Wan Dan, Zhou Hongyuan, Zhang Yutao
Department of Pathology, The First People's Hospital of Zigong, Zigong, China.
Front Oncol. 2022 Jul 7;12:905997. doi: 10.3389/fonc.2022.905997. eCollection 2022.
Adenoid cystic carcinoma (ACC) of the breast (breast ACC) is a rare tumor, especially in men, with only 17 cases reported in the literature. Owing to this rarity, male breast ACC is susceptible to missed or incorrect diagnoses, and data on treatment options and prognosis is also scarce. Herein, we report a case of a male patient with primary breast ACC and performed a detailed clinicopathological analysis of the 17 cases reported in the literature. A 38-year-old Chinese man patient developed right-sided breast nipple retraction in 2013 and presented to our hospital in 2015 with a palpable mass in the right breast for four days. B-scan ultrasound indicated the presence of a solid space-occupying lesion in the right breast. Breast Imaging Reporting and Data System (BI-RADS) classified the lesion as category 4B, and mammography showed a right breast nodule classified as BI-RADS 4C. Modified radical mastectomy for breast cancer was performed on the right breast. Microscopic examination of the excised tissue revealed diffuse tumor invasion of the subcutaneous fibers and adipose tissue, with tumor cells arranged in cribriform, tubular, and microcystic patterns. Immunohistochemical staining indicated that the glandular epithelial cells were positive for CD117, CK7, and Ki67 (approximately 30%) and negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2, while the myoepithelial/basal cells were positive for P63, CK5/6 and S-100. Moreover, basement membrane materials were positive for collagen type IV. Molecular pathology analysis by fluorescence hybridization revealed that the tumor was negative for rearrangements. The patient was followed up for 82 months with no tumor recurrence or metastasis. According to the current literature, mastectomies have a better prognosis than lumpectomy. Accurately identifying the diagnosis of male breast ACC and considering the surgery of mastectomy may be the key factors for patients to obtain a good prognosis based on the microscopic characteristics of the tumor.
乳腺腺样囊性癌（乳腺ACC）是一种罕见肿瘤，在男性中尤为罕见，文献中仅报道过17例。由于其罕见性，男性乳腺ACC易被漏诊或误诊，关于治疗方案和预后的数据也很匮乏。在此，我们报告一例原发性男性乳腺ACC病例，并对文献报道的17例病例进行了详细的临床病理分析。一名38岁的中国男性患者于2013年出现右侧乳腺乳头内陷，2015年因右侧乳腺可触及肿块4天前来我院就诊。B超显示右侧乳腺存在实性占位性病变。乳腺影像报告和数据系统（BI-RADS）将该病变分类为4B类，乳腺钼靶显示右侧乳腺结节分类为BI-RADS 4C。对右侧乳腺实施了乳腺癌改良根治术。对切除组织的显微镜检查显示肿瘤弥漫性侵犯皮下纤维和脂肪组织，肿瘤细胞呈筛状、管状和微囊状排列。免疫组化染色显示腺上皮细胞CD117、CK7和Ki67（约30%）呈阳性，雌激素受体、孕激素受体和人表皮生长因子受体2呈阴性，而肌上皮/基底细胞P63、CK5/6和S-100呈阳性。此外，基底膜物质IV型胶原呈阳性。荧光杂交分子病理分析显示肿瘤重排呈阴性。对该患者进行了82个月的随访，未见肿瘤复发或转移。根据目前的文献，乳房切除术的预后优于肿块切除术。根据肿瘤的微观特征，准确识别男性乳腺ACC的诊断并考虑乳房切除术可能是患者获得良好预后的关键因素。
