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Cancer Treatment and Research... 2020Microglandular adenosis (MGA) is a rare benign proliferative lesion lacking a myoepithelial cell layer; 27% of all reported cases have progressed to invasive carcinoma.... (Review)
Review
INTRODUCTION
Microglandular adenosis (MGA) is a rare benign proliferative lesion lacking a myoepithelial cell layer; 27% of all reported cases have progressed to invasive carcinoma. Salivary gland-type carcinomas of the breast are also uncommon, representing 2% of all breast cancers. This wide spectrum of neoplasms tends to be triple negative and generally has an excellent prognosis. Given the rarity of salivary gland-type carcinomas of the breast arising from MGA, there are few reports of these cases in literature. As such, there is uncertainty regarding their diagnosis and treatment strategies.
PRESENTATION OF CASE
We report the rare case of a 66-year-old woman who presented with a triple negative, invasive carcinoma with salivary gland-type features, arising from MGA. The patient underwent mastectomy with sentinel lymph node biopsy, followed by Taxotere and Cyclophosphamide (TC) chemotherapy and 50 Gy in 25 fractions of radiation to her chest wall. We reviewed the available literature on salivary gland-type breast carcinomas arising from MGA.
DISCUSSION
Despite the generally unfavourable characteristics associated with carcinoma arising in microglandular adenosis (MGACA), most patients with MGACA have favourable outcomes.
CONCLUSIONS
The findings of the present case and reviewed cases are consistent with the literature on MGA, atypical MGA (AMGA), and MGACA. Future study of this rare entity is warranted to establish a consensus surrounding its clinical significance and treatment methods.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Breast; Carcinoma, Ductal, Breast; Chemoradiotherapy, Adjuvant; Cyclophosphamide; Diagnosis, Differential; Docetaxel; Dose Fractionation, Radiation; Female; Fibrocystic Breast Disease; Humans; Mastectomy; Sentinel Lymph Node Biopsy; Treatment Outcome; Triple Negative Breast Neoplasms
PubMed: 32454386
DOI: 10.1016/j.ctarc.2020.100178 -
Journal of Medical Imaging and... Aug 2023With modern technological advances in imaging, radial scars are more frequently encountered in clinical practice. The management of radial scars remains challenging due...
With modern technological advances in imaging, radial scars are more frequently encountered in clinical practice. The management of radial scars remains challenging due to associated upgrade to malignancy at excision. Contrast-enhanced mammography (CEM) has a similar sensitivity compared to MRI in addition to lower cost, better availability and fewer contra-indications. CEM is reported to have an overall excellent negative predictive value for malignancy. In this study, imaging of 55 patients with a core biopsy diagnosis of radial scar since the introduction of CEM into local practice was reviewed. Nine patients underwent CEM as part of their diagnostic work-up and these appearances are presented as a pictorial essay to demonstrate enhancement patterns of radial scars on CEM in this cohort and consider how this knowledge may influence management.
Topics: Female; Humans; Cicatrix; Mammography; Fibrocystic Breast Disease; Biopsy, Large-Core Needle; Predictive Value of Tests; Retrospective Studies; Breast Neoplasms; Breast
PubMed: 37401164
DOI: 10.1111/1754-9485.13554 -
The Journal of Pathology Jun 2016Microglandular adenosis (MGA) and atypical MGA (AMGA) are unusual lesions of the breast. They were once regarded as benign proliferative lesions and innocent bystanders....
