- Case Report
- Open Access
- Published:
Amyloid tumor of the breast
Surgical Case Reports volume 5, Article number: 31 (2019)
Abstract
Background
Amyloid tumor of the breast is a rare disease, which was first reported in 1973. To date, only six cases have been reported in Japan.
Case presentation
A 45-year-old woman who had a medical history of Sjogren’s syndrome presented with a lump of 3 cm in diameter on the outer side of the right breast. Mammography showed no abnormality. Ultrasonography showed a well-defined and rough hypoechoic mass of 32 mm in diameter at the site of the lump. With suspicion of breast cancer, an ultrasound-guided vacuum-assisted breast biopsy was performed. For pathological diagnosis, hematoxylin and eosin staining showed deposits of nonstructural substances in the interstitium. The specimen stained red with Congo red staining and showed green birefringence under a polarizing microscope. Thus, the mass was diagnosed as an amyloid tumor. Since the patient had Sjogren’s syndrome, it was considered a breast finding of autoimmune disease. We considered further therapy to be unnecessary, and annual follow-up was recommended.
Conclusions
We diagnosed the mass as an amyloid tumor by an ultrasound-guided vacuum-assisted breast biopsy without resection. The patient had no systemic symptoms suspected systemic amyloidosis, and we diagnosed localized amyloidosis. An amyloid tumor of the breast may show findings suggestive of breast cancer. Pathological diagnosis before surgery is important to avoid excessive invasion. If deposits of nonstructural substances are observed by hematoxylin and eosin staining, Congo red staining should be added.
Background
Amyloid tumor of the breast, first reported in 1973 [1], is a rare disease, with only six cases [2,3,4,5,6,7] reported in Japan to date.
Amyloidosis is defined as a disease that causes abnormalities in organs due to extracellular deposition of fibrous abnormal proteins called amyloid [8]. It is divided into systemic amyloidosis in which amyloid deposits form in organs throughout the body, and localized amyloidosis which is limited to an individual organ [8]. Systemic amyloidosis causes a variety of symptoms, such as fatigue, weight loss, anemia, cardiac symptoms (congestive heart failure, arrhythmia), renal symptoms (nephrotic syndrome, kidney failure), gastrointestinal symptoms (malabsorption syndrome, macroglossia, hepatomegaly, splenomegaly), neurological symptoms (polyneuropathy, carpal tunnel syndrome, orthostatic hypotension, constipation, diarrhea, dysuria), and bleeding symptoms [8]. Examinations used to check for systemic amyloidosis include electrocardiography, echocardiography, blood analysis (renal dysfunction, M protein, free light chain, autoimmune antibody, chronic inflammatory findings), urine analysis (Bence-Jones protein), nerve conduction test, bone marrow biopsy, and biopsy of sites suspected of amyloid deposition [8]. The diagnosis of amyloidosis is confirmed by Congo red staining which stains amyloid red, and the stained amyloid also shows green birefringence under a polarizing microscope [8].
A report of 15 patients with amyloid tumor of the breast at the Mayo Clinic showed that amyloid tumor of the breast, when a manifestation of systemic amyloidosis, is mostly found as a late presentation, and none of the patients with a localized amyloid tumor of the breast developed systemic amyloidosis [9].
Case presentation
A 45-year-old woman originally visited a different hospital because of a focal asymmetric density of the left breast identified by screening mammography. She had a medical history of Sjogren’s syndrome. Ultrasonography showed no abnormality in the left breast, whereas an indistinct hypoechoic mass of 25 mm in diameter was detected in the outer side of the right breast. Although cytology of the right breast mass indicated no malignant feature, she came to our hospital for further examinations.
A lump of 3 cm in diameter was palpable on the outer side of the right breast. Mammography at our hospital showed no abnormality (Fig. 1). Ultrasonography showed a well-defined and rough hypoechoic mass of 32 mm in diameter at the site of the lump (Fig. 2). With suspicion of breast cancer, an ultrasound-guided vacuum-assisted breast biopsy was performed.
