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Table of Contents
Definition / general | Epidemiology | Prognostic factors | Case reports | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Cytology images | Positive stains | Negative stains | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Adenoid cystic carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantadenoidcystic.html. Accessed July 14th, 2017.
Definition / general
- Identical to salivary gland counterpart
- May be associated with microglandular adenosis (Am J Surg Pathol 2003;27:1052)
Epidemiology
- Rare, 0.1% of breast carcinomas (Am J Surg 2002;183:646)
- Mean age 50 - 63 years, range 25 - 80 years
- 50% are subperiareolar
Prognostic factors
Treatment and prognosis:
- Good to excellent prognosis (Breast Cancer Res Treat 2004;87:225)
- Recurs or metastasizes less than usual ductal carcinoma
- High rates of positive margins (Am J Clin Oncol 2010;33:28)
- Axillary nodal metastases are rare
- Treatment is excision with clear margins, possibly radiation, axillary dissection may not be necessary
- Prognosis better than that of adenoid cystic carcinoma of other localizations (Breast 2012;21:124)
- Existence of a dedifferentiated component of higher malignancy grade worsens the prognosis (Mod Pathol 2003;16:1265)
Case reports
- 54 year old woman with palpable upper outer quadrant left breast nodule (University of Pittsburg)
- 55 year old woman with adenoid cystic carcinoma of breast (The Internet Journal of Pathology 2007;7(2))
- 61 year old woman with mammographic left breast mass (Case of the Week #271)
- 67 year old woman with adenoid cystic carcinoma intermingled with ductal carcinoma of the breast (J Med Case Rep 2011;5:437)
- 71 year old woman with primary adenoid cystic carcinoma of the breast (Int Semin Surg Oncol 2006;3:17)
- 75 year old woman with breast lump (Arch Pathol Lab Med 2003;127:e436)
- 82 year old man with adenoid cystic carcinoma of the male breast (Int Surg 2006;91:234)
- PIK3CA and PTEN mutations in adenoid cystic carcinoma of the breast metastatic to kidney (Hum Pathol 2007;38:1425)
Clinical images
Images hosted on PathOut server:
Mammogram - courtesy of Dr. Mark R. Wick
Gross description
- 1 - 3 cm, well circumscribed, firm
- May have cystic cut surface
Microscopic (histologic) description
- Identical to salivary gland counterpart; has cribriform, solid, trabecular or basaloid patterns
- Two types of cavities and two types of cells: (1) true glandular lumina lined by ductal epithelium (EMA+, keratin+) and (2) eosinophilic "cylinders" with basement membrane material lined by basal / myoepithelial type cells (vimentin+)
- Microscopic infiltration and perineural invasion are common
- May have sebaceous differentiation (Arch Pathol Lab Med 1986;110:1045)
Microscopic (histologic) images
Scroll to see all images.
Images hosted on PathOut server:
AFIP Third Series:
Case of the Week #271:
Images hosted on other servers:
Courtesy of Dr. Mark R. Wick
AFIP Third Series:
Tumor nodule, central cysts and invasive elements above
13 y / o boy with classic invasive growth pattern
Primarily cylindromatous
component and
rare glands (arrow)
Case of the Week #271:
61 year old woman with a mammographic left breast mass
61 year old woman with a mammographic left breast mass
Images hosted on other servers:
Solid, cribriform, tubular and trabecular patterns
Cribriform, H&E
CK5 / 6 and
CK8 / 18
H&E and stains
Various images
Smooth muscle actin+
CK5 / 6,
CK 8 / 18
and p63
c-kit / CD117+
H&E and stains, comparison with collagenous spherulosis
C-kit comparison with collagenous spherulosis
Mucicarmine
Cytology description
- Clusters of epithelial cells oriented around solid spheres of basement membrane material
Cytology images
Images hosted on PathOut server:
FNAB - courtesy of Dr. Mark R. Wick
Images hosted on other servers:
Various images
Monomorphic tumor cells around mucoid material
Positive stains
- Ductal epithelial cells:
- Basaloid / myoepithelial-type cells:
- Secretions in true lumina:
- PAS+ diastase resistant
- Cribriform spaces:
Negative stains
Molecular / cytogenetics description
- MYB-NFIB fusion gene (t(6;9)(q22-23;p23-24)) has been found in adenoid cystic carcinomas of breast (J Pathol 2012;226:84), making them a genomically distinct subgroup of triple negative breast cancer
Differential diagnosis
- Collagenous spherulosis: has one cell type, calponin+, smooth muscle myosin heavy chain+, c-kit / CD117- (Mod Pathol 2006;19:1351)
- Cribriform carcinoma: in situ or invasive, has only one cell type, ER+, PR+, p63-, c-kit / CD117-
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