrative), perineural invasion, lymphovascular invasion, necrosis, and distance from the closest margin. Various grading systems were evaluated, including NG, salivary gland-type grading systems, and a new proposed grading system. The new grading system incorporated the growth pattern (percent solid, percent cribriform), percent basaloid morphology, and mitotic count using the Youden index criterion. All variables were correlated with recurrence-free survival. Nineteen (25%) women developed local and/or distant recurrence. Basaloid morphology (≥25% of the tumor) was identified in 20 (26.3%) cases and a solid growth pattern (using ≥60% cutoff) in 22 (28.9%) cases. In the univariate analysis, the following variables were significantly correlated with worse recurrence-free survival: solid growth pattern, basaloid morphology, lymphovascular invasion, necrosis, perineural invasion, and pN-stage. In the multivariate analysis including basaloid morphology, pN-stage, lymphovascular invasion, and perineural invasion, basaloid morphology was statistically significant, with a hazard ratio of 3.872 (95% CI, 1.077; 13.924; P =.038). The NG and the new grading system both correlated with recurrence-free survival. However, grade 2 had a similar risk as grade 3 in the NG system and a similar risk as grade 1 in the new grading system. For solid growth patterns and basaloid morphology, using a 2-tier system with 1 cutoff was better than a 3-tier system with 2 cutoffs. Basaloid morphology and solid growth pattern have prognostic values for AdCC, with a 2-tier grading system performing better than a 3-tier system.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York.
| | - Marilin Rosa
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Anupma Nayak
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rouzan Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego Health, La Jolla, California
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bradley Turner
- Department of Pathology, University of Rochester, Rochester, New York
| | - Yisheng Fang
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Asangi Kumarapeli
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Xiaoxian Li
- Department of Pathology, Emory University, Atlanta, Georgia
| | - Numbereye Numbere
- Department of Pathology, University of Rochester, Rochester, New York
| | - Tatiana Villatoro
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women Hospital, Pittsburgh, Pennsylvania
| | - Ji-Gang Wang
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Saed Sadeghi
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Anthony George
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women Hospital, Pittsburgh, Pennsylvania
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9
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Wagner VP, Ferrarotto R, Vargas PA, Martins MD, Bingle CD, Bingle L. Drug-based therapy for advanced adenoid cystic carcinoma: Current landscape and challenges based on an overview of registered clinical trials. Crit Rev Oncol Hematol 2023; 181:103886. [PMID: 36427771 DOI: 10.1016/j.critrevonc.2022.103886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) has a significant patient-population in need of effective systemic therapy, as no drug is currently approved by the FDA for its management. We critically reviewed ACC-clinical trials (CT) registered on the ClinicalTrials.gov website using "ACC" under condition or disease. Trials specifically designed to test a drug-based therapy for ACC (n = 33) were analyzed with most being one-arm phase II trials enrolling advanced, recurrent/metastatic, incurable ACC cases. Site restriction, maximum ECOG status, and period of disease progression varied as inclusion criteria. Small-molecule inhibitors were those most commonly investigated with Apatinib, Axitinib and Lenvatinib showing the best results in association with rigid enrollment criteria. The overall median time to progression remains modest and more efforts are urgently needed in this field. CTs designed to test drugs that act on key pathways associated with ACC aggressiveness are being conducted and represent a promising pathway if efficacy is proved.
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Affiliation(s)
- Vivian Petersen Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Renata Ferrarotto
- Department of Thoracic Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Manoela Domingues Martins
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil; Oral Pathology Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin D Bingle
- Academic Unit of Respiratory Medicine, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Lynne Bingle
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
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10
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Guldogan N, Esen G, Kayadibi Y, Taskin F, Alfatli AO, Boy FNS, Balci P, Bugdayci O, Tokat F, Ozturk T, Tunaci M, Arikan AE. Adenoid Cystic Carcinoma of the Breast: Multimodality Imaging Findings and Review of the Literature. Acad Radiol 2022; 30:1107-1117. [PMID: 36357304 DOI: 10.1016/j.acra.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/25/2022] [Accepted: 10/01/2022] [Indexed: 11/09/2022]
Abstract
RATIONALE AND OBJECTIVES Adenoid cystic carcinoma (ACC) of the breast is a rare type of breast cancer with favorable prognosis. There is limited data on the radiological findings of this rare tumor in literature. The aim of this study is to determine the most common imaging features and review the literature. MATERIALS AND METHODS Pathological databases of seven institutions from 2009 to 2021 were retrospectively reviewed, and patients with a diagnosis of ACC of the breast were determined. Thirteen patients whose imaging studies could be recalled from the picture archiving systems (PACS) were included in the study. Clinical and pathological findings as well as follow-up data were recorded. Radiological findings were analyzed and categorized based on BI-RADS 5th edition. RESULTS There were 16 mass lesions in 13 patients (two multifocal cases, one case with recurrence). Mammography demonstrated 14 masses, while ultrasound (US) demonstrated all. MRI was available in only seven cases, with eight masses. The most common findings were round or oval shape on all modalities (78.57%-93.75%). Other frequent findings were parallel orientation (81.25%), isoechoic or hyperechoic echogenicity (62.5%), high T2 signal (87.5%), restricted diffusion (71.43%), and homogeneous enhancement (62.5%). Mammography, US and MRI showed circumscribed margins resembling a benign lesion in 35.71%, 37.5% and 50% of the lesions respectively. Three patients had a cyst-like echogenicty on US. Half of the lesions were avascular on Doppler US (6/12) and half were soft (2/4) on strain elastography. Although there were benign features on all imaging modalities seperately, all lesions could be categorized as BI-RADS 4 or 5 when the findings were combined. However 9/16 masses were BI-RADS 4A, emphasizing the subtlety of the malignant features. CONCLUSION ACC of the breast can present with findings resembling a benign lesion on different imaging modalities. Although combination of all imaging findings correctly indicated the suspicious nature of the lesions in all cases, final classification was BI-RADS 4A in most of them. Radiologists should be aware of the more frequent findings of ACC of the breast for early diagnosis. US findings of isoechoic or hyperechoic appearance, and cyst-like echogenicity have not been reported previously in literature.
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11
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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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12
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Yang L, Wang C, Liu M, Wang S. Evaluation of Adjuvant Treatments for Adenoid Cystic Carcinoma of the Breast: A Population-Based, Propensity Score Matched Cohort Study from the SEER Database. Diagnostics (Basel) 2022; 12:diagnostics12071760. [PMID: 35885663 PMCID: PMC9324850 DOI: 10.3390/diagnostics12071760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is an extremely rare type of breast cancer. The role of adjuvant treatments for ACC remains controversial. Patients with a histology-confirmed diagnosis of ACC of the breast were identified based on the SEER (Surveillance, Epidemiology and End Results) database. Propensity score matching (PSM) was performed to balance the baseline characteristics. The Kaplan–Meier method and Cox regression models were performed to determine the impact of the adjuvant chemotherapy (CT) and radiotherapy (RT) associated with breast cancer-specific survival (BCSS) and overall survival (OS). A total of 1036 patients with ACC of the breast were included. After a median follow-up of 11.3 years, the 10-year OS and BCSS rate was 76.2% and 92.6%, respectively. After PSM, adjuvant CT converted into neither OS (Log-rank p = 1.000) nor BCSS (Log-rank p = 0.900) benefits in patients with ACC of the breast. Adjuvant RT also did not improve OS (Log-rank p = 0.060) and BCSS (Log-rank p = 0.400). According to the univariate stratified analysis, adjuvant RT was favorable for OS in patients who underwent breast-conserving surgery (HR 0.66, 95% CI 0.45, 0.99, p = 0.042). From the multivariate analysis, histology grade and nodal status were independent prognostic factors for both OS and BCSS. In conclusion, ACC of the breast presented a favorable prognosis. Adjuvant treatment, especially adjuvant CT, might not be essential for patients with this disease.
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Affiliation(s)
| | | | - Miao Liu
- Correspondence: (M.L.); (S.W.); Tel.: +86-1088324010 (M.L.); +86-1088324011 (S.W.)
| | - Shu Wang
- Correspondence: (M.L.); (S.W.); Tel.: +86-1088324010 (M.L.); +86-1088324011 (S.W.)