Mammogram findings. Mammography showed no abnormality
Ultrasonographic findings. Ultrasonography showed a well-defined and rough hypoechoic mass of 32 mm in diameter at the site of the lump
For pathological diagnosis, hematoxylin and eosin staining showed deposits of nonstructural substances in the interstitium (Fig. 3a). The specimen was positively stained by Congo red (Fig. 3b) and showed green birefringence under a polarizing microscope (Fig. 3c). Thus, the mass was diagnosed as an amyloid tumor. She had no systemic symptoms suggestive of systemic amyloidosis. We considered further therapy to be unnecessary, and annual follow-up was recommended.
Microscopic observations. Hematoxylin and eosin staining showed deposits of nonstructural substances in the interstitium (a). The specimen stained red with Congo red staining (b), and the Congo red staining showed green birefringence under a polarizing microscope (c)
Conclusions
Amyloid tumor of the breast is a rare disease. To date, only six cases [2,3,4,5,6,7] have been reported in Japan (Table 1). All were women, with a median age of 67.5 years. Findings may be suggestive of breast cancer, such as microcalcifications identified by mammography or an indistinct hypoechoic mass by ultrasonography. Excisional biopsy was performed in five of the six patients, and resection for confirmation was carried out in the sixth patient. Two patients had medical histories of autoimmune disease.
Between 1998 and 2018, only 65 patients with amyloid tumor of the breast [2,3,4,5,6,7, 9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43] have been reported worldwide including Japan. Nine patients were diagnosed with systemic amyloidosis. Five of those had already been diagnosed with systemic amyloidosis before the diagnosis of amyloid tumor of the breast. Three patients had some systemic symptoms associated with systemic amyloidosis. The remaining patient had received hemodialysis for 20 years and was diagnosed with systemic amyloidosis secondary to hemodialysis. However, we found no details regarding whether she had systemic symptoms suspected of systemic amyloidosis. We found that most patients diagnosed with systemic amyloidosis had systemic symptoms.
In our case, we were able to diagnose the mass as an amyloid tumor by an ultrasound-guided vacuum-assisted breast biopsy without resection. The patient had no systemic symptoms indicative of systemic amyloidosis, and therefore, we considered examination for systemic amyloidosis to be unnecessary and diagnosed localized amyloidosis. If the patient develops systemic symptoms, she should be checked for systemic amyloidosis.
Since the findings of amyloid tumor of the breast may be confused with breast cancer, pathological diagnosis before surgery is important to avoid excessive invasion and unnecessary surgery. If deposits of nonstructural substances are observed by hematoxylin and eosin staining, Congo red staining should be added for confirmation.
References
- 1.
Fernandez BB, Hernandez FJ. Amyloid tumor of the breast. Arch Pathol. 1973;95(2):102–5.
- 2.
Yokoo H, Nakazato Y. Primary localized amyloid tumor of the breast with osseous metaplasia. Pathol Int. 1998;48(7):545–8.
- 3.
Honda K, Kashima K, Daa T, Gamachi A, Nakashima K, Yokoyama S, et al. A case of amyloid tumor of the breast. Jpn J Diagn Pathol. 2000;17(4):380–2.
- 4.
Hukushima M, Nakayama J, Mitani M, Katoh R, Tsuchiya S. A case of bilateral breast tumors caused by secondary amyloidosis. J Jpn Soc Clin Cytol. 2002;41(1):68–9.
- 5.
Hosoi K, Manabe T, Shiooka T, Shiraishi M, Nakano M, Ogino T, et al. Amyloid tumor of the breast complicated with Sjogren’s syndrome. J Jpn Soc Clin Cytol. 2008;47(3):196–9.
- 6.
Ito M, Yodonawa S, Ito H, Yoshida S, Ogawa I. A case of an amyloid tumor of the breast with local recurrence. J Jpn Surg Assoc. 2011;72(1):22–6.
- 7.
Tsuji W, Takeuchi E, Oka S, Yamashita T, Yotsumoto F. Localized primary amyloidosis of the breast: a case report and review of the literature. BMC Surg. 2016;16(1):62.
- 8.
Masahito Y. Amyloidosis clinical practice guideline 2010. 2010. [1st:[Available from: http://minds4.jcqhc.or.jp/minds/Amyloidosis//CPG2010_amyloidosis.pdf.
- 9.
Said SM, Reynolds C, Jimenez RE, Chen B, Vrana JA, Theis JD, et al. Amyloidosis of the breast: predominantly AL type and over half have concurrent breast hematologic disorders. Mod Pathol. 2013;26(2):232–8.
