Case Of The Month -September 2005

Adenoid Cystic Carcinoma of the Breast

Introduction

This month's case is from Karin Bradshaw of SCL Christchurch and is based on a poster presented at this year's conference in Christchurch

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Clinical Details

A 41 year old female presented with a painful lump in the inner upper quadrant of her right breast for fine needle aspiration.

Five air-dried smears as well as a needle wash for a cellblock were prepared from three aspirates. This was followed by a core biopsy and a subsequent wide local excision with level and 1 and 2 axillary lymphnode clearance.

Cytology

The air-dried smears were stained using DiffQuick stain and the material btained from the needle washing s were used for a cellblock that was routinely processed in histology and sections cut and stained using the H&E stain.

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Diagnosis

On microscopic examination the smears contained atypical cells of small basaloid type arranged in sheets and clusters admixed with round globules of hyaline material. After deliberations a diagnosis of Adenoid Cystic Carcinoma of the Breast was made.

The diagnosis of Adenoid Cystic Carcinoma (B5) was confirmed histologically.

Discussion

Adenoid Cystic Carcinoma of the Breast is an extremely rare type of lesion comprising 0.1% of all breast cancer. The prognosis of this rare tumour is relatively favourable.

Cytologically this tumour is identical to Adenoid Cystic Carcinoma that occurs in the salivary gland and elsewhere.

Smears from this tumour are cellular, with clusters of small cells with scant cytoplasm, round hyperchromatic nuclei and occasional micronucleoli. These cells can be arranged around cores of acellular, homogenous material.

References

  1. Hara,Hitoshi Oyama,T Suda, K : New Criteria for Cytologic Diagnosis of Adenoid Cystic Carcinoma - Acta Cytologica 2005;49:43-50
  2. Masood,Shahla : Cytopathology of the Breast 265-266
  3. Atkinson,BF : Atlas of Diagnostic Cytopathology 438,573
  4. DeMay,R : The Art & Science of Cytopathology - Aspiration Cytology 887
  5. Sheen-Chen, SM Eng, HL Chen, WJ Cheng, YF Ko,SF : Adenoid Cystic Carcinoma of the Breast: truly uncommom or easily overlooked : Anticancer Res 2005 Jan - Feb (1B) 455-8
  6. McClenathan,JH de la Roza,G : Adenoid Cystic Breast Carcinoma : American Journal of Surgery 2002 Jun (6) 646-9
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Thanks to Karin for submitting this case