Apocrine Carcinoma Research Articles

Eccrine and Apocrine Carcinoma in Dogs

Background: Sweat gland carcinomas divide into eccrine, apocrine, mixed origin (eccrine and apocrine). Eccrine carcinoma (EC) is a rare malignant neoplasm of the sweat glands that can affect dogs, cats, and humans. EC can present itself as a solitary swelling in the pads, digits, or distal limbs. EC is more common in elder animals, and exhibits no predisposition according to breed. In humans, EC is more frequent in the head and neck, and is more likely to occur in mid-aged people; metastases can develop in any site of the body. A diagnosis of this type of tumor can be determined by histopathological examination. Apocrine carcinomas occur most frequently in the axillary areas even though they may occur in other regions of the body, and affect mainly elder animals.Case: A 13-year-old male mongrel dog with a history of presence of smooth reddish infiltrative nodule in the skin of the thorax, but with no history of progression, was examined. After running complementary tests, a fragment of the skin on the thorax was taken for biopsy. The second animal was an 8-year-old female Golden Retriever, which was presented with a history of presence of a nodule on the right digital pad. After running complementary tests, a fragment of this nodule was collected. In both cases, the excised fragments were placed in 10% buffered formalin and routinely processed for the preparation of histological slides, which were stained with hematoxylin and eosin, and subjected to histopathological evaluation. Light microscopy analysis revealed, in both cases, the presence of a poorly delimited, non-encapsulated mass infiltrating the muscle and adipose tissue. Necrotic areas, and presence of eosinophilic material in the nucleus were observed. Additionally, the samples from both cases were subjected to immunohistochemical staining for cytokeratin (CK Pan).Discussion: A definitive diagnosis of sweat gland carcinoma was achieved by means of the histopathological analysis. Sweat gland neoplasms are uncommon and difficult to diagnose; distinguishing eccrine carcinoma from apocrine carcinoma requires knowledge on the site of origin of the tumor. Some authors assert that, in spite the growing number of reports on tumors of cutaneous glands in dogs, there are only few immunohistochemical studies on cutaneous gland neoplasms in these animals. There is no specific immunohistochemical marker to distinguish eccrine carcinoma from apocrine carcinoma. Consequently, investigation on the anatomical origin of the tumor is important. In the cases describe herein, involvement of the thorax (apocrine) and digital pad (eccrine) are reported. However, there are accounts of the occurrence of sweat gland tumors in axillary and inguinal regions, as well as in the limbs. Both biopsy samples tested positive for cytokeratin (CK) after immunohistochemical examination. This marker is specific for simple epithelium and, according to some authors, can distinguish an eccrine carcinoma from basal cell carcinoma. The antibody used did not stain the innermost are of the tumor, where cells may be negative for CK. Some tumors may not have specific markers, which makes a combination of clinical data and complementary histopathological and immunohistochemical exams necessary for the determination of a diagnosis, as is the case for eccrine and apocrine carcinomas. In view of the scarcity of reports on eccrine carcinoma in the literature, and considering the small number of immunohistochemical studies on cutaneous gland tumors in dogs and cats, this work can help the determination of the diagnosis of cutaneous neoplasms, which are frequently observed in the clinical routine.

A Rare Case of Primary Cutaneous Apocrine Carcinoma

Primary cutaneous apocrine carcinoma is a rare malignant tumor that originates from apocrine sweat glands. Apocrine sweat gland tumor is infrequent: the first case was published by Horn in 1944 and less than 50 cases are described in literature worldwide. For this reason, there are no clear guidelines for the management and treatment of this uncommon cancer. We report a clinical case of primary cutaneous apocrine carcinoma in a 86 year-old female patient.

High Ki-67 expression is a marker of poor survival in apocrine breast carcinoma.

