Fine-needle aspiration cytodiagnosis of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare breast cancer with a good prognosis. Its morphology is identical to its counterpart in the salivary glands. In this brief report, two cases of ACC of the breast are presented in which the diagnosis was established on a fine-needle aspiration cytology (FNAC) and correlated with subsequent examination of cell blocks of aspirate and tissue. The cytodiagnostic criteria for ACC of the breast are discussed. Diagn Cytopathol 1996;14:328–330. © 1996 Wiley-Liss, Inc.     

Fine‐needle aspiration cytology of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and has a better prognosis than its counterpart in the salivary glands. In this communication, our experience with seven cases of ACC of the breast is presented in which the diagnosis was established on fine‐needle aspiration cytology (FNAC). The cytologic samples in all cases were cellular and featured three‐dimensional clusters of uniform ductal epithelial cells with cystic spaces, bland nuclei, fine chromatin, and scanty cytoplasm arranged around spheres or cores of homogenous material. The cytodiagnosis of ACC in all cases correlated with subsequent examination of cell blocks of the aspirate and tissue. The cytodiagnostic criteria for ACC of the breast which are useful in a correct FNAC diagnosis are discussed. Diagn. Cytopathol. 1999;20:82–84. © 1999 Wiley‐Liss, Inc.     

Adenoid cystic carcinoma of the breast diagnosed by fine-needle aspiration

Fine-needle aspiration cytology remains a useful tool for preoperative diagnosis of breast lesions. We describe a case of adenoid cystic carcinoma (ACC) of the breast detected by ultrasound-guided fine-needle aspiration (FNA). Subsequent histopathology corroborated the diagnosis. ACC is a rare but distinctive neoplasm of the breast that can be accurately diagnosed by FNA. Its infrequent presentation, favorable prognosis, and relatively conservative management in the breast prompt us to reinforce its features.     

Fine‐needle aspiration cytology for the diagnosis of solid basaloid adenoid cystic carcinoma of the breast: Its role,limitation, and perspective

Solid basaloid adenoid cystic carcinoma (SB‐AdCC) is a subtype of breast AdCC which shows more aggressive clinical behavior than other subtypes. Fine‐needle aspiration (FNA) cytology is a useful diagnostic tool for breast malignancies. However, most of the diagnostic cytological characteristics of AdCC are not present in SB‐AdCC and cytomorphological studies of this subtype are limited. Here, we evaluated the utility of FNA in the diagnosis of SB‐AdCC of the breast. A search of the pathology archives of our institutions for FNA specimens of histologically confirmed SB‐AdCC between 2012 and 2019 identified four patients with SB‐AdCC of the breast. All patients were female and the average age was 60 years. Cytologically, one case was classified as malignant, two as indeterminate, and one as unsatisfactory. Smears had low to moderate cellularity. All smears showed ribbon‐like material surrounding the clusters and a vertical nuclear arrangement toward the peripheral rim. Hyaline globules appeared only in one case. Cells in all cases showed an oval, angular, and spindle shape hyperchromatic nuclei with mild to severe atypia, and also dispersed naked nuclei similar to the cells of the clusters were detected in one case. In histological sections, these cytological findings were compatible with the histological findings and divergent histological differentiation was detected. Diagnosing of few cellular smears of SB‐AdCC is difficult whereas the features of peripheral rim of the clusters, naked nuclei, and the divergent differentiation may be important for diagnosing SB‐AdCC of the breast.     

Fine-needle aspiration biopsy of adenoid cystic carcinoma of the breast: A case report

We describe the cytologic findings of a fine-needle aspiration (FNA) breast lesion with a typical histology for adenoid cystic carcinoma. The aspirate yielded highly cellular smears with a monomorphic population of small, slightly atypical cells, arranged in multilayered groups with abundant fine intercellular metachromatic substance between cell groups. There were also fragments of fibrillar stroma in close relation to epithelial cells. The diagnosis based on the FNA material was suspicious of malignancy. The cytomorphology in this case presented a difficult differential diagnosis with pleomorphic adenoma. Features indicative of adenoid cystic carcinoma were nuclear cell hyperchromasia, the presence of small nucleoli, and scant, poorly defined, or absent cytoplasms. Differential diagnosis of breast adenoid cystic carcinoma with other entities will also be discussed. Diagn Cytopathol 1996;15:431–434. © 1996 Wiley-Liss, Inc.     

