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Breast-nonmalignant
Adenosis
Apocrine adenosis
Author: Nat Pernick, M.D.
Revised: 1 March 2010, last major update - March 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Adenosis (including sclerosing adenosis) with apocrine metaplasia in >50% of adenosis area
Terminology
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● Also called secretory adenosis or adenomyoepithelial adenosis by some (Stanford School of Medicine)
Epidemiology
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Sites
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Etiology
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Clinical features
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● May be premalignant, based on loss of heterozygosity, allelic imbalance (Cancer Detect Prev 2001;25:262) and clonality (Histopathology 2001;38:221)
Prognostic factors
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Case reports
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Treatment
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Clinical images
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Gross description (Macroscopy)
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Gross images
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Micro description (Histopathology)
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● Ducts lined by eosinophilic cells with apical snout formation and decapitation secretion characteristic of apocrine differentiation
● Cells have large nuclei and prominent nucleoli
● Cells may have vacuolated cytoplasm
● May appear infiltrative
● Atypical lesions may resemble apocrine DCIS (Arch Pathol Lab Med 2009;133:1817)
Micro images
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AFIP Fig 60: Within a lobule At “B”
circumscribed lesion
Expansion of lobular units with marked apocrine metaplasia
With sclerosing adenosis
AFIP Fig 62: appears AFIP Fig 61: Ducts lined by AFIP Fig 63: Cells have vacuolated
Infiltrative apocrine cells with large nuclei cytoplasm, large nuclei and
and prominent nucleoli prominent nucleoli
With atypia: 3x Cytologic atypia
variation in nuclear size
Androgen receptor positive
Drawings
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Virtual Slides
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Videos
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Cytology description
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● Often highly cellular
● Cells have apocrine metaplasia with occasional prominent nucleoli and pleomorphism resembling carcinoma, but minimal hyperchromasia
● Naked nuclei are present (Diagn Cytopathol 2007;35:296)
Cytology images
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Positive stains
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● EMA, GCDFP-15 (Am J Surg Pathol 1993;17:99)
● Androgen receptor (J Clin Pathol 1999;52:838), PAS for basement membrane (Mod Pathol 1993;6:318)
Negative stains
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Electron microscopy descriptions
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● Distinct basal lamina present
Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Sclerosing adenosis with apocrine metaplasia: sclerotic stroma, compressed lumens, no prominent myoepithelial cells, no association with adenomyoepithelioma
● Tubular adenosis: haphazard proliferation of elongated tubules, no association with adenomyoepithelioma
● Microglandular adenosis: glands are smaller, more regular; no myoepithelial cells, GCDFP15 negative
● Apocrine carcinoma: malignancy should be obvious, large nuclei with prominent nucleoli, no myoepithelial cells
Additional references
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End of Breast-nonmalignant > Adenosis > Apocrine adenosis
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