J Breast Cancer.  2015 Dec;18(4):400-403. 10.4048/jbc.2015.18.4.400.

Malignant Adenomyoepithelioma of the Breast and Responsiveness to Eribulin

Affiliations
  • 1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea. kimhj@dau.ac.kr
  • 2Department of Pathology, Dong-A University College of Medicine, Busan, Korea.
  • 3Department of Surgery, Dong-A University College of Medicine, Busan, Korea.

Abstract

Adenomyoepithelioma (AME) of the breast is an uncommon tumor characterized by its dual differentiation into luminal cells and myoepithelial cells. In most cases these tumors have a benign clinical course, but distant metastases have been reported. We present the case of a 51-year-old woman diagnosed with malignant AME. The patient underwent a right modified radical mastectomy, and pathological examination confirmed the diagnosis of malignant AME. Ten months after the operation, multiple hepatic, pleural, and abdominal wall metastases were detected. A number of palliative chemotherapeutic agents were tried, including anthracycline and taxanes. However, the disease continued to progress, and superior vena cava syndrome developed as a result of direct tumor invasion. The patient received salvage eribulin monotherapy. After two cycles of this treatment, her clinical symptoms were ameliorated, and a computed tomography scan showed a partial response. Eribulin chemotherapy was thus effective in treating malignant AME in this case.

Keyword

Breast; Eribulin; Malignant adenomyoepithelioma; Neplasm metastasis

MeSH Terms

Abdominal Wall
Adenomyoepithelioma*
Breast*
Diagnosis
Drug Therapy
Female
Humans
Mastectomy, Modified Radical
Middle Aged
Neoplasm Metastasis
Phenobarbital
Superior Vena Cava Syndrome
Taxoids
Phenobarbital
Taxoids

Figure

  • Figure 1 Malignant adenomyoepithelioma of the breast. (A) Biphasic proliferation of both inner eptithelial and outer myoepithelial cells was shown (H&E stain, ×200). (B) Atypia was obvious in both myoepithelial and ductal epithelial cells with moderate degree of nuclear pleomorphism, prominent nucleoli, high nuclear cytoplasmic ratio and increased mitotic figures (H&E stain, ×400). (C) The ductal cells were positive for CK5/6 (immunoperoxidase, ×40). (D) The myoepithelial cells were positive for p63 (immunoperoxidase, ×40). (E) The tumor showed lymphovascular invasion (H&E stain, ×100).

  • Figure 2 Radiologic findings for chest computed tomography (CT). CT scan showed marked enlarged recurred mass lesion in right mediastinal pleural areas, which invaded to right pulmonary trunk and superior vena cava.

  • Figure 3 Histological features of metastatic lesion. The abdominal mass showed similar histological findings as in malignant adenomyoepithelioma of the breast (H&E stain, ×20).

  • Figure 4 Chest computed tomography (CT) after eribulin treatment. After two cycles of eribulin treatment, the follow-up CT scan showed decreased extent of recurred mass lesion in right mediastinal pleural areas.


Reference

1. Hamperl H. The myothelia (myoepithelial cells): normal state; regressive changes; hyperplasia; tumors. Curr Top Pathol. 1970; 53:161–220.
2. Loose JH, Patchefsky AS, Hollander IJ, Lavin LS, Cooper HS, Katz SM. Adenomyoepithelioma of the breast: a spectrum of biologic behavior. Am J Surg Pathol. 1992; 16:868–876.
3. Simpson RH, Cope N, Skálová A, Michal M. Malignant adenomyoepithelioma of the breast with mixed osteogenic, spindle cell, and carcinomatous differentiation. Am J Surg Pathol. 1998; 22:631–636.
Article
4. Michal M, Baumruk L, Burger J, Manhalová M. Adenomyoepithelioma of the breast with undifferentiated carcinoma component. Histopathology. 1994; 24:274–276.
Article
5. Rasbridge SA, Millis RR. Adenomyoepithelioma of the breast with malignant features. Virchows Arch. 1998; 432:123–130.
Article
6. Kihara M, Yokomise H, Irie A, Kobayashi S, Kushida Y, Yamauchi A. Malignant adenomyoepithelioma of the breast with lung metastases: report of a case. Surg Today. 2001; 31:899–903.
Article
7. Hayes MM. Adenomyoepithelioma of the breast: a review stressing its propensity for malignant transformation. J Clin Pathol. 2011; 64:477–484.
Article
8. Muñoz-Couselo E, Pérez-García J, Cortés J. Eribulin mesylate as a microtubule inhibitor for treatment of patients with metastatic breast cancer. Onco Targets Ther. 2011; 4:185–192.
9. Cortes J, O'Shaughnessy J, Loesch D, Blum JL, Vahdat LT, Petrakova K, et al. Eribulin monotherapy versus treatment of physician's choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomized study. Lancet. 2011; 377:914–923.
Article
10. Ahmadi N, Negahban S, Aledavood A, Daneshbod K, Daneshbod Y. Malignant adenomyoepithelioma of the breast: a review. Breast J. 2015; 21:291–296.
Article
11. Dewar R, Fadare O, Gilmore H, Gown AM. Best practices in diagnostic immunohistochemistry: myoepithelial markers in breast pathology. Arch Pathol Lab Med. 2011; 135:422–429.
Article
12. Yoon JY, Chitale D. Adenomyoepithelioma of the breast: a brief diagnostic review. Arch Pathol Lab Med. 2013; 137:725–729.
Article
13. Koyama M, Kurotaki H, Yagihashi N, Aizawa S, Sugai M, Kamata Y, et al. Immunohistochemical assessment of proliferative activity in mammary adenomyoepithelioma. Histopathology. 1997; 31:134–139.
Article
14. Mastropasqua MG, Maiorano E, Pruneri G, Orvieto E, Mazzarol G, Vento AR, et al. Immunoreactivity for c-kit and p63 as an adjunct in the diagnosis of adenoid cystic carcinoma of the breast. Mod Pathol. 2005; 18:1277–1282.
Article
15. Cortes J, Vidal M. Beyond taxanes: the next generation of microtubuletargeting agents. Breast Cancer Res Treat. 2012; 133:821–830.
Article
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