Advertisement

Adenoid Cystic Carcinoma of the Breast: Multimodality Imaging Findings and Review of the Literature

Published:November 07, 2022DOI:https://doi.org/10.1016/j.acra.2022.10.003

      Rationale and Objectives

      Adenoid cystic carcinoma (ACC) of the breast is a rare type of breast cancer with favorable prognosis. There is limited data on the radiological findings of this rare tumor in literature. The aim of this study is to determine the most common imaging features and review the literature.

      Materials and Methods

      Pathological databases of seven institutions from 2009 to 2021 were retrospectively reviewed, and patients with a diagnosis of ACC of the breast were determined. Thirteen patients whose imaging studies could be recalled from the picture archiving systems (PACS) were included in the study. Clinical and pathological findings as well as follow-up data were recorded. Radiological findings were analyzed and categorized based on BI-RADS 5th edition.

      Results

      There were 16 mass lesions in 13 patients (two multifocal cases, one case with recurrence). Mammography demonstrated 14 masses, while ultrasound (US) demonstrated all. MRI was available in only seven cases, with eight masses. The most common findings were round or oval shape on all modalities (78.57%–93.75%). Other frequent findings were parallel orientation (81.25%), isoechoic or hyperechoic echogenicity (62.5%), high T2 signal (87.5%), restricted diffusion (71.43%), and homogeneous enhancement (62.5%). Mammography, US and MRI showed circumscribed margins resembling a benign lesion in 35.71%, 37.5% and 50% of the lesions respectively. Three patients had a cyst-like echogenicty on US. Half of the lesions were avascular on Doppler US (6/12) and half were soft (2/4) on strain elastography. Although there were benign features on all imaging modalities seperately, all lesions could be categorized as BI-RADS 4 or 5 when the findings were combined. However 9/16 masses were BI-RADS 4A, emphasizing the subtlety of the malignant features.