Microglandular adenosis: a prime suspect in triple‐negative breast cancer development

Microglandular adenosis (MGA) and atypical MGA (AMGA) are unusual lesions of the breast. They were once regarded as benign proliferative lesions and innocent bystanders. Several lines of evidence suggested that they could be neoplastic, clonal lesions and a non‐obligate precursor for triple‐negative breast cancers (TNBC). Recent work published in The Journal of Pathology by Guerini‐Rocco and colleagues provided further evidence regarding the precursor–product relationship between MGA/AMGA and TNBC. Using a massively parallel sequencing approach, they demonstrated that MGA/AMGA, particularly those associated with TNBC, could be clonal neoplastic lesions showing clonal non‐synonymous mutations, but none in pure MGA. Importantly, those alterations were observed in the associated TNBC. They were also able to identify recurrent alterations in TP53 in those MGA/AMGA cases as well as their associated TNBC. The findings, in conjunction with others, underscore the significance for MGA in clinical diagnosis. The potential of a benign lesion to progress into an aggressive malignant tumour implies that modification of the current management approach may be necessary. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Morphological spectrum of adenoid-cystic carcinoma of the breast: focus on diagnostic and prognostic features

Adenoid cystic carcinoma (AdCC) is a salivary gland-type of cancer that may also occur in the breast. Breast AdCC shows the same morphological spectrum as is observed in salivary glands, with recognition of individual subtypes that may differ in their clinical behaviour. AdCC classic variant (C-AdCC) is a slowly growing tumour, with a low rate of axillary node and distant metastases. Local recurrences may develop as a consequence of incomplete surgical excision. C-AdCC should be differentiated from the solid-basaloid variant of AdCC (SB-AdCC) that is characterized by nuclear atypia, frequent mitotic figures and necrosis, in addition to the solid architecture. SB-AdCC is a more aggressive tumour, with higher rates of axillary node and distant metastases. AdCC may also co-exist with more aggressive types of carcinoma including metaplastic and neuroendocrine carcinoma, referred to as AdCC with high grade transformation (HG-AdCC). This paper reviews the key diagnostic criteria of the different subtypes of breast AdCC with emphasis on differential diagnosis and prognostic parameters.     

The repertoire of somatic genetic alterations of acinic cell carcinomas of the breast: an exploratory,hypothesis‐generating study

Acinic cell carcinoma (ACC) of the breast is a rare form of triple‐negative (that is, oestrogen receptor‐negative, progesterone receptor‐negative, HER2‐negative) salivary gland‐type tumour displaying serous acinar differentiation. Despite its triple‐negative phenotype, breast ACCs are reported to have an indolent clinical behaviour. Here, we sought to define whether ACCs have a mutational repertoire distinct from that of other triple‐negative breast cancers (TNBCs). DNA was extracted from microdissected formalin‐fixed, paraffin‐embedded sections of tumour and normal tissue from two pure and six mixed breast ACCs. Each tumour component of the mixed cases was microdissected separately. Tumour and normal samples were subjected to targeted capture massively parallel sequencing targeting all exons of 254 genes, including genes most frequently mutated in breast cancer and related to DNA repair. Selected somatic mutations were validated by targeted amplicon resequencing and Sanger sequencing. Akin to other forms of TNBC, the most frequently mutated gene found in breast ACCs was TP53 (one pure and six mixed cases). Additional somatic mutations affecting breast cancer‐related genes found in ACCs included PIK3CA, MTOR, CTNNB1, BRCA1, ERBB4, ERBB3, INPP4B, and FGFR2. Copy number alteration analysis revealed complex patterns of gains and losses similar to those of common forms of TNBCs. Of the mixed cases analysed, identical somatic mutations were found in the acinic and the high‐grade non‐acinic components in two out of four cases analysed, providing evidence of their clonal relatedness. In conclusion, breast ACCs display the hallmark somatic genetic alterations found in high‐grade forms of TNBC, including complex patterns of gene copy number alterations and recurrent TP53 mutations. Furthermore, we provide circumstantial genetic evidence to suggest that ACCs may constitute the substrate for the development of more aggressive forms of triple‐negative disease. Copyright © 2015 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Diagnosis of adenoid cystic carcinoma of the breast using fine‐needle aspiration cytology: A case report and review of the literature

Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and is associated with an excellent prognosis. ACC accounts for 0.1% of all breast carcinomas. It has favorable biological characteristics and an excellent prognosis. A 77‐year‐old woman presented with a lump in the right breast. Ultrasonography and mammography showed a 12‐mm, well‐defined, lobulated mass in the retroareolar region of the right breast. The lump was diagnosed as ACC on the basis of immunohistochemical staining results for c‐kit (CD117), muscle‐specific actin, p63, estrogen receptor, and progesterone receptor using a fine‐needle aspiration cytology (FNAC) specimen. This diagnosis was subsequently confirmed by excision biopsy. To the best of our knowledge, this is the first case of ACC of the breast to date to be diagnosed on the basis of immunohistochemical staining of an FNAC cell block material. From our experience, we recommend the usage of cell block material for immunohistochemical studies to accurately diagnose ACC of the breast. Diagn. Cytopathol. 2015;43:722–726. © 2015 Wiley Periodicals, Inc.     

Cytological features of dedifferentiated adenoid cystic carcinoma of the trachea

Adenoid cystic carcinoma (AdCC) is a distinct type of carcinoma, and cytological examination has been recognized as a useful tool in its diagnosis. Dedifferentiation is defined as the abrupt transformation of a low‐grade tumor into a tumor with high‐grade components. Albeit extremely rare, dedifferentiated AdCC has been reported: however, the cytological features of this tumor have not been documented. We observed a case in which a 66‐year‐old Japanese male had stenosis and thickness of the lower tracheal and bronchial walls. Cytological smears of a bronchial brush specimen revealed features typical for low‐grade AdCC. However, a few cohesive epithelial cell clusters composed of large, atypical polygonal cells with large nuclei and conspicuous nucleoli also were present. This component was considered to represent dedifferentiated carcinoma. Histopathological study of the resected bronchial tumor revealed dedifferentiated AdCC. The cytological diagnosis of conventional low‐grade AdCC is straightforward in most cases, although extremely rare, dedifferentiated carcinoma can occur within the conventional AdCC, and detection of a dedifferentiated component is possible in a cytological specimen because of obvious nuclear atypia. Therefore, careful observation is needed because cytologic diagnosis of dedifferentiated AdCC can help expedite treatment of this highly aggressive tumor. Diagn. Cytopathol. 2014;42:880–883. © 2013 Wiley Periodicals, Inc.     

乳腺腺样囊性癌18例临床病理分析

目的探讨乳腺腺样囊性癌(adenoid cystic carcinoma of the breast,ACC)的临床病理特征、免疫表型及其鉴别诊断。方法复习18例ACC的临床病理资料,观察肿瘤的组织形态学及免疫表型特点。同时对患者进行随访获取预后信息。结果 18例ACC患者均为女性,年龄29～80岁。肿瘤大体上多界限清楚,镜下呈浸润性生长,主要由筛状、管状-梁索状、实体和微囊结构组成。肿瘤成分包括腺上皮、肌上皮、基底样细胞和细胞外基质。肿瘤的腺上皮成分表达CK7、CK5/6和CD117,肌上皮成分表达SMA和p63,基底样细胞不同程度表达CK5/6、p63和CD117。随访期内有2例患者肿瘤局部复发,无患者死亡。结论 ACC是一组具有形态学异质性的肿瘤,其腺上皮、肌上皮和基底样细胞成分的免疫表型各有特点,联合运用CK7、CK5/6、p63、SMA和CD117有助于诊断与鉴别诊断。ACC预后良好,具有基底样特征的实体型ACC可能是侵袭性更强的组织学亚型。     

Ultrastructural similarities of adenoid cystic carcinoma and pleomorphic adenoma

Ultrastructural examination of five adenoid cystic carcinomas, three breast and two salivary gland, reveals identical patterns of tumour cell differentiation, organization and distribution of cellular products (Zaloudek, Oertel & Orenstein 1984). In both sites, there is proliferation of two populations of cells, one with characteristics and organization of duct-type luminal epithelial cells and a second that forms the principal proliferating component and has the overall organization and appearance that would suggest that they represent modified myoepithelial cells. Recent ultrastructural studies also indicate that tumour cell types and histological organization similar to those described for adenoid cystic carcinoma occur during histodifferentiation of salivary gland pleomorphic adenoma (Dardick et al. 1983a, b). The characteristic histological pattern of adenoid cystic carcinoma is dependent on the formation of pseudolumina containing proteoglycans and reduplicated basal lamina. Similar, but smaller, lumina of like organization and contents are evident in some cases of pleomorphic adenoma. Both the ultrastructural similarities of the tumour cell types and their organization, in adenoid cystic carcinoma and pleomorphic adenoma, suggest that these tumours have a similar histogenetic basis. The fact that one lesion is malignant and the other benign does not preclude common types of tumour cells and developmental processes.     

