Difference between revisions of "Apocrine carcinoma of the breast"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Breast ApocrineCarcinoma MP2 CTR.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Apocrine carcinoma of the breast. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = apocrine morphology (cells with prominent [[nucleoli]] - may be multiple, abundant granular eosinophilic cytoplasm) - must be >=90% of tumour, loss of basal cells | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = | | LMDDx = [[glycogen-rich clear cell carcinoma of the breast]] | ||
| Stains = | | Stains = | ||
| IHC = AR +ve, [[GCDFP-15]] +ve, ER -ve, PR -ve | | IHC = AR +ve, [[GCDFP-15]] +ve, ER -ve, PR -ve, HER2 +ve/-ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = [[breast grossing]] | ||
| Staging = [[breast cancer staging]] | |||
| Site = [[breast]] - see ''[[invasive breast cancer]]'' | | Site = [[breast]] - see ''[[invasive breast cancer]]'' | ||
| Assdx = | | Assdx = | ||
| Line 25: | Line 26: | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = | | Prognosis = poor, worse the ductal carcinoma | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = other breast masses | ||
| Tx = | | Tx = excision | ||
}} | }} | ||
'''Apocrine carcinoma of the breast''' is a rare form of [[invasive breast cancer]]. | '''Apocrine carcinoma of the breast''' is a rare form of [[invasive breast cancer]]. | ||
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==General== | ==General== | ||
*Need >=90% apocrine morphology.<ref name=Ref_BP217>{{Ref BP|217}}</ref> | *Need >=90% apocrine morphology.<ref name=Ref_BP217>{{Ref BP|217}}</ref> | ||
*Worse prognosis that [[invasive ductal carcinoma of the breast]] in a large series.<ref name=pmid23245877>{{Cite journal | last1 = Dellapasqua | first1 = S. | last2 = Maisonneuve | first2 = P. | last3 = Viale | first3 = G. | last4 = Pruneri | first4 = G. | last5 = Mazzarol | first5 = G. | last6 = Ghisini | first6 = R. | last7 = Mazza | first7 = M. | last8 = Iorfida | first8 = M. | last9 = Rotmensz | first9 = N. | title = Immunohistochemically defined subtypes and outcome of apocrine breast cancer. | journal = Clin Breast Cancer | volume = 13 | issue = 2 | pages = 95-102 | month = Apr | year = 2013 | doi = 10.1016/j.clbc.2012.11.004 | PMID = 23245877 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=Ref_BP217>{{Ref BP|217}}</ref> | Features:<ref name=Ref_BP217>{{Ref BP|217}}</ref> | ||
*Prominent [[nucleoli]]. | *Prominent red [[nucleoli]]. | ||
**Often multiple.<ref>{{Cite journal | last1 = O'Malley | first1 = FP. | last2 = Bane | first2 = A. | title = An update on apocrine lesions of the breast. | journal = Histopathology | volume = 52 | issue = 1 | pages = 3-10 | month = Jan | year = 2008 | doi = 10.1111/j.1365-2559.2007.02888.x | PMID = 18171412 }}</ref> | **Often multiple.<ref>{{Cite journal | last1 = O'Malley | first1 = FP. | last2 = Bane | first2 = A. | title = An update on apocrine lesions of the breast. | journal = Histopathology | volume = 52 | issue = 1 | pages = 3-10 | month = Jan | year = 2008 | doi = 10.1111/j.1365-2559.2007.02888.x | PMID = 18171412 }}</ref> | ||
*Abundant granular eosinophilic cytoplasm. | *Abundant granular eosinophilic cytoplasm. | ||
*Architecture like invasive ductal carcinomas ''no special type''. | *Architecture like invasive ductal carcinomas ''no special type''. | ||
DDx: | |||
*[[Glycogen-rich clear cell carcinoma of the breast]]. | |||
*Cutaneous Apocrine Carcinoma | |||
***A possible cutaneous apocrine carcinoma in a patient with a history of mammary apocrine carcinoma is problematic but fortunately a relatively infrequent conundrum. | |||
*Apocrine-like carcinoma - immunoprolife doesn't fit for invasive AC (ER +ve, PR +ve, AR -ve).<ref name=pmid23245877/> | |||
===Images=== | ===Images=== | ||
www: | www: | ||
*[http://path.upmc.edu/cases/case209/micro.html Apocrine carcinoma (upmc.edu)]. | *[http://path.upmc.edu/cases/case209/micro.html Apocrine carcinoma (upmc.edu)]. | ||
<gallery> | |||
Image:Breast ApocrineCarcinoma LP2 CTR.jpg|Breast - Apocrine Carcinoma - Low power (SKB) | |||
Image:Breast ApocrineCarcinoma PerienuralInvasion MP CTR.jpg|Breast - Apocrine Carcinoma - Perineural invasion - High power (SKB) | |||
Image:Breast ApocrineCarcinoma LP CTR.jpg|Breast - Apocrine Carcinoma - Low power (SKB) | |||
Image:Breast ApocrineCarcinoma MP2 CTR.jpg|Breast - Apocrine Carcinoma - Medium power (SKB) | |||
