Breast – Malignant, Males, Children - Adenoid cystic carcinoma

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Breast-malignant, males, children

Adenoid cystic carcinoma

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 7 September 2009

Last major update: September 2009

See below - Solid variant

Definition

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● Identical to salivary gland counterpart

● May be associated with microglandular adenosis (AJSP 2003;27:1052)

Epidemiology

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● Rare, 0.1% of breast carcinomas (Am J Surg 2002;183:646)

● Mean age 50-63 years, range 25-80 years

● 50% are sub-periareolar

Treatment and prognosis

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● Good to excellent prognosis (Breast Cancer Res Treat 2004;87:225)

● Recurs or metastasizes less than usual ductal carcinoma

● High rates of positive margins (Am J Clin Oncol 2009 Aug 28 [Epub ahead of print])

● Axillary nodal metastases are rare

● Treatment is excision with clear margins, possibly radiation, axillary dissection may not be necessary

Case reports

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● 54 year old woman (UPMC Case #140)

● 55 year old woman (The Internet Journal of Pathology 2008;7(2))

● 71 year old woman (Int Semin Surg Oncol 2006;3:17)

● 75 year old woman (Archives 2003;127:e436)

● 82 year old man (Int Surg 2006;91:234)

● Metastatic to kidney (Hum Path 2007;38:1425)

Gross description

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● 1-3 cm, well circumscribed, firm

● May have cystic cut surface

Microscopic description / grading

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● Identical to salivary gland counterpart; has cribriform, solid (see below), trabecular or basaloid patterns

● Two types of cavities and two types of cells: (1) true glandular lumina lined by ductal epithelium (EMA+, keratin+) and (2) eosinophilic “cylinders” with basement membrane material lined by basal / myoepithelial-type cells (vimentin+)

● Microscopic infiltration and perineural invasion are common

● May have sebaceous differentiation (Archives 1986;110:1045)

Micro images

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Low power Cribriform pattern Trabecular pattern #1 #2

Solid, cribriform, tubular and trabecular

patterns of small dark tumor cells

with scant cytoplasm and vesicular nuclei

Cribriform architecture in Lumina contain blue material Resembles salivary

fibrous background or eosinophilic cylinders gland tumor

Low power High power

H&E and stains CK5/6, CK 8/18 c-kit/CD117+

and p63

H&E and stains - comparison with c-kit comparison with Mucicarmine

collagenous spherulosis collagenous spherulosis

Smooth muscle actin+ Various stains

AFIP Third Series:

Tumor nodule with central cysts 13 year old boy with classic invasive

and invasive elements above growth pattern

Area with primarily cylindromatous component and rare glands (arrow)

Cytology description

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● Clusters of epithelial cells oriented around solid spheres of basement membrane material

Cytology images

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Various images Eosinophilic cylindrical material

surrounded by small basaloid cells

Other images: monomorphic tumor cells around mucoid material #1; #2; #3; #4

Positive stains

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Ductal epithelial cells

● EMA, keratin, c-kit/CD117 (Mod Path 2005;18:1623)

Basaloid/myoepithelial-type cells

● p63, S100, smooth muscle actin

Secretions in true lumina

● PAS+ diastase resistant

Cribriform spaces

● Alcian blue (AJCP 2005;124:733)

Negative stains

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● ER, PR (usually), HER2 (Mod Path 2005;18:1277)

● Calponin, smooth muscle myosin heavy chain

Differential diagnosis

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● Collagenous spherulosis - has one cell type, calponin+, smooth muscle myosin heavy chain+, c-kit/CD117-, Mod Path 2006;19:1351)

● Cribriform carcinoma - in situ or invasive, has only one cell type, ER+, PR+, p63-, c-kit/CD117-

Additional references

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● AJSP 1998;22:569, Hum Path 1987;18:1276 (grading), Mod Path 1996;9:215, Stanford University

Solid variant of adenoid cystic carcinoma

Terminology

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● Also called basaloid type

Features

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● Axillary nodal metastases in 2 of 6 cases (AJSP 2002;26:413)

● May have poorer prognosis than classic type (APMIS 1999;107:762)

Case reports

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● Merging with small cell carcinoma (Pathol Res Pract 2005;201:705)

Gross description

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● Solitary mass, mean 4 cm

Gross images

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Contributed by Dr. Semir Vranic, University of Sarajevo, Bosnia and Herzegovina

Micro description

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● Basaloid cells with moderate to marked nuclear atypia, often with 5+ mitotic figures/10 HPF

Micro images

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Solid pattern with inconspicuous cylindromatous elements at arrows (AFIP)

Contributed by Dr. Hind Nassar, Johns Hopkins Medical Center, Maryland (USA):

p63 Actin

Contributed by Dr. Semir Vranic, University of Sarajevo, Bosnia and Herzegovina

Core biopsy

Low power

Medium power

High power

Virtual slides

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Adenoid cystic carcinoma - solid/basaloid type

Positive stains

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● Keratin, basement membrane, vimentin

Negative stains

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● ER, PR

Differential diagnosis

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● Cylindroma - no atypia, no mitotic figures, no infiltration, no mucin (AJCP 2005;123:866)

End of Breast – Malignant, Males, Children > Adenoid cystic carcinoma

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