Breast malignant, males, children

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Breast malignant, males, children

In situ carcinoma

Apocrine DCIS

Reviewer: Dina Kandil, M.D. (see Reviewers page)
Revised: 3 November 2012, last major update January 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Definition
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● DCIS with cells containing abundant eosinophilic cytoplasm, vesicular nuclei and prominent nucleoli
● Uncommon variant; clinical behavior similar to classic DCIS

Micro description / grading
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● Growth pattern may be solid, cribriform or micropapillary
● Tumor grade is based on nuclear features and presence of comedo-type necrosis (Hum Pathol 2001;32:487)
● Nuclei are graded 1-3 based on nuclear size, pleomorphism and nucleoli
● Nuclear size (compared to benign apocrine cells) is either small (1-2x), intermediate (3-4x) or large (5x or larger)
● Grade 1 nuclei: low pleomorphism, small/intermediate size, usually single prominent nucleolus
● Grade 2 nuclei: moderate pleomorphism, small/intermediate size, multiple nucleoli; may have occasional large nuclei or multinucleated cells
● Grade 3 nuclei: intermediate/large size, marked pleomorphism, coarse chromatin, irregular nuclear contour, frequently multiple nucleoli
● Necrosis: punctuate or comedo necrosis
● Low-grade: nuclear grade 1 or 2 without necrosis
● High-grade: tumors with grade 3 nuclei and necrosis; similar to high grade nonapocrine DCIS, but with cytoplasmic apocrine features and 10%+ nuclei with single large nucleolus and vesicular chromatin
● Intermediate-grade: cases not classified as low or high histologic grade

Micro images
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Various images


Low, intermediate and high power

Granular cytoplasm

Involving lobules

Forming tufts


Secretory features


Cells have abundant cytoplasm, vesicular nuclei and prominent nucleoli (AFIP)

Micropapillary pattern

Cribriform pattern

Androgen receptor staining

p53

Virtual slides
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High grade apocrine DCIS

Positive stains
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● Androgen receptor, B72.3 (92%, APMIS 2006;114:712), ER-beta (73%, Histopathology 2007;50:425)
● p53 (62%), HER2 (47%), Ki-67 (5% of cells) (Mod Pathol 2000;13:13)

Negative stains
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● ER-alpha, PR, bcl2

Differential diagnosis
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● Atypical apocrine hyperplasia: difficult to distinguish from low-grade apocrine DCIS; absence of fully-developed architectural features of DCIS

Additional references
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● Hum Pathol 1994;25:164; Mod Pathol 1994;7:813; Stanford University

End of Breast malignant, males, children > In situ carcinoma > Apocrine DCIS

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