Image:Breast ApocrineCarcinoma HP CTR.jpg|Breast - Apocrine Carcinoma - High power (SKB) | |||
Image:Breast ApocrineCarcinoma HP2 CTR.jpg|Breast - Apocrine Carcinoma - High power (SKB) | |||
</gallery> | |||
==IHC== | ==IHC== | ||
Smaller tumours classically:<ref name=pmid16045781>{{Cite journal | last1 = Honma | first1 = N. | last2 = Takubo | first2 = K. | last3 = Akiyama | first3 = F. | last4 = Sawabe | first4 = M. | last5 = Arai | first5 = T. | last6 = Younes | first6 = M. | last7 = Kasumi | first7 = F. | last8 = Sakamoto | first8 = G. | title = Expression of GCDFP-15 and AR decreases in larger or node-positive apocrine carcinomas of the breast. | journal = Histopathology | volume = 47 | issue = 2 | pages = 195-201 | month = Aug | year = 2005 | doi = 10.1111/j.1365-2559.2005.02181.x | PMID = 16045781 }}</ref> | Smaller tumours classically:<ref name=pmid16045781>{{Cite journal | last1 = Honma | first1 = N. | last2 = Takubo | first2 = K. | last3 = Akiyama | first3 = F. | last4 = Sawabe | first4 = M. | last5 = Arai | first5 = T. | last6 = Younes | first6 = M. | last7 = Kasumi | first7 = F. | last8 = Sakamoto | first8 = G. | title = Expression of GCDFP-15 and AR decreases in larger or node-positive apocrine carcinomas of the breast. | journal = Histopathology | volume = 47 | issue = 2 | pages = 195-201 | month = Aug | year = 2005 | doi = 10.1111/j.1365-2559.2005.02181.x | PMID = 16045781 }}</ref> | ||
*AR +ve. | *[[Androgen receptor|AR]] +ve. | ||
*[[GCDFP-15]] +ve. | *[[GCDFP-15]] +ve. | ||
Usually:<ref name=Ref_BP217>{{Ref BP|217}}</ref> | Usually:<ref name=Ref_BP217>{{Ref BP|217}}</ref> | ||
*ER -ve. | *ER -ve. | ||
*PR -ve. | *PR -ve. | ||
*Often HER2 +ve but can be HER2 -ve.<ref name=pmid19898421>{{Cite journal | last1 = Niemeier | first1 = LA. | last2 = Dabbs | first2 = DJ. | last3 = Beriwal | first3 = S. | last4 = Striebel | first4 = JM. | last5 = Bhargava | first5 = R. | title = Androgen receptor in breast cancer: expression in estrogen receptor-positive tumors and in estrogen receptor-negative tumors with apocrine differentiation. | journal = Mod Pathol | volume = 23 | issue = 2 | pages = 205-12 | month = Feb | year = 2010 | doi = 10.1038/modpathol.2009.159 | PMID = 19898421 }}</ref> | |||
Notes: | |||
*[[Salivary duct carcinoma]] and cutaneous adnexal tumours can show a similar IHC profile. | |||
*Apocrine carcioma can be a non-basal type 'triple negative carcinoma'.<ref name=pmid22450930>{{Cite journal | last1 = Tsutsumi | first1 = Y. | title = Apocrine carcinoma as triple-negative breast cancer: novel definition of apocrine-type carcinoma as estrogen/progesterone receptor-negative and androgen receptor-positive invasive ductal carcinoma. | journal = Jpn J Clin Oncol | volume = 42 | issue = 5 | pages = 375-86 | month = May | year = 2012 | doi = 10.1093/jjco/hys034 | PMID = 22450930 }}</ref> | |||
**May show different behaviour to other types of triple negative carcinoma. | |||
**May respond to treatments targeting the androgen receptor.<ref name=pmid25310144>{{Cite journal | last1 = Safarpour | first1 = D. | last2 = Tavassoli | first2 = FA. | title = A Targetable Androgen Receptor-Positive Breast Cancer Subtype Hidden Among the Triple-Negative Cancers. | journal = Arch Pathol Lab Med | volume = | issue = | pages = | month = Oct | year = 2014 | doi = 10.5858/arpa.2014-0122-RA | PMID = 25310144 }}</ref> | |||
*Be careful when reading the literature in this area - is the author discussing 'molecular apocrine' (ER -ve, AR +ve) or 'morphologic apocrine' carcinoma. | |||
*Many [[invasive ductal carcinoma of the breast|ductal carcinomas, NOS]] show AR positivity but are often ER +ve. | |||
==See also== | ==See also== | ||
Latest revision as of 11:38, 8 September 2016
| Apocrine carcinoma of the breast | |
|---|---|
| Diagnosis in short | |
 Apocrine carcinoma of the breast. H&E stain. | |
|
| |
| LM | apocrine morphology (cells with prominent nucleoli - may be multiple, abundant granular eosinophilic cytoplasm) - must be >=90% of tumour, loss of basal cells |
| LM DDx | glycogen-rich clear cell carcinoma of the breast |
| IHC | AR +ve, GCDFP-15 +ve, ER -ve, PR -ve, HER2 +ve/-ve |
| Grossing notes | breast grossing |
| Staging | breast cancer staging |
| Site | breast - see invasive breast cancer |
|
| |
| Prevalence | uncommon |
| Prognosis | poor, worse the ductal carcinoma |
| Clin. DDx | other breast masses |
| Treatment | excision |
Apocrine carcinoma of the breast is a rare form of invasive breast cancer.
