Radiotherapy in the Multidisciplinary Management of Adenomyoepithelioma of the Breast with an Axillary Lymph Node Metastasis: A Case Report and Review of the Literature

Abstract

We describe a case of aggressive adenomyoepithelioma (AME) of the breast with a lymph node metastasis. A 63-year-old female presented with a fluctuating breast mass and clinically palpable lymph nodes. The patient underwent excisional biopsy followed by mastectomy with lymph node dissection and adjuvant radiotherapy (RT). Clinical behavior of both benign and malignant AME is described with the review of the literature and treatment recommendations.

Adenomyoepithelioma with malignant transformation and repeated local recurrence: A case report

“…Characteristically, AMEs tend to exhibit benign clinical behavior, although malignant transformation has been reported in a small number of cases. This transformation is indicated by features such as prominent cytological atypia, an elevated mitotic index, necrosis, and metastasis [7,8]. Because of the biphasic nature of the tumor, carcinomas may arise from the glandular epithelium, myoepithelium, or both [9][10][11].…”

Malignant adenomyoepithelioma of the breast: A rare case report

“…These tumors range in size from 1 to 17 cm, may contain small cystic areas, and can be classified into three variants: spindle cell, lobulated, and tubular type; the last variant is most common [6,7]. The immunohistochemical analysis of an adenomyoepithelioma generally yields positive staining for AE1/AE3, epithelial membrane antigen, low-molecular-weight keratin, CK antibody, CK AE1/3, CK CAM 5.2, and/or CK7 in the luminal surfaces of glandular cells in the epithelial component, as well as p53, smooth muscle myosin heavy chain (most sensitive), CK5, CD10, calponin, actin, S100, and Ki-67 in the myoepithelial component [2,3,6,7]. Consistent with previous findings, the immunohistochemistry analysis in the present case yielded positive staining for smooth muscle actin and S-100 in myoepithelial cells, which facilitated the diagnosis of AME.…”

“…The differential diagnosis of adenomyoepithelioma includes intraductal papilloma, nipple adenoma, clear cell carcinoma, metaplastic tumors associated with papilloma, invasive ductal cancer with necrosis or hemorrhage, tubular adenoma, sclerosing adenosis, complex sclerosing lesion, ductal adenoma, low-grade adenosquamous carcinoma, metaplastic carcinoma, malignant myoepithelioma, and papillary carcinoma [2,3,7,8]. Characteristically, adenomyoepitheliomas tend to exhibit benign clinical behavior, although malignant transformation has been reported in a small number of cases.…”

“…Characteristically, adenomyoepitheliomas tend to exhibit benign clinical behavior, although malignant transformation has been reported in a small number of cases. This transformation is indicated by features such as prominent cytological atypia, high mitotic activity, necrosis, and an infiltrative growth pattern [6,7,9]. Generally, only one cellular component (epithelial or myoepithelial) becomes malignant, whereas the presence of malignant changes in both cell types is an extremely rare occurrence [10,11].…”

Clinical presentation, national practice patterns, and outcomes of breast adenomyoepithelioma

“…Management of AME also remains controversial owing to the lack of high volume data and absence of prospective studies. Based on the available evidence, nonmalignant AMEs may only require complete surgical resection, whereas malignant tumors involving the breast and/or regional lymphatics could benefit from radiotherapy (RT) . Rare instances of metastatic disease would presumably require chemotherapy, but targeted agents have also been studied in case reports …”