Microglandular adenosis (MGA) and atypical MGA (AMGA) are unusual lesions of the breast. They were once regarded as benign proliferative lesions and innocent bystanders. Several lines of evidence suggested that they could be neoplastic, clonal lesions and a non-obligate precursor for triple-negative breast cancers (TNBC). Recent work published in The Journal of Pathology by Guerini-Rocco and colleagues provided further evidence regarding the precursor-product relationship between MGA/AMGA and TNBC. Using a massively parallel sequencing approach, they demonstrated that MGA/AMGA, particularly those associated with TNBC, could be clonal neoplastic lesions showing clonal non-synonymous mutations, but none in pure MGA. Importantly, those alterations were observed in the associated TNBC. They were also able to identify recurrent alterations in TP53 in those MGA/AMGA cases as well as their associated TNBC. The findings, in conjunction with others, underscore the significance for MGA in clinical diagnosis. The potential of a benign lesion to progress into an aggressive malignant tumour implies that modification of the current management approach may be necessary. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Topics: Breast; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Fibrocystic Breast Disease; Humans; Triple Negative Breast Neoplasms; United Kingdom
PubMed: 27061094
DOI: 10.1002/path.4726 -
Journal of Pathology and Translational... Jul 2017Mammary carcinoma arising in microglandular adenosis (MGA) is extremely rare, and MGA is regarded as a non-obligate precursor of triple-negative breast cancer. We report...
Mammary carcinoma arising in microglandular adenosis (MGA) is extremely rare, and MGA is regarded as a non-obligate precursor of triple-negative breast cancer. We report five cases of carcinoma arising in MGA of the breast. All cases showed a spectrum of proliferative lesions ranging from MGA to atypical MGA, ductal carcinoma in situ or invasive carcinoma. Immunohistochemically, all cases were triple-negative and expression of S-100 protein gradually decreased as the lesions progressed from MGA to atypical MGA and carcinoma. Three cases showed acinic cell differentiation with reactivity to α1-antitrypsin, and one case was metaplastic carcinoma. During clinical follow-up, one patient developed local recurrence. Carcinoma arising in MGA is a rare but distinct subset of triple-negative breast cancer with characteristic histologic and immunohistochemical findings.
PubMed: 28372344
DOI: 10.4132/jptm.2016.11.11 -
Journal of Clinical Pathology Jan 2022Blunt duct adenosis (BDA) is a breast lesion first described by Foote and Stewart in 1945 as a proliferative benign lesion of the terminal duct lobular unit. Throughout... (Review)
Review
Blunt duct adenosis (BDA) is a breast lesion first described by Foote and Stewart in 1945 as a proliferative benign lesion of the terminal duct lobular unit. Throughout recent decades, further literature descriptions of BDA have been confusing. Some consider BDA to be a separate entity, some a growth pattern of columnar cell changes. The WHO 2012 considered BDA and columnar cell changes to be synonyms, while columnar cell lesions, especially those with atypia, are part of a spectrum of early precursors of the low nuclear grade breast neoplasia family. In the updated WHO 2019 version, BDA is mentioned as 'not recommended' terminology for columnar cell lesions without further discussing it, leaving the question open if BDA should be considered a separate entity.Good diagnostic criteria for BDA have however largely been lacking, and its biological background has not yet been unravelled. In this paper, we point out that BDA is mainly associated with benign breast lesions and not with other recognised precursor lesions. Further, 16q loss, which is the hallmark molecular event in the low nuclear grade breast neoplasia family, is lacking in BDA. We therefore hypothesise that BDA may not be a true precursor lesion but a benign polyclonal lesion, and propose morphological diagnostic criteria to better differentiate it from columnar cell lesions.
Topics: Breast Diseases; Breast Neoplasms; Epithelial Cells; Female; Fibrocystic Breast Disease; Humans; Hyperplasia
PubMed: 33858936
DOI: 10.1136/jclinpath-2020-207359 -
International Journal of Clinical and... 2014Carcinoma arising in microglandular adenosis (MGACA) is an extremely rare subtype of breast carcinoma. In this study, clinicopathological analysis of MGACA from 11...
