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Breast-nonmalignant
Benign tumors / changes
Pleomorphic adenoma of breast
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 8 October 2012, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Tumor with benign epithelial and stromal components similar to counterpart elsewhere, but rare in breast
Terminology
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● Also called mixed tumor, chondroid syringoma (in skin)
Epidemiology
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● Rare in humans in breast (<100 cases reported, usually postmenopausal women)
Sites
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Etiology
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● May derive from a single cell with divergent differentiation and not really be “mixed”
Clinical features
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Prognostic factors
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Case reports
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● 55 year old woman (Pathol Res Pract 2005;201:333)
● 59 year old woman with 10 year history of breast mass (Archives 2003;127:474)
● 81 year old woman (Arch Pathol Lab Med 2003;127:e233)
● With two recurrences (Breast J 2007;13:418)
Treatment
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● Wide excision with clear margins to avoid recurrence (Hum Pathol 1991;22:1206)
● Excellent prognosis
Clinical images
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Gross description (Macroscopy)
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● Circumscribed, single or multiple yellow-white firm nodules, 1-4 cm
● Often subareolar
Gross images
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Micro description (Histopathology)
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● Similar to counterpart in salivary glands or skin (Am J Surg Pathol 1990;14:913)
● Fibrous pseudocapsule surrounds benign glandular epithelial and myoepithelial cells in chondromyxoid or osseous stroma
● Epithelial cells are arranged in tubules, islands, cords or sheets, are cuboidal or columnar with bland nuclear features and minimal mitotic figures
● Myoepithelial cells are polygonal or stellate with clear to eosinophilic cytoplasm and small nuclei
Micro images
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Fibrosis, dilated ducts and chondroid metaplasia
Virtual Slides
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Videos
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Cytology description
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Cytology images
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Fig 1/2: FNA shows hypercellular smears with cohesive fragments of proliferative epithelium with papillary architecture and background of myxoid stroma
Fig 3: Epithelial cells have scant fragile cytoplasm with round hyperchromatic nuclei and stromal cells in mucinous background
Fig 4: Tissue sections show encapsulated nodule in subcutis composed of chords and nests of tubuloglandular structures within myxohyaline stroma
Positive stains
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Epithelial cells:
● Keratin, CEA, EMA
● Variable vimentin
Myoepithelial cells:
● Vimentin, S100, keratin, muscle specific actin, calponin, p63
Negative stains
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Electron microscopy descriptions
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● Intermediate filaments with dense bodies and intercellular junctions
Electron microscopy images
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Molecular / cytogenetics description
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● May have similar rearrangements as salivary gland tumor of 8q12 (PLAG1 gene, Cancer Genet Cytogenet 2007;177:1), 12q15 (HMGI-C), and 6p21 (HMGI-Y) (Pathol Res Pract 2005;201:333)
Molecular / cytogenetics images
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Differential Diagnosis
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● Metaplastic carcinoma: malignant epithelial component present
● Mucinous / colloid carcinoma
● Intraductal papilloma with chondro-osseous differentiation
Additional references
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End of Breast-nonmalignant > Benign tumors / changes > Pleomorphic adenoma
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