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\begin{document}

\title{Sonographic Findings of the Primary Mucoepidermoid Carcinoma of the
Breast}



\author[1]{Gui-Wu Chen}%
\author[1]{Wen-Qin Liu}%
\author[1]{Xiao-Min Liao}%
\author[1]{Fen-Fen Yu}%
\author[1]{Yuhuan Xie }%
\affil[1]{Dongguan People's Hospital}%


\vspace{-1em}



  
  \date{June 17, 2024}


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\textbf{Sonographic Findings of the Primary Mucoepidermoid Carcinoma of
the Breast}

Gui-Wu Chen\textsuperscript{1}, Wen-Qin Liu\textsuperscript{1}, Xiao-Min
Liao\textsuperscript{2}, Fen-Fen Yu\textsuperscript{3}, Yu-Huan
Xie\textsuperscript{1}

\textsuperscript{1}Department of Ultrasound, Affiliated Dongguan
Hospital, Southern Medical University, Dongguan, China

\textsuperscript{2}Department of Pathology, Affiliated Dongguan
Hospital, Southern Medical University, Dongguan, China

\textsuperscript{3}Department of Radiology, Affiliated Dongguan
Hospital, Southern Medical University, Dongguan, China

\textbf{Running Title:} Mucoepidermoid Carcinoma of the Breast

\textbf{Corresponding Author:}

Yu-Huan Xie

Department of Ultrasound, Dongguan People's Hospital, Southern Medical
University, No.78, Wandao Road, Dongguan City, Dongguan 52300, Guangdong
Province, China.

Telephone Number: +86 13713130989

Fax Number: 0769-28636378

E-mail Address: xieyuhuan0989@163.com

\textbf{First Author:}

Gui-Wu Chen

Department of Ultrasound, Dongguan People's Hospital, Southern Medical
University, No.78, Wandao Road, Dongguan City, Dongguan 52300, Guangdong
Province, China.

Telephone Number: +86 13427808564

E-mail Address: chenguiwu\_6996@163.com

ORCID ID: 0000-0003-2805-9007

\textbf{Data Availability Statement}

The data used to support the findings of this study are available from
the corresponding author upon request.

\textbf{Funding Statement}

No funding was received for this study.

\textbf{Conflicts of Interest Disclosure}

The authors declare that there is no conflict of interest.

\textbf{Ethics of Approval Statement and Clinical Trial Registration}

The corresponding author had the written consent of the patient to use
the data for publication.

\textbf{Patient Consent Statement}

The patient agreed to use his/her information and samples (including
blood, urine, excrement, and excised tissue) for medical research for
non-commercial purposes under the premise of strict privacy protection.

\textbf{Permission to Reproduce Material from Other Sources}

No material from other source was applied.

\textbf{Title:} Sonographic Findings of the Primary Mucoepidermoid
Carcinoma of the Breast

\textbf{Running Title:} Mucoepidermoid Carcinoma of the Breast

\textbf{Keywords:} mucoepidermoid carcinoma, breast tumor, mammography,
ultrasonography, magnetic resonance imaging

\textbf{Number of Characters in the Title:} 74

\textbf{Number of Words in the Manuscript:} 493

\textbf{Number of Figures:} 3

\textbf{Number of Tables:} 0

Mucoepidermoid carcinoma (MEC) is an invasive tumor that has been
reported in many organs, such as the salivary glands, lungs, esophagus,
and thymus; however, it rarely affects the
breast.\textsuperscript{1}Only a few case reports about the primary MEC
of the breast are available that provide pathological evidence, which is
limited to imaging, including mammography, ultrasonography, and magnetic
resonance imaging.

A 38-year-old woman with a history of breast masses for 1 year presented
to our hospital with a mass in the right breast, which had been rapidly
grown in 1 week. On physical examination, the biggest mass was palpated
in the lower outer quadrant of the right breast, which felt pliable but
strong, was well-defined and movable. Before being admitted to the
hospital, mammography was performed, which revealed a well-defined huge
mass with a partly-lobulated boundary (Figure 1).