Apocrine carcinoma is avery rare type ofbreast cancer, which represents 0.5-4% ofall breast cancers. Theaim ofthestudy was to analyze biological and clinical features ofapocrine carcinoma and their influence on patients survival. The studied group consists of57 patients, who underwent treatment between 1987 and 2010. Expression ofER, PgR, HER2, AR, GCDFP-15, EGFR, CK 5/6, CK 8/18 and Ki-67 was assessed immunohistochemically on formalin-fixed paraffin-embedded tissue sections. Presence ofemboli and extent oflymphocyte infiltration were assessed on haematoxylin-eosin-stained slides. In the investigated group, 16 cases were ER/PgR positive and 49 were AR-positive. ER/PgR-negative tumours were often characterised by CK5/6 and EGFR positivity. The presence ofAR was related to HER-2 and GCDFP-15 expression and tumours with expression ofCK5/6 were more likely be EGFR positive and had higher Ki-67 LI. Higher probability of10-years OS and DFS was observed in patients with tumours characterized by Ki-67 LI<20% (p=0.036 and p=0.009, respectively). Favourable trend in OS was noted for patients with smaller tumours (p=0.053), without lymph node metastases (p=0.074) and without EGFR expression (p=0.060). In apocrine breast carcinoma expression ofKi-67 is one ofthemost important factors influencing patients' survival.

Comparative Study of Clinicopathologic Features of Apocrine Carcinoma of Breast with Invasive Breast Carcinoma of No Special Type- A Tertiary Care Centre Experience

Introduction: Apocrine Carcinoma (AC) of breast is a rare breast cancer comprising only 0.3-1.0% of all breast cancers. Microscopically, Invasive Duct Carcinoma of No Special Type (IDC-NST) and AC have similar architecture, but they differ in cell morphology. Immunohistochemistry for both the tumour types is also different. Aim: This study was undertaken to know the incidence of AC and analyse them with respect to different clinicopathological features and compare them with that of IDC-NST. Materials and Methods: This was an observational study conducted in Department of Pathology, Veer Surendra Sai Institute of Medical Science and Research, Burla from March 2010 to February 2019. Patients diagnosed as invasive breast carcinoma were taken as study group. Breast cancer in male patients and female patients taking neoadjuvant chemotherapy were excluded from study group. Clinical features, pathological features and immunohistochemical findings of IDC-NST and AC were studied and statistical data were analysed by SPSS version 23.0 for windows. Comparison of data was done by using Pearson’s Chi-square test. Results having p-value &lt;0.05 were accepted as significant. Results: During the 10 years, 05 cases of AC and 560 cases of IDC-NST were found. Mean age of presentation of AC was 59.5 years and that of IDC-NST was 50.4 years. Most cases of AC and IDC-NST presented with breast lump of size &gt;5 cm. Low grade (grade 1) carcinoma was seen in 20% of AC. Immunohistochemistry showed 3 (60%) cases of AC as triple negative, whereas 213 (38.2%) of IDC-NST were triple negative. All the cases of AC were Gross Cystic Disease Fluid Protein (GCDFP-15) and CK-7 positive. Conclusion: AC is a rare category of breast cancer. Although prognosis of AC and IDC are almost similar, correct diagnosis of AC is important as antiandrogenic therapy can be given to Androgen Receptor (AR) positive AC cases.

Carcinoma of breast with apocrine differentiation: A distinct entity with typical histomorphology and molecular signature

Apocrine Carcinoma (APC) is a rare and distinct entity among all the histological variants of invasive ductal carcinoma(IDC) of breast. It is common to encounter focal apocrine differentiation, but only 4% of IDCs show extensive apocrine differentiation. In the 2012 WHO classification of tumors of breast, it is placed under specialized subtypes of IDC and named “carcinomas with apocrine differentiation.” Apocrine differentiation is seen with IDC-no specific type (IDC-NST) as well as in special type carcinomas such as tubular, lobular, micropapillary, and medullary and that's why it does not represent as a separate entity. Although clinical, radiological, and gross appearance is indistinguishable from IDC-NST (the most common form), APC has a typical histomorphological picture with distinct molecular apocrine signature and immunohistochemistry. It is characterized by increased androgen expression overlapping with HER2/neu expression and estrogen receptor (ER) as well as progesterone receptor (PR) negativity. It is thought to have worse prognosis; hence, diagnosing this entity at the earliest is very important for implementation of new treatment modalities. Here, we report two such cases of carcinomas with apocrine features – 47-year-old and 52-year-old patients showing features of apocrine carcinoma and positivity for androgen receptor with negativity for ER and PR.

