Uğur FIRAT, Bülent MIZRAK, Ayşenur KELEŞ

Yüksek Ki-67 indeksi ile birlikte memenin malign adenomiyoepitelyoması: Literatür eşliğinde olgu sunumu

Meme bezleri ve tükrük bezleri benzer morfolojik özellikler ile karakterli tümörler sergileyebilmektedirler. Memenin tükrük bezi benzeri tümörleri iki tiptir: myoepitelyal diferansiasyon gösteren ve bu diferansiasyondan yoksun olan tümörler. Pür myoepitelyal ya da epimyoepitelyal diferansiasyon gösteren meme tümörleri ise nadirdir. Memenin adenomyoepitelyoması (AME) bifazik bir tümör olup, tükrük bezinin epitelyal-myoepitelyal karsinomu ile özdeştir. Histolojik olarak AME myoepitlyal ve epitelyal olmak üzere iki hücre tipinden oluşmaktadır. Epitelyal komponent, apokrin hücre özellikleri gösteren kolumnar hücrelerden oluşmaktadır. Dış tabaka ise myoepitelyal hücrelerin immün ve histolojik profilini gösteren şeffaf hücrelerden oluşmaktadır. Bizim vakamız, sağ memesinde periferal yerleşimli ağrısız kitle ile başvuran 45 yaşında kadın hasta idi. Makroskopik incelemede, eksizyon materyalinin kesit yüzünde solid, iyi sınırlı, beyaz-gri renkte, sert kitle lezyonu izlendi. Mikroskopik incelemede, tümör epitelyal ve myoepitelyal komponentlerden oluşmakta olup, büyük oranda lobüle, fokal infiltratif marjinler ile karakterli idi. Hem epitelyal hem myoepitelyal komponentte, belirgin pleomorfizm, mitotik aktivite, atipi ve fokal nekrozlar dikkati çekti. İmmünohistokimyasal olarak SMA, CD10, p63 ve sitokeratin 5/6 myoepitelyal komponentte ve sitokeratin 7 epitelyal komponentte pozitif saptandı, Ki-67 proliferasyon indeksi % 20 idi. Östrojen ve progesteron reseptörleri ise negatifdi. Vakamızı meme dokusunda malign AME’nin oldukça nadir olması, yüksek ki-67 indeksi göstermesi ve literatürde bildirilen birkaç vakadan biri olması nedeni ile bildiriye değer bulduk.

Malign adenomyoepithelioma of the breast with high Ki-67 index: Case report with the literature review

Breast glands and salivary glands can manifest as tumors with similar morphological features. Salivary gland-like tumors of the breast are of two types: tumors with myoepithelial differentiation and those devoid of that. The breast tumors showing pure myoepithelial or epimyoepithelial differentiation are rare. Adenomyoepithelioma (AME) of the breast is a biphasic tumor, identical to the epithelial-myoepithelial cell carcinoma of the salivary gland. Histologically, AME is composed of two cell types; myoepithelial and epithelial. The epithelial component is composed of columnar cells showing features of apocrine cells. The outer layer is composed of clear cells with the immunohistological profile of myoepithelial cells. Our case was a 45-year-old woman presenting with a painless mass located peripherally on her right breast. Grossly, on the cut surface of the excision material a solid, well-circumscribed, white-gray, firm mass was seen. Microscopically, the tumoral lesion was composed of epithelial and myoepithelial components and had lobulated and focally infiltrating margins. Both epithelial and myoepithelial components showed marked pleomorphism, mitotic activity, atypia, and focal necrosis. Immunohistochemically SMA, CD10, p63 and CK5/6 were positive in the myoepithelial component and CK7 was positive in the epithelial component, Ki-67 proliferation index was 20% in the tumor. But estrogen and progesterone receptors were negative. We find our case worthy to report because of the tumor showed high Ki-67 index, and extremely rarity of malignant AME in the breast tissue that it has only rarely been documented in the literature.