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13
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Butcher MR, White MJ, Rooper LM, Argani P, Cimino-Mathews A. MYB RNA In Situ Hybridization Is a Useful Diagnostic Tool to Distinguish Breast Adenoid Cystic Carcinoma From Other Triple-negative Breast Carcinomas. Am J Surg Pathol 2022; 46:878-888. [PMID: 35522890 DOI: 10.1097/pas.0000000000001913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Breast adenoid cystic carcinoma (AdCC) has overlapping features with basal-like triple-negative breast carcinoma (TNBC), yet carries a more favorable prognosis, and accurate diagnosis is critical. Like salivary gland AdCC, breast AdCC demonstrates recurrent alterations in the MYB gene. Novel chromogenic RNA in situ hybridization (ISH) for MYB has emerged as sensitive and specific for salivary gland AdCC. Here, we evaluate MYB RNA ISH in invasive ductal carcinomas (IDCs) including basal-like TNBC, and in the histologic mimics ductal carcinoma in situ (DCIS) and collagenous spherulosis. MYB RNA ISH was also performed on previously constructed tissue microarrays containing 78 evaluable IDC, including 30 basal-like TNBC (EGFR+ and/or CK5/6+), 19 luminal A (ER+/HER-2-), 12 HER-2+ (ER-/HER-2+), 11 non-basal-like TNBC, and 6 luminal B (ER+/HER-2+). MYB RNA ISH overexpression was seen in 100% (n=18/18) of primary breast AdCC and 10% (n=8/78) of IDC (P<0.0001). MYB RNA ISH was overexpressed in 37% (n=7/19) of luminal A and 8% (n=1/12) of HER-2+ IDC, and in no cases of TNBC or luminal B IDC. The majority (67%, n=8/12) of DCIS and all (n=7) cases of collagenous spherulosis demonstrated overexpression of MYB RNA. MYB gene rearrangement was detected in 67% (n=4/6) evaluable AdCC. Although MYB RNA ISH overexpression cannot be used to distinguish between cribriform DCIS or collagenous spherulosis and AdCC, MYB RNA ISH is absent in basal-like TNBC and rare in ER+ or HER-2+ IDC. MYB RNA ISH could be a useful, sensitive, and rapid diagnostic adjunct in the workup of a triple-negative carcinoma in the breast.
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Affiliation(s)
| | | | | | - Pedram Argani
- Departments of Pathology
- Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashley Cimino-Mathews
- Departments of Pathology
- Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
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14
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Zhang M, Liu Y, Yang H, Jin F, Zheng A. Breast adenoid cystic carcinoma: a report of seven cases and literature review. BMC Surg 2022; 22:113. [PMID: 35331206 PMCID: PMC8953026 DOI: 10.1186/s12893-022-01560-9] [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: 12/13/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Primary adenoid cystic carcinoma (ACC) of breast is rarely seen clinically. It is a special subtype of triple-negative breast cancer characterized by low expression of Ki-67, low malignant potential, slow progression and favorable prognosis. To date, treatment for this disease is controversial and no consensus is reached. We analyzed clinical manifestations and pathological characteristics of seven primary breast ACC cases and reported in combination with literature review to promote understanding, diagnosis and treatment of this disease. Case presentation We collected seven breast ACC cases pathologically diagnosed and treated in Department of breast surgery of the First Affiliated Hospital of China Medical University from January 2015 to December 2018. We organized and summarized the clinical, imaging, pathological and prognostic information and performed statistical analysis. The median age was 60 years (ranging from 54 to 64 years). Tumors of all patients were detected by immunohistochemistry. Molecular types were mostly triple negative (4/7), and Ki-67 expression was low (5/7). Lymph node metastases were absent in all patients received axillary lymph node surgery. Median follow-up time was 39 months (ranging from 25 to 68 months). There was no occurrence of relapse, distant metastasis or death. Conclusion Breast ACC is accompanied with favorable diagnosis, which is different from typical triple-negative breast cancer. Accurate diagnosis of ACC is particularly important.
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Affiliation(s)
- Meilin Zhang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Burn Plastic Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Yanbiao Liu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongguang Yang
- Department of Burn Plastic Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Feng Jin
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Ang Zheng
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
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15
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Fusco N, Sajjadi E, Venetis K, Ivanova M, Andaloro S, Guerini-Rocco E, Montagna E, Caldarella P, Veronesi P, Colleoni M, Viale G. Low-risk triple-negative breast cancers: Clinico-pathological and molecular features. Crit Rev Oncol Hematol 2022; 172:103643. [PMID: 35217131 DOI: 10.1016/j.critrevonc.2022.103643] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 12/18/2022] Open
Abstract
Triple-negative breast cancers (TNBC) comprise biologically and clinically heterogeneous diseases characterized by the lack of hormone receptors (HR) and HER2 expression. This subset of tumors accounts for 15-20% of all breast cancers and pursues an ominous clinical course. However, there is a spectrum of low-risk TNBCs with no/minimal metastatic potential, including the salivary gland-type tumors, those with extensive apocrine differentiation and/or high tumor-infiltrating lymphocytes, and small-sized, early-stage (pT1a/bN0M0) TNBCs. De-escalating the treatment in low-risk TNBC, however, is not trivial because of the substantial lack of dedicated randomized clinical trials and cancer registries. The development of new diagnostic and/or prognostic biomarkers based on clinical and molecular aspects of low-risk TNBCs would lead to improved clinical treatment. Here, we sought to provide a portrait of the clinicopathological and molecular features of low-risk TNBC, with a focus on the diagnostic challenges along with the most important biological characteristics underpinning their favorable clinical course.
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Affiliation(s)
- Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy.
| | - Elham Sajjadi
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Mariia Ivanova
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Silvia Andaloro
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Emilia Montagna
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Pietro Caldarella
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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16
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The clinical behavior and genomic features of the so-called adenoid cystic carcinomas of the solid variant with basaloid features. Mod Pathol 2022; 35:193-201. [PMID: 34599282 PMCID: PMC9197148 DOI: 10.1038/s41379-021-00931-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 01/17/2023]
Abstract
Classic adenoid cystic carcinomas (C-AdCCs) of the breast are rare, relatively indolent forms of triple negative cancers, characterized by recurrent MYB or MYBL1 genetic alterations. Solid and basaloid adenoid cystic carcinoma (SB-AdCC) is considered a rare variant of AdCC yet to be fully characterized. Here, we sought to determine the clinical behavior and repertoire of genetic alterations of SB-AdCCs. Clinicopathologic data were collected on a cohort of 104 breast AdCCs (75 C-AdCCs and 29 SB-AdCCs). MYB expression was assessed by immunohistochemistry and MYB-NFIB and MYBL1 gene rearrangements were investigated by fluorescent in-situ hybridization. AdCCs lacking MYB/MYBL1 rearrangements were subjected to RNA-sequencing. Targeted sequencing data were available for 9 cases. The invasive disease-free survival (IDFS) and overall survival (OS) were assessed in C-AdCC and SB-AdCC. SB-AdCCs have higher histologic grade, and more frequent nodal and distant metastases than C-AdCCs. MYB/MYBL1 rearrangements were significantly less frequent in SB-AdCC than C-AdCC (3/14, 21% vs 17/20, 85% P < 0.05), despite the frequent MYB expression (9/14, 64%). In SB-AdCCs lacking MYB rearrangements, CREBBP, KMT2C, and NOTCH1 alterations were observed in 2 of 4 cases. SB-AdCCs displayed a shorter IDFS than C-AdCCs (46.5 vs 151.8 months, respectively, P < 0.001), independent of stage. In summary, SB-AdCCs are a molecularly heterogeneous but clinically aggressive group of tumors. Less than 25% of SB-AdCCs display the genomic features of C-AdCC. Defining whether these tumors represent a single entity or a collection of different cancer types with a similar basaloid histologic appearance is warranted.
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17
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Accardo G, Capobianco AM, Torre GL, Thodas A, Marino G, Sisti LG, Vita G. Adenoid cystic carcinoma of the breast and intraoperative electron radiotherapy: single case report and review of literature. Future Oncol 2021; 18:871-881. [PMID: 34904444 DOI: 10.2217/fon-2021-0860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a very rare neoplasm. It presents a triple-negative phenotype in most cases, but its prognosis is generally considered to be better than other breast cancers with the same immunohistochemical pattern. Due to its controversial features, no data are available in the literature regarding a consensus approach for ACC treatment, especially for subtypes with worse prognosis like solid basaloid ACC. We present for the first time a rare case of ACC with multifocal presentation treated with breast-conservative surgery and intraoperative electron radiotherapy, thus supporting this treatment of ACC in selected patients like young women affected by the solid basaloid variant who commonly present a worse prognosis. In this case, no local or systemic recurrence was detected after 30 months of follow-up.