Histological and molecular classification of breast cancer: what do we know?

Breast cancer is the neoplasm most diagnosed malignancy and the leading cause of mortality among women on a global scale. A profound increase in the understanding and clinical management of breast cancer has occurred over the past two decades, which has led to significant progress in prevention, early detection, and personalized breast cancer therapy. However, the biggest obstacle still faced in clinical practice is the complete understanding of intertumoral and intratumoral heterogeneity, in addition to the mechanisms of multiple drug resistance in the systemic treatment of the disease. In view of this, many studies focus on analyzing morphological and, mainly, molecular patterns of breast cancer, with the purpose of grouping these tumors into classes or entities to assist in clinical management, in the elaboration of epidemiological and functional studies, and in the performance of clinical trials. The most common special histological types of breast cancer include: medullary carcinoma, metaplastic carcinoma, apocrine carcinoma, mucinous carcinoma, cribriform carcinoma, tubular carcinoma, neuroendocrine carcinoma, classic lobular carcinoma, and pleomorphic lobular carcinoma, in addition to the non-specific type of invasive ductal carcinoma, which constitutes the majority of newly diagnosed cases. As to their molecular aspect, intrinsic subtypes were identified based on global studies of gene expression profiles. Today, four molecular subgroups are widely reproduced and well established in the clinical routine, namely: Luminal A, Luminal B, HER2 +, and Triple Negative. Thus, the present article aims to briefly address the histological and molecular classification of breast cancer.

Favorable response to combined androgen blockade for metastatic cutaneous apocrine carcinoma: a case report

Introduction: Most cases of cutaneous apocrine carcinoma (CAC) express androgen receptor. Androgen signal is thought to have a relationship on the survival and cell growth of the tumor. Presentation of Case: A 53-year-old man with a red superficial nodule on the left axilla and a back pain was diagnosed with CAC in the left axilla with multiple bone and bone marrow metastases. After cytotoxic chemotherapy for around 4 years, severe anemia, thrombocytopenia, and disseminated intravascular coagulation progressed. We started combined androgen blockade by bicaltamide and degarelix, and the therapy had successfully maintained stable disease for more than 6 months. Discussion: Most cases of CAC express androgen receptor. Androgen signal could have a relationship on the survival and cell growth of the tumor. Conclusion: Antiandrogen therapy for androgen-receptor positive CAC is a promising therapeutic option.

Histo- and clinico-pathological analysis of a large series of triple-negative breast cancer in a single center in China: Evidences on necessity of histological subtyping and grading.

ObjectiveTo investigate histo-pathological distribution and clinico-pathological significance in a large Chinese triple-negative breast cancer (TNBC) patients serials based on the latest understanding of its clinico-pathological diversity, and to provide more information to clinicians to improve precision of individualized treatment of TNBC.MethodsA retrospective analysis was performed on patients with TNBC at Breast Disease Center, Peking University First Hospital between January 2010 and December 2019. Histo- and clinico-pathological characteristics were analyzed by Chi-square test and Student’s t-test, and prognoses were calculated using Kaplan-Meier method and a Cox proportionate hazards model. Bonferroni correction was used to correct for multiple comparison. ResultsConventional type of TNBC (cTNBC) were identified in 73.7% of 582 TNBC, while special type of TNBC (sTNBC) were 26.3%, including 71 apocrine carcinoma, 20 medullary carcinoma, 31 metaplastic carcinoma, 18 invasive lobular carcinoma, 7 invasive micropapillary carcinoma, 5 adenoid cystic carcinoma and 1 acinic cell carcinoma. Compared to sTNBC, cTNBC was associated with high histologic grade (P<0.001) and lower androgen receptor (AR) expression (P<0.001). TNM stage of low-grade cTNBC was significantly lower than that of high-grade cTNBC (P=0.002). Although no significant difference, there was a trend that the rate of 5-year disease-free survival (DFS) and 5-year overall survival (OS) were longer in high-grade cTNBC than in high-grade sTNBC (P=0.091 and 0.518), and were longer in low-grade sTNBC than in high-grade sTNBC (P=0.051 and 0.350). Metaplastic carcinomas showed larger tumor size (P=0.008) and higher proliferative Ki67 index (P=0.004) than cTNBCs.ConclusionsResults from our cohort imply that sub-categorization or subtyping and histological grading could be meaningful in pathological evaluation of TNBC, and need to be clarified in more large collections of TNBC.

