Breast adenomyoepithelioma, a case report
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• Adenomyoepithelioma is a rare tumor of the breast characterized by a biphasic proliferation.

•Variable spectrum of behavior ranging from benign to malignant, with tendency to local recurrence.

•Combine sentinel lymph node dissection (SLND), with simple mastectomy

•Hematogenous spread is the more common means of spread.

•Adjuvant chemotherapy for malignant AME cases is recommended.

A 66-year-old female patient, with an unremarkable medical or family history, operated with cholecystectomy and hysterectomy. The patient presented with a right breast mass, that was discovered by self-examination. She denied any nipple retraction or discharge, breast pain, redness, or swelling.

The patient had a good general condition. She denies any systemic complaint. The physical examination was unremarkable except for a palpable right breast mass in the lower inner quadrant. There is no palpable axillary masses.

Mammography showed an oval opacity in the lower inner quadrant, with hazy margins, containing scattered microcalcifications. Ultrasound described the mammography findings as a heterogeneous soft tissue mass, measuring 18?×?17?x?15?mm, with irregular borders, with no obvious vascularization. no axillary lymph nodes visible. Imaging of the left breast was unremarkable. A breast core biopsy was done and showed fibroadenoma changes. In the metastatic workup, a CT scan of the chest, abdomen, and pelvis was done, with an injection of intravenous contrast showing no significant changes.

She was planned for nipple-sparing right partial mastectomy, and the mass was sent for frozen section and was reported as low-grade carcinoma, reaching the surgical margins. Wide local excision of additional tissue was done and negative surgical margins were achieved. The procedure was completed with a right axillary lymph node dissection because the methylene blue dye or technetium was not injected preoperatively due to low suspicion of malignancy.

The patient had a smooth post-op course and was discharged home on a postoperative day 4, after removal of the surgical drains, in a stable medical condition.

The final pathology reported an Adenomyoepithelioma. “Microscopically, the tumor composed of multiple nodules, surrounding a sclerotic core. Proliferating small acinar structures are seen, associated in areas to myoepithelial cells, forming a trabecular pattern, and small nests. A discontinuous myoepithelial layer was identified, and nuclei are mildly enlarged with weak mitotic activity. (Ki67 mitotic index <5%). The intervening stroma is fibrotic and collagenized in central areas, entrapping small proliferating acini. Immunohistochemical stains P63, ACTIN, and Ki67). Axillary lymph nodes were negative for malignant cells. The patient is to be followed up in 6 months.