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Affiliation(s)
- Giuseppe Accardo
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Alba Ml Capobianco
- Head of Multidisciplinary Oncology Unit, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Giuseppe La Torre
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Alexios Thodas
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Graziella Marino
- Department of Breast Surgery, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
| | - Leuconoe Grazia Sisti
- Center for Global Health Research and studies and Department of Public Health, Section of Hygiene, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Giulia Vita
- Department of Pathology, Centro di riferimento oncologico della Basilicata (IRCCS-CROB), 85028, Rionero in Vulture (PZ), Italy
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18
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Li JX, Zhang XM, Xiao YX, Tang ZM, Huang T, Ming J. Male Adenoid Cystic Carcinoma of the Breast. J Med Cases 2021; 12:503-510. [PMID: 34970375 PMCID: PMC8683108 DOI: 10.14740/jmc3790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) of the breast, a rare malignancy that makes up less than 0.1% of all breast malignancies, is much rarer in males than in females. Due to the rarity of this disease, an optimal treatment strategy for male breast ACC has not been established, and therapy for male patients is currently based on guidelines for female patients. According to previous reported cases, some authors believe that male breast ACC may have higher invasive potential than female breast ACC and the prognoses in male patients may be worse than those in female patients. Therefore, a more proactive diagnosis and treatment regimen may be required. However, the clinical feature of our case is inconsistent with this view. Herein we report the case of a 24-year-old male without any antecedent medical or family history who presented with a slow-growing lump on his left chest wall for 5 years. The patient initially underwent lumpectomy, and the mass was pathologically diagnosed as breast ACC. Systemic examination was performed, and no evidence of distant metastasis was found. Then, he received modified radical mastectomy and ipsilateral axillary lymph node dissection. The mastectomy pathological examination revealed that no cancerous tissue was detected around the primary tumor bed, and all 22 axillary lymph nodes were negative. The patient did not receive postoperative chemotherapy, radiotherapy or endocrine therapy and remained well after 28 months of follow-up. In this study, we review the literature and summarize the clinical manifestations, imaging and histopathological characteristics, treatments and outcomes of male breast ACC. We share our experience in the hopes that this evidence will aid in the development of better therapeutics.
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Affiliation(s)
- Jie Xiao Li
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Xi Meng Zhang
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yun Xiao Xiao
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Zi Mei Tang
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
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Cserni G, Quinn CM, Foschini MP, Bianchi S, Callagy G, Chmielik E, Decker T, Fend F, Kovács A, van Diest PJ, Ellis IO, Rakha E, Tot T. Triple-Negative Breast Cancer Histological Subtypes with a Favourable Prognosis. Cancers (Basel) 2021; 13:5694. [PMID: 34830849 PMCID: PMC8616217 DOI: 10.3390/cancers13225694] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
Triple-negative breast cancers (TNBC), as a group of tumours, have a worse prognosis than stage-matched non-TNBC and lack the benefits of routinely available targeted therapy. However, TNBC is a heterogeneous group of neoplasms, which includes some special type carcinomas with a relatively indolent course. This review on behalf of the European Working Group for Breast Screening Pathology reviews the literature on the special histological types of BC that are reported to have a triple negative phenotype and indolent behaviour. These include adenoid cystic carcinoma of classical type, low-grade adenosquamous carcinoma, fibromatosis-like metaplastic carcinoma, low-grade mucoepidermoid carcinoma, secretory carcinoma, acinic cell carcinoma, and tall cell carcinoma with reversed polarity. The pathological and known molecular features as well as clinical data including treatment and prognosis of these special TNBC subtypes are summarised and it is concluded that many patients with these rare TNBC pure subtypes are unlikely to benefit from systemic chemotherapy. A consensus statement of the working group relating to the multidisciplinary approach and treatment of these rare tumour types concludes the review.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, University of Szeged, 6725 Szeged, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | - Cecily M. Quinn
- Department of Histopathology, BreastCheck, Irish National Breast Screening Programme & St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Maria Pia Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, 40139 Bologna, Italy;
| | - Simonetta Bianchi
- Department of Health Sciences, Division of Pathological Anatomy, University of Florence, 50134 Florence, Italy;
| | - Grace Callagy
- Discipline of Pathology, School of Medicine, National University of Ireland Galway, H91 TK33 Galway, Ireland;
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Thomas Decker
- Department of Surgical Pathology, Dietrich Bonhoeffer Medical Centre, 17036 Neubrandenburg, Germany;
- Reference Centre for Mammography Münster, University Hospital Münster, 48149 Münster, Germany
- Reference Center for Mammography, 10623 Berlin, Germany
| | - Falko Fend
- Department of Pathology, University of Tübingen, 72076 Tübingen, Germany;
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41 345 Gothenburg, Sweden;
| | - Paul J. van Diest
- Department of Pathology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Ian O. Ellis
- Department of Histopathology, University of Nottingham and The Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham NG5 1PB, UK; (I.O.E.); (E.R.)
| | - Emad Rakha
- Department of Histopathology, University of Nottingham and The Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham NG5 1PB, UK; (I.O.E.); (E.R.)
| | - Tibor Tot
- Pathology & Cytology Dalarna, Falun County Hospital, 791 82 Falun, Sweden;
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20
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An JK, Woo JJ, Kim EK, Kwak HY. Breast adenoid cystic carcinoma arising in microglandular adenosis: A case report and review of literature. World J Clin Cases 2021; 9:7579-7587. [PMID: 34616829 PMCID: PMC8464440 DOI: 10.12998/wjcc.v9.i25.7579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/13/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast adenoid cystic carcinoma (AdCC) is a rare invasive carcinoma composed of epithelial and myoepithelial cells. Microglandular adenosis (MGA) is a rare benign proliferative lesion consisting of small, uniform, and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer. MGA may progress to atypical MGA and carcinoma arising in MGA. Among various invasive carcinomas from MGA, AdCC has been rarely reported. Here, we report a case of AdCC arising in MGA.
CASE SUMMARY A 59-year-old woman was diagnosed with a newly developed density on a routine mammogram. The density was similar to or slightly lower than that of the breast parenchyma. Sonography showed an irregular mass with a slightly higher echo than that of fat. Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma. The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern. Microscopically, the tumor was composed of invasive AdCC, in situ AdCC, and MGA. AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets, or haphazardly scattered small cribriform or tubular glands. MGA showed small glands with a single epithelial lining and retained lumen. S-100 staining was strongly positive in MGA area. The patient underwent breast-conserving surgery with sentinel lymph node biopsy.
CONCLUSION Breast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.
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Affiliation(s)
- Jin Kyung An
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Jeong Joo Woo
- Department of Radiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Eun Kyung Kim
- Department of Pathology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
| | - Hee Yong Kwak
- Department of Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, South Korea
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21
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Trapani D, Giugliano F, Uliano J, Zia VAA, Marra A, Viale G, Ferraro E, Esposito A, Criscitiello C, D'amico P, Curigliano G. Benefit of adjuvant chemotherapy in patients with special histology subtypes of triple-negative breast cancer: a systematic review. Breast Cancer Res Treat 2021; 187:323-337. [PMID: 34043122 DOI: 10.1007/s10549-021-06259-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Breast cancer (BC) is a leading cause of morbidity, disability, and mortality in women, worldwide; triple-negative BC (TNBC) is a subtype traditionally associated with poorer prognosis. TNBC special histology subtypes present distinct clinical and molecular features and sensitivity to antineoplastic treatments. However, no consensus has been defined on the best adjuvant therapy. The aim of the review is to study the evidence from literature to inform the choice of adjuvant treatments in this setting. METHODS We systematically searched literature assessing the benefit of adjuvant chemotherapy in patients with TNBC special histotypes (PROSPERO: CRD42020153818). RESULTS We screened 6404 records (15 included). All the studies estimated the benefit of different chemotherapy regimens, in retrospective cohorts (median size: 69 patients (range min-max: 17-5142); median follow-up: 51 months (range: 21-268); mostly in Europe and USA). In patients with early-stage adenoid cystic TNBC, a marginal role of chemotherapy was reported. Similar for apocrine TNBC. Medullary tumors exhibited an intrinsic good prognosis with a limited role of chemotherapy, suggested to be modulated by the presence of tumor-infiltrating lymphocytes. A significant impact of chemotherapy on the overall survival was estimated in patients with metaplastic TNBC. Limitations were related to the retrospective design of all the studies and heterogeneous treatments received by the patients. CONCLUSIONS There is potential opportunity to consider treatment de-escalation and less intense therapies in some patients with early, special histology-type TNBC. International efforts are indispensable to validate prospective clinical decision models.