Primary Apocrine Carcinoma of the Axilla: A Case Report, Review of Literature and Treatment Recommendation

Primary Apocrine Carcinoma of the Axilla: A Case Report, Review of Literature and Treatment Recommendation

A clinical, pathological and immunohistochemical series of 9 cases of primary cutaneous apocrine carcinomas of the head and neck.

Primary cutaneous apocrine carcinoma is a rare malignant adnexal skin tumour that can recur locally, spread to regional lymph nodes and metastatize to visceral organs. Wide dissemination and death from disease are much less common. The axilla is the most common site of presentation. It is infrequently reported in the head and neck region. All cases diagnosed as primary cutaneous apocrine carcinoma of the head and neck were retrospectively collected from the archives of the Division of Pathological Anatomy, University of Florence from 1996 to 2016. There was no history or clinical evidence of breast cancer. Clinical data and follow-up were collected by the clinicians. Nine cases were found, with a mean age of 76years, ranging in size between 0.3 and 3.5cm. Clinically, they were frequently mistaken for basal cell carcinomas. Histopathologically, all the tumours showed decapitation secretion, a tubular, solid or mixed (tubulo-papillary and solid-tubular) growth pattern and were predominantly classified as grade 2 tumours. GCDFP-15 and hormone receptors were variably expressed. HER2 and podoplanin were negative in all cases. In one case, spreading to regional lymph nodes was observed. No cases were associated with death due to the disease. As immunohistochemical analysis lacks specificity in distinguishing primary cutaneous apocrine carcinoma from a cutaneous metastasis of breast carcinoma, detailed clinical history, breast examination, adequate treatment and follow-up are necessary to confirm a diagnosis of primary cutaneous apocrine carcinoma.

Apocrine breast carcinoma as an extremely rare breast cancer subtype – histopathological characteristics

Apocrine carcinoma (AC) is a distinctive and rare type of malignancy, counted for 0.3–4% of all breast cancer cases. It does not have a particular clinical or radiological features, although it is characterized by the apocrine morphology, estrogen receptor-negative and androgen receptor-positive profile. In the present study, among 1122 patients with breast cancer only 5 of them were diagnosed with apocrine carcinoma (0.4%). All patients were above 50 years old (51–63, mean: 57). Tumor size varied from 1.4 cm to 3.8 cm with a mean size of 2.4 cm, while mean size of all 1122 studied cases counted for 1.9 cm. Two tumors were classified as high-grade (G3), 2 as G2, and 1 as G1. Four tumors out of 5 did not affect lymph nodes (pN0 stage), whereas 1 was classified as pN2 with 9/19 regional lymph nodes affected. This observation was consistent with the whole studied group, in which pN0 stage made up the largest percentage. Presented results suggest that AC is less frequent in premenopausal patients. AC tends to present as invasive malignancy without nodal involvement and is usually characterized by relatively less aggressive biological behavior compared to other histological types of breast cancer. Due to the fact that AC is definitely a rare type of breast cancer, modern medicine has still limited treatment options to offer. Further research needs to be conducted in order to develop target therapies for this carcinoma.

Cryotherapy to treat benign skin tumours in conscious dogs.

