Tubular Adenomyoepithelioma of the Breast Mimicking Retroareolar Carcinoma Managed by Central Excision and Chest Wall Perforator Flap Reconstruction: A Case Report and Literature Review

ABSTRACT: Adenomyoepithelioma (AME) of the breast is a rare biphasic epithelial-myoepithelial tumor that can mimic carcinoma clinically and radiologically. A 65-year-old woman presented with a progressively enlarging painful left retroareolar lump of 2 months' duration. Examination revealed a firm 3 cm × 3 cm mass with nipple retraction and skin puckering, along with palpable ipsilateral axillary nodes. Ultrasound showed an ill-defined hypoechoic lesion involving the nipple-areolar complex (Breast Imaging Reporting and Data System IV). Magnetic resonance imaging demonstrated a T2-intermediate lesion with spiculated margins but persistent enhancement and no diffusion restriction. Trucut biopsy suggested a benign sclerosing lesion, creating radiology-pathology discordance. The patient underwent central excision with removal of the nipple-areolar complex. Frozen section confirmed clear margins, followed by immediate oncoplastic reconstruction using a chest wall perforator flap. Histopathology and immunohistochemistry confirmed tubular variant AME. Tubular AME is a rare lesion that may mimic malignancy. Radiology-pathology correlation and margin-oriented excision with appropriate reconstruction are essential for optimal management.