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Affiliation(s)
- D Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Giugliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - J Uliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - V A A Zia
- Division of Medical Oncology, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04037-004, Brazil
| | - A Marra
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Viale
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - E Ferraro
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - A Esposito
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - C Criscitiello
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - P D'amico
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Curigliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy.
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22
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Cheung YC, Ueng SH, Ng SH, Kuo WL. Adenoid Cystic Carcinoma of the Breast. Curr Med Imaging 2021; 17:539-543. [PMID: 33038915 DOI: 10.2174/1573405616666201009144337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/15/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Contrast-enhanced spectral mammogram (CESM) is a modern technique providing additional information to detect or diagnose breast cancers. INTRODUCTION We present a rare ACC of the breast on CESM. METHODS A 49-year-old woman with surgicopathological proved ACC was reported with tumor features on CESM, sonography and contrast-enhanced magnetic resonance imaging (CE-MRI). RESULTS Sonography revealed a 1.4 cm × 1.2 cm × 1 cm circumscribe round mass in the upper outer quadrant of the left breast that was diagnosed with fibroadenoma. The mammogram did not show any discernible mass, however, the recombined subtracted images displayed a circumscribe mass with thin rim enhancement and enhanced internal patches that were resembling CE-MRI. Finally, the mass was proved to ACC. CONCLUSION CESM facilitates the detection of isodense cancer and provides the enhanced features for differential diagnosis. Resembling CE-MRI, CESM displayed rim enhancement and internal enhanced patches as diagnostic clues for this case of ACC.
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Affiliation(s)
- Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkuo, Taoyuan City, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital at Linkuo, Taoyuan City, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkuo, Taoyuan City, Taiwan
| | - Wen-Lin Kuo
- Department of Surgery, Chang Gung Memorial Hospital at Linkuo, Taoyuan City, Taiwan
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23
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Zhang W, Fang Y, Zhang Z, Wang J. Management of Adenoid Cystic Carcinoma of the Breast: A Single-Institution Study. Front Oncol 2021; 11:621012. [PMID: 33791208 PMCID: PMC8005703 DOI: 10.3389/fonc.2021.621012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of our study was to analyze the clinicopathologic features and surgical and oncological outcomes of adenoid cystic carcinoma (ACC) of the breast and to provide the basis for a clinical therapeutic schedule. Methods A total of 14 patients with primary breast adenoid cystic carcinoma treated at Cancer Hospital of the Chinese Academy of Medical Sciences from January 2000 to December 2017 were included. Data on clinical presentation, treatment strategy, and outcome, as well as the pathological features of ACC, were reviewed and analyzed. Results Fourteen patients were diagnosed with ACC of the breast, out of 23205 total patients treated for breast cancer (0.06%). All but three patients were postmenopausal, with a median age at diagnosis of 60.5 years (range, 39–73 years). The most common clinical presentation was a palpable mass (85.7%), and the imaging characteristics of all patients on color Doppler ultrasound and mammography were nonspecific. Six patients (42.9%) were suspected of having ACC by fine-needle aspiration cytology (FNAC) and were confirmed by postoperative histology and immunohistochemistry. All 14 patients underwent surgery, and no patient had a positive lymph node status. Median tumor size was 1.75 cm (range, 1–3 cm). Eight/14 (57.1%) patients were hormone receptor negative (HR−) and HER-2/neu (−) (HER2−). The remaining patients were hormone receptor positive (HR+). There was no significant difference in clinicopathological characteristics between the HR+ group and the HR- group (P>0.05). The mean follow-up period was 57 months. Local recurrence occurred in 14.3% of patients, 1.7% of patients had distant metastasis, all patients with local recurrence or distant metastasis were in the HR (-) group, and all patients were alive at the last follow-up. Conclusion ACC of the breast cannot be simply summarized as triple-negative breast cancer because it also includes a small number of hormone receptor-positive breast cancers. Establishing a preoperative diagnosis is difficult on the basis of clinical imaging examination, FNAC may be useful tool in the diagnosis. the final diagnosis can only be assessed based on the results of the histopathological and immunohistochemical examination. Breast-conserving surgery may be an alternative treatment strategy, and axillary lymph node dissection or sentinel node biopsy may not be necessary in some cases.
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Affiliation(s)
- Wenxiang Zhang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihui Zhang
- Cytology Section Department of Pathology, National Cancer Centre/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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24
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Prognostic and predictive parameters in breast pathology: a pathologist's primer. Mod Pathol 2021; 34:94-106. [PMID: 33154551 DOI: 10.1038/s41379-020-00704-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Abstract
The pathologist's role in the breast cancer treatment team has evolved from rendering a diagnosis of breast cancer, to providing a growing list of prognostic and predictive parameters such that individualized treatment decisions can be made based on likelihood of benefit from additional treatments and potential benefit from specific therapies. In all stages, ER and HER2 status help segregate breast cancers into treatment groups with similar outcomes and treatment response rates, however, traditional pathologic parameters such as favorable histologic subtype, size, lymph node status, and Nottingham grade also have remained clinically relevant in early stage disease decision-making. This is especially true for the most common subtype of breast cancer; ER positive, HER2 negative disease. For this same group of breast cancers, an ever-expanding list of gene-expression panels also can provide prediction and prognostication about potential chemotherapy benefit beyond standard endocrine therapies, with the 21-gene Recurrence Score, currently the only prospectively validated predictive test for this purpose. In the more aggressive ER-negative cancer subtypes, response to neoadjuvant therapy and` the extent of tumor infiltrating lymphocytes (TILs) are more recently recognized powerful prognostic parameters, and clinical guidelines now offer additional treatment options for those high-risk patients with residual cancer after standard neoadjuvant therapy. In stage four disease, predictive tests like germline BRCA status, tumor PIK3CA mutation status (in ER+ metastatic disease) and PDL-1 status (in triple negative metastatic disease) are now used to determine additional new treatment options. The objective of this review is to describe the latest in prognostic and predictive parameters in breast cancer as they are relevant to standard pathology reporting and how they are used in breast cancer clinical treatment decisions.
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25
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Liu L, Lin X, Xiang H, Tang G, Li C. Adenoid cystic carcinoma of the breast: a study of five cases. J Radiol Case Rep 2020; 14:16-25. [PMID: 33708341 DOI: 10.3941/jrcr.v14i11.3921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adenoid cystic carcinoma of the breast is a rare type of breast cancer. Most patients present with a bilateral palpable mass. Ultrasound and mammography are non-specific and can sometimes lead to misdiagnosis because of their variable imaging features. Pathological examination is the standard reference. Surgery is the mainstay of treatment for patients. Although adenoid cystic carcinoma has an excellent prognosis, metastatic cases have been reported. This report aims to discuss the clinical and imaging features of one case of adenoid cystic carcinoma with a poor prognosis and four cases with a good prognosis at our center.
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Affiliation(s)
- Lixian Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xi Lin
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Huiling Xiang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guoxue Tang
- Department of Ultrasound, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chunyan Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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26
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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: 0.6] [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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27
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Zhang H, Zhang N, Moran MS, Li Y, Liang Y, Su P, Haffty BG, Yang Q. Special subtypes with favorable prognosis in breast cancer: A registry-based cohort study and network meta-analysis. Cancer Treat Rev 2020; 91:102108. [PMID: 33075683 DOI: 10.1016/j.ctrv.2020.102108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to explore whether cribriform and adenoid cystic carcinoma had comparable prognoses to mucinous, tubular and papillary carcinoma, which were long recognized as favorable histologies by NCCN guidelines. METHODS A retrospective analysis based on the Surveillance, Epidemiology, and End Results Study (SEER) database (1994-2014) was conducted. The prognostic significance of all clinicopathological factors was calculated using univariate and multivariate analyses. A systematic review based on PubMed and network meta-analysis was conducted. RESULTS From the SEER database, the histologic subtypes of breast cancer (tubular, cribriform, adenoid cystic, mucinous, and papillary) were sorted by overall survival (OS) (94.4%, 91.6%, 90.8%, 87.6%, and 84.2%, respectively) and tubular, cribriform, mucinous, papillary, and adenoid cystic carcinoma by breast cancer-specific survival (BCSS) (99.4%, 98.4%, 97.7%, 95.2%, and 94.9%, respectively). A network meta-analysis combining 11 studies (886,649 patients) was conducted, which demonstrated consistent outcomes. SEER-based analyses revealed that, among the favorable subtypes, systemic chemotherapy did not improve OS or BCSS in hormone receptor-positive, node-negative patients, validating that these subtypes are generally associated with excellent outcomes, for which systemic chemotherapy may not be warranted. CONCLUSIONS Our data are consistent with guidelines suggesting that the mucinous, tubular, and papillary subtypes of breast cancer have favorable histologies. SEER data and meta-analysis supports this favorable category to include adenoid cystic and cribriform carcinoma, whose OS and BCSS outcomes are comparable to the former three. These findings add to the body of data, suggesting that patients with these histologic subtypes confer excellent prognosis, which may guide optimal therapeutic management strategies.
