Acinic cell breast carcinoma
Acinic cell breast carcinoma has only been recognized since the 1990s, and it is essentially the breast counterpart of a similar tumor commonly found in the parotid (salivary) gland. Another way to view the disease is as a generic invasive ductal carcinoma which shows features of acinic cell differentiation, similar to those encountered in homologous tumors of salivary glands. Acinic cell breast tumors have been known to effect women between the ages of 35 and 80 years of age, with an average age of development of about 56 years.
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Clinical and mammographic presentation of acinic cell breast tumors
Acinic cell breast tumors will usually range in size from 2 to 5 cm at the time of presentation, and most of the time they will present as a palpable breast nodule. If they are discovered on a mammogram, the lesion will usually appear as an ill-defined mass on the Xray.
Histological characteristics associated with acinic cell carcinoma of the breast
Histologically, acinic cell breast carcinoma will tend to show a micro glandular pattern merging with solid areas, but the histological pattern remains somewhat variable. Most acinic cell breast tumors will have infiltrative margins, occasionally surrounded by a thin fibrous pseudocapsule. Often acinic cell carcinomas of the breast will be predominantly made up of a monotonous proliferation of cells with a fine granular cytoplasm, though some neoplastic cells may have clear cytoplasm.
Cellular appearance may be similar to micro glandular adenosis
Neoplastic cells in acinic cell breast carcinomas tend to be arranged in small glandular structures which are somewhat reminiscent of micro glandular adenosis and solid nests. Glands tend to be distributed haphazardly in a dense fatty and fibrous stroma, and are often round to irregularly shaped, and lined by a single layer of columnar cells.
Neoplastic cells in breast acinic cell carcinomas tend to be cuboidal to columnar in shape in acinic cell breast carcinomas, with well-defined boundaries. Neoplastic malignant cells also tend to contain moderate to abundant amounts of eosinophilic to amphophilic granular cytoplasm. Nuclei of cancer cells in breast acinic cell carcinomas tend to be irregular, round to oval. They will quite often show a thick nuclear membrane, and will also have prominent nucleoli.
The amount of cell mitoses is variable. Most of the time it seems to be low in breast acinic cell carcinomas, but in select cases the amount of mitotic activity may be moderate to high.
Immunohistochemical aspects of breast acinic cell carcinomas
Dense eosinophilic PAS-diastase-positive materials are quite often evident within the glandular lumina of acinic cell breast carcinomas. Most neoplastic cells in acinic cell breast carcinomas will stain intensely with anti-amylase, anti-lysozyme, anti-a1-antichymotrypsin, anti-epithelial membrane antigen, and most often the anti-S100 protein antisera as well.
A moderate number of acinic cell breast tumors will also test positive for the GCDFP15 antibody, which is a marker of apocrine differentiation in breast cancer tumors. Estrogen, progesterone and androgen receptors consistently test negative in acinic cell carcinomas of the breast.
Certain immunohistological ‘markers’ confirm an acinic cell carcinoma
Acinic cell (serous) differentiation in salivary gland tumors is typically defined by the presence of zymogen-type granules within the cytoplasm neoplastic cells. One also looks for amylase, lysozyme, and a1-antichymotrypsin; all normal constituents of salivary gland acinar cells. So, when all or most of these markers are found in a primary breast cancer tumor, it confirms an acinic cell differentiation, or acinic cell breast carcinoma.
Common treatments and prognosis for acinic cell carcinoma of the breast
There are really too few cases of breast acinic cell carcinoma to make firm generalizations about prognosis. The significance of a breast carcinoma with acinic cell differentiation remains unclear. However, the limited number of cases which have been studied to date do on-the-whole suggest a favorable prognosis. It is considered to be a slow growing form of breast cancer, which is generally treated by wide local excision or mastectomy, often accompanied by systemic breast cancer therapies.
The prognosis for acinic cell cancer of the salivary gland is known to have a 5 year survival rate of almost 90% and a 20 years survival rate of just under 60%. It is not always appropriate to assume that breast cancers will behave in a similar fashion to similar morphological cancer types in other areas of the body, but the few statistics that are available suggest that this approximate survival rate is a reasonable estimate of the outlook for acinic cell carcinoma of the breast.
Some patients do experience local and systemic recurrences, but a vast majority of patients are alive and disease free five years after the initial breast cancer diagnosis.
For further reading, I suggest you visit this page on an overview of breast cancer treatments.
- Coyne JD, Dervan PA. Primary acinic cell carcinoma of the breast. J Clin Pathol. 2002 Jul;55(7):545-7.
- Damiani, S., Pasquinelli, G., Lamovec, J., Peterse, L., Eusebi, V., Acinic cell carcinoma of the breast: an immunohistochemical and ultrastructural study. Virchows Archiv Volume 437, Number 1, 74-81
- Lytvak, Irina Salivary Gland-Like Tumors of the Breast. Pathology Case Reviews (2009) 14(4)
- Garland TA, Innes DJ Jr, Fechner RE (1984) Salivary duct carcinoma: an analysis of four cases with review of literature. Am J Clin Pathol 81:436–441
- Roncaroli F, Lamovec J, Zidar A, Eusebi V (1996) Acinic cell-like carcinoma of the breast. Virchows Arch 429:69–74
- Caselitz J, Seifert G, Grenner G, Schmidtberger R (1983) Amylase as an additional marker of salivary gland neoplasms. An immunoperoxidase study. Pathol Res Pract 176:276–283
- Eusebi V, Casadei GP, Bussolati G, Azzopardi JG (1987) Adenomyoepithelioma of the breast with a distinctive type of apocrine adenosis. Histopathology 11:305–315
- Tanahashi C, Yabuki S, Akamine N, Yatabe Y, Ichihara S. Pure acinic cell carcinoma of the breast in an 80-year-old Japanese woman. Pathol Int. 2007 Jan;57(1):43-6.
- Yerushalmi R, Hayes MM, Gelmon KA. Breast carcinoma–rare types: review of the literature. Ann Oncol. 2009 Nov;20(11):1763-70. Epub 2009 Jul 14.
- Peintinger F,Leibl S, Reitsamer R,et al. Primary acinic cell carcinoma of the breast: a case report with long-term follow-up and review of the literature. Histopathology 2004;45(6):645-648.