Breast malignant, males, children

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Breast malignant, males, children

Carcinoma subtypes

Apocrine carcinoma

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 18 March 2012, last major update March 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● >90% of tumor cells have cytologic or immunohistochemical features of apocrine cells
● Rare, 1-4% of all breast carcinomas

Case reports
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● 46 year old woman (Univ Pittsburgh Case #209)
● 71 year old woman with nipple (skin) tumor (Cases J 2008 Aug 12;1(1):88)
● 84 year old woman (Case of the Week #68)

Treatment and prognosis
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● Similar (Breast J 2008;14:164), or slightly better (Breast 2005;14:3) prognosis as invasive ductal carcinoma

Gross description
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● Indistinguishable from infiltrating ductal carcinoma (J Clin Pathol 2007;60:1313)
● May be mural nodule within cyst
● Often multicentric (Breast Cancer Res Treat 2004;88:49)

Micro description
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● Tumor cells have distinct cell margins, abundant acidophilic cytoplasm with eosinophilic granules, central to eccentric vesicular nuclei with prominent nucleoli
● May have glandular differentiation with apocrine snouts and prominent nucloeoli
● Limit diagnosis to tumors with widespread apocrine change and obvious malignancy
● Type A cells: abundant granular and intensely eosinophilic cytoplasm, granules are PAS+ diastase resistant, nuclei vary from globoid with prominent nucleoli to hyperchromatic
● Type B cells: abundant cytoplasm with fine empty vacuoles, creating a foamy appearance resembling histiocytes, nuclei are similar to type A cells
● Exclude: cases with clear cells of any type in any amount; other subtypes including tubular, lobular, mucinous, invasive micropapillary or medullary

Micro images
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Various images


Contributed by Dr. Semir Vranic, Sarajevo


Case of the week images

Cells have abundant cytoplasm with distinct cell margins

Cytoplasm is granular, nuclei are round with prominent nucleoli


GCDFP-15

bcl2 negative

AR expression, 20x

Estrogen receptor, 20x

Her2 protein, 20x


HER2 gene, CISH 2

AFIP Fascicle Third Series

Tumor with solid growth pattern

Histiocytoid variant with isolated cells resembling
histiocytes in desmoplastic stroma, may be confused with granular cell tumor

Other images: cells have abundant cytoplasm with distinct cell margins #1; #2; #3; cytoplasm is granular, nuclei are round with prominent nucleoli #1; #2; #3; #4; #5; with apocrine DCIS

Positive stains
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● Keratin, GCDFP-15 (76-100%), B72.3 (92%, APMIS 2006;114:712), PAS (granules)
● ER-beta (73%, Histopathology 2007;50:425), particularly ER-beta1 (APMIS 2008;116:923)
● Androgen receptor (54%)
● HER2 (33%), p53 (29-39%), Ki-67
● Note that GCDFP-15 and AR expression decrease in larger or node-positive tumors (Histopathology 2005;47:195)

Negative stains
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● ER-alpha (usually), PR (usually), bcl-2

EM description
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● Prominent mitochondria, some with abnormal cristae
● Large membrane bound vesicles with dense homogenous osmophilic cores

EM images
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Cytoplasm is rich in organelles

Electron dense granules, condensed, at secretory pole of cell

AFIP Fascicle Third Series

Smooth and rough endoplasmic reticulum, dense nucleoli

Cytokeratin filaments (arrow), lipid droplets, mitochondria, lysosomes

Cytoplasm contains numerous lysosomes, lipid droplets, dilated mitochondria and vesicular endoplasmic reticulum

Molecular/cytogenetics description
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● Form a distinct, even if heterogeneous, molecular subgroup of breast carcinomas that recapitulate the phenotype of apocrine sweat glands (Mol Oncol 2009;3:220)
● Abnormalities at 7q (codes for GCDFP-15 and prolactin-inducible protein)
● Also loss of heterozygosity for p53 gene, VHL (3p25) gene, NB gene (1p35-36), PKD1/TSC2 gene at 16p13 (Mod Pathol 1999;12:1083)

Differential diagnosis
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● Apocrine metaplasia: not infiltrative, no atypia
● Granular cell tumor
● Lipid rich carcinoma: may overlap, although in lipid tumors, 90%+ cells have prominent intracytoplasmic neutral lipid (Am J Surg Pathol 2011;35:861)
● Histiocytic proliferation
● Inflammation
● Granular cell tumors

Additional references
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● Pathol Res Pract 2008;204:367, Breast Cancer 2002;9:43, Stanford University

End of Breast malignant, males, children > Carcinoma subtypes > Apocrine carcinoma

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