Initially, breast ultrasound examinations were performed during her
hospital admission. Multiple cystic breast masses bilaterally were
observed; most of them were oval, anechoic, well-defined, and
thin-walled. However, the biggest mass was some solid tissue within the
septa-divided cystic spaces with rich blood flow signals and high
resistance (Figure 2). No lymph node metastasis was found in the
bilateral axillary nodes.

Afterward, magnetic resonance imaging (MRI) of the breast was performed
before excising the biggest mass, which showed different signals on
T1-weighted and T2-weighted imaging at the solid tissue, while both
revealed a high signal at the mass peripherally. Additionally, it was
observed that the lateral thoracic artery of the right breast was
thicker on maximum intensity projection (Figure 3).

Eventually, the patient underwent surgical resection of the biggest mass
and a diagnosis of primary low-grade MEC was confirmed. No recurrence
and metastasis were reported during the 6-months follow-up
postoperatively.

Most of the case reports have insufficient imaging. Only a few cases of
breast MEC mammography have been reported which described an unclear
mass with or without accumulation of calcific deposits. Likewise, the
studies reporting ultrasound imaging also lacked detailed descriptions
and only mentioned minimal details. Most ultrasound images of primary
breast MEC show a complex cystic or solid mass with a rough or regular
surface.\textsuperscript{2}When breast ultrasound is unavailable or
inconclusive, MRI offers more diagnostic information to confirm the
characteristics of the mass, including its components and composition;
however, the evidence is still too deficient to characterize the
findings.

Based on the evidence describing pathological characteristics, primary
breast MECs are histologically classified into three categories---low,
intermediate, and high grade. These are usually characterized by a
prominent cystic component, intraductal papillary proliferation, and
solid architecture, respectively. Most low or intermediate-grade primary
breast MECs have an indolent behavior whereas high-grade masses could be
fatal due to distant metastasis.\textsuperscript{3}

In summary, exploring the imaging manifestations of primary breast MEC
in detail is essential for which various imaging modalities, including
mammography, ultrasonography, and MRI are available. These modalities
are crucial in not only characterizing the mass but may also influence
the histological grading of the mass before surgical treatment.

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Sherwell-Cabello S, Maffuz-Aziz A, R\selectlanguage{ngerman}íos-Luna NP, et al. Primary
  mucoepidermoid carcinoma of the breast. \emph{The Breast Journal} ,
  2017;23:753-755.
\item
  Ye RP, Liao YH, Xia T, et al. Breast mucoepidermoid carcinoma: a case
  report and review of literature. International Journal of Clinical and
  Experimental Pathology, 2020;13:3192-3199.
\item
  WHO classification of tumours editorial board. breast tumors. Lyon:
  IARC Press, 2019;2:149-150.
\end{enumerate}\selectlanguage{english}
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\textbf{Figure 1:} Mammography in the case of primary breast
mucoepidermoid carcinoma showed the biggest mass was a well-defined mass
with a partly-lobulated boundary as seen on the axial and coronal plane
views.

\textbf{Hosted file}

\verb`image3.emf`  available at \url{https://authorea.com/users/451161/articles/549387-sonographic-findings-of-the-primary-mucoepidermoid-carcinoma-of-the-breast}\selectlanguage{english}
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\textbf{Figure 2} : Ultrasonography of primary breast mucoepidermoid
carcinoma. (A) Gray-scale ultrasound showed the mass was irregular,
lobulated, and well-defined. (B) Color Doppler ultrasound showed the
solid tissue with rich blood flow signals. (C) Pulsed-wave Doppler
ultrasound showed the blood flow had high resistance.\selectlanguage{english}
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\textbf{Figure 3:} Magnetic resonance imaging of primary breast
mucoepidermoid carcinoma. (A) T1-weighted imaging showed the solid
tissue had an equal-intensity signal with a high-intensity signal at the
periphery of the mass. (B) T2-weighted imaging showed the solid tissue
had a low-intensity signal with a high signal at the periphery of the
mass. (C) Maximum intensity projection showed the lateral thoracic
artery of the right breast was thicker than the left breast.

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