The potential role of breast conservation surgery and adjuvant breast radiation for adenoid cystic carcinoma of the breast

Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, University Health Network, Ont., Canada.
Breast Cancer Research and Treatment (Impact Factor: 4.2). 11/2004; 87(3):225-32. DOI: 10.1007/s10549-004-8693-z
Source: PubMed

ABSTRACT Adenoid cystic carcinoma (ACC) of the breast is a rare breast cancer variant and optimal management is unclear. A review of this unusual tumour was performed at our Institution, to assess the role of breast conservation in the management of this disease.
A review of all cases of ACC of breast (1960-2000) treated at Princess Margaret Hospital (PMH) was undertaken. Information was collected on age at diagnosis, presenting features, tumour size and treatment modalities. Treatment outcomes were evaluated.
Eighteen female and one male patient were identified. Median age at diagnosis was 58 years (range 35-76 years). Four patients had lymph-node positive disease at presentation; the single male patient presented with metastatic disease. Surgery was either a lumpectomy (10 cases) or a simple, radical or modified radical mastectomy (9 patients). Nine of 19 patients received adjuvant radiotherapy (RT). The median follow-up time was 14 years; the recurrence rate at 10 years was 31% (95% CI 7-54%) with a range in time of recurrence from 2.3 to 11.9 years. Seven recurrences were identified (4 local, 1 regional, 2 metastatic). Two of these patients developed metastatic spread and died. Six of the 19 cases went on to develop second malignancies of whom four died. Among the 18 female patients, the 10-year overall (OS), cause-specific (CSS), and relapse free survival (RFS) rates were 75, 100, and 46% respectively.
ACC of the breast has a relatively prolonged natural history, and responds well to conservative management at presentation, with good outcome, even following local recurrence.

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    • "ACC predominantly affects postmenopausal women with a median age of 60 years (Table 1) in contrast to TNBC, which affects younger patients (b50 years) [2] [8]. In addition, a few ACC cases have been described in men [25] [26] [27] "
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    ABSTRACT: Breast carcinomas that do not express estrogen receptor α, progesterone receptor, or human epidermal growth factor receptor 2 are frequently grouped together as "triple negative" and considered an aggressive type of breast malignancy; however, this group is not homogeneous. Adenoid cystic carcinoma of the breast is a rare type of breast cancer with such triple-negative features and, generally, a more favorable clinical course. This comprehensive review describes diagnostic, molecular, and clinical features of adenoid cystic carcinoma and compares them with those of triple-negative breast carcinomas of no special type.
    Human pathology 03/2013; 44(3):301-9. DOI:10.1016/j.humpath.2012.01.002 · 2.81 Impact Factor
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    • "Adenoid cystic carcinoma (ACC), a salivary gland–like subtype of breast carcinoma, constitutes approximately 0.1% of all breast carcinomas [1]. The typical immunohistochemical profile for ACC is negative for estrogen receptor (ER), progesterone receptor (PR) and Her-2/neu but is positive for basal cell markers including basal cytokeratins (CK5/6, CK14, or CK17) and/or epidermal growth factor receptor (EGFR), p63, SMA, and C-Kit [2] [3]. "
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    ABSTRACT: Adenoid cystic carcinoma of the breast is a rare subtype of breast cancer with basal-like features. Published studies on breast adenoid cystic carcinoma are limited, resulting in relatively scarce information on the value of predictive tumor markers. We studied 20 primary cases of adenoid cystic carcinoma of the breast for expression of estrogen receptor, progesterone receptor, androgen receptor, epidermal growth factor receptor, HER-2/neu, and topoisomerase IIα using immunohistochemistry and fluorescent in situ hybridization methods. Estrogen and progesterone receptor expression were detected in 1 case each. All tumors were uniformly negative for Her-2/neu expression. Androgen receptor and topoisomerase IIα expression were weakly positive in three cases and 7 cases, respectively. Epidermal growth factor receptor overexpression was detected in 13 cases (65% of all cases). Amplification of TOP2A or HER-2/neu gene was not detected in any of the cases. Our study shows that the majority of adenoid cystic carcinomas of the breast do not overexpress Her-2/neu, topoisomerase IIα, or estrogen receptor, and thus, they are unlikely to respond to therapies targeting these proteins. However, these tumors frequently over-express epidermal growth factor receptor, indicating a potential benefit from anti-epidermal growth factor receptor therapy for patients with advanced adenoid cystic carcinomas of the breast.
    Human pathology 11/2010; 41(11):1617-23. DOI:10.1016/j.humpath.2010.04.013 · 2.81 Impact Factor
  • Breast Cancer Research and Treatment 11/2005; 93(3):189-90. DOI:10.1007/s10549-005-5198-3 · 4.20 Impact Factor
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