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Virchows Archiv : An International... Jan 2022Papillary lesions of the breast represent a heterogeneous group of lesions including benign papillomas, papillomas with focal epithelial atypia, fully fledged ductal... (Review)
Review
Papillary lesions of the breast represent a heterogeneous group of lesions including benign papillomas, papillomas with focal epithelial atypia, fully fledged ductal carcinoma in situ (DCIS) or lobular neoplasia, papillary DCIS, encapsulated papillary carcinomas without or with invasion, solid papillary carcinomas, and invasive papillary carcinomas. A micropapillary pattern characterized by lack of fibrous stalks within the papillae is observed in micropapillary DCIS and invasive micropapillary carcinoma. In addition, a variety of other rare breast lesions reveals a papillary architecture such as tall cell carcinoma with reversed polarity (TCCRP) and mucinous cystadenocarcinoma, adenomyoepithelioma, and secretory carcinoma. In addition, benign lesions such as usual ductal hyperplasia, apocrine metaplasia, gynecomastia, and juvenile papillomatosis may show a papillary or micropapillary architecture. Fragments of a benign papilloma in a breast biopsy are considered a lesion of uncertain malignant potential (B3 in the European classification) and excision is mostly recommended. Although the knowledge about molecular pathology of papillary breast lesions has increased, there is not sufficient evidence for diagnostically useful molecular features, yet. The aim of this review is to provide an update on papillary and micropapillary lesions with emphasis on problematic areas for daily diagnostic work including biopsies.
Topics: Breast; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Carcinoma, Papillary; Humans; Male; Papilloma
PubMed: 34734332
DOI: 10.1007/s00428-021-03182-7 -
Modern Pathology : An Official Journal... Jun 2021Papillary neoplasms of the breast encompass a wide range of tumor types ranging from the benign intraductal papilloma to in situ and invasive papillary carcinomas. In... (Review)
Review
Papillary neoplasms of the breast encompass a wide range of tumor types ranging from the benign intraductal papilloma to in situ and invasive papillary carcinomas. In this review, we considered each tumor entity listed under the Papillary Neoplasms category in the latest WHO Classification of Breast Tumors (5th edition), namely intraductal papilloma, papillary ductal carcinoma in situ, encapsulated papillary carcinoma, solid-papillary carcinoma, and invasive papillary carcinoma. We examined their pathological features, current issues pertaining to diagnosis and prognostication, as well as the latest molecular findings. We also briefly addressed adenomyoepithelioma and the newly included tall cell carcinoma with reversed polarity, highlighting areas where they overlap with papillary neoplasms.
Topics: Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Carcinoma, Papillary; Female; Humans
PubMed: 33462367
DOI: 10.1038/s41379-020-00732-3 -
Radiologia Mar 2022Adenomyoepithelioma of the breast (AB) is an uncommon tumor that is characterized by the biphasic proliferation of epithelial and myoepithelial cells. The radiologic...
Adenomyoepithelioma of the breast (AB) is an uncommon tumor that is characterized by the biphasic proliferation of epithelial and myoepithelial cells. The radiologic findings for AB have been scantly reported. This paper aims to analyze the characteristic findings for AB on ultrasonography (US) and mammography. This retrospective descriptive study used the Breast Imaging-Reporting and Data System (BI-RADS) to analyze the US and mammography findings for histologically confirmed AB in patients attended at our institution between 2007 and 2019. We identified a total of 13 AB in 13 women. All patients underwent US. On US, 12 lesions were seen as oval nodules, and the remaining lesion was irregular-shaped; 8 lesions had circumscribed margins, 3 had angled margins, and 2 had microlobulated margins. Regarding the echo pattern, 8 lesions were hypoechoic and 5 were complex (solid-cystic). On color Doppler, 11 lesions were vascularized nodules and 2 were avascular nodules. In conclusion, we present the imaging characteristics for a series of cases of AB. It is unlikely that this lesion can be suspected solely on the basis of the imaging findings; nevertheless, it is important for radiologists to be familiar with AB to carry out a good radiopathologic correlation.
