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Breast-malignant, males, children
Apocrine carcinoma
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)
Revised: 8 September 2009
Last major update: September 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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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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● May be mural nodule within cyst
● Often multicentric (Breast Cancer Res Treat 2004;88:49)
Microscopic description / grading
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● Tumor cells have distinct cell margins, acidophilic cytoplasm with eosinophilic granules, central to eccentric vesicular nuclei with prominent nucleoli
● May have glandular differentiation with apocrine snouts
● 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
Micro images
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Low power Cancerization of lobule
Case of the week images
Low power High power
Cells have abundant cytoplasm Cytoplasm is granular, nuclei
with distinct cell margins are round with prominent nucleoli
GCDFP-15 #1 #2 (most cells stain) bcl2 negative
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
Electron microscopy
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● Prominent mitochondria, some with abnormal cristae
● Large membrane bound vesicles with dense homogenous osmophilic cores
Electron microscopy 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 Cytokeratin filaments (arrow),
reticulum, dense nucleoli lipid droplets, mitochondria,
lysosomes
Cytoplasm contains numerous lysosomes, lipid droplets,
dilated mitochondria and vesicular endoplasmic reticulum
Molecular / cytogenetics
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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 Feb 3 [Epub ahead of print])
● 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 Path 1999;12:1083)
Differential diagnosis
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● Apocrine metaplasia - not infiltrative, no atypia
● 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 > Apocrine carcinoma
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