Rare imaging appearance of adenoid cystic carcinoma of the breast: A case report

Abstract

Abstract. Adenoid cystic carcinoma (ACC) of the breast is a rare tumor comprising <0.1% of all breast malignancies. The present study reports the case of a 66-year-old woman who underwent multiple imaging techniques, including mammography, ultrasonography and magnetic resonance imaging (MRI). The patient reported gradual enlargement of a mass in the left breast. Mammography identified a high-density, irregular mass, with nipple retraction. Ultrasonography revealed an irregular, complex cystic and solid mass with an unclear margin in the subareolar region. The internal vascularity was seen on Doppler examination. The lesion on MRI was also mixed cystic and solid, with an irregular shape and irregular margins. The solid part of the lesion appeared heterogeneously isointense on T1-weighted imaging (WI) and a slightly high signal on T2WI, and exhibited internal septations with a low signal on T2WI. Following injection of contrast agent, the enhancement of the solid part was rapid and heterogeneous. The cystic parts of lesion appeared as high-signal on T1WI and T2WI. The tumor infiltrated the left nipple and adjacent skin. The patient underwent a left modified radical mastectomy with axillary lymph node dissection. The pathological examination confirmed the tumor as ACC of the left breast. The axillary lymph nodes were negative for tumor metastasis. Therefore, the differential diagnosis of mixed cystic and solid breast masses with unclear margins and internal septations on T2WI exhibiting delayed enhancement, must include ACC. IntroductionAdenoid cystic carcinoma (ACC) usually occurs in salivary glands, but it has also been described in other organs, including the breast, trachea, uterine cervix, larynx and Bartholin's glands (1-5). However, ACC of the breast is rare (6); thus, there are only a few published studies describing the findings of multiple imaging techniques, and non-specific imaging characteristics have been found on mammography and ultrasonography (7,8). The aim of this study was to present a rare case of proven ACC of the breast and describe its imaging characteristics. Case reportIn April 2016, a 66-year-old woman was admitted to the Sun Yat-sen Memorial Hospital (Guangzhou, China) with a mass in the left breast that had been present for 4 years. The patient reported gradual enlargement of this mass over the last 2 months. Breast examination revealed a palpable mass in the subareolar region measuring 5.0x5.0 cm, with nipple retraction. There was no abnormal nipple discharge or skin redness. Axillary and subclavicular lymph nodes were not palpable. Mammography identified a 6.8x5.0 cm, high-density, irregular mass, with nipple retraction (Fig. 1). Ultrasonography revealed an irregular mass sized 5.0x4.3x5.0 cm, without a clearly circumscribed margin, in the subareolar region. The internal echo of the mass was mixed cystic and solid, with partial enhancement of the posterior echo (Fig. 2). On Doppler examination, internal vascularity was seen. The patient underwent a contrast-enhanced bilateral breast ma...

Triple-Negative Breast Cancer Histological Subtypes with a Favourable Prognosis

“…Adenoid cystic carcinoma (AdCC) is a rare salivary gland type tumour in the breast, first described as a cylindroma of the breast by Billroth in 1856 [ 43 , 44 ]. According to the current WHO classification of breast tumours three subtypes of AdCC are recognized: classic, solid basaloid, and AdCC with high-grade transformation [ 11 ].…”

Adenoid cystic carcinoma of the breast - Discordant size on imaging and pathology: A case report and review of literature

“…On mammograms, the majority of ACC's of the breast present as high-density masses with irregular or lobulated shape and indistinct margins, described as malignant-appearing, in contradistinction to our case [ 2 ]. The mammogram in our patient was noted to be BiRAD-2 without direct or indirect signs of malignancy, likely in part due to the density of the patient's breast tissue.…”

“…ACC was first described by Billroth in 1856 and called ‘cylindroma’. Much later, further scientific investigation by Geschickter and Copeland discovered its eccrine gland origin in 1945 [ 1 , 2 ]. ACC is generally negative for estrogen (ER), progesterone receptors (PR), and HER2.…”

Breast adenoid cystic carcinoma arising in microglandular adenosis: A case report and review of literature

“…It also appears as an architectural distortion or asymmetry[ 22 - 26 ]. In the US examination, it shows an irregular shape, circumscribed or ill-defined margins, and iso-, hypo- or complex echogenicity[ 22 , 23 , 25 , 27 , 28 ]. In MR images, it shows circumscribed round mass with intermediate high T2 SI and persistent enhancing curve[ 23 ], increased T2 SI with variable kinetic curves[ 22 ], spicules and early phase enhancement[ 28 ], and mixed cystic and solid mass with irregular shape and margin, and rapid and heterogeneous enhancement[ 25 ].…”