General
- Need >=90% apocrine morphology.[1]
- Worse prognosis that invasive ductal carcinoma of the breast in a large series.[2]
Microscopic
Features:[1]
- Prominent red nucleoli.
- Often multiple.[3]
- Abundant granular eosinophilic cytoplasm.
- Architecture like invasive ductal carcinomas no special type.
DDx:
- Glycogen-rich clear cell carcinoma of the breast.
- Cutaneous Apocrine Carcinoma
- A possible cutaneous apocrine carcinoma in a patient with a history of mammary apocrine carcinoma is problematic but fortunately a relatively infrequent conundrum.
- Apocrine-like carcinoma - immunoprolife doesn't fit for invasive AC (ER +ve, PR +ve, AR -ve).[2]
Images
www:
Breast - Apocrine Carcinoma - Low power (SKB)
Breast - Apocrine Carcinoma - Perineural invasion - High power (SKB)
Breast - Apocrine Carcinoma - Low power (SKB)
Breast - Apocrine Carcinoma - Medium power (SKB)
Breast - Apocrine Carcinoma - High power (SKB)
Breast - Apocrine Carcinoma - High power (SKB)
IHC
Smaller tumours classically:[4]
Usually:[1]
- ER -ve.
- PR -ve.
- Often HER2 +ve but can be HER2 -ve.[5]
Notes:
- Salivary duct carcinoma and cutaneous adnexal tumours can show a similar IHC profile.
- Apocrine carcioma can be a non-basal type 'triple negative carcinoma'.[6]
- May show different behaviour to other types of triple negative carcinoma.
- May respond to treatments targeting the androgen receptor.[7]
- Be careful when reading the literature in this area - is the author discussing 'molecular apocrine' (ER -ve, AR +ve) or 'morphologic apocrine' carcinoma.
- Many ductal carcinomas, NOS show AR positivity but are often ER +ve.
See also
References
- ↑ 1.0 1.1 1.2 O'Malley, Frances P.; Pinder, Sarah E. (2006). Breast Pathology: A Volume in Foundations in Diagnostic Pathology series (1st ed.). Churchill Livingstone. pp. 217. ISBN 978-0443066801.
- ↑ 2.0 2.1 Dellapasqua, S.; Maisonneuve, P.; Viale, G.; Pruneri, G.; Mazzarol, G.; Ghisini, R.; Mazza, M.; Iorfida, M. et al. (Apr 2013). "Immunohistochemically defined subtypes and outcome of apocrine breast cancer.". Clin Breast Cancer 13 (2): 95-102. doi:10.1016/j.clbc.2012.11.004. PMID 23245877.
- ↑ O'Malley, FP.; Bane, A. (Jan 2008). "An update on apocrine lesions of the breast.". Histopathology 52 (1): 3-10. doi:10.1111/j.1365-2559.2007.02888.x. PMID 18171412.
- ↑ Honma, N.; Takubo, K.; Akiyama, F.; Sawabe, M.; Arai, T.; Younes, M.; Kasumi, F.; Sakamoto, G. (Aug 2005). "Expression of GCDFP-15 and AR decreases in larger or node-positive apocrine carcinomas of the breast.". Histopathology 47 (2): 195-201. doi:10.1111/j.1365-2559.2005.02181.x. PMID 16045781.
- ↑ Niemeier, LA.; Dabbs, DJ.; Beriwal, S.; Striebel, JM.; Bhargava, R. (Feb 2010). "Androgen receptor in breast cancer: expression in estrogen receptor-positive tumors and in estrogen receptor-negative tumors with apocrine differentiation.". Mod Pathol 23 (2): 205-12. doi:10.1038/modpathol.2009.159. PMID 19898421.
- ↑ Tsutsumi, Y. (May 2012). "Apocrine carcinoma as triple-negative breast cancer: novel definition of apocrine-type carcinoma as estrogen/progesterone receptor-negative and androgen receptor-positive invasive ductal carcinoma.". Jpn J Clin Oncol 42 (5): 375-86. doi:10.1093/jjco/hys034. PMID 22450930.
- ↑ Safarpour, D.; Tavassoli, FA. (Oct 2014). "A Targetable Androgen Receptor-Positive Breast Cancer Subtype Hidden Among the Triple-Negative Cancers.". Arch Pathol Lab Med. doi:10.5858/arpa.2014-0122-RA. PMID 25310144.