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: 3.94). 11/2004; 87(3):225-32. DOI: 10.1007/s10549-004-8693-z
Source: PubMed


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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    • "The prognosis of ACC of the breast is improved in comparison to other pathological types of breast cancer and ACC of the salivary gland (1,6). High survival rates following mastectomy or breast protective surgery have been reported previously (7). "
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    ABSTRACT: Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the breast that occurs in <0.1% of all patients diagnosed with breast cancer. The mean patient age at the time of diagnosis is 50-60 years. Typically, the tumor presents as a subareolar mass or as pain in the breast. While the radiological appearances of ACC are generally non-specific, the diagnosis can be made on fine-needle aspiration cytology. In the present study, a 58-year-old female patient was admitted to the Department of Radiation Oncology (Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey) with complaints of pain in the upper outer quadrant of the right breast. An excision biopsy of a lump in the upper outer quadrant revealed ACC, and perineural invasion was present. Subsequently, the patient underwent breast conservation surgery and sentinel lymph node dissection. Pathology from the second surgery depicted ACC in the form of microscopic foci around the initial surgical cavity, with two reactive sentinel lymph nodes and the closest negative margin at 2 mm. The patient was treated with radiotherapy following the surgery. No recurrence and metastasis were found after 20 months of follow-up. In conclusion, mammary ACC is a rare malignant neoplasm of the breast. Although surgery is the main treatment, the optimal adjuvant treatment of ACC of the breast has not yet been determined due to its low incidence.
    Full-text · Article · May 2014 · Oncology letters
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    • "ACCs of the breast have favorable outcomes compared with other forms of breast cancer and ACCs of the salivary glands [3]. The 10-year survival rate for patients with ACCs of the breast has ranged from 85% to 100% [4,5]. Due to the rarity of the tumor and large variations in the patterns of practice, guidelines for treatment have not been established. "
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    ABSTRACT: Adenoid cystic carcinoma (ACC) of the breast is a very rare and indolent tumor with a favorable prognosis, despite its triple-negative status. Due to its rarity, there has been no consensus regarding treatments, and treatment guidelines have not been established. Here, we report on six patients with ACC of the breast. All of the patients initially presented with localized disease and no axillary lymph node metastases. Although some of our patients developed local recurrence or distant metastases, all patients had a favorable clinical course, and to date, none of the patients has died from complications of her disease. Here, we described the clinicopathologic features of ACC of the breast and review the current literature.
    Full-text · Article · Jan 2014 · Cancer Research and Treatment
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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.
    Full-text · Article · Mar 2013 · Human pathology
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