Benign metastasizing adenomyoepithelioma of the breast. A report of 2 cases

Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Ángeles, California, United States
Archives of pathology & laboratory medicine (Impact Factor: 2.84). 10/2006; 130(9):1349-53. DOI: 10.1043/1543-2165(2006)130[1349:BMAOTB]2.0.CO;2
Source: PubMed


Adenomyoepitheliomas of the breast are rare tumors composed of a proliferation of 2 cell populations. For the most part, they are considered to be benign, but they locally recur. Those neoplasms that metastasize are deemed to have come from a histologically malignant primary tumor. Herein, we describe 2 cases of metastases of histologically "benign" adenomyoepitheliomas of the breast to the lung. In both cases, the primary neoplasms and the metastases did not show histologic features of malignancy. These unique cases represent another example of neoplasms that can metastasize in the absence of histologic features that would suggest malignant behavior. Establishing the diagnosis, determining optimal therapy, and predicting outcome are problematic because of the rarity of this entity. Perhaps, classification of adenomyoepitheliomas should be changed to recognize those neoplasms with malignant behavior.

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    • "Although it is difficult to reach a conclusion concerning the degree of malignancy, extirpation of the tumor may be recommended owing to the tendency to develop breast cancer or malignant adenomyoepithelioma (Tsuda et al. 1994; Kiaer et al. 1984), if the preoperative diagnosis of adenomyoepithelial adenosis is performed using needle biopsy . As two cases recurred after excisional biopsy (Kiaer et al. 1984; Erel et al. 2008), re-excision may be recommended in cases of suspected inadequate margin, like adenomyoepithelioma (Nadelman et al. 2006). The best predictors of recurrence are initial incomplete or close excision margins. "
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    ABSTRACT: Adenomyoepithelial adenosis of the breast is an extremely rare type of adenosis. We herein present the case of a 35-year-old woman, who presented with a small painless hard lump and elastic soft induration of 5 cm in diameter in her left breast. Clinical examination and diagnostic workup were suggestive of a breast carcinoma, and a modified radical mastectomy and sentinel node biopsy were performed. Histopathological examination revealed adenomyoepithelial adenosis along with fibrocystic change and small invasive ductal carcinoma, slightly away from the adenosis. The presented case was thought to be initial-stage adenomyoepithelial adenosis and independently developing breast cancer. From a review of five reported cases of adenomyoepithelial adenosis, complete resection of the tumor and coexisting malignant disease may be recommended, owing to the tendency to develop breast cancer or malignant adenomyoepithelioma, or recurrence.
    Full-text · Article · Dec 2013 · SpringerPlus
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    • "Recurrent tumors and distant metastases have been reported in association of both groups. Among the 11 cases of either epithelial and myoepithelial changes included in these studies [7,8], two cases showed malignant transformation of the myoepithelial component only [1,9] and one cases showed malignant transformation of the epithelial component only [10] (Table 2). Because of the capacity of adenomyoepithelioma with both epithelial and myoepithelial malignant transformation to metastasize, this entity should preferably be treated by wide local excision with appropriate margins [7]. "
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    ABSTRACT: Breast adenomyoepithelioma is an unusual tumor characterized by a biphasic proliferation of epithelial and myoepithelial cells. Most breast adenomyoepitheliomas are considered to be benign or to have a low-grade malignant potential, characterized by propensity for local recurrence. Malignant changes arising in this lesion are extremely rare and may involve one or both cellular components.Case report: We discuss a case of a 60 year-old woman who began to experience pain in her right breast in January 2009. Breast ultrasound and mammography were performed showing a rounded, hypoechoic solid lesion with ill-defined margins in the right inner-inferior quadrant, suspicious of malignancy. Quadrantectomy of the inner-inferior quadrant of the right breast with sampling of ipsilateral axillary lymph nodes was performed. The histological analysis confirmed the diagnosis of adenomyoepithelioma with focal malignant change of the epithelial component, associated with high-grade malignant myoepithelial change. The patient was treated with adjuvant radiotherapy and her right breast received a dose of Gy 50 with a boost of Gy 10 to the tumor bed. At present, the patient shows no sign of tumor recurrence. Breast malignant adenomyoepithelioma is a rare tumor which should be considered in the differential diagnosis of other solid breast lesions. Only few cases have been reported in the literature. Diagnosis, optimal therapy and predicting the outcome are problematic issues due to the rarity of this disease which appears to have hematogenous rather than lymphatic spread and usually occurs in primary tumors >= 1.6 cm in size.
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