Stanford School of Medicine
use browser back button to return

Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Pleomorphic Adenoma of the Breast

Definition

  • Rare breast neoplasm with epithelial, myoepithelial and chondromyxoid components identical in appearance to pleomorphic adenoma of the salivary gland

Alternate/Historical Names

  • Benign mixed tumor

Diagnostic Criteria

  • Sharply circumscribed
    • Thick sclerotic pseudocapsule
    • Tumor may penetrate capsule
  • Frequently intraductal
    • Duct may be obliterated and recognized only on keratin or EVG stain
  • May be associated with papilloma
  • Mixture of epithelial, myoepithelial and chondromyxoid components
    • Epithelial cells form acini, islands, ducts
      • Ducts lined by columnar to cuboidal cells
    • Myoepithelial cells surround ducts and merge into stroma
      • Small bland oval or polyhedral cells
      • Eosinophilic cytoplasm
    • Myxoid or chondromyxoid stroma
      • Contains stellate and spindled cells
      • May form hyaline cartilage
      • Occasional ossification
      • Rare adipose differentiation
  • No atypia or mitotic figures

    Richard L Kempson MD
    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting: May 1, 2006

 

Supplemental studies

Immunohistology

Epithelial Cells Myoepithelial Cells Cells in Myxoid Stroma
Keratin + + +
S100 + + +
Actin - + +
GFAP + + +
GCDFP15 + + +
ER + + -
There is considerable merging between cell types and some of the phenotypic differences above are inconsistent

Differential Diagnosis

Pleomorphic Adenoma Infiltrating Ductal Carcinoma
Circumscribed Infiltrating
Cytologically bland Usually cytologically atypical in cases resembling pleomorphic adenoma
Myoepithelial cells present Lacks myoepithelial cells
Chondromyxoid stroma No chondromyxoid stroma
Pleomorphic adenoma can be mistaken for infiltrating carcinoma, especially at frozen section

Pleomorphic Adenoma Metaplastic Carcinoma
Circumscribed Not circumscribed
Cytologically bland Usually cytologically atypical in cases resembling pleomorphic adenoma
No necrosis May be necrotic

Pleomorphic Adenoma Adenomyoepithelioma
Chondromyxoid stroma Lacks chondromyxoid stroma
Otherwise the lesions may be identical

Clinical

  • Frequently subareolar
    • May be multifocal
  • Age 37-85 years
  • Size 0.6-5 cm
  • Infrequent recurrences reported
    • None aggressive
    • No metastases
  • Most cases in females but has been reported in male breast

Lists

Breast Adenomas (not all are true adenomas)

Breast Tumors and Lesions Exhibiting Reactivity for Muscle/Myoepithelial Markers

(Most benign lesions with an epithelial component will have a myoepithelial cell layer)

Lesions Preferentially Localized to the Nipple and Subareola

Bibliography

  • Sato K, Ueda Y, Shimasaki M, Ozaki M, Nitta N, Chada K, Ishikawa Y, Katsuda S. Pleomorphic adenoma (benign mixed tumor) of the breast: a case report and review of the literature. Pathol Res Pract. 2005;201(4):333-9.
  • Narita T, Matsuda K. Pleomorphic adenoma of the breast: case report and review of the literature. Pathol Int. 1995 Jun;45(6):441-7.
  • Diaz NM, McDivitt RW, Wick MR. Pleomorphic adenoma of the breast: a clinicopathologic and immunohistochemical study of 10 cases. Hum Pathol. 1991 Dec;22(12):1206-14.
  • Ballance WA, Ro JY, el-Naggar AK, Grignon DJ, Ayala AG, Romsdahl MG. Pleomorphic adenoma (benign mixed tumor) of the breast. An immunohistochemical, flow cytometric, and ultrastructural study and review of the literature. Am J Clin Pathol. 1990 Jun;93(6):795-801.
  • Moran CA, Suster S, Carter D. Benign mixed tumors (pleomorphic adenomas) of the breast. Am J Surg Pathol. 1990 Oct;14(10):913-21.
Printed from Surgical Pathology Criteria: http://surgpathcriteria.stanford.edu/
© 2005  Stanford University School of Medicine