An unusual presentation of adenoid cystic carcinoma of the breast with metastatic disease in the clavicle

Abstract

Adenoid cystic carcinoma (ACC) of the breast is a rare subtype of invasive breast cancer. Prognosis is excellent with low rates of recurrence and metastatic disease compared with other triple-negative forms of breast carcinoma and other non-breast forms of ACC. We present a case of a 63-year-old female with metastatic disease in the clavicle 13 years after excision of the breast primary. Metastasis to bone is rare, and this is the first case described in the clavicle. There are no specific radiological features of breast primaries but imaging usually reveals a circumscribed mass, often without microcalcifications. Histology is similar to that of non-breast forms of ACC. Mastectomy or wide local excision is curative in virtually all cases without lymph node involvement. However, as our case demonstrates, the presence of bone pain with a history of ACC of the breast should prompt musculoskeletal imaging. Discussion at a multidisciplinary team meeting is essential for accurate diagnosis.

Adenoid cystic carcinoma of breast: A case report in breast clinic at a Tertiary Care Hospital.

“…However one case of metastatic to Clavicle 13 years after primary surgery has been reported. 8,9 Histologically these tumors resemble their salivary gland counterparts and depict biphasic cellular pattern of myoepithelial as well as epithelial cells (basaloid and ductal components). There can be three varied growth patterns: Glandular, tubular and solid.…”

Clinical and Imaging Analysis of Primary Tumors of the Clavicle

“…The age was older compared to other bone metastases. These tumors mostly had expansile osteolytic destruction with discontinuation of the cortex and soft tissue masses (8). CT displayed lytic bone destruction with ill-defined margins, a soft tissue mass, discontinued cortex and a primary tumor.…”

“…Bone lesions in the clavicle are rare and not common even though every kind of bone lesion which occurs in the skeleton bone has been described in the clav-icle. Many clavicular lesions have been reported in the literature despite that most articles are of single case reports or very small number of patients (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) even though some larger samples have been reported (1,2,16). The great variety of diseases in the clavicle makes radiological diagnosis challenging especially because of limited experience of individual radiologists with these tumors and tumor-like lesions.…”