Carcinoma arising in microglandular adenosis (MGACA) is an extremely rare subtype of breast carcinoma. In this study, clinicopathological analysis of MGACA from 11 Chinese patients was conducted. Microscopically, all cases showed a spectrum of structure and glandular proliferations ranging from microglandular adenosis (MGA) to atypical MGA (AMGA) to MGACA. Carcinoma components were composed of high grade ductal carcinoma in situ (DCIS) in 1 case and invasive carcinoma in 10 cases. Invasive carcinomas were grade 3 in 10 tumors and grade 2 in 1. Invasive components in 5 of 10 cases were composed of invasive carcinoma of no special type (NST), and 1 case showed partially acinic cell differentiation. In 5 cases, invasive components were mixed of NST and matrix-producing carcinoma (MPC). All epitheliums in 11 cases were triple negative (ER-, PR-, HER2-), and diffuse positive for CK and S-100 protein. No myoepithelial cells were demonstrable from MGA to invasive components with immunohistochemical staining for P63 and calponin. PAS or reticulin stain showed the presence of a basement membrane around glands in MGA, AMGA, DCIS, and its absence in invasive components. Follow-up time ranged from 10 to 64 months. One patient developed a lung metastasis 24 months after surgery, 10 patients have been alive without recurrence. Our study revealed that MGACA is a distinct subset of breast carcinoma, with triple negative phenotype, high grade nuclear and variable morphology. Despite histopathologic and immunohistochemical features usually associated with a poor prognosis, MGACA seems to have a relatively favorable outcome.
Topics: Adult; Biomarkers, Tumor; Biopsy; Carcinoma; Cell Differentiation; Cell Proliferation; China; Female; Fibrocystic Breast Disease; Humans; Immunohistochemistry; Lung Neoplasms; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Phenotype; Time Factors; Treatment Outcome; Triple Negative Breast Neoplasms
PubMed: 25337263
DOI: No ID Found -
Hormone and Metabolic Research =... Apr 2021Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. There is no clear association between PCOS and benign breast disease... (Review)
Review
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. There is no clear association between PCOS and benign breast disease (BBD). The latter is a frequent benign disorder, affecting women between 20 and 50 years of age. To date, the classification remains controversial, and the risk of developing breast cancer that is associated with these changes is different depending on the histopathological findings. The most frequent changes are breast cysts, which are noted in up to 50% of patients older than 30 years of age. This up-to-date review presents the relationship between PCOS and BBD. In conclusion, there is no clear association between benign breast disease and PCOS. Further studies on a large population with prospectively collected data using updated PCOS criteria are necessary.
Topics: Animals; Female; Fibrocystic Breast Disease; Humans; Polycystic Ovary Syndrome
PubMed: 33684949
DOI: 10.1055/a-1392-0938 -
Journal of the West African College of... 2022Breast lumps have been reported as the most common breast symptom among adult females in Western Nigeria and are benign in 60% of cases. In South-Eastern Nigeria,... (Review)
Review
BACKGROUND
Breast lumps have been reported as the most common breast symptom among adult females in Western Nigeria and are benign in 60% of cases. In South-Eastern Nigeria, fibroadenoma has been reported as the most common breast disease (47.5%), followed by carcinoma (30.4%) and fibrocystic disease. The aim of this study was to determine the correlation between sonographic and histopathologic findings in women who presented with breast masses.
MATERIALS AND METHODS
This was a cross-sectional study conducted among 160 consecutive female patients who presented with breast masses. A breast ultrasound scan was carried out to categorize the masses using the American College of Radiology Breast Imaging Reporting and Data System classification, and the histopathological diagnoses of the masses were obtained. The correlation of the sonographic findings and histopathological diagnoses was determined using the Statistical Package for Social Sciences (SPSS) IBM version 23.0.
RESULTS
Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were found to be 79.5%, 98.3%, 93.9%, 93.7%, and 93.8%, respectively. There was a positive correlation between the sonographic findings and histopathological diagnoses of the breast masses, which was statistically significant ( = 0.000, r = 0.846).
CONCLUSION
This study found a statistically significant positive correlation between sonographic findings and histopathological diagnoses of breast masses.
PubMed: 36213797
DOI: 10.4103/jwas.jwas_84_22 -
Journal of the Belgian Society of... Sep 2015To describe imaging features of different breast adenosis lesions. Mammographic and ultrasonographic findings of patients with different types of adenosis were...
