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      = apocrine morphology (cells with prominent [[nucleoli]] - may be multiple, abundant granular eosinophilic cytoplasm) - must be >=90% of tumour, loss of basal cells
| Micro      = apocrine morphology (cells with prominent [[nucleoli]] - may be multiple, abundant granular eosinophilic cytoplasm) - must be >=90% of tumour, loss of basal cells
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| LMDDx      = [[glycogen-rich clear cell carcinoma of the breast]]
| 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      =
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| 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.
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*Cutaneous Apocrine Carcinoma
*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.   
***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===
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==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
*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
Notes:
*Salivary gland carcinoma and cutaneous adnexal tumors can show a similar IHC profile.
*[[Salivary duct carcinoma]] and cutaneous adnexal tumours can show a similar IHC profile.
*Apocrine carcioma can be a non-basal type 'triple negative carcinoma' identified by both morphology and AR positivity<ref>{{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>.
*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 show different behaviour to other types of triple negative carcinoma.
**May respond to treatments targeting the androgen receptor<ref>{{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 }}
**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>
</ref>
*Be careful when reading the literature in this area - is the author discussing 'molecular apocrine' (ER -ve, AR +ve) or 'morphologic apocrine' carcinoma.   
**Be carefull when reading the literature in this area - is the author discussing 'molecular apocrine', 'IHC apocrine' or 'morphologic apocrine' carcinoma.  Many ductal carcinomas, NOS will show AR positivity.
*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

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. ↑ 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. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
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