Breast cancer is a heterogeneous disease with various histological and molecular subtypes. Among them, salivary gland tumors are rare and can be divided into three groups: pure myoepithelial differentiation, pure epithelial differentiation and myoepithelial with mixed epithelial differentiation. In the last group, adenoid cystic carcinoma stands out, a rare entity with low malignant potential. It represents less than 0.1–3% of breast cancer cases and has the most frequent clinical presentation as a palpable mass. The diagnosis is confirmed by histology and immunohistochemistry. Classically, they are low-aggressive triple-negative tumors, with overall survival and specific cancer survival at five and ten years greater than 95%. However, there are rare reports of aggressive variants with a risk of distant metastasis and death. Treatment is based on surgical resection with margins. Lymphatic dissemination is rare, and there is no consensus regarding the indication of an axillary approach. Adjuvant radiotherapy is indicated in cases of conservative surgery and should be discussed in other cases. The benefit of chemotherapy remains uncertain, as most tumors are indolent. We report a case that required individualized decisions based on its peculiarities of presentation, diagnosed in an asymptomatic elderly patient during screening, in which mammography showed heterogeneous gross calcifications clustered covering 1.6 cm. Stereotacticguided vacuum-assisted biopsy was performed, and the area was marked with a clip. The anatomopathological examination led to a diagnosis of salivary gland-type carcinoma, triple-negative. The patient underwent segmental resection of the right breast and sentinel lymph node biopsy. The final anatomopathological result was similar to that of the biopsy, with an immunohistochemical profile of the adenoid cystic type and two sentinel lymph nodes free of neoplasia. Considering age and histological subtype, adjuvant therapy was not indicated. Follow-up for three years showed no evidence of disease.

Introduction: Pure mucinous breast carcinoma (PMBC) is rare, representing about 2% of breast cancers. Histologically, it is defined as having 90% or more of a mucinous component. It usually affects women between the ages of 55 and 60 years. Only 1% occurs in women below 35 years. It usually has positive hormone receptors (HRs); however, the positivity of HER-2 is rare. The management is not well established, being extrapolated from data on invasive ductal carcinoma. It usually presents a favorable prognosis, with rare lymph node (LN) involvement and metastasis rate of less than 15%. HR status and nodal involvement are important prognostic factors. Case Report: A 34-year-old female arrived at the clinic with a tumor occupying all quadrants of the left breast for 5 months, along with skin thickening and hyperemia, hardened and enlarged left axillary LN. Ultrasonography showed a lesion with indistinct limits occupying almost the entire mammary parenchyma measuring 11.1×12.8×5.5 cm, and the left LN enlarged in size, the largest measuring 3.1×1.7 cm. Bone scintigraphy and computed tomography (CT) showed suspicious metastatic lesion in the sternum, which could not be proven as metastasis due to the absence of structure to perform a biopsy. A clinical-prognostic staging IV, T4bN1Mx, was determined. Incisional biopsy diagnosed PMBC, histological grade 2. Immunohistochemistry results were HR positive, HER-2 positive (3+), and Ki67 70%. The patient was treated chemotherapy drugs such as Adriamycin, cyclophosphamide, paclitaxel, and trastuzumab. Subsequently, a modified radical mastectomy was performed. The anatomopathology of the surgical specimen showed a complete pathological response. A new CT showed partial remission of sternal metastasis. Adjunctive treatment with trastuzumab, tamoxifen, radiotherapy, and surgical castration were performed. We brought an atypical case due to the presentation of PMBC in young woman, with a more aggressive pattern, with positive HER-2, metastasis, and complete pathological response with chemotherapy.

Objective: The aim was to evaluate an atypical case due to the rare pathologic finding of metaplastic breast carcinoma in a young woman, with an aggressive pattern. Case Report: A 45-year-old female presented with suspicious palpable right axillary lesion at level 1 topography of 2.5 cm size on the physical examination. No breast mass was palpable. Mammography was BIRADS classification 1. Breast and axillar ultrasound done 2 months before showed benign findings on the left side and axillary lymph node (LN) of 2.3 cm and breast nodule of 1.1×0.9 cm on the right side. Core-needle biopsy showed fibroadenoma in the right-sided breast nodule and metastatic carcinoma in the axillary LN. Immunohistochemistry expression of the markers was consistent with breast origin and was progesterone and estrogen receptors positive and HER-2 negative. Magnetic resonance imaging (MRI) showed this atypical LN with 1.5 cm. Clinical staging is T0N1M0. Neoadjuvant chemotherapy was performed with Adriamycin, cyclophosphamide, and paclitaxel. There was tumor remission with another MRI and ultrasonography showed the node metastasis with 1 cm. Right radical mastectomy was performed. Anatomopathology showed cytoarchitectural changes due to chemotherapy, complete pathological response in the LN, and immunohistochemistry unchanged. In addition, tumorectomy were performed in the left-sided nodule, with anatomopathology showing ductal ectasia and histiocitary abscess. Radiotherapy at the supraclavicular area and tangents was performed and tamoxifen was prescribed. The patient remained cancer free for 2 years after surgery. Conclusion: Metaplastic carcinoma represents less than 1% of breast cancers. Histologically, it is invasive and has subtypes based on the proportion of squamous, mesenchymal, and heterologous elements, such as cartilage and bone. Most common in women in the fifth decade and rare in younger than 35 years old. Usually, it is triple negative and has hematogenous dissemination, with little LN involvement and more distant metastasis. There is currently no described standard treatment. Owing to aggressiveness and poor prognosis, chemotherapy and modified radical mastectomy are performed. It is often refractory to standard regimens, so chemotherapy is indicated through the extrapolation of current data to invasive ductal carcinoma. The metastasis rate is about 35% in 5 years. The main prognostic factor is the size of the tumor at the time of diagnosis, LN metastasis, and poorly differentiated tumors.