To describe imaging features of different breast adenosis lesions. Mammographic and ultrasonographic findings of patients with different types of adenosis were reviewed retrospectively Tissue samples were obtained either with US-guided core needle biopsy or localization with needle-wire system and surgical excision. Forty-three adenosis lesions were diagnosed in 41 patients: 27 sclerosing adenosis, 13 blunt duct adenosis and 3 microglandular adenosis. Most frequent abnormal findings of sclerosing adenosis were masses with non-circumscribed margins and focal acoustic shadowing without mass configuration (54%) on ultrasonography. Mammography was normal in 54% of sclerosing adenosis, the most common abnormality was architectural distortion (21%). In blunt duct adenosis, usually circumscribed masses (46%) were detected on ultrasonography, clustered punctate microcalcifications (23%) and circumscribed masses (23%) were observed on mammography. All microglandular adenosis lesions were non-circumscribed masses. Premalignant components were detected only with surgical excisional biopsy in three patients that showed suspicious radiological findings and benign pathological result on core biopsy. The adenosis lesions have no pathognomonic characteristics on mammography and ultrasound. Total excision may be considered when suspicious radiological findings are present although core needle biopsy results are benign.
PubMed: 30039060
DOI: 10.5334/jbr-btr.850 -
Diagnostic Pathology Dec 2022The multistep molecular model of breast carcinogenesis is based on the oestrogen receptor(ER) status of the tumour. Its two main arms comprise ER-positive and...
Proliferative epithelial changes in tumour adjacent tissue in Sri Lankan women with breast carcinoma: do morphological changes support molecular models of breast carcinogenesis?
BACKGROUND
The multistep molecular model of breast carcinogenesis is based on the oestrogen receptor(ER) status of the tumour. Its two main arms comprise ER-positive and ER-negative breast carcinomas(BCa), which are associated with Nottingham grade(NG) of the tumour and different proliferative epithelial changes. According to the model, columnar cell lesions(CCL), lobular carcinoma in-situ(LCIS) and atypical ductal hyperplasia(ADH), low-grade ductal carcinoma in-situ (LG-DCIS) are associated with low grade ER-positive tumours and microglandular adenosis (MGA), pleomorphic LCIS(PLCIS), high-grade DCIS(HG-DCIS) are associated with ER-negative high grade tumours. This study aims to describe the association between proliferative epithelial changes in breast tissue adjacent to tumour, in relation to the ER status and NG of the tumour.
METHODS
This descriptive cross-sectional study included 420, wide local excision and mastectomy specimens of BCa from National Hospital of Sri Lanka, between 2017-2019. The histopathological features of the tumour and proliferative epithelial changes in tumour adjacent tissue within 10 mm distance from the tumour-host interface were evaluated independently by two pathologists. The ER, PR(Progesterone receptor) and HER2 status assessed by immunohistochemistry(IHC) was reviewed. The associations between above epithelial lesions and ER status and NG{categorised as low grade (NG1 and NG2) and high grade (NG3)} of the tumour were analyzed.
RESULTS
ER positive BCa showed significant associations with CCH (p = 0.04), FEA (p = 0.035) and LGDCIS (p < 0.001). Although PLCIS was more frequent in ER positive tumours, the association did not attain statistical significance. ER negative BCa showed a significant association with HGDCIS (p = 0.016). CCLs as a whole (p = 0.005) and also CCC (p = 0.006) and FEA (p = 0.048) and LGDCIS (p < 0.001) showed significant associations with low NG tumours. High NG tumours showed a significant association with HGDCIS (p < 0.001). Microglandular adenosis was not identified in our study population.
CONCLUSION
These morphological findings support the multistep molecular based pathogenetic pathways of breast carcinoma in the studied setting in South Asia. Identification of these proliferative epithelial components in a core biopsy that is negative for BCa, should prompt for close clinicoradiological correlation, and if necessary re-biopsy of women suspected of harbouring a BCa.
Topics: Humans; Female; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Sri Lanka; Cross-Sectional Studies; Mastectomy; Breast Carcinoma In Situ; Carcinogenesis; Carcinoma, Ductal, Breast
PubMed: 36581929
DOI: 10.1186/s13000-022-01281-w