Topics: Adenomyoepithelioma; Breast Neoplasms; Female; Humans; Male; Mammography; Retrospective Studies; Ultrasonography
PubMed: 35428465
DOI: 10.1016/j.rxeng.2021.06.004 -
The American Journal of Case Reports Apr 2022BACKGROUND Breast adenomyoepithelioma is a rare benign breast tumor characterized by a biphasic proliferation of epithelial and myoepithelial cells with variable...
BACKGROUND Breast adenomyoepithelioma is a rare benign breast tumor characterized by a biphasic proliferation of epithelial and myoepithelial cells with variable clinical and diagnostic features. Establishing the diagnosis, determining optimal therapy, and predicting outcome are problematic because of the rarity of this entity. There have been only 2 large series of adenomyoepitheliomas of the breast, reported by Tavassoli and Rosen, which included 27 and 18 patients, respectively. In this report, we present 3 cases of breast adenomyoepithelioma. CASE REPORT Herein, we report 3 cases of breast adenomyoepithelioma. The first case is of a 64-year-old woman who was found to have right breast microcalcification on a screening mammogram. The second case is of a 74-year-old woman who had a right breast mass. These 2 patients were managed by wide local excision. Postoperative microscopic examination revealed adenomyoepithelioma. The third case is of a 49-year-old woman with bilateral saline breast implants who presented with a left breast mass. A core needle biopsy was done and revealed adenomyoepithelioma associated with usual ductal hyperplasia and ductal carcinoma in situ. CONCLUSIONS Breast adenomyoepithelioma is a rare condition that can pose diagnostic challenges due to variable imaging presentations, necessitating percutaneous core biopsy for initial diagnosis. Correct diagnosis is usually possible only on excisional biopsy and confirmed by demonstrating the biphasic nature of the tumor by IHC. Clinical suspicion coupled with utilizing both radiological and histopathological facilities can aid in the accurate diagnosis and management. For the most part, they are considered to be benign, but they can locally recur.
Topics: Adenomyoepithelioma; Aged; Breast; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Middle Aged; Myoepithelioma; Neoplasm Recurrence, Local
PubMed: 35400730
DOI: 10.12659/AJCR.936070 -
Surgical Case Reports May 2020Adenomyoepithelioma (AME) of the breast is a very rare tumor and is generally considered to be benign. However, some show malignant transformation, which results in...
BACKGROUND
Adenomyoepithelioma (AME) of the breast is a very rare tumor and is generally considered to be benign. However, some show malignant transformation, which results in local recurrences or distant metastases. The morphological features of AME that might predict malignant potential have not been elucidated. Moreover, there is also no established multidisciplinary treatment for malignant AME aside from complete excision at an early stage.
CASE PRESENTATION
A 64-year-old female diagnosed with AME of the left breast underwent lumpectomy. The surgical margins were negative. Six months after the operation, however, malignant AME recurred locally in the left breast. MRI showed multiple masses, which invaded the skin. A left mastectomy with axillary lymph node dissection was performed. Additional areas of AME were found in about one third of the entire breast. Eight months after the mastectomy, lung metastases were detected. She underwent chemotherapy with fluorouracil, epirubicin, and cyclophosphamide (FEC) for 9 cycles with little response. Lung metastasectomy was performed. Nine months after lung metastasectomy, the metastases were widespread to the brain, heart, and kidney; she subsequently died 2 months later.
CONCLUSIONS
Malignant AME has various morphological features, and in this report, we characterize new findings from both imaging and pathology/autopsy. Malignant potency is related to the tumor size, tumor appearance, and mitoses, even if only a few. Given that ductal spread is one of the morphological features of malignant AME, it is of paramount importance to assess the surgical margins.
PubMed: 32472226
DOI: 10.1186/s40792-020-00881-2 -
World Journal of Surgical Oncology Apr 2022Malignant adenomyoepithelioma of the breast is a rare tumor and most of relevant literature consists of individual case reports. This study objective was designed to...
BACKGROUND
Malignant adenomyoepithelioma of the breast is a rare tumor and most of relevant literature consists of individual case reports. This study objective was designed to evaluate clinicopathological features and treatment outcomes of 15 cases of malignant adenomyoepithelioma at a single institute.