Introduction: Occult breast carcinoma (OBC) is the histologically proven axillary lymph node (LN) metastasis, consistent with primary breast cancer, with no identifiable primary site. It is most commonly found in women above 60 years. Owing to the absence of protocols, management is challenging. According to the National Comprehensive Cancer Network (NCCN), the therapeutic options are mastectomy plus lymphadenectomy with or without radiotherapy, or lymphadenectomy with breast irradiation with or without axillary irradiation. Mastectomy is often used, but advances in neoadjuvant chemotherapy have made the survival between mastectomy and conservative breast management same. The prognosis is controversial, with lymph node (LN) involvement being the main factor. Case Report: A 45-year-old female presents with suspicious palpable right axillary lesion at level 1 topography of 2.5 cm size on the physical examination. No breast mass was palpable. Mammography was BIRADS classification 1. Breast and axillar ultrasound done 2 months before showed benign findings on the left side and axillary LN of 2.3 cm and breast nodule of 1.1 cm × 0.9 cm on the right side. Core-needle biopsy showed fibroadenoma in the right-sided breast nodule and metastatic carcinoma in the axillary LN. Immunohistochemistry expression of the markers was consistent with breast origin and was progesterone and estrogen receptors positive and HER-2 negative. Magnetic resonance imaging (MRI) showed this atypical LN with 1.5 cm. Clinical staging is T0N1M0. Neoadjuvant chemotherapy was performed with Adriamycin, cyclophosphamide, and paclitaxel. There was tumor remission with another MRI and ultrasonography showing the node metastasis with 1 cm. Right radical mastectomy was performed. Anatomopathology showed cytoarchitectural changes due to chemotherapy, complete pathological response in the LN, and immunohistochemistry unchanged. In addition, tumorectomy were performed in the left-sided nodule, with anatomopathology showing ductal ectasia and histiocitary abscess. Radiotherapy at the supraclavicular area and tangents was performed, and tamoxifen was prescribed. The patient remained cancer free for 2 years after surgery.

Introduction: The risk of breast cancer in transgender men is similar to that of cisgender women. The average age at diagnosis is 44 years, suggesting an early incidence with greater tumor aggressiveness. It commonly presents as a palpable mass, years after masculinizing mastectomy, and has a histological subtype of invasive ductal carcinoma and luminal molecular subtype. Although there are no screening and treatment protocols for these cases, similar follow-up to CIS is recommended, including mastectomy, hormone therapy, radiotherapy and chemotherapy. Case report: Patient, 42 years old, woman, transgender, nulliparous, no use of hormones, presented to an appointment asking for aesthetic mastectomy. She reported a family history of aunt and two cousins with breast cancer and a 32 year-old sister with atypical ductal hyperplasia. She identified a mass in the superolateral quadrant of the left breast through self-examination of the breasts. The mammography showed dense breasts, BIRADS 0. Breast ultrasound resulted in a solid, hypoechoic nodule, irregularly contoured, microlobulated, measuring 1.1x0.6 cm, between 2h and 3h, and about 3 cm from the areola of the left breast and BIRADS 5. Resonance imaging showed this hypointense nodule with lobulated contours measuring 1.3 x 0.6 cm, 3.3 cm from the nipple and 1.7 cm from the pectoral muscles. USG-guided thick needle biopsy diagnosed IDC (Invasive ductal carcinoma), histological grade 2, nuclear grade 3, with moderate stromal fibrosis, severe stromal elastosis, mild lymphocytic inflammatory infiltratation and vascular invasion present. It was 100% positive estrogen receptor and 50% positive progesterone receptor, with 12% Ki67 and negative HER-2, luminal molecular subtype A at immunohistochemistry. A bilateral skin and papillary areolar complex saving mastectomy was performed with sentinel node biopsy on the left. Anatomopathological examination showed absence of metastatic neoplasia in the lymph nodes and left breast with IDC in the retroareolar region, with the same characteristics as the previous biopsy. Pathological staging was T1N0M0 and anatomical staging and pathological prognosis was Ia. Oncotype DX Recurrence Score test was equal to 26. The patient was subjected to six cycles of Taxotere plus Cyclophosphamide and is using Tamoxifen and hormone with Androgel. We report a case of subcutaneous mastectomy used in an innovative way with preservation of the areola-papillary complex (APC), with an aesthetic contour of the chest wall and adjustment of the APC, allowing greater satisfaction in the experience of the genus. The same breast pathology that occurs in women should be expected in transgender women. So, we must consider that the focus on the aesthetic result may result in less precaution with the thickness of the remaining dermogreasy flap, with residual breast glandular tissue, and a higher risk of breast cancer.