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Adenoid Cystic Carcinoma of the Breast: A Case Report
Taef Hasan Alhussan1*, Ahmad Hadad2, Sayed Agha Ali Shah3
1Department of Radiology, Armed Forces Hospital, Khamis Mushait, Saudi Arabia. 2Department of Diagnostic Radiology, Military Hospital, Southern Region, Saudi Arabia. 3Department of pathology, Armed Forces Hospital, Khamis Mushait, Saudi Arabia.
Abstract
Adenoid cystic carcinoma (ACC) is a basal-like subtype of mammary cribriform, solid, tubular, or trabecular architectural patterns. Epithelial and myoepithelial components make up the distinctive histologic pattern of ACC of the breast, which is like a well-known tumor with the same nomenclature that originates in the salivary gland. In this report, we describe a rare case of ACC in the breast cribriform, trabecular growth pattern. Here we present a rare case of breast adenoid cystic carcinoma with a cribriform, trabecular growth pattern. Imaging studies are nonetheless extremely useful in ACC cases for screening and management planning but might be non-specific due to their variable imaging characteristics. The standard reference is pathological examination. Even though the pathological classification of ACC is still controversial, it is critically important in the decision of treatment options. However, the primary form of therapy for breast ACC patients is currently understood to be surgery. Because this pathological type is so uncommon, there is no clear direction in the selection of specific surgical treatments for this condition, which leads to variations in therapy.
Keywords: Adenoid Cystic Carcinoma, Breast, Pathological, Tumor, Screening
ACC is a basal-like subtype of mammary cribriform, solid, tubular, or trabecular architectural patterns.[1, 2] Epithelial and myoepithelial components make up the distinctive histologic pattern of ACC of the breast, which is similar to a well-known tumor with the same nomenclature that originates in the salivary gland.[3, 4] Cribriform neoplasms such as carcinoma of the lung, prostate, stomach, and colon have been reclassified as more aggressive entities than previously thought.[5, 6] Therefore, pathologists and oncologists may be affected in terms of practical prognostication by the discovery of a cribriform pattern.[7, 8] Less than 4% of all breast cancers are invasive cribriform carcinomas, an uncommon histological subtype of invasive breast cancer.[9, 10] Here we present a rare case of breast adenoid cystic carcinoma with a cribriform, trabecular growth pattern.[11, 12]
A 48-year-old premenopausal female, (gravida 5, para 5), medically free, presented to our hospital in 2016 complaining of right breast pain. There is no family history of breast cancer or any tumor or malignancy. On examination, no palpable masses or axillary lymph nodes, and no skin changes. Mild serous discharge with squeezing is noted.
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Figure 1. Ultrasound showed multiple cystic lesions within the right breast, the largest one measuring about (1.5×1 cm), with thin walls and well-defined outlining, some of them showing fluid debris level, with no mural nodules inside. |
Annual follow-up was recommended.
The patient missed follow-up until January 2023, she came with the same complaint. Examination found a tender lump (2x1 cm) in the upper outer quadrant of the right breast.
On diagnostic mammogram and ultrasound was a BI-RADS-4 as shown in Figures 2 and 3 and recommendations were given for tissue diagnosis with ultrasound-guided core biopsy.
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