286 Breast Metastatic Carcinoma Presenting as a Periodontal Mass, an Immunohistochemical Challenge to Distinguish From Primary Malignant Salivary Gland Tumors. (11th January 2018)

• Record Type: Journal Article
• Authors: Heidarian, Amin; Banihashemi, Amir; Shao, Charles
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S121
• Page End: S122
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx123.285
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: A 45-year-old woman with history of breast high-grade invasive ductal carcinoma (Nottingham histologic score of 3) status post mastectomy and neoadjuvant chemotherapy presented with a 3-month history of new onset pain in the mouth. Exam showed a 1.2 cm mass in the gingiva of upper left side of the mouth. The CT scan and MRI showed no bone involvement. The patient underwent an excisional biopsy. Histological examination revealed nests of tumor cells with round nuclei, prominent nucleoli and pink homogenous cytoplasm with more than 10 mitoses per 10 high-power fields. Differential diagnoses included primary malignant salivary gland tumors vs breast metastatic carcinoma. Review of the previous breast biopsy showed similar morphology with the gingival tumor. The primary breast tumor was immunohistochemically ER positive, and PR and Her2 negative. The tumor cells in the gingiva were immunoreactive for GATA3 (diffusely) and BCA-225 (partially). These cells were immunohistochemically negative for PR, DOG1, and P63. Metastasis of breast cancer to gingiva with no facial bone involvement is an unusual presentation. The positivity of breast immunomarkers (including GATA3 and mammaglobin) in considerable numbers of salivary gland tumors, make this distinction even more difficult. A negative immunomarker panel of DOG1 and P63 exclude salivary myoepithelial carcinoma, acinic cell carcinoma, mucoepidermoid carcinomas, and oncocytic carcinoma. However, none of them help to distinct salivary ductal carcinoma and mammary analogue secretory carcinoma from metastatic breast carcinoma. Thus histomorphologic comparison of primary breast carcinoma with the gingival tumor still remains the key factor. There is no specific study of BCA-225 immunomarker on salivary duct carcinoma or mammary analogue secretory carcinoma in the literature. Although BCA-225 is a nonspecific marker for breast carcinoma, it may help to exclude these two types of salivary gland tumor in a patient with history of breast ductal carcinoma.