A tumor consisting of both myoepithelial and epithelial cells proliferating at the same time is called a mammary gland adenomyeloblastoma. The two types of cells may have a tubular structure, similar to that of a normal adenoma, with epithelial cells in the inner layer and myoepithelial cells in the outer layer, but they are not evenly distributed. It is the same as the adenomyelinating epithelioma that occurs in salivary glands. Adenomyoepithelioma (AME) is a rare tumor that occurs in the breast, most of which are benign with a tendency to recur and a few are malignant and can metastasize.
It occurs in elderly women (>50 years old) and a few in men. Since myoepithelial cells of the breast normally exist between the epithelium and basement membrane of the ducts, tumor cells growing around the ducts are often regarded as sclerosing adenopathy, and those growing in a ductal structure are treated as general ductal or ductal adenomas, so they are easily overlooked. In malignant AME, there are abundant spindle-shaped or clear myoepithelial cells with obvious heterogeneity and markedly increased nuclear schizophrenia, >5 cells/10HPF and up to 20 cells/10HPF, with a large number of tumor necrosis inside.
The tumor tissues were infiltrating into the surrounding adipose tissues in the form of cords; some of the interstitial spindle cells were obviously proliferating; some of the interstitial mucous degeneration was obvious, and there was vascular plexus proliferation in the area. Adenomyeloblastoma of the breast is usually seen in women, but occasionally reported in men, and its age of onset can be around 27-80. Most patients present with a solitary painless mass in the breast, which can be located in any area of the breast, while a few patients have a mass of variable average diameter.
Adenosarcoma of the breast usually presents as a solitary, solid nodular mass with borders, and in rare cases the mass is poorly defined. It needs to be associated with the following cancers
(1) Myoepithelial-rich carcinoma
(2), myoepithelial carcinoma
(3), septic carcinoma
(4), adenomyelinating epithelial adenopathy
(5), intraductal papillary tumor
(6) Clear cell tumor
(7) Myofibroblastoma of the breast
(8) Smooth muscle tumor of the breast.
Malignant adenomyeloblastoma of the breast: the differential diagnosis between benign and malignant is difficult, except for the presence of metastatic foci in the tumor, which can be referred to.
(1), nuclear schizophrenia is significantly increased, >5/10HPF;
(2) The cells are abundant and have obvious heterogeneity;
(3), tumor appears infiltrative growth and satellite foci;
(4) Necrosis was found in the tumor;
(5) NA polyploidy analysis was aneuploidy.
Treatment of adenomyelinating epithelioma of the breast.
For benign tumors, local excision of the tumor is the treatment of choice. Occasionally, recurrence and carcinoma may occur after local excision, mostly within 5 to 6 years after surgery. Recurrence is common in glandular duct type, because this type of tumor and surrounding tissues often lack clear boundaries, so that the tumor is not easy to complete excision, resulting in the possibility of local recurrence of tumor after surgery. If the tumor recurs, the corresponding local excision can be performed again, and further judgment can be made according to the pathological results, and if cancer is confirmed, the corresponding radical surgery can be performed.
Prognosis and treatment of mammary adenomyeloblastoma is benign tumor, but it is prone to recurrence if the resection is not complete. Recurrence is related to the following factors: polymorphism of tumor cells, increased nuclear division, necrosis in tumor, tumor infiltration of surrounding tissues, glandular epithelial papillomatous hyperplasia or myoepithelial hyperplasia in tumor surrounding tissues, coexistence of mammary adenomyeloblastoma with other malignant tumors. The tumor may become malignant after multiple recurrences, such as invasive ductal carcinoma, myoepithelial carcinoma, malignant adenomyeloblastic tumor or with osteosarcoma and undifferentiated carcinoma components, etc., which need to be followed up closely.