Mammary Analogue Secretory

Carcinoma
Mammary analogue secretory carcinoma (MASC) is a
relatively recently described low-grade salivary gland
neoplasm which is identical to its mammary counterpart
at morphologic as well as molecular genetic levels.

The majority of cases involve the parotid gland and a

small proportion occur in the minor salivary glands. 

MASC usually consists of multiple lobules separated

by fibrotic stroma.

The lobules display a variety of architectural patterns,

including solid, microcystic, macrocystic, papillary,
tubular and cribriform
Mammary analogue secretory carcinoma (MASC) is a
relatively recently described low-grade salivary gland
neoplasm which is identical to its mammary counterpart
at morphologic as well as molecular genetic levels.

The majority of cases involve the parotid gland and a

small proportion occur in the minor salivary glands. 

MASC usually consists of multiple lobules separated

by fibrotic stroma.

The lobules display a variety of architectural patterns,

including solid, microcystic, macrocystic, papillary,
tubular and cribriform
Mammary analogue secretory carcinoma (MASC) usually
consists of multiple lobules separated by fibrotic
stroma.

The lobules display a variety of architectural

patterns, including solid, microcystic,
macrocystic, papillary, tubular and cribriform
(shown here).

Multiple patterns may be seen within one tumor. The

tumor cells have bland morphology with uniform
round to oval vesicular nuclei and small nucleoli.

The cytoplasm is pale eosinophilic and granular or

vacuolated.

High-grade cytologic features and increased mitotic

activity are usually not present.
Mammary analogue secretory carcinoma (MASC) usually
consists of multiple lobules separated by fibrotic
stroma.

The lobules display a variety of architectural

patterns, including solid, microcystic,
macrocystic, papillary, tubular and cribriform
(shown here).

Multiple patterns may be seen within one tumor.

The tumor cells have bland morphology with uniform

round to oval vesicular nuclei and small nucleoli.

The cytoplasm is pale eosinophilic and granular or

vacuolated.

High-grade cytologic features and increased mitotic

activity are usually not present.
Immunohistochemistry: Mammary analogue secretory
carcinomas (MASC) are usually positive for cytokeratin
AE1/AE3, CAM5.2, Cytokeratin 7, vimentin,
STAT5a and S-100 protein.

Mammaglobin and GCDFP-15 are also positive.

DOG-1 is negative. Basal cell and myoepithelial cell

markers, including CK5/6, SMA, p63, and calponin are
usually not expressed. 

This focus shows an admixture of papillary, solid, and

cribriform architecture.
Molecular Genetics: Most cases of mammary analogue
secretory carcinoma ( MASC) carry a translocation t(12;15)
(p13;q25) resulting in ETV6-NTRK3 gene fusion.

This genetic rearrangement is not specific to secretory

carcinomas of breast and salivary gland, but has also been
observed in congenital fibrosarcoma, cellular mesoblastic
nephroma, and in some cases of acute myeloid leukemia. 

In a subset of MASC cases, the ETV6 is rearranged on

FISH but ETV6-NTRK3 fusion transcript is not detectable by
RT-PCR, suggesting heterogenous breakpoints or
another partner gene. 

Differential Diagnosis: The differential diagnosis of MASC

includes zymogen-poor acinic cell carcinoma (ACC), low-
grade salivary duct carcinoma, cystadenocarcinoma, and
low-grade adenocarcinoma, NOS.

Among these, the most challenging entity to distinguish from

MASC is the zymogen-poor ACC.

The presence of DOG-1 positivity and the absence of ETV6-

NTRK3 fusion support the diagnosis of zymogen-poor ACC
Prognosis: Mammary analogue secretory carcinoma (MASC) is
currently regarded as a low-grade carcinoma with a generally
favorable prognosis.

It has a low risk of local recurrences (15%), lymph node

metastases (20%)and distant metastases (5%).

There have been case reports of transformation to a high-

grade lesion marked by accelerated growth and poor outcome.

Overall, mortality is seen in 6% to 13% of cases of MASC. 

The image shows a focus of MASC with solid growth pattern.

The tumor cells have bland morphology with uniform round to

oval vesicular nuclei and small nucleoli.

The cytoplasm is pale eosinophilic and granular or vacuolated. 

High-grade cytologic features and increased mitotic

activity are not present.