Skip to main content

Advertisement

Log in

Uncommon Tumors and Uncommon Presentations of Cancer in the Breast

  • Best Practice Approaches Breast Radiology-Pathology Correlation and Management (J Scheel and MR Kilgore, Section Editors)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose is to present a case series of rare diagnoses and unusual presentations of breast lesions with radiologic-pathologic correlation from a major cancer center, and to review the recent literature on each entity with a focus on radiology-pathology concordance. We present our findings and experience from cases of metastatic small cell lung carcinoma to the breast, IgG-4-related breast disease, breast implant-associated anaplastic large cell lymphoma, granular cell tumor, pleomorphic sarcoma, adenomyoepithelioma, postradiation angiosarcoma, and breast carcinoma after risk-reducing total mastectomy.

Recent Findings

It is essential for physicians to have knowledge of rare breast diagnoses and unusual breast disease presentations to formulate a complete differential diagnosis, recognize radiological-pathological concordance of these entities, and provide appropriate patient care.

Summary

Current literature on these rare described entities exists mainly as case reports, case series, and small-scale studies. By sharing our findings, we hope to educate trainees in radiology, pathology, and other fields across the continuum of care in radiologic-pathologic correlation, while also augmenting the existing literature on these rare entities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ota T, Hasegawa Y, Okimura A, Sakashita K, Sunami T, Yukimoto K, et al. Breast metastasis from EGFR-mutated lung adenocarcinoma: a case report and review of the literature. Clin Case Rep. 2018;6(8):1510–6. https://doi.org/10.1002/ccr3.1636.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lee AH. The histological diagnosis of metastases to the breast from extramammary malignancies. J Clin Pathol. 2007;60(12):1333–41. https://doi.org/10.1136/jcp.2006.046078.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lee SK, Kim WW, Kim SH, Hur SM, Kim S, Choi JH, et al. Characteristics of metastasis in the breast from extramammary malignancies. J Surg Oncol. 2010;101(2):137–40. https://doi.org/10.1002/jso.21453.

    Article  PubMed  Google Scholar 

  4. Liu W, Palma-Diaz F, Alasio TM. Primary small cell carcinoma of the lung initially presenting as a breast mass: a fine-needle aspiration diagnosis. Diagn Cytopathol. 2009;37(3):208–12. https://doi.org/10.1002/dc.20995.

    Article  PubMed  Google Scholar 

  5. Vizcaíno I, Torregrosa A, Higueras V, Morote V, Cremades A, Torres V, et al. Metastasis to the breast from extramammary malignancies: a report of four cases and a review of literature. Eur Radiol. 2001;11(9):1659–65. https://doi.org/10.1007/s003300000807.

    Article  PubMed  Google Scholar 

  6. Jochimsen PR, Brown RC. Metastatic melanoma in the breast masquerading as fibroadenoma. JAMA. 1976;236(24):2779–80.

    Article  CAS  PubMed  Google Scholar 

  7. Lee SH, Park JM, Kook SH, Han BK, Moon WK. Metastatic tumors to the breast: mammographic and ultrasonographic findings. J Ultrasound Med. 2000;19(4):257–62. https://doi.org/10.7863/jum.2000.19.4.257.

    Article  CAS  PubMed  Google Scholar 

  8. Luh SP, Kuo C, Tsao TC. Breast metastasis from small cell lung carcinoma. J Zhejiang Univ Sci B. 2008;9(1):39–43. https://doi.org/10.1631/jzus.B072258.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Adegbola T, Connolly CE, Mortimer G. Small cell neuroendocrine carcinoma of the breast: a report of three cases and review of the literature. J Clin Pathol. 2005;58(7):775–8. https://doi.org/10.1136/jcp.2004.020792.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. WHO Classification of Tumours Editorial Board. Breast tumours: WHO classification of tumours. 5th edn., volume 2. IARC: Lyon; 2019.

  11. Toombs BD, Kalisher L. Metastatic disease to the breast: clinical, pathologic, and radiographic features. AJR Am J Roentgenol. 1977;129(4):673–6. https://doi.org/10.2214/ajr.129.4.673.