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Affiliation(s)
- Hanwen Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Ning Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Meena S Moran
- Department of Therapeutic Radiology, Smilow Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson and New Jersey Medical School, New Brunswick, NJ, USA
| | - Qifeng Yang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China; Pathology Tissue Bank, Qilu Hospital of Shandong University, Ji'nan, Shandong, China.
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28
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Moorman AM, Vink R, Rutgers EJT, Kouwenhoven EA. Incidence, clinical features, and outcomes of special types in breast cancer in a single institution population. Breast J 2020; 26:2163-2169. [PMID: 33022133 DOI: 10.1111/tbj.14069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 01/22/2023]
Abstract
The low incidence of special types of breast cancer hinders adequate clinical research efforts. As such, collecting sufficient data to develop well-established therapy strategies are difficult. The aim of our study was to obtain more data on these special types in order to better understand the different characteristics and optimize therapy strategies. A single-institution retrospective cohort study from January 2007 until September 2015. One hundred and five patients remained after excluding the patients with invasive ductal and lobular carcinoma. The percentage of these so called special types in this population was 4%. Tubular carcinoma, cribriform carcinoma, carcinoma with medullary features, carcinoma with apocrine differentiation, secretory carcinoma, mucinous carcinoma, and invasive papillary carcinoma had a good or excellent prognosis, while invasive micropapillary carcinoma, adenoid cystic carcinoma, metaplastic carcinoma, and carcinoma with neuroendocrine features had a worse prognosis. Special types of breast cancer form a heterogeneous group. Submitting them all to the same treatment modality may lead to both over- and under-treatment. We need to combine our data to optimize treatment strategies for the different special types.
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Affiliation(s)
- A M Moorman
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - R Vink
- Laboratory for Pathology East Netherlands (LabPON), Hengelo, The Netherlands
| | - E J Th Rutgers
- Department of Surgery, Antoni van Leeuwenhoek Dutch Cancer centre, Amsterdam, The Netherlands
| | - E A Kouwenhoven
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
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Fernández de Los Reyes I, Córdoba Iturriagagoitia A, Chouza Sanin M, Aguiar Losada B, Larrea Ramirez A, Ruíz de Azúa Ciria Y. [Adenoid cystic carcinoma of the breast, 22 years of experience]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 53:206-212. [PMID: 33012489 DOI: 10.1016/j.patol.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/24/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adenoid cystic carcinoma (ACC) is an uncommon neoplasm in the breast (less than 0.1%). ACC is typically triple negative with a favourable prognosis. Its low frequency and indolent course cause difficulties in the agreement of the evaluation and therapeutic consensus, as well as the use of the sentinel node excision in these carcinomas. OBJECTIVE Our goal is to provide a new series of cases from the Complejo Hospitalario de Navarra, through retrospective review over a period of 22 years. MATERIAL AND METHODS Every case of breast ACC diagnosed between 1998-2020 is reviewed. We analyze the clinical and pathological characteristics, and compare them with the literature. RESULTS We identified twelve cases of ACC, from a total of 18,241 patients diagnosed with breast carcinoma, with an average tumor size of 23.8mm and mean of 63.5 years. All of them were in a stage I-II at diagnosis. One case presented a lymph node micrometastases. One of them presented local recurrences and one case presented metastases 5 months after diagnosis (93.5 months of mean follow-up). According to Nottingham Histological Score, eight cases had a grade 1, two grade 2 and two grade 3. According to the classification of Ro et al., three were grade 1, four grade 2 and five grade 3. One case was ER positive (10%). No case presents positivity for BRAF-V600E in immunohistochemistry. CONCLUSION The management and prognosis ACC of breast, within benignity, remains uncertain, with more studies being needed to understand the clinical evolution and perform adequate therapeutic management.
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Affiliation(s)
| | | | - Mateo Chouza Sanin
- Departamento de Anestesiología y Reanimación, Complejo Hospitalario de Navarra, Pamplona, España
| | - Begoña Aguiar Losada
- Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Alba Larrea Ramirez
- Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, España
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Han Y, Wang J, Xu B. Clinicopathological characteristics and prognosis of breast cancer with special histological types: A surveillance, epidemiology, and end results database analysis. Breast 2020; 54:114-120. [PMID: 32979771 PMCID: PMC7519362 DOI: 10.1016/j.breast.2020.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives To explore the clinicopathological features and prognosis of breast cancer with special histological types. Materials and methods The information of breast cancer patients was obtained from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2016). Comparative analyses were performed to explore the difference in clinicopathological characteristics and propensity score matching (PSM) was used to weaken the effects from clinical profiles. Survival analysis was conducted to investigate the prognostic effects from histological types, and the prognostic factors of this group of patients were identified with the univariate COX proportional model. Results A total of 242863 breast cancer patients were eligible, of which 230213 individuals were ductal breast cancer (IDC) and 12650 individuals were special breast lesions, respectively. Comparatively, special breast cancer had a lower histological grade, a smaller tumor size, a lower proportion of nodal involvement and distant metastasis, in addition to a higher proportion of triple-negative subtype. The overall prognosis of special histological breast cancer was comparable to IDC, while the survival of HER2 enriched breast cancer was in favor of special breast cancer. With the PSM performance, the prognosis exhibited an inferior profile in the metaplastic breast cancer and was significantly favorable to apocrine, medullary, micropapillary, and papillary breast cancer. Conclusion This study revealed that the special histological breast cancer presented distinct clinicopathological characteristics and great heterogeneity in the prognosis among diverse histological subtypes.
Breast cancer is a heterogenous disease with diverse histological subtypes. Special histological breast cancer exhibits distinct clinicopathological profiles. Prognosis of special histological breast cancer is profoundly heterogenous. Histological subtype is an independent prognostic indicator of breast cancer.
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Affiliation(s)
- Yiqun Han
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Tummidi S, Prasad S, Joshi D, Tandon A, Mohan A, Saxena P, Kapoor N. Adenoid Cystic Carcinoma Breast: a Rare Entity. Indian J Surg Oncol 2020; 11:226-231. [PMID: 33364705 PMCID: PMC7732897 DOI: 10.1007/s13193-020-01106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/22/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
| | - Shubhra Prasad
- Department of Pathology & Lab Medicine, AIIMS, Bhopal, MP India
| | - Deepti Joshi
- Department of Pathology & Lab Medicine, AIIMS, Bhopal, MP India
| | - Ashwani Tandon
- Department of Pathology & Lab Medicine, AIIMS, Bhopal, MP India
| | - Anjaly Mohan
- Department of General Surgery, AIIMS, Bhopal, MP India
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Goldbach MM, Hoffman DI, Burkbauer L, Nayak A, Tchou J. Treatment Patterns and Clinical Outcomes of Adenoid Cystic Breast Carcinoma: A Single-Institution Experience. Am Surg 2020; 86:1684-1690. [PMID: 32845724 DOI: 10.1177/0003134820942287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Adenoid cystic breast carcinoma (ACC) is a rare subtype of triple-negative breast cancer. We aim to characterize the treatment patterns and clinical outcomes of women diagnosed with ACC at a large medical center. METHODS Female patients diagnosed with ACC at our institution between 2009 and 2019 were retrospectively identified. Patients with limited clinicopathologic data were excluded. RESULTS In our final study cohort (n = 9), the majority of ACCs (6/9, 66.7%) were hormone receptor (-) (HR-) and HER-2/neu (-) (HER2-), while 3 ACCs were HR+ HER2-. Two patients received adjuvant chemotherapy, and 4 patients received adjuvant radiotherapy. The crude local and distant recurrence rate of our cohort was 22.2% and 11.1% (median follow-up of 36 months). CONCLUSIONS The majority of ACCs were triple negative but some ACCs were HR+. The unadjusted local and distant recurrence rates were not negligible, suggesting that adjuvant chemotherapy and radiotherapy may be warranted in select cases.
