Breast adenomyoepithelioma

• Autor(a) principal: Gomes, Ana Margarida Catarino
• Data de Publicação: 2014
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/5454
• topic: Adenomioepitelioma; Caso-Clínico; Células Mioepiteliais; Imunohistoquímica; Mama; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Adenomyoepithelioma is a biphasic neoplastic proliferation of luminal and myoepithelial cells. Patients are 22 to 92 years old, normally asymptomatic. It is either diagnosed as a palpable mass or as an occasional mammographic finding(1). Fine-needle aspiration cytology is the investigation of choice to diagnose(2) and immunohistochemistry is very useful in confirming the diagnosis(3). Adenomyoepithelioma is usually benign, although it may recur locally(4). Tubular variants and some lobular tumors with high mitotic activity or cytological atypia are particularly prone to local recurrence. Its treatment is complete local excision(5-7) and, in case of recurrence, a wider excision(5). Case Report: 47-year-old female with a breast mass on the external upper quadrant of the left breast. Ultrasound revealed an 8 millimeter homogeneous, well delimitated nodule with regular borders and medio-lateral mammography showed a well defined opaque mass with irregular borders. The anatomo-pathological and immunohistochemisty of the specimen from the needle core biopsy was inconclusive so an excisional biopsy was performed diagnosing a tubular adenomyoepithelioma. No additional treatment was performed with a follow-up of 20 months without recurrence. Review of published cases: 159 cases of adenomyoepithelioma almost all women mostly older than 45 years old. Adenomyoepithelioma is presented as a mass of on average 30 millimeters in either breast of lobular pattern most of the times. Adenomyoepithelioma demonstrated a borderline malignancy especially in women from 15 to 40 years of age or older than 80 years. Lobular pattern proved to be the most benign, while spindle pattern the most malignant variant and tubular pattern is the commonest one to recur. Low mitotic rates are associated with less recurrence or malignancy and high mitotic rates accompany adenomyoepitheliomas with great potential to metastasize. Conclusions: Adenomyoepithelioma affects women aged between 16 and 92 years in either breast. It may display a heterogeneous pattern and a borderline malignancy. Ultrasonographic images may play an important role as a first approach and fine-needle aspiration cytology combined with immunohistochemistry should define the diagnosis. Potential malignant adenomyoepitheliomas are associated with high mitotic activity, cytologic atypia(6), necrosis and infiltrative borders(4). Metastases have only been documented in tumors 20 millimeter in diameter or larger(8) and distant metastases locations include lung, brain, jaw, soft tissues, thyroid, lymph nodes (mediastinal and axillary) and liver(6, 9-13). Mitotic rate appears to be a good parameter for prognosis and to predict the tumor behavior.