    Article  CAS  PubMed  Google Scholar 

  12. Paulus DD, Libshitz HI. Metastasis to the breast. Radiol Clin North Am. 1982;20(3):561–8.

    CAS  PubMed  Google Scholar 

  13. Jakovljević B, Stevanović O, Bacić G. Metastases to the breast from small-cell lung cancer: MR findings. A case report Acta Radiol. 2003;44(5):485–8.

    PubMed  Google Scholar 

  14. Assi HAKK, Mouhieddine TH, Khalil LE, Kanj A, et al. Small cell lung cancer with metastasis to the breast: a case report and review of the literature. J Cancer Biol Res. 2014;2(1):1025.

    Google Scholar 

  15. Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366(6):539–51. https://doi.org/10.1056/NEJMra1104650.

    Article  CAS  PubMed  Google Scholar 

  16. Kamisawa T, Zen Y, Pillai S, Stone JH. IgG4-related disease. Lancet. 2015;385(9976):1460–71. https://doi.org/10.1016/s0140-6736(14)60720-0.

    Article  CAS  PubMed  Google Scholar 

  17. • Yokoe T, Hayashida T, Kikuchi M, Watanuki R, Nakashoji A, Maeda H, et al. IgG4-related mastopathy: a case report and literature review. Clin Case Rep. 2018;6(8):1549–53. https://doi.org/10.1002/ccr3.1657. IgG4-related disease is an immune mediated fibroinflammatory condition that is being increasingly recognized, with rare cases reported in the breast. IgG4- related disease of the breast can present as a mass raising suspicion for carcinoma, highlighting the importance of understanding imaging and clinical features to help distinguish these lesions from breast cancer. This study importantly reviews all current case reports of IgG-4 related disease of the breast and highlights distinguishing imaging characteristics while also presenting their own case with imaging-histologic correlation

    Article  PubMed  PubMed Central  Google Scholar 

  18. Divatia M, Kim SA, Ro JY. IgG4-related sclerosing disease, an emerging entity: a review of a multi-system disease. Yonsei Med J. 2012;53(1):15–34. https://doi.org/10.3349/ymj.2012.53.1.15.

    Article  CAS  PubMed  Google Scholar 

  19. Martínez-de-Alegría A, Baleato-González S, García-Figueiras R, Bermúdez-Naveira A, Abdulkader-Nallib I, Díaz-Peromingo JA, et al. IgG4-related disease from head to toe. Radiographics. 2015;35(7):2007–25. https://doi.org/10.1148/rg.357150066.

    Article  PubMed  Google Scholar 

  20. Vitkovski T, Marder GS, Filardi DA, Gupta E, Breuer F. IgG4-related sclerosing disease of the breast in a male patient. Int J Surg Pathol. 2017;25(8):711–5. https://doi.org/10.1177/1066896917714324.

    Article  PubMed  Google Scholar 

  21. Zen Y, Kasahara Y, Horita K, Miyayama S, Miura S, Kitagawa S, et al. Inflammatory pseudotumor of the breast in a patient with a high serum IgG4 level: histologic similarity to sclerosing pancreatitis. Am J Surg Pathol. 2005;29(2):275–8. https://doi.org/10.1097/01.pas.0000147399.10639.f5.

    Article  PubMed  Google Scholar 

  22. Cheuk W, Chan AC, Lam WL, Chow SM, Crowley P, Lloydd R, et al. IgG4-related sclerosing mastitis: description of a new member of the IgG4-related sclerosing diseases. Am J Surg Pathol. 2009;33(7):1058–64. https://doi.org/10.1097/PAS.0b013e3181998cbe.

    Article  PubMed  Google Scholar 

  23. Ogiya A, Tanaka K, Tadokoro Y, Kikutani M, Uematsu T, Kashiwagi H, et al. IgG4-related sclerosing disease of the breast successfully treated by steroid therapy. Breast Cancer. 2014;21(2):231–5. https://doi.org/10.1007/s12282-010-0225-6.