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Affiliation(s)
- Macy M Goldbach
- 14640 Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel I Hoffman
- 14640 Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Burkbauer
- 14640 Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anupma Nayak
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Tchou
- 14640 Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kim J, Kim JY, Lee HB, Lee YJ, Seong MK, Paik N, Park WC, Park S, Jung SP, Bae SY. Characteristics and prognosis of 17 special histologic subtypes of invasive breast cancers according to World Health Organization classification: comparative analysis to invasive carcinoma of no special type. Breast Cancer Res Treat 2020; 184:527-542. [PMID: 32794061 DOI: 10.1007/s10549-020-05861-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breast cancer is a heterogeneous disease with various histopathologic subtypes. Except for invasive carcinoma of no special type (NST), other subtypes are rare with limited data. The purpose of this study was to analyze the characteristics and prognosis of special histopathologic subtypes of breast cancer compared to NST. METHODS A total of 136,140 patients were analyzed using the Korean Breast Cancer Society Registry database between January 1996 and March 2019. The clinicopathologic features and survival outcomes of special type breast carcinoma were compared with those of NST. RESULTS The prevalence of special subtypes other than NST was 13.7% (n = 18,633). Compared to NST, patients with lobular, medullary, metaplastic, and micropapillary carcinoma had larger tumors (p < 0.001). Patients with mucinous, tubular, medullary, metaplastic, and cribriform carcinoma presented with less node metastasis (p < 0.001), contrary to patients with micropapillary carcinoma. Patients with lobular, mucinous, tubular, papillary, and cribriform carcinoma presented as luminal A subtype much more often (p < 0.001). Micropapillary carcinoma included more luminal B subtype (p < 0.001). Typically, medullary and metaplastic carcinoma included more triple-negative subtypes (p < 0.001). In survival analysis, only medullary (Hazard Ratio (HzR) 0.542, 95% CI 0.345 to 0.852, p = 0.008) and metaplastic carcinoma (HzR 1.655, 95% CI 1.317 to 2.080, p < 0.001) showed significantly different overall survival from NST by multivariate analysis. CONCLUSION Breast cancer had distinct clinicopathologic features according to histopathologic subtype. However, special types of breast cancer had similar survival outcomes compared to NST when adjusting for other prognostic factors, except for metaplastic carcinoma and medullary carcinoma.
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Affiliation(s)
- Jiyoung Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, South Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Young Joo Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Namsun Paik
- Ewha Womans University Cancer Center Hospital for Women, Seoul, South Korea
| | - Woo-Chan Park
- Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sungmin Park
- Department of Breast Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si, Republic of Korea
| | - Seung Pil Jung
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Soo Youn Bae
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
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Lu K, Wang X, Zhang W, Ye H, Lao L, Zhou X, Yao S, Lv F. Clinicopathological and genomic features of breast mucinous carcinoma. Breast 2020; 53:130-137. [PMID: 32781417 PMCID: PMC7419658 DOI: 10.1016/j.breast.2020.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Mucinous carcinoma (MC) of the breast is a special histological type of breast cancer. Clinicopathological characteristics and genomic features of MC is not fully understood. Materials and methods 186,497 primary breast cancer patients from SEER database diagnosed with invasive ductal carcinoma (IDC) or MC were included. 801 primary IDC or MC patients from TCGA cohort were included for transcriptomic and genomic analysis. Results MC patients were older, had lower tumor grade and T and N stage, higher hormone receptor positive proportions and lower HER2 positive proportions than IDC patients. Kaplan-Meier plots showed that the breast cancer-specific survival (BCSS) of MC patients was significantly better than IDC patients (P < 0.001). However, after adjusting for clinicopathological factors, survival advantage of MC disappeared. In terms of genomic features of MC, representative upregulated genes of MC in transcriptomic level were MUC2, TFF1 and CARTPT. Upregulated pathways of MC included neurotransmitter-related pathways. Moreover, MC was featured by the amplification of 6p25.2, 6q12 and 11q12.3. Conclusion MC is a distinct histological subtype compared with IDC in terms of clinicopathological characteristics and genomic features. Further investigation need to be conducted to explore the formation of this specific histological subtype.
Mucinous breast carcinoma is a distinct histological subtype with better prognosis. The clinicopathological characteristics of mucinous breast carcinoma contributed to its good prognosis. Transcriptomic and genomic features of mucinous breast carcinoma contributed to its formation.
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Affiliation(s)
- Kebin Lu
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China
| | - Xiao'e Wang
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China
| | - Wenyuan Zhang
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China
| | - Hui Ye
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China
| | - Lingling Lao
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China
| | - Xiaodong Zhou
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China
| | - Sijie Yao
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China
| | - Feng Lv
- Department of General Surgery, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, 315400, PR China.
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Comparison of Nottingham Prognostic Index, PREDICT and PrognosTILs in Triple Negative Breast Cancer -a Retrospective Cohort Study. Pathol Oncol Res 2020; 26:2443-2450. [PMID: 32564262 PMCID: PMC7471141 DOI: 10.1007/s12253-020-00846-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 01/21/2023]
Abstract
Triple-negative breast cancer (TNBC) represents a heterogenous subtype of breast cancer with generally poor prognosis. The prediction of its prognosis remains essential to clinicians in their therapeutical decision-making process. The aim of our study was to compare the validity of three multivariable analysis derived prognostic systems, the Nottingham Prognostic Index (NPI), PREDICT and PrognosTILs (a prognosticator including tumor infiltrating lymphocytes, TILs) in a series of TNBCs. Patients operated on with TNBC at the Department of Surgery, Bács-Kiskun County Teaching Hospital, Kecskemét between 2005 and 2016 were included. Clinical and pathological parameters and follow-up data were collected from medical charts. TILs were assessed retrospectively, following international recommendations. Estimated survivals of PrognosTILs, PREDICT and NPI were recorded and compared with real outcomes. Altogether 136 patients were included in this retrospective study. In univariate Cox analysis, type of surgery, pT, pN, stage, NPI and type of adjuvant therapy were the significant prognostic variables. The multivariate Cox-regression strengthened that NPI is an independent predictor of overall and disease-free survivals in TNBCs. The NPI, PREDICT and PrognosTILs could be compared directly only in a ROC curve analysis: the sensitivities and specificities of these predicting systems are rather similar with area under the curve values falling between 0.7 and 0.8, and NPI having the highest values. Our findings reflect the diverse prognosis of TNBC and highlight the difficulties of predicting its outcome. None of the three multivariable prognosticators is inferior to the others, the NPI can reliably be used for TNBCs.
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Sanges F, Floris M, Cossu-Rocca P, Muroni MR, Pira G, Urru SAM, Barrocu R, Gallus S, Bosetti C, D'Incalci M, Manca A, Uras MG, Medda R, Sollai E, Murgia A, Palmas D, Atzori F, Zinellu A, Cambosu F, Moi T, Ghiani M, Marras V, Santona MC, Canu L, Valle E, Sarobba MG, Onnis D, Asunis A, Cossu S, Orrù S, De Miglio MR. Histologic subtyping affecting outcome of triple negative breast cancer: a large Sardinian population-based analysis. BMC Cancer 2020; 20:491. [PMID: 32487046 PMCID: PMC7268380 DOI: 10.1186/s12885-020-06998-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing "special types" to high-grade invasive breast carcinomas of no special type (IBC-NST). METHODS This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 1994 and 2015 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types. RESULTS TNBC "special types" showed significant differences for several clinico-pathological features when compared to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively; patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST. CONCLUSIONS Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments.
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Affiliation(s)
- Francesca Sanges
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Matteo Floris
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
| | - Paolo Cossu-Rocca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy.
- Department of Diagnostic Services, "Giovanni Paolo II" Hospital, ASSL Olbia-ATS Sardegna, Olbia, Italy.
| | - Maria R Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Silvana Anna Maria Urru
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
- School of Hospital Pharmacy, University of Sassari, Sassari, Italy
| | - Renata Barrocu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio D'Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Maria Gabriela Uras
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy
| | - Ricardo Medda
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
| | - Elisabetta Sollai
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Alma Murgia
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Dolores Palmas
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Francesca Cambosu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tiziana Moi
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Massimo Ghiani
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | | | - Luisa Canu
- Department of Pathology, ASSL Nuoro, Nuoro, Italy
| | - Enrichetta Valle
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | - Daniela Onnis
- Department of Pathology, Brotzu Hospital, Cagliari, Italy
| | - Anna Asunis
- Department of Pathology, Brotzu Hospital, Cagliari, Italy
| | - Sergio Cossu
- Department of Pathology, ASSL Nuoro, Nuoro, Italy
| | - Sandra Orrù
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy.
