Wang Wei, Chen Long, Wen Shaoji, Jiang Jianzhong, Tang Gang, Gao Cheng, Wei Binan, Zhou Feiyu
Department of Breast and Thyroid Surgery, Ba Zhong Central Hospital, Bazhong, Sichuan, China.
Postgraduate School, North Sichuan Medical College, Nanchong, Sichuan, China.
Front Oncol. 2025 Mar 6;15:1496057. doi: 10.3389/fonc.2025.1496057. eCollection 2025.
Adenomyoepithelioma (AME) is a relatively rare type of tumor formed by the coordinated proliferation of glandular epithelial cells and myoepithelial cells. Clinically, most of them are benign, while malignant ones are extremely rare. Malignant breast adenomyoepithelioma is somewhat invasive and may recur locally or metastasize distantly through the vascular pathway. However, reports on axillary lymph node metastasis are scarce. In this case, we present an extremely rare instance of malignant breast adenomyoepithelioma with axillary lymph node metastasis. By combining previous studies, we conduct an in-depth analysis of the clinicopathological features, treatment methods, and prognosis of this disease, and propose targeted diagnostic and treatment suggestions.
A 64-year-old woman initially presented with no abnormalities in the axillary lymph nodes upon clinical examination or imaging. Following the diagnosis of malignant adenomyoepithelioma, the patient underwent unilateral mastectomy. Six months after surgery, the patient developed ipsilateral axillary lymph node enlargement, which was confirmed by pathological examination as metastasis of malignant adenomyoepithelioma of the breast to the axillary lymph nodes. The patient underwent axillary lymph node dissection, followed by four cycles of epirubicin and cyclophosphamide (AC) chemotherapy. Nine months after the operation, the patient returned to our outpatient clinic for follow-up, and the examination results showed no signs of recurrence or distant metastasis.
We meticulously described the clinical symptoms, signs, and imaging characteristics of both the primary lesion of malignant adenomyoepithelioma of the breast and its axillary metastasis in the patient. Through a comparison of the pathologic features between the primary breast lesion and the axillary metastatic lymph nodes, we found a certain degree of consistency in terms of microscopic pathologic features and immunohistochemical molecular expression. Furthermore, we conducted an extensive review of the literature on breast malignant adenomyoepithelioma over the past decade. By summarizing the clinicopathological characteristics, treatment modalities, and prognosis of the patients, we found that patients with breast malignant adenomyoepithelioma have a certain risk of recurrence and metastasis. Notably, even when the clinical examination of axillary lymph nodes yields negative results and imaging shows no enlargement, a more assertive surgical approach may still be necessary. Specifically, a sentinel lymph node biopsy, despite the potential for false-negative outcomes, could be advantageous for the patient's prognosis by enabling early determination of the need for axillary lymph node dissection.
腺肌上皮瘤（AME）是一种相对罕见的肿瘤，由腺上皮细胞和肌上皮细胞协同增殖形成。临床上，大多数为良性，恶性者极为罕见。乳腺恶性腺肌上皮瘤具有一定侵袭性，可能局部复发或通过血管途径发生远处转移。然而，关于腋窝淋巴结转移的报道较少。在此病例中，我们呈现了一例极为罕见的伴有腋窝淋巴结转移的乳腺恶性腺肌上皮瘤。结合既往研究，我们对该疾病的临床病理特征、治疗方法及预后进行了深入分析，并提出针对性的诊断和治疗建议。
一名64岁女性，临床检查及影像学检查最初显示腋窝淋巴结无异常。在诊断为恶性腺肌上皮瘤后，患者接受了单侧乳房切除术。术后6个月，患者出现同侧腋窝淋巴结肿大，经病理检查证实为乳腺恶性腺肌上皮瘤转移至腋窝淋巴结。患者接受了腋窝淋巴结清扫术，随后进行了4个周期的表柔比星和环磷酰胺（AC）化疗。术后9个月，患者返回我院门诊进行随访，检查结果显示无复发或远处转移迹象。
我们详细描述了患者乳腺恶性腺肌上皮瘤原发灶及其腋窝转移灶的临床症状、体征和影像学特征。通过比较乳腺原发灶与腋窝转移淋巴结的病理特征，我们发现微观病理特征和免疫组化分子表达方面存在一定程度的一致性。此外，我们对过去十年关于乳腺恶性腺肌上皮瘤的文献进行了广泛回顾。通过总结患者的临床病理特征、治疗方式及预后，我们发现乳腺恶性腺肌上皮瘤患者有一定的复发和转移风险。值得注意的是，即使腋窝淋巴结临床检查结果为阴性且影像学显示无肿大，仍可能需要采取更积极的手术方法。具体而言，前哨淋巴结活检尽管可能出现假阴性结果，但通过早期确定是否需要进行腋窝淋巴结清扫术，对患者预后可能有利。