    Article  PubMed  Google Scholar 

  24. Chougule A, Bal A, Das A, Singh G. IgG4 related sclerosing mastitis: expanding the morphological spectrum of IgG4 related diseases. Pathology. 2015;47(1):27–33. https://doi.org/10.1097/pat.0000000000000187.

    Article  CAS  PubMed  Google Scholar 

  25. Moriya THNH, Yasuda M, Kimijima I. IgG4-related disease of the breast: a systemic disease whose mammary manifestations mimic breast cancer. Int Cancer Conf J. 2015;4:67–72.

    Article  Google Scholar 

  26. Erivwo P, Turashvili G. Pathology of IgG4-related sclerosing mastitis. J Clin Pathol. 2020. https://doi.org/10.1136/jclinpath-2020-207029.

    Article  PubMed  Google Scholar 

  27. Deshpande V, Zen Y, Chan JK, Yi EE, Sato Y, Yoshino T, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25(9):1181–92. https://doi.org/10.1038/modpathol.2012.72.

    Article  PubMed  Google Scholar 

  28. Zalaquett E, Razmilic D, Oddo D. Immunoglobulin G4 -related sclerosing mastitis: AIRP best cases in radiologic-pathologic correlation. Radiographics. 2016;36(4):959–62. https://doi.org/10.1148/rg.2016150235.

    Article  PubMed  Google Scholar 

  29. Kriegsmann M, Gomez C, Heil J, Schäfgen B, Gutjahr E, Kommoss FKF, et al. IgG4-related sclerosing mastitis in a 49-year-old patient with multiple, tumor-like nodules-diagnostic accuracy of core needle biopsy. Breast J. 2019;25(6):1251–3. https://doi.org/10.1111/tbj.13436.

    Article  PubMed  Google Scholar 

  30. Keech JA Jr, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100(2):554–5. https://doi.org/10.1097/00006534-199708000-00065.

    Article  PubMed  Google Scholar 

  31. Berlin E, Singh K, Mills C, Shapira I, Bakst RL, Chadha M. Breast implant-associated anaplastic large cell lymphoma: case report and review of the literature. Case Rep Hematol. 2018;2018:2414278. https://doi.org/10.1155/2018/2414278.

    Article  PubMed  PubMed Central  Google Scholar 

  32. A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin’s lymphoma. The Non-Hodgkin’s Lymphoma Classification Project. Blood. 1997;89(11):3909–18.

  33. Collett DJ, Rakhorst H, Lennox P, Magnusson M, Cooter R, Deva AK. Current risk estimate of breast implant-associated anaplastic large cell lymphoma in textured breast implants. Plast Reconstr Surg. 2019;143(3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma):30s–40s. https://doi.org/10.1097/prs.0000000000005567.

    Article  CAS  PubMed  Google Scholar 

  34. de Jong D, Vasmel WL, de Boer JP, Verhave G, Barbé E, Casparie MK, et al. Anaplastic large-cell lymphoma in women with breast implants. JAMA. 2008;300(17):2030–5. https://doi.org/10.1001/jama.2008.585.

    Article  PubMed  Google Scholar 

  35. Doren EL, Miranda RN, Selber JC, Garvey PB, Liu J, Medeiros LJ, et al. U.S. epidemiology of breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2017;139(5):1042–50. https://doi.org/10.1097/prs.0000000000003282.

    Article  CAS  PubMed  Google Scholar 

  36. Magnusson M, Beath K, Cooter R, Locke M, Prince HM, Elder E, et al. The epidemiology of breast implant-associated anaplastic large cell lymphoma in Australia and New Zealand confirms the highest risk for grade 4 surface breast implants. Plast Reconstr Surg. 2019;143(5):1285–92. https://doi.org/10.1097/prs.0000000000005500.

    Article  CAS  PubMed  Google Scholar 

  37. • de Boer M, van Leeuwen FE, Hauptmann M, Overbeek LIH, de Boer JP, Hijmering NJ, et al. Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. 2018;4(3):335–41. https://doi.org/10.1001/jamaoncol.2017.4510. Breast implant associated anaplastic large cell lymphoma (BIA-ALCL), a subtype of peripheral T cell anaplastic large cell lymphoma is an emerging disease entity with increasing incidence over the last several years. This study analyzed important factors involved in relative and absolute risks of breast-ALCL in women with breast implants, highlighting texture of the implant, with macrotextured implants confering the highest risk.

