Breast malignant
Carcinoma subtypes
Adenoid cystic carcinoma


Topic Completed: 1 March 2012

Revised: 16 September 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed search: Adenoid cystic carcinoma [title] breast

Related topics: Solid variant

Monika Roychowdhury, M.D.
Page views in 2018: 6,120
Page views in 2019 to date: 7,710
Cite this page: Roychowdhury M. Adenoid cystic carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantadenoidcystic.html. Accessed November 13th, 2019.
Definition / general
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
Clinical images

Contributed by Dr. Mark R. Wick

Mammogram

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.


Contributed by 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

H&E and stains


Various images

c-kit / CD117+

Mucicarmine

Cytology description
  • Clusters of epithelial cells oriented around solid spheres of basement membrane material
Cytology images

Contributed by Dr. Mark R. Wick

FNAB



Images hosted on other servers:

Various images

Monomorphic tumor cells around mucoid material

Positive stains
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
Board review question #1
Which of the following is true about adenoid cystic carcinoma of the breast?

A. Primary adenoid cystic carcinomas of the breast are more likely to have regional lymph node metastases than invasive ductal carcinoma, NOS.
B. The incidence of adenoid cystic carcinoma of the breast is widely accepted to be ~5%.
C. Adenoid cystic carcinoma of the breast is likely underdiagnosed.
D. HER2 positivity is common in adenoid cystic carcinoma of the breast.
E. Like adenoid cystic carcinoma of the salivary gland, CD117/KIT is positive in luminal-like cells in adenoid cystic carcinoma of the breast.
Board review answer #1
E. Specific MYB-NFIB gene fusion defines majority of ACC of the breast (~ 90%). This causes overexpression of the MYB gene, which causes overexpression of CD117 (c-kit) in luminal-like cells.
Back to top