Sheen-Chen Shyr-Ming, Eng Hock-Liew, Chen Wei-Jen, Cheng Yu-Fan, Ko Sheung-Fat
Department of Surgery, Chang Gung Memorial Hospital, Taiwan.
Anticancer Res. 2005 Jan-Feb;25(1B):455-8.
Adenoid cystic carcinoma of the breast is an uncommon histologic form of breast cancer, comprising in most series less than 1% of all mammary cancers. Due to the rarity, little information about its presentation on image studies has been noted in the literature. Here we report two additional cases with emphasis on the intriguing image presentations.
A 67-year-old woman came to our clinic with the chief complaint of mastodynia. No obvious palpable mass of breast was found on physical examination. Mammography showed a small well-defined nodule in the medial part of the left breast without mammographic evidence of malignancy. Ultrasonography showed a 1.5 cm nodule with well-defined margin and heterogenous echogenicity in the medial part of the left breast. Unusually, a painful sensation was experienced on compression by the probe. The final pathological report was adenoid cystic carcinoma.
A 48-year-old woman also came to our clinic with the chief complaint of mastodynia. No obvious palpable mass of breast was found on physical examination. Mammography showed dense mammary tissue with no mammographic evidence of malignancy. Ultrasonography showed two contiguous well-defined nodules with heterogenous echogenicity in the upper, middle part of the left breast. Unusually, a painful sensation was also noted on compression by the probe. Histopathological examination showed typical features of an adenoid cystic carcinoma.
Adenoid cystic carcinoma of the breast fails to show the typical appearance of invasive ductal carcinoma on both mammogram and ultrasonography, probably due to its relatively well-defined nature with less surrounding architectural disruption and fibrosis. Hence a "negative" finding or a benign-looking breast lesion on mammography cannot completely exclude the existence of this disease. The presence of a painful breast lesion without obvious inflammatory evidence while compressed is a meaningful clue, which should lead to the suspicion of adenoid cystic carcinoma of the breast.
乳腺腺样囊性癌是一种罕见的乳腺癌组织学类型，在大多数系列研究中，其占所有乳腺癌的比例不到1%。由于其罕见性，文献中关于其影像学表现的信息较少。在此，我们报告另外两例病例，并重点关注其有趣的影像学表现。
一名67岁女性因乳房疼痛为主诉前来我院就诊。体格检查未发现乳房有明显可触及肿块。乳腺钼靶显示左乳内侧有一个边界清晰的小结节，无恶性钼靶表现。超声显示左乳内侧有一个1.5厘米的结节，边界清晰，内部回声不均匀。不同寻常的是，探头压迫时会有疼痛感。最终病理报告为腺样囊性癌。
一名48岁女性也因乳房疼痛为主诉前来我院就诊。体格检查未发现乳房有明显可触及肿块。乳腺钼靶显示乳腺组织致密，无恶性钼靶表现。超声显示左乳上中部有两个相邻的边界清晰的结节，内部回声不均匀。同样，探头压迫时也有疼痛感。组织病理学检查显示为典型的腺样囊性癌特征。
乳腺腺样囊性癌在乳腺钼靶和超声检查中均未表现出浸润性导管癌的典型外观，可能是由于其边界相对清晰，周围结构破坏和纤维化较少。因此，乳腺钼靶检查中“阴性”发现或看似良性的乳腺病变并不能完全排除该病的存在。乳房病变在受压时出现疼痛且无明显炎症证据是一个有意义的线索，应引起对乳腺腺样囊性癌的怀疑。