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Noda Y, Nakanishi Y, Nishimae A, Takahashi H, Oshiro C, Inaji H, Yamasaki M. Fine-needle aspiration cytology for the diagnosis of solid basaloid adenoid cystic carcinoma of the breast: Its role, limitation, and perspective. Diagn Cytopathol 2020; 48:652-656. [PMID: 32181598 DOI: 10.1002/dc.24414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
Solid basaloid adenoid cystic carcinoma (SB-AdCC) is a subtype of breast AdCC which shows more aggressive clinical behavior than other subtypes. Fine-needle aspiration (FNA) cytology is a useful diagnostic tool for breast malignancies. However, most of the diagnostic cytological characteristics of AdCC are not present in SB-AdCC and cytomorphological studies of this subtype are limited. Here, we evaluated the utility of FNA in the diagnosis of SB-AdCC of the breast. A search of the pathology archives of our institutions for FNA specimens of histologically confirmed SB-AdCC between 2012 and 2019 identified four patients with SB-AdCC of the breast. All patients were female and the average age was 60 years. Cytologically, one case was classified as malignant, two as indeterminate, and one as unsatisfactory. Smears had low to moderate cellularity. All smears showed ribbon-like material surrounding the clusters and a vertical nuclear arrangement toward the peripheral rim. Hyaline globules appeared only in one case. Cells in all cases showed an oval, angular, and spindle shape hyperchromatic nuclei with mild to severe atypia, and also dispersed naked nuclei similar to the cells of the clusters were detected in one case. In histological sections, these cytological findings were compatible with the histological findings and divergent histological differentiation was detected. Diagnosing of few cellular smears of SB-AdCC is difficult whereas the features of peripheral rim of the clusters, naked nuclei, and the divergent differentiation may be important for diagnosing SB-AdCC of the breast.
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Affiliation(s)
- Yuri Noda
- Department of Diagnostic Pathology, Kaizuka City Hospital, Osaka, Japan
| | - Yuko Nakanishi
- Department of Clinical Laboratory, Kaizuka City Hospital, Osaka, Japan
| | - Ayaka Nishimae
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Hiroyo Takahashi
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Chiya Oshiro
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Hideo Inaji
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Masaru Yamasaki
- Department of Diagnostic Pathology, Kaizuka City Hospital, Osaka, Japan
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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: 26] [Impact Index Per Article: 5.2] [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: 1.0] [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: 0.5] [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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41
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Kashiwagi S, Asano Y, Ishihara S, Morisaki T, Takashima T, Tanaka S, Amano R, Ohsawa M, Hirakawa K, Ohira M. Adenoid Cystic Carcinoma of the Breast: A Case Report. Case Rep Oncol 2019; 12:698-703. [PMID: 31607886 PMCID: PMC6787413 DOI: 10.1159/000502949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Adenoid cystic carcinomas (ACCs) are malignant tumors that most often occur in the salivary glands and bronchi, with occurrence in the breast being rare. ACCs of the breast reportedly give rise to few lymph node metastases or distant metastases and have a favorable prognosis. A 56-year-old woman with a left breast mass identified by mammographic screening was examined at our institute. Breast ultrasound revealed a sharply marginated, hypoechoic mass 12.7 × 9.4 × 8.7 mm in size in the upper outer quadrant of the left breast, and a vacuum-assisted biopsy (VAB) was performed at the mass site. Pathological examination of the VAB specimen revealed atypical cells with a cribriform growth pattern, and mucosal fluid surrounding tumor nests and within tumor ducts. The area around the tumor nests and inside of tumor ducts were also positively stained with alcian blue. These findings, we reached a pathological diagnosis of ACC. The preoperative diagnosis was stage I (cT1N0M0) triple-negative left breast cancer. Surgery consisted of breast-conserving surgery and sentinel node biopsy. The excised specimen was a 15.0 × 12.1 × 9.7 mm mass with a greyish white cut surface. Pathological examination of the excised specimen revealed a so-called adenoid cystic pattern. Results from immunohistochemical staining were identical to those from a VAB specimen, as they were estrogen receptor-negative, progesterone receptors-negative, and human epidermal growth factor receptor 2-negative, with low Ki67 expression. The final diagnosis, given the above findings, was left breast cancer (ACC) pT1N0M0 stage I triple-negative subtype.
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Affiliation(s)
- Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuka Asano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Sae Ishihara
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tamami Morisaki
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsutomu Takashima
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Sayaka Tanaka
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosei Hirakawa
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Gastrointestinal Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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42
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Pang W, Wang Z, Jin X, Zhang Q. Adenoid cystic carcinoma of the breast in a male: A case report. Medicine (Baltimore) 2019; 98:e16760. [PMID: 31393393 PMCID: PMC6708915 DOI: 10.1097/md.0000000000016760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/06/2019] [Accepted: 07/16/2019] [Indexed: 01/27/2023] Open
Abstract
RATIONALE Adenoid cystic carcinoma (ACC) of the breast is an infrequent neoplasm, and the occurrence in males is rare. Therefore, diagnostic and therapeutic challenges are inevitable. PATIENT CONCERNS Herein, we present a case of a 44-year-old man with a tumor on his right breast that he had known about for 6 years. DIAGNOSES The patient underwent a lumpectomy, and the histological examination confirmed a diagnosis of ACC. INTERVENTIONS Modified radical mastectomy was subsequently conducted in the patient. No positive lymph nodes were observed in the postoperative pathological examination. Following the surgery, the patient received adjuvant chemotherapy. OUTCOMES The patient remained recurrence-free at 26 months. LESSONS Compared to female breast ACC, male breast ACC may behave differently biologically and have a different prognosis. Our case will provide more diagnostic and treatment experience to deal with this disease.
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Yang C, Zhang L, Sanati S. SOX10 Is a Sensitive Marker for Breast and Salivary Gland Adenoid Cystic Carcinoma: Immunohistochemical Characterization of Adenoid Cystic Carcinomas. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2019; 13:1178223419842185. [PMID: 31105427 PMCID: PMC6501487 DOI: 10.1177/1178223419842185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
Abstract
Breast adenoid cystic carcinomas (AdCCs) can pose diagnostic difficulty due to their rarity, particularly on limited biopsy material. Given that these tumors are triple-negative breast cancers with favorable prognosis, accurate diagnosis is critical for clinical management. A total of 12 cases of breast AdCCs were studied; 17 age-matched salivary gland AdCCs and 5 metastatic AdCCs (1 breast and 4 salivary gland primaries) were also examined. Immunohistochemical stains for SOX10, Ki-67, c-KIT, β-catenin, epithelial membrane antigen (EMA), p63, cytokeratin 7 (CK7), cytokeratin 5/6 (CK5/6), and androgen receptor (AR) were performed. All breast (100%) and metastatic (100%) AdCCs and all but 2 salivary gland AdCCs showed diffuse nuclear staining (>50% of cells) for SOX10. Epithelial membrane antigen showed lowest expression in breast AdCCs and the highest expression in metastatic AdCCs (P < .01). Except one case of salivary gland AdCC that showed loss of β-catenin expression and developed subsequent metastasis, all AdCCs showed strong and diffuse membranous β-catenin expression. There were no significant differences in expression of CK7, p63, CK5/6, AR, Ki-67, and c-KIT (P > .05) among breast, salivary gland, and metastatic AdCCs. We investigated the immunophenotypic features of breast AdCCs in comparison with salivary gland and metastatic AdCCs. Despite the contrast in prognosis, these tumors are immunophenotypically similar. SOX10 is a sensitive diagnostic marker in all AdCCs, which could potentially aid in diagnosis of these tumors on limited material.
