J Breast Cancer.  2013 Dec;16(4):432-437. 10.4048/jbc.2013.16.4.432.

Invasive Breast Carcinoma Arising in Microglandular Adenosis: Two Case Reports

• Choi JE
• Bae YK

• KMID: 1976382
• DOI: http://doi.org/10.4048/jbc.2013.16.4.432

Abstract

Microglandular adenosis (MGA) is a rare benign disease that shows an infiltrative growth pattern of small glands, and it may progress to include atypia and carcinoma. Here we report two cases of breast carcinoma arising in MGA. Case 1 was a 44-year-old woman with a previous history of ductal carcinoma in situ in her right breast. During a follow-up, a 1.8 cm mass-like lesion was found in her left breast. An excisional biopsy suggested that the lesion was breast carcinoma. Case 2 was a 57-year-old woman with a 2.9 cm mass in her right breast. A core needle biopsy of the lesion suggested invasive carcinoma. Both patients underwent modified radical mastectomy with sentinel lymph node biopsy. Both tumors lacked a myoepithelial cell layer and stained positively for S-100, lysozyme, and alpha1-antitrypsin, which is typical of MGA. Both cases showed invasive carcinoma arising in MGA.

Keyword

Breast; Carcinoma; Fibrocystic breast disease

MeSH Terms

Adult
Biopsy
Biopsy, Large-Core Needle
Breast*
Carcinoma, Intraductal, Noninfiltrating
Female
Fibrocystic Breast Disease*
Follow-Up Studies
Humans
Mastectomy, Modified Radical
Middle Aged
Muramidase
Sentinel Lymph Node Biopsy
Muramidase

Figure

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  Figure 1 Radiologic findings of case 1. (A) Mammography showing a small nodular density in the left upper outer quadrant. (B) Ultrasound showing suspicious small nodular hypoechogenic lesion in the left upper outer quadrant.

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  Figure 2 Gross findings of case 1. The cut surface of the tumor showing an ill-defined small nodular lesion with no definite mass-like lesion.

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  Figure 3 Microscopic findings of case 1. (A) Carcinoma in situ (right side, arrows) arising in typical microglandular adenosis (MGA) (left side) (H&E stain, ×40). (B) Typical MGA (arrowheads) is composed of round glands lined by a single layer of flat to cuboidal epithelial cells and lacks a myoepithelial layer (H&E stain, ×100). (C) Carcinoma in situ area. The glandular lumen is obliterated by a proliferation of low-grade atypical cells with frequent mitoses (H&E stain, ×100). (D) Infiltrating carcinoma (arrowhead) is present in the stroma between normal mammary glands (left side, black arrows) and MGA (right side, blue arrows) (H&E stain, ×100).

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  Figure 4 Ultrasound of case 2 showing a 2.6-cm lobulating heterogeneous hypoechoic mass in the right upper outer quadrant.

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  Figure 5 Gross finding of case 2. The cut surface of the tumor shows a well-demarcated solid and papillary mass.

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  Figure 6 Microscopic findings of case 2. (A) Infiltrating carcinoma (0.3×0.25 cm) with altered chondromyxoid stroma (arrowheads) is seen adjacent to the encapsulated papillary carcinoma (left upper side, black arrows) and atypical microglandular adenosis (MGA) (right side, blue arrows) (H&E stain, ×40). (B) Atypical MGA. Glandular lumens are obscured by the cellular proliferation of large atypical cells with nuclear hyperchromasia and prominent nucleoli. Regular round glands of typical MGA are seen in the background (arrowheads) (H&E stain, ×100). (C) Immunohistochemical staining for smooth muscle myosin-heavy chain (SHH-HC) shows negativity in MGA (left side, arrowheads), which lacks a myoepithelial cell layer. Normal mammary glands were stained positively in myoepithelial cells (right lower side, arrows) (immunohistochemical stain for SMM-HC, ×100). (D) Immunohistochemical staining for S-100 protein is strongly positive in MGA (arrowheads). Entrapped normal mammary gland is negative for S-100 (arrow) (immunohistochemical stain for S-100 protein, ×100).

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