Case report and literature review: Malignant adenomyoepithelioma after breast augmentation

Abstract

Background: Breast malignant adenomyoepithelioma (MAME) after breast augmentation has never been reported.

Case summary: We reported a case of a 55-year-old woman who was diagnosed with breast MAME 16 years after breast augmentation. Breast augmentation was performed on the patient with two 200 ml round textured prostheses in the subpectoral plane through axillary incisions in 2004. However, a breast ultrasound in 2020 revealed a suspicious malignant lump in the right breast, which was finally confirmed as MAME by pathology. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation were performed. Subsequently, the patient received three cycles of chemotherapy with the regimen of anthracycline and cyclophosphamide. In the following nearly 2 years of follow-up, no tumor recurrence and metastasis were found, and the overall treatment was satisfactory for the patient.

Conclusion: Here, we present a unique case in which a patient was diagnosed with breast MAME after breast augmentation. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation are feasible approaches that yield at least short-term oncological safety and acceptable aesthetic results. However, whether there is a potential relationship between MAME and breast implants remains to be further explored. Meanwhile, due to the rarity of breast MAME, more authoritative strategies considering both oncological safety and aesthetics to seek better long-term therapeutic effects are needed.

Keywords: MAME; breast augmentation; breast reconstruction; malignant adenomyoepithelioma; oncological safety; prosthetic implantation.

Figure 1

Medical imaging presentation of the breast mass. (A) Ultrasound image of a mixed-density multilobulated mass subcutaneous to the breast of an irregular shape and uneven margin; (B) ultrasound image of the pocket of breast prosthesis; (C) MRI image of the breast showing a lobulated mass in the right inner quadrant was adjacent to the margin of the prosthesis, and the vessels were increased and thickened; (D) contrast-enhanced MRI imaging showing that several early enhanced small nodules were seen in the upper posterior area of the tumor and the diffusion was limited, which seems like the satellite lesion of the tumor; (E) enlargement of the image in (D). The capsule of the prosthesis was wrinkled, and the edge of the prosthesis presented the change of chronic inflammation.

Figure 2

Hematoxylin–eosin staining indicated malignant adenomyoepithelioma of the breast lump. (A) Magnification of the main body of the lump (original magnification ×40); (B) magnification of the main body of the lump (original magnification ×100); (C) magnification of the different areas of the lump body (original magnification ×100).

Figure 3

Hematoxylin–eosin staining revealed that no metastasis was observed in the sentinel lymph nodes of the right breast. (A) Magnification of the main body of the lymph nodes (original magnification ×40); (B) magnification of the main body of the lymph nodes (original magnification ×100).