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Breast-nonmalignant

Adenosis

Apocrine adenosis

 

Author: Nat Pernick, M.D.

Revised: 5 October 2012, last major update - March 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● 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)

 

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)

 

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

 

Micro images

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AFIP Fig 60:                           Within a lobule                    At “B”

circumscribed lesion

 

 

                               

Expansion of lobular units with marked apocrine metaplasia

 

 

                Object name is jclinpath00233-0048-a.jpg

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

 

 

nfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author                Object name is jclinpath00233-0048-b.jpg               

With atypia: 3x                    Cytologic atypia

variation in nuclear size

 

 

                               

With atypia – contributed by Dr. Semir Vranic

 

 

Object name is jclinpath00284-0047-b.jpg

Androgen receptor positive

 

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)

 

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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● ER, PR

 

Electron microscopy descriptions

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● Distinct basal lamina present

 

Differential Diagnosis

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● Sclerosing adenosis with apocrine metaplasia: no prominent myoepithelial cells

● Tubular adenosis: haphazard proliferation of elongated tubules

● Microglandular adenosis: glands are smaller, more regular; no myoepithelial cells

● Apocrine carcinoma: malignancy should be obvious

 

End of Breast-nonmalignant > Adenosis > Apocrine adenosis

 

 

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