- 10.
Jawahar A, Nagamine A, Gamez R. Breast plasmacytoma with associated amyloidosis mimicking breast carcinoma. Breast J. 2018;24(6):1071–3.
- 11.
Mayhew JM, Alan T, Kalidindi V, Gandamihardja TAK. Isolated insulin-derived amyloidoma of the breast. BMJ Case Rep. 2017;2017. https://doi.org/10.1136/bcr-2017-219491.
- 12.
Herrero L, Naranjo-Hans D, Sole M, Santamaria G, Bargallo X, Velasco M, et al. Amyloidosis of the breast: three different and unusual presentations of a rare entity. Pathobiology. 2015;82(6):264–8.
- 13.
Eghtedari M, Dogan BE, Gilcrease M, Roberts J, Cook ED, Yang WT. Imaging and pathologic characteristics of breast amyloidosis. Breast J. 2015;21(2):197–9.
- 14.
Huerter ME, Hammadeh R, Zhou Q, Weisberg A, Riker AI. Primary amyloidosis of the breast presenting as a solitary nodule: case report and review of the literature. Ochsner J. 2014;14(2):282–6.
- 15.
Shim Y, Kim MJ, Ryu HS, Park SH. Primary breast amyloidosis presenting as microcalcifications only. Korean J Radiol. 2013;14(5):723–6.
- 16.
O'Brien J, Aherne S, McCormack O, Jeffers M, McInerney D. MRI features of bilateral amyloidosis of breast. Breast J. 2013;19(3):338–9.
- 17.
Chiang D, Lee M, Germaine P, Liao L. Amyloidosis of the breast with multicentric DCIS and pleomorphic invasive lobular carcinoma in a patient with underlying extranodal Castleman’s disease. Case Rep Radiol. 2013;2013:190856.
- 18.
Ngendahayo P, Faverly D, Herin M. Primary breast amyloidosis presenting solely as nonpalpable microcalcifications: a case report with review of the literature. Int J Surg Pathol. 2013;21(2):177–80.
- 19.
Charlot M, Seldin DC, O'Hara C, Skinner M, Sanchorawala V. Localized amyloidosis of the breast: a case series. Amyloid. 2011;18(2):72–5.
- 20.
Fernandez-Aguilar S, Sourtzis S, Chaikh A. IgM plasma cell myeloma with amyloidosis presenting as mammary microcalcifications. APMIS. 2008;116(9):846–9.
- 21.
Sabate JM, Clotet M, Torrubia S, Guerrero R, Pineda R, Lerma E, et al. Localized amyloidosis of the breast associated with invasive lobular carcinoma. Br J Radiol. 2008;81(970):e252–4.
- 22.
Tutar E, Onat AM, Aydin A, Kervancioglu S, Buyukhatipoglu H, Inan G, et al. Amyloid tumor of the breast mimicking breast carcinoma. South Med J. 2008;101(2):199–201.
- 23.
Toohey JM, Ismail K, Lonergan D, Lewis CR. Amyloidosis of the breast mimicking recurrence in a previously treated early breast cancer. Australas Radiol. 2007;51(6):594–6.
- 24.
Kersemans P, Van Ongeval C, Van Steen A, Drijkoningen M. Amyloid deposition of the breast in primary Sjogren syndrome. JBR-BTR. 2006;89(6):313–4.
- 25.
Athanasiou A, Vanel D, Tomasic G, Bidault F, Balleyguier C. Quiz. Primary breast amyloidosis. Eur J Radiol. 2007;61(2):184–6.
- 26.
Richter S, Makovitzky J. Case report: amyloid tumors in a case of non-secretory multiple myeloma. Acta Histochem. 2006;108(3):221–6.
- 27.
Munson-Bernardi BD, DePersia LA. Amyloidosis of the breast coexisting with ductal carcinoma in situ. AJR Am J Roentgenol. 2006;186(1):54–5.
- 28.
Turner CA, Rubin CM, Royle GT, Flynn M, Theaker JM. Screen detected sclerosing lymphocytic lobulitis and amyloid of the breast in the same patient--a possible causal link. Breast (Edinburgh, Scotland). 2006;15(2):281–3.
- 29.