    Article  PubMed  PubMed Central  Google Scholar 

  38. McCarthy CM, Loyo-Berríos N, Qureshi AA, Mullen E, Gordillo G, Pusic AL, et al. Patient registry and outcomes for breast implants and anaplastic large cell lymphoma etiology and epidemiology (PROFILE): initial report of findings, 2012–2018. Plast Reconstr Surg. 2019;143(3S A Review of Breast Implant-Associated Anaplastic Large Cell Lymphoma):65s–73s. https://doi.org/10.1097/prs.0000000000005571.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Clemens MW, Medeiros LJ, Butler CE, Hunt KK, Fanale MA, Horwitz S, et al. Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol. 2016;34(2):160–8. https://doi.org/10.1200/jco.2015.63.3412.

    Article  CAS  PubMed  Google Scholar 

  40. Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN consensus guidelines on the diagnosis and treatment of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Aesthet Surg J. 2019;39(Suppl_1):S3-s13. https://doi.org/10.1093/asj/sjy331.

    Article  PubMed  Google Scholar 

  41. Horwitz S, O’Connor OA, Pro B, Illidge T, Fanale M, Advani R, et al. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial. Lancet. 2019;393(10168):229–40. https://doi.org/10.1016/s0140-6736(18)32984-2.

    Article  CAS  PubMed  Google Scholar 

  42. Pandiar D, Smitha T. The, “hallmark” cells. J Oral Maxillofac Pathol. 2019;23(2):176–7. https://doi.org/10.4103/jomfp.JOMFP_177_19.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Adrada BE, Miranda RN, Rauch GM, Arribas E, Kanagal-Shamanna R, Clemens MW, et al. Breast implant-associated anaplastic large cell lymphoma: sensitivity, specificity, and findings of imaging studies in 44 patients. Breast Cancer Res Treat. 2014;147(1):1–14. https://doi.org/10.1007/s10549-014-3034-3.

    Article  CAS  PubMed  Google Scholar 

  44. Meani F, Di Lascio S, Wandschneider W, Montagna G, Vitale V, Zehbe S, et al. Granular cell tumor of the breast: a multidisciplinary challenge. Crit Rev Oncol Hematol. 2019;144: 102828. https://doi.org/10.1016/j.critrevonc.2019.102828.

    Article  PubMed  Google Scholar 

  45. Lack EE, Worsham GF, Callihan MD, Crawford BE, Klappenbach S, Rowden G, et al. Granular cell tumor: a clinicopathologic study of 110 patients. J Surg Oncol. 1980;13(4):301–16. https://doi.org/10.1002/jso.2930130405.

    Article  CAS  PubMed  Google Scholar 

  46. Montagnese MD, Roshong-Denk S, Zaher A, Mohamed I, Staren ED. Granular Cell Tumor of the Breast. Am Surg. 2004;70(1):52–4.

    PubMed  Google Scholar 

  47. Abreu N, Filipe J, André S, Marques JC. Granular cell tumor of the breast: correlations between imaging and pathology findings. Radiol Bras. 2020;53(2):105–11. https://doi.org/10.1590/0100-3984.2019.0056.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Adeniran A, Al-Ahmadie H, Mahoney MC, Robinson-Smith TM. Granular cell tumor of the breast: a series of 17 cases and review of the literature. Breast J. 2004;10(6):528–31. https://doi.org/10.1111/j.1075-122X.2004.21525.x.

    Article  PubMed  Google Scholar 

  49. Papalas JA, Wylie JD, Dash RC. Recurrence risk and margin status in granular cell tumors of the breast: a clinicopathologic study of 13 patients. Arch Pathol Lab Med. 2011;135(7):890–5. https://doi.org/10.1043/2010-0430-oar.1.

    Article  PubMed  Google Scholar 

  50. Jagannathan DM. Benign granular-cell tumor of the breast: case report and literature review. Radiol Case Rep. 2015;10(2):1116. https://doi.org/10.2484/rcr.v10i2.1116.