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1. Foschini Mp, Reis-Filho JS, Eusebi V, et al. Salivary gland-like tumours of the breast: surgical and molecular pathology. J Clin Pathol 2003;56(4):497-506.
2. Rosen PP. Rosen’s Breast Pathology, 3rd edn. Philedelphia: Lippincott Williams&Wilkins, 2009.
3. Gusterson BA, Warburton MJ, Mitchell D, et al. Distribution of myoepithelial cells and basement membrane proteins in the normal breast and in benign and malignant breast diseases. Cancer Res 1982;42(5):763-70.
4. Franke WW, Schmid E, Freudenstein C, et al. Intermediate sized filaments of the prekeratin type in myoepithelial cells. J Cell Biol 1980;36:633-54.
5. Joshi K, Smith JA, Perusingle N, et al. Cell proliferation in human mammary epithelium. Differential contribution of epithelial and myoepithelial cells. Am J Pathol 1986;124(2):199-206.
6. Gudjonsson T, Adriance MC, Sternlicht MD, Petersen OW, Bissell MJ. Myoepithelial cells: Their origin and function in breast morphogenesis and neoplasia. J Mammary Gland Biol Neoplasia 2005;10(3):261-72.
7. Sorlie T, Tibshirani R, Parker J, et al. Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 2003;100(35):8418–23.
8. Rosen PP. Adenomyoepithelioma of the breast. Hum Pathol 1987;18(11):1232-7.
9. Chang A, Bassett L, Bose S. Adenomyoepithelioma of the breast. A cytologic dilemma. Report of a case and review of the literature. Diagn Cytopathol 2002;26:191-196.
10. Tavassoli FA. Myoepithelial lesions of the breast. Myoepitheliosis, adenomyoepithelioma, and myoepithelial carcinoma. Am J Surg Pathol 1991;15(4):554–68.
11. Foschini MP, Eusebi V. Carcinomas of the breast showing myoepithelial cell differentiation. A review of the literature. Virchows Arch 1998;432(3):303–10.
12. Rubin E, Dempsey PJ, Listinsky CM, et al. Adenomyoepithelioma of the breast. A case report. Breast Dis 1995;8(1):103-109.
13. Van Dorpe J, De Weer F, Bekaert J, et al. Malignant myoepithelioma of the breast. Case report with immunohistochemical study. Arch Anat Cytol Pathol 1996;44(2):193-8.
14. Prasad AR, Zarbo RJ. Myoepithelial carcinoma of the breast: A clinicopathologic study of 18 cases. Mod Pathol 2000;13(1):46A.
15. Reis Filho JS, Schmitt FC. Taking advantage of basic research: p63 is a reliable myoepithelial and stem cell marker. Adv Anat Pathol 2002;9(2):280–9.
16. Reis-Filho JS, Milanezi F, Silva P, et al. Maspin expression in myoepithelial tumors of the breast. Pathol Res Pract 2001;197(7):817–21.
17. Loose JH, Patchhefsky AS, Hollander IJ, et al. Adenomyoepithelioma of the breast. A spectrum of biologic behaviour. Am J Surg Pathol 1992;16(6):868-76.
18. Pauwels C, de Potter C. Adenomyoepithelioma of the breast with features of malignancy. Histopathology 1994;24(1):94-6.
19. Rasbridge SA, Millis RR. Adenomyoepithelioma of the breast with malignant features. Virchows Arch 1998;432(1):123-30.
20. Simpson RH, Cope N, Skalova A, et al. Malignant adenomyoepithelioma of the breast with mixed osteogenic, spindle cell, and carcinomatous differentiation. Am J Surg Pathol 1998;22(4):631-6.
21. Chen PC, Chen C-K, Nicastri AD, et al. Myoepithelial carcinoma of the breast with distant metastasis and accompanied by adenomyoepitheliomas. Histopathology 1994;24(4):543-8.
22. Michal M, Baumruk L, Burger J, et al. Adenomyoepithelioma of the breast with undifferentiated carcinoma component. Histopathology 1994;24(2):274-6.
23. Koyama M, Kurotaki H, Yagihashi N et al. Immunohistochemical assessment of proliferative activity in mammary adenomyoepithelioma. Histopathology 1997;31(2):134-9.