METHODS
A retrospective medical record review was performed for 15 subjects confirmed with malignant adenomyoepithelioma upon postoperative pathological diagnosis at the Asan Medical Center from January 2008 to June 2018. Data regarding age at diagnosis, preoperative biopsy results, operation methods, the status of hormone receptors and HER2, and clinical outcomes were collected.
RESULTS
All cases were female patients diagnosed at median age of 50 years. Preoperative core needle biopsy results showed that 40% of the cases (6 out of 15) were benign which was in discordance with the final malignant pathology report. Thirteen cases underwent wide excision with or without sentinel lymph node biopsy (SLNB) and 2 cases had total mastectomy with SLNB. Five of 11 cases (45.5%) were triple negative. Ten of 15 cases underwent postoperative radiation therapy, 3 cases underwent chemotherapy, and 5 cases underwent endocrine therapy. During median follow-up of 55 months, the 5-year overall survival rate was 87.5% and the 5-year disease free survival rate was 91.7%. Two lung metastases developed. One case showed local recurrence 3 years after surgery and radiotherapy and subsequently developed lung metastasis 1 year late. Another case developed lung metastasis one and a half years after surgery in combination with endocrine therapy and neoadjuvant chemotherapy.
CONCLUSION
Preoperative core needle biopsy showed inaccurate results for diagnosing malignant adenomyoepithelioma. Malignant adenomyoepithelioma has a high rate of triple negative subtype but has a relatively good prognosis although there is a risk of local and systemic recurrence.
Topics: Adenomyoepithelioma; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Mastectomy; Middle Aged; Retrospective Studies; Sentinel Lymph Node Biopsy
PubMed: 35459179
DOI: 10.1186/s12957-022-02593-3 -
Surgical Case Reports Dec 2023Adenomyoepithelioma (AME) of the breast is an uncommon tumor characterized by the proliferation of ductal epithelial and myoepithelial cells with the heterogeneity....
BACKGROUND
Adenomyoepithelioma (AME) of the breast is an uncommon tumor characterized by the proliferation of ductal epithelial and myoepithelial cells with the heterogeneity. Although benign AME is relatively easy to differentiate from breast cancer by core needle biopsy (CNB) alone, a definitive diagnosis is often difficult. The imaging findings of AME are also variable, and there are particularly few reports about radiological features, including contrast-enhanced magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) values in AME.
CASE PRESENTATION
We present two cases of benign AME. Case 1 is a 30-year-old woman with a history of asthma. The cystic tumor shows smooth borders, and the intracystic solid component is irregular in shape and high vascularity. The pathological findings of the tumor were benign on CNB. The MRI scan showed a decreased ADC value. Case 2 is a 60-year-old woman with only a history of arrhythmia. The tumor shows a lobulated mass with cystic space and coarse calcifications. The pathological findings of the tumor were found to be benign by CNB. Dynamic MRI scan showed a fast washout pattern with a decreased ADC value. Both patients underwent excisional biopsy to confirm the diagnosis, and the pathological diagnosis was benign AME in both cases.
CONCLUSIONS
The AME of the breast has little specific imaging information, so it can be difficult to diagnose based on pathological findings of biopsy specimen. In our case, the ADC values were exceptionally low, contrary to previous reports. It is essential to carefully diagnose AME, considering the discrepancies in imaging findings observed in this case.
PubMed: 38123876
DOI: 10.1186/s40792-023-01793-7 -
The American Journal of Surgical... Jan 2020Pneumocytic adenomyoepithelioma (PAM) was first described in 2007 and was included in the 2015 World Health Organization Classification of lung tumors as a variant of... (Review)
Review
Pneumocytic adenomyoepithelioma (PAM) was first described in 2007 and was included in the 2015 World Health Organization Classification of lung tumors as a variant of epithelial-myoepithelial tumor. This rare pulmonary neoplasm was reported to show both myoepithelial and duct-like components, with the latter exhibiting pneumocytic differentiation with TTF-1 expression. We present an index case and 6 additional retrospectively identified cases of pulmonary tumors with prototypical features of PAM. However, with additional clinicoradiologic, histologic, immunohistochemical and cytogenetic data, we were able to reclassify them as myoepithelial neoplasms-both primary and metastatic-with entrapped exuberantly hyperplastic alveolar structures lined by TTF-1 pneumocytes. We reviewed the available literature related to PAM and myoepithelial tumors. Our cases suggest that the entity referred to as PAM represents interstitial growth of myoepithelial neoplasms enticing marked proliferation of entrapped pneumocytes rather than a distinct biphasic neoplasm with pneumocytic differentiation.