    Article  PubMed  Google Scholar 

  51. Battistella M, Cribier B, Feugeas JP, Roux J, Le Pelletier F, Pinquier L, et al. Vascular invasion and other invasive features in granular cell tumours of the skin: a multicentre study of 119 cases. J Clin Pathol. 2014;67(1):19–25. https://doi.org/10.1136/jclinpath-2013-201642.

    Article  PubMed  Google Scholar 

  52. • Pareja F, Brandes AH, Basili T, Selenica P, Geyer FC, Fan D, et al. Loss-of-function mutations in ATP6AP1 and ATP6AP2 in granular cell tumors. Nat Commun. 2018;9(1):3533. https://doi.org/10.1038/s41467-018-05886-y. Granular cell tumors are benign tumors of Schwannian differentiation. Histologically, granular cell tumors are composed of cells with fine eosinophilic granules, indistinct cell borders, small nuclei, and prominent nucleoli. This study identifies loss-of-function mutations seen in ATP6AP1 and ATP6AP2 are drivers of tumorigenesis in granular cell tumors. ATP6AP1 and ATP6AP2 are endosomal pH regulators and loss-of-function mutations result in the accumulation of intracytoplasmic vacuoles, which are identified histologically in this tumor. This results in dysfunctional endosomal acidification and tumorigenesis. This study discovers an important genotypic-phenotypic correlation.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Al-Balas M, De Leo A, Serra M, Santini D, Taffurelli M. Granular cell tumour of the breast: a rare presentation of a breast mass in an elderly female with a subsequent breast cancer diagnosis. SAGE Open Med Case Rep. 2019;7:2050313x19841154. https://doi.org/10.1177/2050313x19841154.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Fujiwara K, Maeda I, Mimura H. Granular cell tumor of the breast mimicking malignancy: a case report with a literature review. Acta Radiol Open. 2018;7(12):2058460118816537. https://doi.org/10.1177/2058460118816537.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Hoess C, Freitag K, Kolben M, Allgayer B, Laemmer-Skarke I, Nathrath WB, et al. FDG PET evaluation of granular cell tumor of the breast. J Nucl Med. 1998;39(8):1398–401.

    CAS  PubMed  Google Scholar 

  56. Merino D, Malkin D. p53 and hereditary cancer. Subcell Biochem. 2014;85:1–16. https://doi.org/10.1007/978-94-017-9211-0_1.

    Article  PubMed  Google Scholar 

  57. Kratz CP, Achatz MI, Brugières L, Frebourg T, Garber JE, Greer MC, et al. Cancer screening recommendations for individuals with Li-Fraumeni syndrome. Clin Cancer Res. 2017;23(11):e38–45. https://doi.org/10.1158/1078-0432.Ccr-17-0408.

    Article  CAS  PubMed  Google Scholar 

  58. Dutzmann CM, Vogel J, Kratz CP, Pajtler KW, Pfister SM, Dörgeloh BB. Update on Li-Fraumeni syndrome. Pathologe. 2019;40(6):592–9. https://doi.org/10.1007/s00292-019-00657-y.

    Article  CAS  PubMed  Google Scholar 

  59. Schneider K, Zelley K, Nichols KE, Garber J. Li-Fraumeni syndrome. 1999 Jan 19 [updated 2019 Nov 21]. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mirzaa G, Amemiya A, editors. GeneReviews® [Internet]. Seattle: University of Washington, Seattle; 1993–2021.

  60. Bansal A, Kaur M, Dalal V. Pleomorphic sarcoma of breast: a report of two cases and review of literature. Acta Med Iran. 2017;55(4):272–6.

    PubMed  Google Scholar 

  61. Nizri E, Merimsky O, Lahat G. Optimal management of sarcomas of the breast: an update. Expert Rev Anticancer Ther. 2014;14(6):705–10. https://doi.org/10.1586/14737140.2014.895667.

    Article  CAS  PubMed  Google Scholar 

  62. Robles-Tenorio A, Solis-Ledesma G. Undifferentiated pleomorphic sarcoma. [Updated 2021 Apr 15]. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570612/.

