J Korean Soc Radiol.  2016 Nov;75(5):394-398. 10.3348/jksr.2016.75.5.394.

Adenomyoepithelioma of the Breast with Hemorrhagic Change Diagnosed as Papilloma on Core Needle Biopsy: A Case Report

• Nam K
• Kim JY
• Kim SH
• Bae KE
• Lee JH
• Kang MJ
• Jeong MJ
• Kim SH
• Kim JH

• KMID: 2355994
• DOI: http://doi.org/10.3348/jksr.2016.75.5.394

Abstract

Adenomyoepithelioma (AME) is a rare disease entity that represents biphasic proliferation of ductal epithelial and myoepithelial cells. AME can be confused with other neoplasms including malignancy because AME has various cytologic characteristics and nonspecific radiologic features. We describe an unusual AME with hemorrhagic change that was diagnosed as papilloma on core needle biopsy three times previously. The imaging features of AME are also discussed here.

MeSH Terms

Adenomyoepithelioma*
Biopsy, Large-Core Needle*
Breast*
Papilloma*
Rare Diseases
Ultrasonography

Figure

• 

  Fig. 1 An 85-year-old woman with adenomyoepithelioma of the breast with hemorrhagic change that was diagnosed as papilloma on core needle biopsy. A. Initial US of left breast mass showing a 1.4 cm sized, ovoid shaped, circumscribed, isoechoic mass with internal cystic portion and increased vascularity. The final assessment category of the mass was category 4. US-guided core needle biopsy was performed and the diagnosis wa confirmed as papilloma. B-D. Follow-up imaging studies obtained at one year after the initial biopsy. US (B) showing a complex solid and cystic mass with increased vascularity in the central portion. Mammography (C) showing an approximate 2.5 cm sized, oval shaped, hyperdense mass with partially indistinct margin in the mid-outer aspect of the left breast on the outer zone. PET/CT scan (D) showing hypermetabolic uptake (SUVmax, 9.8) in the left breast mass and pleural nodules with effusion due to non-small cell lung cancer. E. Enhanced chest CT scan performed at four years after the initial biopsy. A growing mass with lobulated contour and irregularly enhancing septa was noted. PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography F. Follow-up US images obtained at five years after the initial biopsy showing an approximately 13 cm sized, irregular shaped, circumscribed complex solid and cystic mass with hyperechoic solid mural nodules. The mural nodules show increased vascularity on color Doppler exam. Mastectomy was performed due to profuse bloody nipple discharge. The mass was confirmed as adenomyoepithelioma. G, H. Immunohistochemical staining of the breast mass. Tumor cells are positive for cytokeratin 19 (× 200) (G), a marker of epithelial cells. They are also positive for p63 (× 200) (H), a myoepithelial marker. US = ultrasonography

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