      Conclusion

      ACC of the breast can present with findings resembling a benign lesion on different imaging modalities. Although combination of all imaging findings correctly indicated the suspicious nature of the lesions in all cases, final classification was BI-RADS 4A in most of them. Radiologists should be aware of the more frequent findings of ACC of the breast for early diagnosis. US findings of isoechoic or hyperechoic appearance, and cyst-like echogenicity have not been reported previously in literature.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Rosen PP.
        Adenoid cystic carcinoma of the breast. A morphologically heterogeneous neoplasm.
        Pathol Annu. 1989; 24 Pt 2: 237-254
        • Ghabach B
        • Anderson WF
        • Curtis RE
        • et al.
        Adenoid cystic carcinoma of the breast in the United States (1977 to 2006): a population-based cohort study.
        Breast Cancer Res. 2010; 12: R54
        • Santamaría G
        • Velasco M
        • Zanón G
        • et al.
        Adenoid cystic carcinoma of the breast: mammographic appearance and pathologic correlation.
        AJR Am J Roentgenol. 1998; 171: 1679-1683
        • Glazebrook KN
        • Reynolds C
        • Smith RL
        • et al.
        Adenoid cystic carcinoma of the breast.
        AJR Am J Roentgenol. 2010; 194: 1391-1396
        • Tang W
        • Peng WJ
        • Gu YJ
        • et al.
        Imaging manifestation of adenoid cystic carcinoma of the breast.
        J Comput Assist Tomogr. 2015; 39: 523-530
        • Liu L
        • Lin X
        • Xiang H
        • et al.
        Adenoid cystic carcinoma of the breast: a study of five cases.
        J Radiol Case Rep. 2020; 14: 16-25
        • Tsuboi N
        • Ogawa Y
        • Inomata T
        • et al.
        Dynamic MR appearance of adenoid cystic carcinoma of the breast in a 67-year-old female.
        Radiat Med. 1998; 16: 225-228
        • Okamoto Y
        • Sumiyama Y
        • Arima Y
        • et al.
        A case of adenoid cystic carcinoma (ACC) of the breast and review of the utility of preoperative imaging diagnose.
        Breast Cancer. 2001; 8: 84-89
        • Tang P
        • Yang S
        • Zhong X
        • et al.
        Breast adenoid cystic carcinoma in a 19-year-old man: a case report and review of the literature.
        World J Surg Oncol. 2015; 13: 19
        • Sheen-Chen SM
        • Eng HL
        • Chen WJ
        • et al.
        Adenoid cystic carcinoma of the breast: truly uncommon or easily overlooked?.
        Anticancer Res. 2005; 25: 455-458
        • Huang M
        • Jiang T
        • Zhao Q
        • et al.
        Breast adenoid cystic carcinoma: report of a case with emphasis on routine sonographic findings and shear wave elastography.
        J Med Ultrason (2001). 2018; 45: 181-184
        • Dinkel HP
        • Clees M
        • Gassel AM.
        Role of sonography in detecting recurrence in adenoid cystic carcinoma of the breast.
        AJR Am J Roentgenol. 1999; 173: 497-498
        • Delanote S
        • Van den Broecke R
        • Schelfhout VR
        • et al.
        Adenoid cystic carcinoma of the breast in a 19-year-old girl.
        Breast. 2003; 12: 75-77
        • Youk JH
        • Kim MJ
        • Kim EK
        • et al.
        Recurrence of adenoid cystic carcinoma in the breast after lumpectomy and adjuvant therapy.
        J Ultrasound Med. 2006; 25: 921-924
        • Alis H
        • Yigitbas H
        • Kapan S
        • et al.
        Multifocal adenoid cystic carcinoma of the breast: an unusual presentation.
        Can J Surg. 2008; 51: E36-E37
        • Wang H
        • Liu F
        • Gu R
        • et al.
        Rare imaging appearance of adenoid cystic carcinoma of the breast: a case report.
        Mol Clin Oncol. 2017 Sep; 7: 473-475
        • Sperber F
        • Blank A
        • Metser U.
        Adenoid cystic carcinoma of the breast: mammographic, sonographic, and pathological correlation.
        Breast J. 2002; 8: 53-54
        • Bourke AG
        • Metcalf C
        • Wylie EJ.
        Mammographic features of adenoid cystic carcinoma.
        Australas Radiol. 1994; 38: 324-325
        • D'Orsi CJ
        • Sickles EA
        • Mendelson EB
        • Morris EA
        • et al.
        ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston.
        American College of Radiology, VA2013
        • McClenathan JH
        • de la Roza G.
        Adenoid cystic breast cancer.
        Am J Surg. 2002; 183: 646-649
        • Kim M
        • Lee DW
        • Im J
        • et al.
        Adenoid cystic carcinoma of the breast: a case series of six patients and literature review.
        Cancer Res Treat. 2014; 46: 93-97
        • Cadoo KA
        • McArdle O
        • O'Shea AM
        • Power CP
        • Hennessy BT
        Management of unusual histological types of breast cancer.
        Oncologist. 2012; 17: 1135-1145
        • Arpino G
        • Clark GM
        • Mohsin S
        • et al.
        Adenoid cystic carcinoma of the breast: molecular markers, treatment, and clinical outcome.
        Cancer. 2002; 94: 2119-2127
        • Kulkarni N
        • Pezzi CM
        • Greif JM
        • et al.
        Rare breast cancer: 933 adenoid cystic carcinomas from the National Cancer Data Base.
        Ann Surg Oncol. 2013; 20: 2236-2241
        • Thompson K
        • Grabowski J
        • Saltzstein SL
        • et al.
        Adenoid cystic breast carcinoma: is axillary staging necessary in all cases? Results from the California Cancer Registry.
        Breast J. 2011; 17: 485-489
        • Michaelson JS
        • Silverstein M
        • Wyatt J
        • et al.
        Predicting the survival of patients with breast carcinoma using tumor size.
        Cancer. 2002; 95: 713-723
        • Acs G
        • Simpson JF
        • Bleiweiss IJ
        • et al.
        Microglandular adenosis with transition into adenoid cystic carcinoma of the breast.
        Am J Surg Pathol. 2003; 27: 1052-1060