  63. Smith TB, Gilcrease MZ, Santiago L, Hunt KK, Yang WT. Imaging features of primary breast sarcoma. AJR Am J Roentgenol. 2012;198(4):W386–93. https://doi.org/10.2214/ajr.11.7341.

    Article  PubMed  Google Scholar 

  64. Chadaz T, Hobbs SK, Son H. Chest wall sarcoma: 18F-FDG PET/CT in a patient with Li-Fraumeni syndrome. Clin Nucl Med. 2013;38(10):818–20. https://doi.org/10.1097/RLU.0b013e3182a20033.

    Article  PubMed  Google Scholar 

  65. Yoon JY, Chitale D. Adenomyoepithelioma of the breast: a brief diagnostic review. Arch Pathol Lab Med. 2013;137(5):725–9. https://doi.org/10.5858/arpa.2011-0404-RS.

    Article  PubMed  Google Scholar 

  66. •• Geyer FC, Li A, Papanastasiou AD, Smith A, Selenica P, Burke KA, et al. Recurrent hotspot mutations in HRAS Q61 and PI3K-AKT pathway genes as drivers of breast adenomyoepitheliomas. Nat Commun. 2018;9(1):1816. https://doi.org/10.1038/s41467-018-04128-5. Adenomyoepitheliomas can be ER positive or ER negative. This study identifies the underlying molecular drivers of tumorigenesis seen in each. ER positive AMEs usually have PIK3CA or AKT1 activating mutations, whereas ER negative AMEs have HRAS Q61 hotspot mutations. This study demonstrates AMEs, while rare, are genetically heterogeneous with different recurrent molecular drivers in ER positive versus ER negative AMEs.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Ginter PS, McIntire PJ, Kurtis B, Mirabelli S, Motanagh S, Hoda S, et al. Adenomyoepithelial tumors of the breast: molecular underpinnings of a rare entity. Mod Pathol. 2020;33(9):1764–72. https://doi.org/10.1038/s41379-020-0552-x.

    Article  CAS  PubMed  Google Scholar 

  68. Howlett DC, Mason CH, Biswas S, Sangle PD, Rubin G, Allan SM. Adenomyoepithelioma of the breast: spectrum of disease with associated imaging and pathology. AJR Am J Roentgenol. 2003;180(3):799–803. https://doi.org/10.2214/ajr.180.3.1800799.

    Article  CAS  PubMed  Google Scholar 

  69. Haque W, Verma V, Suzanne Klimberg V, Nangia J, Schwartz M, Brian Butler E, et al. Clinical presentation, national practice patterns, and outcomes of breast adenomyoepithelioma. Breast J. 2020;26(4):653–60. https://doi.org/10.1111/tbj.13638.

    Article  PubMed  Google Scholar 

  70. Hayes MM. Adenomyoepithelioma of the breast: a review stressing its propensity for malignant transformation. J Clin Pathol. 2011;64(6):477–84. https://doi.org/10.1136/jcp.2010.087718.

    Article  PubMed  Google Scholar 

  71. Park YM, Park JS, Jung HS, Yoon HK, Yang WT. Imaging features of benign adenomyoepithelioma of the breast. J Clin Ultrasound. 2013;41(4):218–23. https://doi.org/10.1002/jcu.22036.

    Article  PubMed  Google Scholar 

  72. Adejolu M, Wu Y, Santiago L, Yang WT. Adenomyoepithelial tumors of the breast: imaging findings with histopathologic correlation. AJR Am J Roentgenol. 2011;197(1):W184–90. https://doi.org/10.2214/ajr.10.6064.

    Article  PubMed  Google Scholar 

  73. Hikino H, Kodama K, Yasui K, Ozaki N, Nagaoka S, Miura H. Intracystic adenomyoepithelioma of the breast–case report and review. Breast Cancer. 2007;14(4):429–33. https://doi.org/10.2325/jbcs.14.429.

