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Breast-nonmalignant
Fibrocystic disease
Apocrine metaplasia of breast
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 10 May 2010, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Common non-neoplastic condition as part of (non-proliferative) fibrocystic changes
Terminology
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● See also apocrine (adenomyoepithelial) adenosis, apocrine adenoma
Epidemiology
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● Common in women >30 y of age but most common in post-menopausal women
Etiology
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● Not known, may be related to hormonal imbalances
Clinical features
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● There are no specific clinical features in the majority of cases
● in some cases, lesions with complex papillary and cystic architecture can present as a mass
Prognostic factors
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● Benign lesion; risk for breast cancer is controversial:
- may be a risk factor (low) for cancer (Cancer Epidemiol Biomarkers Prev 2007;16:467)
- there is no significant increase in relative risk of breast cancer in cases isolated apocrine metaplasia (Cancer Epidemiol Biomarkers Prev 1996;5:29)
● Highly complex papillary apocrine change: rare, but can coexist with ADH (Cancer Epidemiol Biomarkers Prev 1996;5:29)
Treatment
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● No treatment is necessary if isolated finding
Gross description (Macroscopy)
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● No specific gross findings
Micro description (Histopathology)
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● Cells resemble apocrine sweat glands; are enlarged with abundant eosinophilic cytoplasm and apical snouts, often supranuclear vacuoles, medium sized round nuclei with prominent nucleoli
● Changes may be partial/incomplete, usually involving a cystic space
● Usually forms a flat or micropapillary epithelium; in rare cases the lesion can be complex cystic and papillary (with benign cytological features)
● May have more atypical features in sclerosing adenosis
● Highly complex architecture with cytologic atypia should be categorized as ADH or DCIS
Micro images
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Subgross
Apocrine metaplasia
With epithelial Papillary epithelial Papillary proliferation
hyperplasia hyperplasia
Strong androgen Negative for progesterone receptor
receptor staining (positive internal control in normal breast at upper left)
Highly complex papillary apocrine change
Cytology description
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● Atypical apocrine metaplasia with signet ring cells (such as from sclerosing papilloma) may resemble mucinous carcinoma (Acta Cytol 2002;46:749)
Positive stains
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● PAS (coarse glycolipid granules), GCDFP-15, androgen receptor (J Clin Pathol 1999;52:838)
● c-myc (nuclear staining, but no amplification by FISH, Breast 2002;11:466)
Negative stains
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● ER, PR
● p53, bcl-2
● Low Ki-67 (Mod Path 2000;13:13), but higher in complex papillary cases (Breast J 2009;15:475)
Electron microscopy descriptions
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● Numerous mitochondria in the cytoplasm
Molecular / cytogenetics description
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● Loss of heterozygosity in 53% (Am J Pathol 2000;157:323)
Differential Diagnosis
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● In cases of complex architecture, rule out ADH or DCIS
● Invasive apocrine carcinoma when apocrine metaplasia involves sclerosing adenosis or other sclerosing lesions
Additional references
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End of Breast-nonmalignant > Fibrocystic disease > Apocrine metaplasia of breast
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