Breast – Malignant, Males, Children

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Breast-malignant, males, children

Morphologic variants of DCIS

Apocrine DCIS

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 15 August 2009

Last major update: August 2009

Definition

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● DCIS with cells containing abundant eosinophilic cytoplasm, vesicular nuclei and prominent nucleoli

● Uncommon variant; clinical behavior similar to classic DCIS

Microscopic description / grading

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● Tumor grade is based on nuclear features and presence of comedo-type necrosis (Hum Path 2001;32:487)

● Low grade lesions have micropapillary architecture

● Lesion size / extent are important in differential diagnosis due to partial overlap with apocrine atypia

● Nuclei are graded 1-3 based on nuclear size, pleomorphism and nucleoli
● Nuclear size (compared to benign apocrine cells) is either small (1-2x), intermediate (3-4x) or large (5x or larger)

● Grade 1 nuclei: low pleomorphism, small/intermediate size, usually single prominent nucleolus

● Grade 2 nuclei: moderate pleomorphism, small/intermediate size, multiple nucleoli; may have occasional large nuclei or multinucleated cells

● Grade 3 nuclei: intermediate/large size, marked pleomorphism, coarse chromatin, irregular nuclear contour, frequently multiple nucleoli
● Necrosis: focal or extensive comedo-type necrosis, must be centrally localized in at least 1 duct or acinus; isolated necrotic or apoptotic cells are ignored

● Low-grade: nuclear grade 1 or 2 without necrosis
● High-grade: tumors with grade 3 nuclei and necrosis; similar to high grade nonapocrine DCIS, but with cytoplasmic apocrine features and 10%+ nuclei with single large nucleolus and vesicular chromatin

● Intermediate-grade: cases not classified as low or high histologic grade

Micro images

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Comedonecrosis Present in adenosis Apocrine-type cells

Granular cytoplasm Involving lobules Forming tufts

Secretory features #1 #2 #3

Secretory features #4 #5

Low power Intermediate power High power

Cells have abundant cytoplasm, vesicular nuclei and prominent nucleoli (AFIP)

Micropapillary pattern Cribriform pattern

Apocrine adenosis with atypia (not DCIS)

Androgen receptor staining

Virtual slides

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High grade apocrine DCIS

Positive stains

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● Androgen receptor, B72.3 (92%, APMIS 2006;114:712), ER-beta (73%, Histopathology 2007;50:425)

● p53 (62%), HER2 (47%), Ki-67 (5% of cells) (Mod Path 2000;13:13)

Negative stains

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● ER-alpha, PR, bcl2

Additional references

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● Hum Path 1994;25:164, Mod Path 1994;7:813, Stanford University

End of Breast – Malignant, Males, Children > Apocrine DCIS

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