Microglandular adenosis associated with triple‐negative breast cancer is a neoplastic lesion of triple‐negative phenotype harbouring TP53 somatic mutations

Microglandular adenosis (MGA) is a rare proliferative lesion of the breast composed of small glands lacking myoepithelial cells and lined by S100‐positive, oestrogen receptor (ER)‐negative, progesterone receptor (PR)‐negative, and HER2‐negative epithelial cells. There is evidence to suggest that MGA may constitute a non‐obligate precursor of triple‐negative breast cancer (TNBC). We sought to define the genomic landscape of pure MGA and of MGA, atypical MGA (AMGA) and associated TNBCs, and to determine whether synchronous MGA, AMGA, and TNBCs would be clonally related. Two pure MGAs and eight cases of MGA and/or AMGA associated with in situ or invasive TNBC were collected, microdissected, and subjected to massively parallel sequencing targeting all coding regions of 236 genes recurrently mutated in breast cancer or related to DNA repair. Pure MGAs lacked clonal non‐synonymous somatic mutations and displayed limited copy number alterations (CNAs); conversely, all MGAs (n = 7) and AMGAs (n = 3) associated with TNBC harboured at least one somatic non‐synonymous mutation (range 3–14 and 1–10, respectively). In all cases where TNBCs were analyzed, identical TP53 mutations and similar patterns of gene CNAs were found in the MGA and/or AMGA and in the associated TNBC. In the MGA/AMGA associated with TNBC lacking TP53 mutations, somatic mutations affecting PI3K pathway‐related genes (eg PTEN, PIK3CA, and INPP4B) and tyrosine kinase receptor signalling‐related genes (eg ERBB3 and FGFR2) were identified. At diagnosis, MGAs associated with TNBC were found to display subclonal populations, and clonal shifts in the progression from MGA to AMGA and/or to TNBC were observed. Our results demonstrate the heterogeneity of MGAs, and that MGAs associated with TNBC, but not necessarily pure MGAs, are genetically advanced, clonal, and neoplastic lesions harbouring recurrent mutations in TP53 and/or other cancer genes, supporting the notion that a subset of MGAs and AMGAs may constitute non‐obligate precursors of TNBCs. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Exfoliative cytology of tracheobronchial adenoid cystic carcinoma

The cytologic findings in the bronchial brushing and washing specimens of three cases of tracheobronchial adenoid cystic carcinoma are reported and compared with those reported in the literature. The cytodiagnostic features including cribriform epithelial clusters, epithelial balls, branching epithelial cylinders, cellular hyaline mucous globules, and a heretofore unemphasized diagnostic clue in exfoliative cytology—naked hyaline globules in washing smears, are illustrated and discussed. Diagn Cytopathol 1996;15:132–135. © 1996 Wiley-Liss, Inc.     

Hybrid carcinoma of the salivary gland: salivary duct adenocarcinoma adenoid cystic carcinoma

AIMS: Hybrid tumours of the salivary gland are rare neoplasms that have been described only in the parotid and palate. Their recognition is important particularly when the component tumours have different biological behaviours. The occurrence of a submandibular hybrid tumour has not been reported. METHODS AND RESULTS: We describe a case of a 36-year-old woman with a hybrid carcinoma composed of salivary duct adenocarcinoma and adenoid cystic carcinoma of the right submandibular gland. There was no evidence of a pre-existing or concurrent pleomorphic adenoma. The presence of the two components was verified by differential immunohistochemical staining using a panel of cytokeratin, vimentin, smooth muscle actin and S100. The patient subsequently developed metastases to the pelvis, lumbar, vertebra and wrist. The clinical course in this patient was consistent with the behaviour of the salivary duct adenocarcinoma component. CONCLUSIONS: The histogenesis of hybrid tumours is largely unknown, but in this case it may represent diverging differentiation of luminal tumour cells. Because some histological features of different salivary gland tumours overlap, immunohistochemistry is a valuable tool especially when used to delineate the components of a hybrid tumour.