Article

KIT is highly expressed in adenoid cystic carcinoma of the breast, a basal-like carcinoma associated with a favourable outcome. Mod Path

Department of Pathology, Institut Curie, Paris Cedex, France.
Modern Pathology (Impact Factor: 6.36). 01/2006; 18(12):1623-31. DOI: 10.1038/modpathol.3800483
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ABSTRACT Recent biological studies have classified breast carcinomas into HER2-overexpressing, estrogen receptor-positive/luminal, basal- and normal-like groups. According to this new biological classification, the objectives of our study were to assess the clinical, morphologic and immunophenotypic characteristics of adenoid cystic carcinoma of the breast in order to classify this subtype of breast carcinoma. A total of 18 cases of adenoid cystic carcinoma were identified from the Institut Curie files. Clinical information was available for 16 patients with a median follow-up of 6.5 years. Morphologically, all tumors were graded according to the system defined by Kleer and Oberman (histologic and nuclear grade). Immunophenotype was assessed with anti-ER, PR, HER-2, KIT, basal (CK5/6) and luminal cytokeratins (CK8/18) and p63 antibodies. One out of 18 tumors was nuclear grade 1 (16%), nine were nuclear grade 2 (50%) and eight were nuclear grade 3 (44%). All cases were estrogen receptor, progesterone receptor and HER-2 negative. Epithelial cells were strongly positive around glandular lumina with one or both cytokeratins, identifying the coexistence of CK5/6+ cells, CK5/6 and CK8/18+ cells, CK8/18+ cells and p63+ cells. All cases (100%) were also KIT positive. In all, 15 patients were treated by surgery. Nine of them received adjuvant radiotherapy. Follow-up was available for 16 patients. In all, 14 patients were alive. Two of them, initially treated by surgery only, presented a local recurrence. Two patients died (one of them treated by radiation therapy only died from her disease). Our study shows that adenoid cystic carcinoma of the breast is a special, estrogen receptor, progesterone receptor, HER-2 negative and highly KIT-positive, basal-like breast carcinoma, associated with an excellent prognosis. This highly specific immunophenotype could be useful to differentiate adenoid cystic carcinoma of the breast from other subtypes of breast carcinoma such as cribriform carcinoma.

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    • "Informed consents were not required, women were informed of the research use of their tissues, and did not declare any opposition for such researches. We performed IHC on these tissues, as described previously [27] and we determined after haematoxylin-eosin-safran (HES) staining that the tumors contained between 50–90% cancerous cells. We recorded ER and PR positive nuclear staining in accordance with standardized guidelines, using 10% as the cut-off for ER and PR positive cells. "
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    • "Invasive ductal carcinoma was the most frequent histological subtype identified for the BLBCs in this study (76.59%), in accordance with the literature [7,10,27,28]. Although basal-like tumors were usually shown to have worse prognosis [4,16], several studies have also revealed that carcinomas known to have a good prognosis, such as invasive lobular carcinoma, adenoid cystic carcinoma and tubular carcinomas, may also show basal-like phenotype [29-31]. Most of the medullary carcinomas with their favourable outcome, also, had basal-like phenotype with both GEP and immunohistochemistry [32-34]. "
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    • "The ETV6-NTRK3 and MYB-NFIB fusion genes have been recently described in secretory and adenoid cystic carcinomas, respectively.62,63 In Azoulay’s series (n = 18, median follow-up 6.5 years, one patient died of disease) adenoid cystic TNBCs had excellent outcomes even in the absence of adjuvant chemotherapy, and on reviewing the literature (n = 219 adenoid cystic TNBC cases), they found a 3% breast cancer specific death rate, although information on adjuvant treatment was lacking.64 Despite the histological features of classical medullary carcinomas (ie, highly proliferative, poorly differentiated carcinomas), these tumors frequently carry a good prognosis. "
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