Zardawi IM, Catterall N, Clark DA. Fine needle aspiration cytology of a primary amyloid tumor of the breast. Acta Cytol. 2004;48(2):286–8.
- 30.
Fleury AM, Buetens OW, Campassi C, Argani P. Pathologic quiz case: a 77-year-old woman with bilateral breast masses. Amyloidosis involving the breast. Arch Pathol Lab Med. 2004;128(4):e67–9.
- 31.
Jaswal TS, Marwah N, Singh S, Gupta S, Marwah S, Arora B. Solitary amyloid tumour of breast--a case report. Indian J Pathol Microbiol. 2003;46(4):634–5.
- 32.
White JD, Marshall DA, Seywright MM, Evans TR. Primary amyloidosis of the breast associated with invasive breast cancer. Oncol Rep. 2004;11(4):761–3.
- 33.
Lui PC, Pang LM, Hlaing TT, Tse GM. Tumorous amyloidosis of the breast associated with disseminated malignant lymphoma. J Clin Pathol. 2004;57(3):334–5.
- 34.
Patel B, Torbiak C, Danyluk JM, Callahan D. Primary amyloidosis of the breast presenting as nonpalpable microcalcifications: case report. Can Assoc Radiol J. 2003;54(5):277–8.
- 35.
Sahoo S, Reeves W, DeMay RM. Amyloid tumor: a clinical and cytomorphologic study. Diagn Cytopathol. 2003;28(6):325–8.
- 36.
Kambouchner M, Godmer P, Guillevin L, Raphael M, Droz D, Martin A. Low grade marginal zone B cell lymphoma of the breast associated with localised amyloidosis and corpora amylacea in a woman with long standing primary Sjogren’s syndrome. J Clin Pathol. 2003;56(1):74–7.
- 37.
Ayers DE, Beer TW, Barker P. Amyloid tumour of the breast mimicking carcinoma. Cytopathology. 2002;13(4):254–6.
- 38.
Deolekar MV, Larsen J, Morris JA. Primary amyloid tumour of the breast: a case report. J Clin Pathol. 2002;55(8):634–5.
- 39.
Rocken C, Kronsbein H, Sletten K, Roessner A, Bassler R. Amyloidosis of the breast. Virchows Arch. 2002;440(5):527–35.
- 40.
Diaz-Bustamante T, Iribar M, Vilarrasa A, Benito A, Lopez-Rios F. Primary amyloidosis of the breast presenting solely as microcalcifications. AJR Am J Roentgenol. 2001;177(4):903–4.
- 41.
Fu K, Bassett LW. Mammographic findings of diffuse amyloidosis and carcinoma of the breast. AJR Am J Roentgenol. 2001;177(4):901–2.
- 42.
Gluck BS, Cabrera J, Strauss B, Ricca R, Brancaccio W, Tamsen A. Amyloid deposition of the breast. AJR Am J Roentgenol. 2000;175(6):1590.
- 43.
Echevarria JJ, Lopez JA, Alvarez JA, Astigarraga E. Breast involvement in a case of primary systemic amyloidosis: mammographic, US, and MR appearances. J Comput Assist Tomogr. 2000;24(3):451–3.
Acknowledgements
We thank NAI, Inc. (https://www.nai.co.jp/) for the English language editing.
Funding
Not applicable.
Availability of data and materials
The data supporting the conclusions of this article are included within the article.
Author information
Affiliations
Contributions
MM drafted the manuscript. HK helped with finalizing the manuscript, and HI gave the final approval of the article. All authors have read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
The patient provided informed consent for the publication of this report and any accompanying images.
Competing interests
Outside the submitted work, H. Iwata has received honoraria from Chugai, AstraZeneca, and Pfizer, and research funding from MSD, Kyowa Hakko Kirin, GSK, Daiichi-Sankyo, Lilly, Chugai, Novartis, Bayer, Pfizer, and advisory fees or rewards from Chugai, Daiichi-Sankyo, AstraZeneca, and Pfizer. All other authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
About this article
Cite this article
Mori, M., Kotani, H., Sawaki, M. et al. Amyloid tumor of the breast. surg case rep 5, 31 (2019). https://doi.org/10.1186/s40792-019-0591-z
Received:
Accepted:
Published:
Keywords
- Breast tumor
- Amyloid tumor
- Amyloidosis
- Sjogren syndrome
