Kondo Senri, Oura Shoji
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Case Rep Oncol. 2024 Jul 31;17(1):831-836. doi: 10.1159/000539644. eCollection 2024 Jan-Dec.
Apocrine adenoma of the breast is extremely rare and its typical images remain uncertain.
A 66-year-old woman was incidentally found of her left breast tumor with computed tomography for ascending colon cancer staging work. Mammography showed a well-demarcated oval mass. Ultrasonography showed an oval mass with indistinct borders, internal iso-echoes with multiple high echo spots, and unchanged posterior echoes. Magnetic resonance imaging of the mass showed a hypo-intense pattern both on T1- and T2-weighted images and a long-lasting rim enhancement pattern up to the late phase on time-signal intensity images. Probably due to the inappropriate tissue sampling, no definitive pathological diagnosis was obtained with core needle biopsy, forcing us to do lumpectomy of the breast mass at the time of colon cancer surgery. The resected breast mass was hard, clearly demarcated, and 8 mm in size. Cut surface of the mass was flesh-colored and had multiple white spots. Pathological study showed dense predominantly oval glandular ducts with luminal apocrine cell layers, outer myoepithelium cell layers, and slight fibrosis. Glandular cavities on pathology well matched to the white spots on macroscopic view, seemed vacant in a cyst-like fashion, and had aggregated foamy histiocytes in some of them. These pathological findings led us to the diagnosis of apocrine adenoma of the breast.
Diagnostic physicians should note this extremely rare breast disorder and its image findings.
乳腺大汗腺腺瘤极为罕见,其典型影像仍不明确。
一名66岁女性因升结肠癌分期检查行计算机断层扫描时偶然发现左乳肿物。乳房X线摄影显示一个边界清晰的椭圆形肿块。超声检查显示一个边界不清的椭圆形肿块,内部等回声,有多个高回声点,后方回声无变化。该肿块的磁共振成像在T1加权和T2加权图像上均显示低信号模式,在时间-信号强度图像上直至晚期均呈持续边缘强化模式。可能由于组织取样不当,粗针活检未获得明确的病理诊断,因此我们在结肠癌手术时对乳腺肿块进行了肿块切除术。切除的乳腺肿块质地硬,边界清晰,大小为8毫米。肿块切面呈肉色,有多个白色斑点。病理研究显示主要为密集的椭圆形腺管,有腔内大汗腺细胞层、外层肌上皮细胞层和轻度纤维化。病理上的腺腔与大体观上的白色斑点非常匹配,似乎呈囊肿样空虚,其中一些有聚集的泡沫状组织细胞。这些病理结果使我们诊断为乳腺大汗腺腺瘤。
诊断医师应注意这种极为罕见的乳腺疾病及其影像表现。