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Table of Contents
Definition / general | Prognostic factors | Case reports | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy description | Electron microscopy images | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Apocrine carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantapocrine.html. Accessed July 14th, 2017.
Definition / general
- > 90% of tumor cells have cytologic or immunohistochemical features of apocrine cells
- Rare, 1% - 4% of all breast carcinomas
Prognostic factors
- Similar (Breast J 2008;14:164), or slightly better (Breast 2005;14:3) prognosis as invasive ductal carcinoma
Case reports
- 71 year old woman with apocrine adenocarcinoma of the nipple (Cases J 2008;1:88)
- 84 year old woman had a total mastectomy with axillary dissection for a breast nodule (Case of the Week #68)
Gross description
- Indistinguishable from infiltrating ductal carcinoma (J Clin Pathol 2007;60:1313)
- May be mural nodule within cyst
- Often multicentric (Breast Cancer Res Treat 2004;88:49)
Microscopic (histologic) description
- Tumor cells have distinct cell margins, abundant acidophilic cytoplasm with eosinophilic granules, central to eccentric vesicular nuclei with prominent nucleoli
- May have glandular differentiation with apocrine snouts and prominent nucloeoli
- Limit diagnosis to tumors with widespread apocrine change and obvious malignancy
- Type A cells: abundant granular and intensely eosinophilic cytoplasm, granules are PAS+ diastase resistant, nuclei vary from globoid with prominent nucleoli to hyperchromatic
- Type B cells: abundant cytoplasm with fine empty vacuoles, creating a foamy appearance resembling histiocytes, nuclei are similar to type A cells
- Exclude: cases with clear cells of any type in any amount; other subtypes including tubular, lobular, mucinous, invasive micropapillary or medullary
Microscopic (histologic) images
Scroll to see all images.
Images hosted on PathOut server:
Images from AFIP:
Case of the Week #68:
Flickr images:
Images hosted on other servers:
Courtesy of Dr. Mark R. Wick
GCDFP-15
bcl2 negative
Images from AFIP:
Solid growth (AFIP)
Histiocytoid variant with isolated
cells resembling histiocytes
in desmoplastic stroma,
resembles granular cell tumor
Case of the Week #68:
Case of the week images
Flickr images:
Contributed by Dr. Semir Vranic, Sarajevo
GCDFP-15
AR expression, 20x
Estrogen receptor, 20x
HER2, 20x
HER2 gene, CISH 2
Images hosted on other servers:
Abundant cytoplasm with distinct cell margins
Cytoplasm is granular, nuclei are round
Cells have abundant cytoplasm with distinct cell margins
Cytoplasm is granular, nuclei are round with prominent nucleoli
With apocrine DCIS
Vesicular nuclei
Cancerization of lobule
H&E
GCDFP-15
Positive stains
- Keratin, GCDFP-15 (76% - 100%), B72.3 (92%, APMIS 2006;114:712), PAS (granules)
- ER-beta (73%, Histopathology 2007;50:425), particularly ER-beta1 (APMIS 2008;116:923)
- Androgen receptor (54%)
- HER2 (33%), p53 (29% - 39%), Ki67
- Note that GCDFP-15 and AR expression decrease in larger or node positive tumors (Histopathology 2005;47:195)
Electron microscopy description
- Prominent mitochondria, some with abnormal cristae
- Large membrane bound vesicles with dense homogenous osmophilic cores
Electron microscopy images
Images hosted on PathOut server:
AFIP Fascicle Third Series:
Smooth and rough
endoplasmic
reticulum,
dense nucleoli
Cytokeratin fila-
ments (arrow), lipid
droplets, mito-
chondria, lysosomes
Images hosted on other servers:
AFIP Fascicle Third Series:
endoplasmic
reticulum,
dense nucleoli
ments (arrow), lipid
droplets, mito-
chondria, lysosomes
Cytoplasm contains numerous
lysosomes, lipid droplets,
dilated mitochondria and
vesicular endoplasmic reticulum
Images hosted on other servers:
Cytoplasm rich in organelles
Electron dense
granules, condensed, at
secretory pole of cell
Molecular / cytogenetics description
- Form a distinct, even if heterogeneous, molecular subgroup of breast carcinomas that recapitulate the phenotype of apocrine sweat glands (Mol Oncol 2009;3:220)
- Abnormalities at 7q (codes for GCDFP-15 and prolactin inducible protein)
- Also loss of heterozygosity for p53 gene, VHL (3p25) gene, NB gene (1p35-36), PKD1/TSC2 gene at 16p13 (Mod Pathol 1999;12:1083)
Differential diagnosis
- Apocrine metaplasia: not infiltrative, no atypia
- Granular cell tumors
- Histiocytic proliferation
- Inflammation
- Lipid rich carcinoma: may overlap, although in lipid tumors, 90%+ cells have prominent intracytoplasmic neutral lipid (Am J Surg Pathol 2011;35:861)
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