Khan Muhammad Umair
Armed forces institute of Pathology, Rawalpindi-Pakistan.
J Ayub Med Coll Abbottabad. 2024 Jul-Sep;36(3):667-669. doi: 10.55519/JAMC-03-13011.
Adenomyoepithelioma (AME) is a rare variant of breast neoplasm. It is a biphasic tumour characterized by small epithelial-lined spaces with inner luminal cells and outer of abluminal (myoepithelial) cells. Either - or both - of these two cells may rarely undergo malignant transformation. We present a case of a 61-year-old lady who arbored a mass in her right breast. She presented with few left sided pulmonary nodules as well and was initially diagnosed with extensive DCIS on core biopsy. Lung biopsy of nodule was diagnosed as epithelial myoepithelial neoplasm. Ultimately, modified radical mastectomy and pneumonectomy was performed. The final histopathological diagnosis turned out to be malignant. Adenomyoepithelioma with carcinoma; epithelial-myoepithelial carcinoma of breast with pulmonary metastasis. The malignant transformation of adenomyoepithelioma has been documented in only a limited number of cases. Benign AME often undergoes treatment through wide local excision, given its rare local recurrence. In contrast, the approach to malignant AME typically involves a mastectomy, with or without a lymph node biopsy. Metastases may manifest several years' post-primary diagnosis, even in cases of AMEs lacking atypical histological features. However, in our case metastasis was seen with in first four months of clinical presentation. Adenomyoepithelioma with carcinoma is an exceptionally rare neoplasm that may present with early metastasis, challenging the conventional findings of late metastasis as reported in studies. Consequently, the behaviour and prognosis of this entity remains a grey area, necessitating further exploration with a substantial sample size.
腺肌上皮瘤（AME）是一种罕见的乳腺肿瘤变体。它是一种双相性肿瘤，其特征是有小的上皮内衬腔隙，腔内有内层细胞，腔外有肌上皮细胞。这两种细胞中的一种或两种很少会发生恶性转化。我们报告一例61岁女性，其右乳有一肿块。她还伴有左侧少量肺结节，最初经粗针活检诊断为广泛导管原位癌。肺结节活检诊断为上皮肌上皮肿瘤。最终进行了改良根治性乳房切除术和肺切除术。最终组织病理学诊断为恶性。腺肌上皮瘤伴癌；乳腺上皮-肌上皮癌伴肺转移。腺肌上皮瘤的恶性转化仅在少数病例中有记录。良性AME由于很少局部复发，通常通过广泛局部切除进行治疗。相比之下，恶性AME的治疗方法通常包括乳房切除术，可伴有或不伴有淋巴结活检。转移可能在原发诊断后数年出现，即使是缺乏非典型组织学特征的AME病例也是如此。然而，在我们的病例中，转移在临床表现后的头四个月内就出现了。腺肌上皮瘤伴癌是一种极其罕见且可能早期转移出现的肿瘤，挑战了既往研究报道的晚期转移这一传统发现。因此，该实体的行为和预后仍不明确，需要用大量样本进一步探索。