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Affiliation(s)
- Chen Yang
- Department of Pathology & Immunology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Lingxin Zhang
- Department of Pathology & Immunology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Souzan Sanati
- Department of Pathology & Immunology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
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Nozoe T, Nozoe E, Ohga T, Ezaki T, Sueishi K. A case of adenoid cystic carcinoma of the breast. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 65:289-291. [PMID: 30282876 DOI: 10.2152/jmi.65.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Tadahiro Nozoe
- Department of Surgery, Fukuoka Higashi Medical Center.,Department of Breast Surgery, Saiseikai Fukuoka General Hospital
| | - Emiko Nozoe
- Department of Breast Surgery, Saiseikai Fukuoka General Hospital
| | - Takefumi Ohga
- Department of Surgery, Fukuoka Higashi Medical Center
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45
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Tuzlali S, Yavuz E. Pathology of Breast Cancer. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baraban E, Zhang PJ, Jaffer S, Lubin D, Feldman M, Bleiweiss IJ, Nayak A. MYB
rearrangement and immunohistochemical expression in adenomyoepithelioma of the breast: a comparison with adenoid cystic carcinoma. Histopathology 2018; 73:897-903. [DOI: 10.1111/his.13708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/11/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Ezra Baraban
- Department of Pathology and Laboratory Medicine; Perelman School of Medicine and Hospital of the University of Pennsylvania; Pennsylvania PA USA
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine; Perelman School of Medicine and Hospital of the University of Pennsylvania; Pennsylvania PA USA
| | - Shabnam Jaffer
- Department of Pathology; Mount Sinai Hospital and Icahn School of Medicine; New York NY USA
| | - Daniel Lubin
- Department of Pathology and Laboratory Medicine; Perelman School of Medicine and Hospital of the University of Pennsylvania; Pennsylvania PA USA
| | - Michael Feldman
- Department of Pathology and Laboratory Medicine; Perelman School of Medicine and Hospital of the University of Pennsylvania; Pennsylvania PA USA
| | - Ira J Bleiweiss
- Department of Pathology and Laboratory Medicine; Perelman School of Medicine and Hospital of the University of Pennsylvania; Pennsylvania PA USA
| | - Anupma Nayak
- Department of Pathology and Laboratory Medicine; Perelman School of Medicine and Hospital of the University of Pennsylvania; Pennsylvania PA USA
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47
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Chen QX, Li JJ, Wang XX, Lin PY, Zhang J, Song CG, Shao ZM. Similar outcomes between adenoid cystic carcinoma of the breast and invasive ductal carcinoma: a population-based study from the SEER 18 database. Oncotarget 2018; 8:6206-6215. [PMID: 28008158 PMCID: PMC5351624 DOI: 10.18632/oncotarget.14052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/12/2016] [Indexed: 02/01/2023] Open
Abstract
Adenoid cystic carcinoma of the breast (breast-ACC) is a rare and indolent tumor with a good prognosis despite its triple-negative status. However, we observed different outcomes in the present study. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled a total of 89,937 eligible patients with an estimated 86 breast-ACC cases and 89,851 invasive ductal carcinoma (IDC) patients. In our study, breast-ACC among women presented with a higher proportion of triple-negative breast cancer (TNBC), which was more likely to feature well-differentiated tumors, rare regional lymph node involvement and greater application of breast-conserving surgery (BCS). Kaplan-Meier analysis revealed that patients with breast-ACC and breast-IDC patients had similar breast cancer-specific survival (BCSS) and overall survival (OS). Moreover, using the propensity score matching method, no significant difference in survival was observed in matched pairs of breast-ACC and breast-IDC patients. Additionally, BCSS and OS did not differ significantly between TNBC-ACC and TNBC-IDC after matching patients for age, tumor size, and nodal status. Further subgroup analysis of molecular subtype indicated improved survival in breast-ACC patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/Her2-) tumors compared to IDC patients with HR+/Her2- tumors. However, the survival of ACC-TNBC and IDC-TNBC patients was similar. In conclusion, ACCs have an indolent clinical course and result in similar outcomes compared to IDC. Understanding these clinical characteristics and outcomes will endow doctors with evidence to provide the same intensive treatment for ACC-TNBC as for IDC-TNBC and lead to more individualized and tailored therapies for breast-ACC patients.
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Affiliation(s)
- Qing-Xia Chen
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Jun-Jing Li
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Xiao Wang
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Pei-Yang Lin
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Jie Zhang
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Chuan-Gui Song
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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Zhao S, Ma D, Xiao Y, Jiang YZ, Shao ZM. Clinicopathologic features and prognoses of different histologic types of triple-negative breast cancer: A large population-based analysis. Eur J Surg Oncol 2018; 44:420-428. [PMID: 29429597 DOI: 10.1016/j.ejso.2017.11.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/05/2017] [Accepted: 11/21/2017] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To examine the clinicopathologic characteristics and survival outcomes of different histologic types of triple-negative breast cancer (TNBC). METHODS We used the SEER database to identify patients with TNBC diagnosed between 2010 and 2014. Our analysis focused on the seven most prevalent histologic types. Differences were compared between invasive carcinoma of no special type (NST) and the other six types. RESULTS Significant differences were observed in age at diagnosis, tumor grade, size, nodal status and treatment. As tumor size increased, the number of positive lymph nodes increased markedly in invasive lobular carcinoma (ILC) and mixed NST and lobular carcinoma (NST-ILC), while in metaplastic carcinoma the number only increased slightly. In multivariate survival analyses, compared with patients with invasive carcinoma NST, breast cancer-specific survival (BCSS) and overall survival (OS) were worse for those with NST-ILC (BCSS: hazard ratio [HR] 1.81, P < .001; OS: HR 1.56, P = .005) or metaplastic carcinoma (BCSS: HR 1.95, P < .001; OS: HR 1.73, P < .001). By contrast, patients with medullary (HR 0.40, P = .010) or apocrine carcinoma (HR 0.27, P = .008) showed better BCSS. Time-dependent receiver operating characteristic (ROC) analyses indicated that T category in ILC and N category in metaplastic carcinoma were of less prognostic value. CONCLUSIONS According to the histologic classification of TNBC, this heterogeneous disease can be divided into several entities with different clinicopathologic features and prognoses. In the era of molecular subtyping of breast cancer, the histologic classification of TNBC is still of considerable clinical significance.
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Affiliation(s)
- Shen Zhao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Ding Ma
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Yi Xiao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Yi-Zhou Jiang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China.
| | - Zhi-Ming Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, PR China; Institutes of Biomedical Sciences, Fudan University, Shanghai, PR China.
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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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50
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Yan Z, Leong MY, Lim GH. Discordant correlation of breast adenoid cystic carcinoma on imaging and pathology: A case report and literature review on surgical management. Int J Surg Case Rep 2017; 42:196-199. [PMID: 29268125 PMCID: PMC5737954 DOI: 10.1016/j.ijscr.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Adenoid cystic carcinomas (ACC) of the breast are extremely rare tumours, accounting for <0.1% of newly diagnosed breast cancer cases. Little data exist regarding the correlation of radiological findings with histology of this rare subtype. To our knowledge, gross size discrepancy between the 2 modalities has not been reported. We describe a case of ACC with appreciable size discordance between imaging and pathology report. PRESENTATION OF CASE A 71 years old lady presented with a painless right breast lump of a few months duration. Clinical examination revealed a 1.5 cm right breast upper outer quadrant mass. Axillary and systemic examinations were unremarkable. Mammogram showed an asymmetric density in the right upper outer quadrant which corresponded to a suspicious nodule measuring about 2 cm on the ultrasound. Ultrasound of the axilla showed an indeterminate right lymph node. Core needle biopsy of the right breast nodule showed ACC while the lymph node biopsy was non- metastatic. Staging scans did not reveal any definite distant metastasis. Her naso-endoscopy and MRI of the neck were normal. She underwent a right mastectomy and sentinel lymph node biopsy. Final histology returned as a grade II 55 mm ACC. Lympho-vascular invasion was absent. The tumour was triple negative for Estrogen receptor (ER), Progesterone receptor (PR) and Human epidermal receptor 2 (HER 2). Sentinel lymph node biopsy was negative for metastasis. She recovered well but declined adjuvant chemotherapy and radiation therapy. She is currently well 6 months post operation. DISCUSSION ACC is an extremely rare subtype, therefore there are limited reports in literature on its imaging and pathological characteristics. Of this sparse data, there was no mention that there might be a big size discrepancy between the 2 modalities. This appreciable discrepancy has implications for pre-operative planning and the choice of breast surgery. It will be useful if the pathological extent of ACC could be determined more accurately radiologically. However, there are no distinctive imaging characteristics for ACC. ACC can appear as a smooth round mass similar to that of a benign mass or as an irregular mass on mammogram. On ultrasound, ACC often manifested as a hypo- echoic heterogeneous mass with minimal vascularity on Doppler imaging and may have an indistinct margin. MRI has a higher sensitivity than mammogram and ultrasound in determining the true extent of the tumour, but there remains little data on its usefulness in ACC. CONCLUSION ACC can be extensively infiltrative and present much larger than its radiological size, as reported in our case. Use of better imaging modalities judiciously, in these cases, are needed to more accurately predict the true pathological size of ACC to prevent inadequate surgery.
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Affiliation(s)
- Zhiyan Yan
- KK Women and Children's Hospital, Breast Department, 100 Bukit Timah Road, 229899, Singapore.
| | - May Ying Leong
- KK Women and Children's Hospital, Breast Department, 100 Bukit Timah Road, 229899, Singapore
| | - Geok Hoon Lim
- KK Women and Children's Hospital, Breast Department, 100 Bukit Timah Road, 229899, Singapore
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