Topics: Adenomyoepithelioma; Aged; Aged, 80 and over; Alveolar Epithelial Cells; Female; Humans; Lung Neoplasms; Male; Middle Aged; Myoepithelioma; Retrospective Studies
PubMed: 31567188
DOI: 10.1097/PAS.0000000000001376 -
Journal of the Korean Society of... Mar 2023This study aimed to evaluate the radiological and clinical characteristics of benign adenomyoepitheliomas of the breast.
PURPOSE
This study aimed to evaluate the radiological and clinical characteristics of benign adenomyoepitheliomas of the breast.
MATERIALS AND METHODS
Over the last 20 years, 120 patients were histologically diagnosed with breast adenomyoepithelioma (AME) at our institution. We excluded 43 patients who were incidentally diagnosed during mastectomy for breast cancer, 28 who underwent percutaneous biopsy without further excision, and 8 who had biopsy-confirmed benign AME and were found to have another pathology after complete excision. We retrospectively reviewed the clinical records and radiological findings of the remaining 41 patients with histologically diagnosed benign breast AMEs after complete excision.
RESULTS
All 41 patients underwent US; 38 underwent mammography (MG) and US; and 18 underwent MG, US, and MRI. MG detected 38 cases with a round or oval shape (56%), and mass (89%), were non-circumscribed (62%), hyperdense (53%), and without microcalcifications (95%). Breast US revealed suspicious masses (98%) with a non-circumscribed margin (66%), hypoechogenicity (43%), and intratumoral vascularity (63%). All lesions on breast MRI showed suspicious masses (100%) with ill-defined margins (61%), and 84% showed wash-out kinetics. Benign AMEs showed suspicious features of Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 in 83%-95% of the MG, US, and MRI. Sixteen of the 41 cases were misdiagnosed on the initial core needle biopsy and two were diagnosed as malignancy.
CONCLUSION
Benign breast AME often shows suspicious radiological features mimicking a malignant mass on MG, US, and MRI. Differentiating benign AME from other pathologies might be difficult on core needle biopsy, and complete excision is needed for a correct diagnosis.
PubMed: 37051396
DOI: 10.3348/jksr.2022.0021 -
Current Breast Cancer Reports Nov 2021The purpose is to present a case series of rare diagnoses and unusual presentations of breast lesions with radiologic-pathologic correlation from a major cancer center,...
PURPOSE OF REVIEW
The purpose is to present a case series of rare diagnoses and unusual presentations of breast lesions with radiologic-pathologic correlation from a major cancer center, and to review the recent literature on each entity with a focus on radiology-pathology concordance. We present our findings and experience from cases of metastatic small cell lung carcinoma to the breast, IgG-4 related breast disease, breast implant associated anaplastic large cell lymphoma, granular cell tumor, pleomorphic sarcoma, adenomyoepithelioma, post-radiation angiosarcoma, and breast carcinoma after risk-reducing total mastectomy.
RECENT FINDINGS
It is essential for physicians to have knowledge of rare breast diagnoses and unusual breast disease presentations to formulate a complete differential diagnosis, recognize radiological-pathological concordance of these entities and provide appropriate patient care.
SUMMARY
Current literature on these rare described entities exists mainly as case reports, case series and small-scale studies. By sharing our findings, we hope to educate trainees in radiology, pathology and other fields across the continuum of care in radiologic-pathologic correlation, while also augmenting the existing literature on these rare entities.
PubMed: 36589040
DOI: 10.1007/s12609-021-00435-x