    Article  PubMed  Google Scholar 

  74. Moro K, Sakata E, Nakahara A, Hashidate H, Gabriel E, Makino H. Malignant adenomyoepithelioma of the breast. Surg Case Rep. 2020;6(1):118. https://doi.org/10.1186/s40792-020-00881-2.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Nascimento AF, Raut CP, Fletcher CD. Primary angiosarcoma of the breast: clinicopathologic analysis of 49 cases, suggesting that grade is not prognostic. Am J Surg Pathol. 2008;32(12):1896–904. https://doi.org/10.1097/PAS.0b013e318176dbc7.

    Article  PubMed  Google Scholar 

  76. Yang WT, Hennessy BT, Dryden MJ, Valero V, Hunt KK, Krishnamurthy S. Mammary angiosarcomas: imaging findings in 24 patients. Radiology. 2007;242(3):725–34. https://doi.org/10.1148/radiol.2423060163.

    Article  PubMed  Google Scholar 

  77. Sher T, Hennessy BT, Valero V, Broglio K, Woodward WA, Trent J, et al. Primary angiosarcomas of the breast. Cancer. 2007;110(1):173–8. https://doi.org/10.1002/cncr.22784.

    Article  PubMed  Google Scholar 

  78. Young RJ, Natukunda A, Litière S, Woll PJ, Wardelmann E, van der Graaf WT. First-line anthracycline-based chemotherapy for angiosarcoma and other soft tissue sarcoma subtypes: pooled analysis of eleven European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group trials. Eur J Cancer. 2014;50(18):3178–86. https://doi.org/10.1016/j.ejca.2014.10.004.

    Article  CAS  PubMed  Google Scholar 

  79. Billings SD, McKenney JK, Folpe AL, Hardacre MC, Weiss SW. Cutaneous angiosarcoma following breast-conserving surgery and radiation: an analysis of 27 cases. Am J Surg Pathol. 2004;28(6):781–8. https://doi.org/10.1097/01.pas.0000126055.33916.0b.

    Article  PubMed  Google Scholar 

  80. Brenn T, Fletcher CD. Radiation-associated cutaneous atypical vascular lesions and angiosarcoma: clinicopathologic analysis of 42 cases. Am J Surg Pathol. 2005;29(8):983–96.

    Article  PubMed  Google Scholar 

  81. Manner J, Radlwimmer B, Hohenberger P, Mössinger K, Küffer S, Sauer C, et al. MYC high level gene amplification is a distinctive feature of angiosarcomas after irradiation or chronic lymphedema. Am J Pathol. 2010;176(1):34–9. https://doi.org/10.2353/ajpath.2010.090637.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Fineberg S, Rosen PP. Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol. 1994;102(6):757–63. https://doi.org/10.1093/ajcp/102.6.757.

    Article  CAS  PubMed  Google Scholar 

  83. Soren DN, Gunasekaran G, Naik D, Prusty GC, Chinnakkulam KS. Primary mammary angiosarcoma: literature review. Cureus. 2020;12(6): e8589. https://doi.org/10.7759/cureus.8589.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Rao P, Lahat G, Arnold C, Gavino AC, Lahat S, Hornick JL, et al. Angiosarcoma: a tissue microarray study with diagnostic implications. Am J Dermatopathol. 2013;35(4):432–7. https://doi.org/10.1097/DAD.0b013e318271295a.

    Article  PubMed  Google Scholar 

  85. •• Chikarmane SA, Gombos EC, Jagadeesan J, Raut C, Jagannathan JP. MRI findings of radiation-associated angiosarcoma of the breast (RAS). J Magn Reson Imaging. 2015;42(3):763–70. https://doi.org/10.1002/jmri.24822. Postradiation angiosarcoma is a rare and aggressive endothelial tumor occuring in patients after breast radiation. These tumors can be difficult to detect clinically as well as on conventional breast imaging with mammography and ultrasound due to presence of post-treatment changes and non-specific findings such as skin thickening. This study importantly highlights the role for MRI in diagnosis of postradiation breast angiosarcoma and presents distinguishing MRI features of these tumors.

    Article  PubMed  Google Scholar 

  86. Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, et al. Angiosarcoma: clinical and imaging features from head to toe. Br J Radiol. 2017;90(1075):20170039. https://doi.org/10.1259/bjr.20170039.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Glazebrook KN, Magut MJ, Reynolds C. Angiosarcoma of the breast. AJR Am J Roentgenol. 2008;190(2):533–8. https://doi.org/10.2214/ajr.07.2909.

