Breast adenoid cystic carcinoma arising in microglandular adenosis: A case report and review of literature

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.

A rare borderline neoplastic lesion of breast, a mimicker and precursor of carcinoma

“…The entity which lacks myoepithelial layer and can infiltrate into surrounding adipose tissue of breast is Microglandular adenosis. 1,3 An interesting fact is that these lesions will be negative for estrogen, progesterone and HER2 but the epithelial cells lining the ducts show strong positivity for S-100. 4,5 The molecular studies show that acquisition of P53 mutation in microgladular adenosis can lead to triple negative breast carcinoma due to increased genetic instability.…”