21 December 2006 – Case of the Week #68

 

These cases can also be accessed by clicking on the Case of the Week button on the left hand side of our Home Page at www.PathologyOutlines.com.  This email is sent only to those who subscribe in writing or by email.  To view the images or references, you must click on the links in blue.

 

To subscribe or unsubscribe, email info@PathologyOutlines.com, indicating subscribe or unsubscribe to Case of the Week.  We do not sell, share or use your email address for any other purpose.  We also maintain two other email lists: to receive a biweekly update of new jobs added to our Jobs pages, and to receive a monthly update of changes made to the website.  You must subscribe or unsubscribe separately to these email lists.

 

Thanks to all who have purchased books or other items through Amazon.com.  Our 2006 Amazon sales have now exceeded $80,000, which helps our website financially without costing you anything.  We now list books discounted at least 10% by Amazon.com on our Books page under Discounts (from the Home Page, click on the Books button).  In addition, for Lippincott books, visit www.Lww.com and use discount code W5ECA1ZZ to get a 10% discount.

 

We thank Dr. Carmen Luz Menéndez, staff Pathologist at Hospital de Cabueñes, Gijón, Asturias, Spain, for contributing this case.  We invite you to contribute a Case of the Week by sending an email to NPernick@PathologyOutlines.com with microscopic images (any size, we will shrink if necessary) in JPG or GIF format, a clinical history, your diagnosis and any other images (gross, immunostains, EM, etc.) that may be helpful or interesting.  We will write the discussion (unless you want to), list you as the contributor, and send you a check for $35 (US) for your time after we send out the case.  Please only send cases with a definitive diagnosis.  

 

Case of the Week #68

 

Clinical history

 

An 84 year old woman had a total mastectomy with axillary dissection for a breast nodule.  The main mass was 5 x 3.5 cm, and a 2 cm mass was nearby.

 

The tumor was negative for ER, PR and HER2.

 

Micro images: image #1;  #2;  #3;  #4;  GCDFP-15;  bcl2  

 

What is your diagnosis? 

 

(scroll down to continue)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis:

 

Invasive apocrine carcinoma with an in situ component

 

Discussion

 

Invasive apocrine carcinoma is an uncommon subtype of breast carcinoma, representing 1-4% of all carcinomas.  It typically affects older women than infiltrating ductal carcinoma (Breast Cancer 2002;9:43).  Grossly, it may present as a mural nodule within a cyst.  Microscopically, the tumors are composed of cells with distinct cell margins, eosinophilic cytoplasm and granules.  They have vesicular nuclei with prominent nucleoli, and may have glands with apocrine snouts.  This diagnosis should be limited to tumors with widespread apocrine change and obvious malignancy.

 

These tumors are immunoreactive for GCDFP-15, although less often in advanced tumors (Histopathology 2005;47:195).  They are also frequently positive for p53 and androgen receptor, and the cytoplasmic granules are PAS positive.  As in this case, the tumor cells are negative for ER, PR and bcl2 (lymphoycytes serve as a positive internal control).  A recent report suggests that B72.3 may be a more sensitive and specific marker than GCDFP-15 (APMIS 2006;114:712)

 

Although traditionally considered to behave similar to infiltrating ductal carcinoma NOS (Breast Cancer Res Treat 2004;88:49), pure cases may be less aggressive (Breast 2005;14:3).

 

 

 

Nat Pernick, M.D., President
PathologyOutlines.com, Inc.

30100 Telegraph Road, Suite 404
Bingham Farms, Michigan (USA) 48025

Telephone: 248/646-0325
Fax: 248/646-1736
Email: NPernick@PathologyOutlines.com