    Article  PubMed  Google Scholar 

  88. Zeng W, Styblo TM, Li S, Sepulveda JN, Schuster DM. Breast angiosarcoma: FDG PET findings. Clin Nucl Med. 2009;34(7):443–5. https://doi.org/10.1097/RLU.0b013e3181a7d0eb.

    Article  PubMed  Google Scholar 

  89. van der Kolk DM, de Bock GH, Leegte BK, Schaapveld M, Mourits MJ, de Vries J, et al. Penetrance of breast cancer, ovarian cancer and contralateral breast cancer in BRCA1 and BRCA2 families: high cancer incidence at older age. Breast Cancer Res Treat. 2010;124(3):643–51. https://doi.org/10.1007/s10549-010-0805-3.

    Article  CAS  PubMed  Google Scholar 

  90. •• Heemskerk-Gerritsen BAM, Jager A, Koppert LB, Obdeijn AI, Collée M, Meijers-Heijboer HEJ, et al. Survival after bilateral risk-reducing mastectomy in healthy BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat. 2019;177(3):723–33. https://doi.org/10.1007/s10549-019-05345-2. Patients with BRCA1/BRCA2 germline mutations undergoing bilateral risk reducing mastectomies have a significant decrease in breast cancer incidence, with a breast cancer occurrence of only 0-1% during long term follow up after mastectomy. This paper highlights there is decreased all-cause mortality as well as breast cancer specific mortality rate in BRCA1 mutation carriers that undergo bilateral mastectomies compared to surveillance alone. However, BRCA2 mutation carriers undergoing bilateral risk reducing mastectomy have a similar breast cancer specific survival to those undergoing surveillance, suggesting different management strategies may be appropriate if a BRCA1 or BRCA2 mutation is present. This paper highlights important factors to consider when managing patients with BRCA1 or BRCA2 mutations.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967–75. https://doi.org/10.1001/jama.2010.1237.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Alaofi RK, Nassif MO, Al-Hajeili MR. Prophylactic mastectomy for the prevention of breast cancer: Review of the literature. Avicenna J Med. 2018;8(3):67–77. https://doi.org/10.4103/ajm.AJM_21_18.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Shammas RL, Broadwater G, Cason RW, Glener AD, Sergesketter AR, Vernon R, et al. Assessing the utility of post-mastectomy imaging after breast reconstruction. J Am Coll Surg. 2020;230(4):605-14.e1. https://doi.org/10.1016/j.jamcollsurg.2020.01.006.

    Article  PubMed  Google Scholar 

  94. Dashevsky BZ, Hayward JH, Woodard GA, Joe BN, Lee AY. Utility and outcomes of imaging evaluation for palpable lumps in the postmastectomy patient. AJR Am J Roentgenol. 2019;213(2):464–72. https://doi.org/10.2214/ajr.18.20550.

    Article  PubMed  Google Scholar 

  95. Chapman MC, Hayward JH, Woodard GA, Joe BN, Lee AY. The role of breast MRI in detecting asymptomatic recurrence after therapeutic mastectomy. AJR Am J Roentgenol. 2020;215(1):254–61. https://doi.org/10.2214/ajr.19.21640.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marina J. Corines.

Ethics declarations

Conflict of Interest

Marina Corines, Melissa Krystel-Whittemore, and Melissa Murray declare that they have no conflict of interest. Victoria Mango reports personal fees from Bayer Healthcare, personal fees from Koios Medical, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Best Practice Approaches Breast Radiology-Pathology Correlation and Management

Marina J. Corines and Melissa Krystel-Whittemore shared co-first authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Corines, M.J., Krystel-Whittemore, M., Murray, M. et al. Uncommon Tumors and Uncommon Presentations of Cancer in the Breast. Curr Breast Cancer Rep 13, 331–346 (2021). https://doi.org/10.1007/s12609-021-00435-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-021-00435-x

Keywords

Navigation