Multifocal adenoid cystic carcinoma of the breast: an unusual presentation

• Published in: Canadian Journal of Surgery 2008-04, Vol.51 (2), p.E36-E37
• Main Authors: Alis, Halil, MD, Yigitbas, Hakan, MD, Kapan, Selin, MD, Kalayci, Mustafa, MD, Kilic, Giray, MD, Aygun, Ersan, MD
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Analysis; Biopsy, Needle; Breast - pathology; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breasts; Carcinoma, Adenoid Cystic - diagnosis; Carcinoma, Adenoid Cystic - pathology; Carcinoma, Adenoid Cystic - surgery; Carcinoma, Ductal - diagnosis; Carcinoma, Ductal - pathology; Carcinoma, Ductal - surgery; Care and treatment; Case Note; Case studies; Cysts; Diagnosis; Diagnosis, Differential; Female; Health aspects; Humans; Mammography; Mastectomy, Radical; Medical treatment; Patient outcomes; Risk factors; Surgery; Tumors; Ultrasonography, Mammary; Women
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1016/S0008-428X(08)50191-3

An 83-year-old woman was seen with a mass in her left breast that had been present for 20 years. She complained of rapid enlargement of this mass over the previous 2 months. She had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy 45 years earlier. Her medical history revealed that for the last 20 years she had controlled diabetes and coronary artery disease. Breast examination revealed 2 palpable masses in the upper lateral quadrant measuring 8 × 7 cm and 4 × 3 cm. No axillary lymphadenopathy was detected. Ultrasonography identified 3 similar macrolobulated solid lesions with irregular contours (7 × 6 × 3 cm, 4 × 2 cm and 2 × 1 cm in dimension, respectively). Adjacent to these masses were several hypoechoic masses, the largest having a diameter of 10 mm. We could not determine whether these were round satellite lesions or metastatic intramammarian lymph nodes. Mammography revealed 3 macrolobulated masses with irregular contours: a 7 × 6-cm mass located in the upper lateral quadrant of the left breast, a 4 × 2-cm mass superior to this and adjacent to the axillary tail, and adjacent to the latter, another 3 × 2-cm mass that could not be clearly evaluated owing to superposition (Fig. 1). Pathological examination of a tru-cut biopsy specimen identified an invasive ductal carcinoma with focal intraductal carcinoma. A modified left radical mastectomy was performed. Pathological examination of the surgical specimen revealed 2 multifocal adenoid cystic carcinomas, 5.5 cm and 2.5 cm, respectively, in greatest diameter (Fig. 2). Resection borders were free of carcinoma, 16 axillary lymph nodes showed only reactive hyperplasia and testing for both estrogen-progesterone receptor and c-erbB2 gave negative results. Findings on follow-up examination at 6 and 12 months were unremarkable.