Adenoid cystic carcinoma of the breast: a study of five cases

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.

Keywords: Breast Adenoid cystic carcinoma; Clinical features; Mammography; Prognosis; Ultrasound.

Figure 1

49-year-old woman with adenoid cystic carcinoma of the right breast. FINDINGS: Figure 1a An oval hypoechoic heterogeneous solid mass (41 × 31 mm) with a circumscribed margin, a parallel orientation, and posterior enhancement is shown on B-mode ultrasound. Color Doppler shows minimal vascularity and an arterial spectrum is detected by pulse wave Doppler. Figure 1b Mammography shows bilateral diffuse heterogeneous dense breasts. A hyperintense irregular large mass (56 × 52 mm, yellow arrow) with a sharp margin but without calcification is seen in the upper outer quadrant of the enlarged right breast. Figure 1c Hematoxylin and eosin stained sections show tumor cells arranged in small dispersed nests with cribriform growth and moderate cytoplasmic staining. Figure 1d After 53 months, sagittal contrast-enhanced T1-weighted magnetic resonance imaging demonstrates multiple lesions with strong signals (yellow arrow and circle) which reflect vertebrae metastases. TECHNIQUE: Figure 1a Ultrasound using the GE Vivid 7 (GE Healthcare, USA) ultrasound machine with a 12L linear transducer. Figure 1b Mammogram using the Senographe DS (GE Healthcare, USA) (28 kVp and 48mAs). Figure 1c Hematoxylin and eosin stained sections: ×500 and ×200. Figure 1d magnetic resonance imaging using the SIGNA Pioneer (GE Healthcare, USA); sagittal SE water T1-weighted IDEAL +C, 3.0 T; slice thickness, 3 mm; repetition time, 444 ms, echo time, 10.144 ms, contrast material, 10ml of Multihance (Bracco, Italy)

Figure 2

50-year-old woman with adenoid cystic carcinoma in the left breast. FINDINGS: Figure 2a An irregular heterogeneous mass (20 × 17 mm) with an indistinct, angular, microlobulated margin, a parallel orientation, and posterior shadowing is shown using B-mode ultrasound. Color Doppler shows minimal vascularity. The entire area of the tumor and its surrounding area are blue on elastography. The elasticity imaging score of the lesion was 5. Figure 2b A mammogram demonstrates bilateral scattered fibroglandular tissue. An irregular hyperintense mass (14 × 11 mm) with an indistinct margin is seen in the outer quadrants of the left breast (yellow arrow). No suspicious microcalcification is noted. TECHNIQUE: Figure 2a Ultrasound using the LOGIQ S8 (GE Healthcare, USA) ultrasound machine with a 6–15L linear transducer. Figure 2b Mammography using the Senographe DS (GE Healthcare, USA) (31 kV and 32 mAs).

Figure 3

54-year-old woman with adenoid cystic carcinoma of the right breast. FINDINGS: Figure 3a A heterogeneous hypoechoic solid mass (11 × 8 mm, yellow arrow) with a microlobulated margin, an unparallel orientation, and posterior enhancement is shown on ultrasound. No vascular signal is detected inside the tumor on color Doppler. Figure 3b Mammography demonstrates bilateral heterogenous dense breasts. A hyperintense irregular mass (14 × 11 mm, yellow arrow) is shown within the lower inner quadrant of the right breast. No suspicious microcalcification is observed. Hematoxylin and eosin staining shows cribriform and tubular growth (Figure 3c, ×500). Immunohistochemical staining shows CD117 (Figure 3d, ×200) and Ck5/6 (Figure 3e, ×200) positivity. TECHNIQUE: Figure 3a Ultrasound using the DC-8 (Mindray, China) with a 12L-3 linear transducer. Figure 3b Mammography using the Senographe DS (GE Healthcare, USA) (34 kV and 22 mAs). Figure 3c Hematoxylin and eosin stained sections, (×500). Figure 3d & 3e Immunohistochemical staining, (×200).

Figure 4

60-year-old woman with adenoid cystic carcinoma in the left breast. FINDINGS: Figure 4a An irregular heterogeneous hypoechoic mass (11 × 8 mm) with a parallel orientation, a microlobulated margin, and posterior enhancement is shown on B-mode ultrasound. Color Doppler shows minimal vascularity in the mass. Figure 4b Mammography demonstrates bilateral scattered fibroglandular tissue. An irregular hyperintense mass (14 × 11 mm) with an indistinct margin is shown in the outer quadrant of the left breast. No suspicious microcalcification is observed. TECHNIQUE: Figure 4a Ultrasound using the ACUSON Sequoia 512 (Siemens, USA) with a 15L-8 linear transducer. Figure 4b Mammography using the Senographe DS (GE Healthcare, USA) (31 kV and 20 mAs).

Figure 5

61-year-old woman with adenoid cystic carcinoma in the right breast. FINDINGS: Figure 5a Two adjacent irregular tumors with a parallel orientation and microlobulated and angular margins are shown on B-mode ultrasound. Color Doppler shows minimal vascularity and an arterial spectrum is detected on pulse wave Doppler. Figure 5b Mammography demonstrates bilateral heterogeneous dense breasts with an irregular hyperintense mass in the right breast (yellow arrow). Figure 5c Hematoxylin and eosin staining (×200) shows cribriform and solid growth. TECHNIQUE: Figure 5a Ultrasound using the AplioTM 400 (Toshiba, Japan) with a 14L-5 linear transducer. Figure 5b Mammography using the Senographe DS (GE Healthcare, USA) (32 kV and 25 mAs). Figure 5c Hematoxylin and eosin stained sections (×200).