Cryotherapy can be used to treat benign skin lesions without general anaesthesia. This technique has only been described in anaesthetized dogs. To describe the feasibility, safety and efficacy of cryotherapy to treat benign skin tumours in conscious dogs. Twenty-five client-owned dogs with 52 skin tumours diagnosed as benign sebaceous neoplasia (46) or follicular cysts (six). Cryotherapy was performed in conscious dogs using a liquid nitrogen spray technique with a handheld spray-release system. If needed, cryotherapy was repeated every three to four weeks until complete cure was achieved or for a maximum of eight treatments. Effectiveness and adverse effects were recorded. Resolution was obtained for 29 of 52 lesions (57%) with a median number of one to two cryotherapy sessions. Eighteen of 52 (35%) lesions shrank to <0.1cm. In one case, the tumour enlarged after cryotherapy, and histopathological examination of the excisional biopsy revealed an apocrine gland carcinoma. Pain and discomfort during the treatment were the most common adverse effects (33%). In the present study, cryotherapy was possible in conscious dogs and proved to be effective to cure or reduce the size of benign sebaceous tumours and follicular cysts. The procedure is safe but the degree of pain during the treatment needs to be further investigated. Worsening of the lesion after cryotherapy suggests the need for surgical removal and histopathological examination.

Prognosis in triple-negative apocrine carcinomas of the breast: A population-based study.

BackgroundTriple‐negative apocrine carcinoma (TNAC) of the breast is a very rare type of breast cancer. Furthermore, the clinicopathological features, prognosis, and potential impact of treatment strategies in TNAC remain unclear.MethodsData from the Surveillance, Epidemiology, and End Results (SEER) program were used to identify breast cancer patients diagnosed between 2010 and 2016 with TNAC and triple‐negative breast cancer (TNBC, IDC [invasive ductal carcinoma], NOS [not otherwise specified]). Chi‐squared tests were used to examine the categorical variables between the two groups. Overall survival (OS) of TNAC and TNBC was assessed by Kaplan‐Meier analyses and Cox regression. Breast cancer‐specific survival (BCSS) was evaluated by Nelson‐Aalen analyses and competing risk regression.ResultsWe identified 31 362 patients from the SEER database, including 366 patients with TNAC and 30 996 patients with TNBC. TNAC was correlated with older age, lower T stage and lower tumor grade. Patients with TNAC had better OS compared with TNBC patients; the 5‐year OS rates were 82.2% vs 73.5% (P < .001). The breast cancer‐related death rate was significantly lower in patients with TNAC than in patients with TNBC, with a 5‐year cumulative incidence of 9.1% vs 22.9% (P < .001). Chemotherapy was significantly associated with improved OS in TNAC patients, but radiotherapy was not associated with OS in TNAC patients. In the multivariable Cox regression, TNAC was still associated with improved OS (HR [hazard ratio], 0.61; 95% CI [confidence interval] 0.45‐0.83; P = .002). In the multivariable competing risk regression, the significantly higher BCSS in patients with TNAC compared patients with TNBC remained (subdistribution HR [SHR], 0.42; 95% CI, 0.27‐0.64; P < .001).ConclusionPatients with TNAC had a better prognosis than patients with TNBC, and chemotherapy was associated with survival advantages in TNAC patients.

238P - Elderly patients in the Japanese breast cancer registry

BackgroundAim: To clarify the clinicopathological characters and treatments and prognosis in elderly breast cancer patients using the Japanese Breast Cancer Registry (JBCR) system. MethodsWe reviewed data from JBCR, which is the nation-wide registry of newly diagnosed and operated primary breast cancer patients in Japan. To clarify its characteristics, we compared elderly patients aged 75 and over (elderly) with aged from 65 to 74 (young-old; y-o) and that from 55 to 64 (post-menopausal; p-m), respectively. ResultsIn total 132,240 cases diagnosed between 2004 and 2011 were reviewed (elderly; n=27,385, y-o; n=43,839, p-m; n=61,016). In histology, the proportion of mucinous carcinoma and apocrine carcinoma were higher in elderly (6.1%, 1.8%, y-o; 3.5%, 1.7%, p-m; 1.8%, 1.3%, respectively). Patients with clinical stage II and III were more frequent in elderly (45.1%, y-o; 39.0%, p-m; 39.8%). ER -positive rate was higher (76.8%, y-o; 76.3%, p-m; 72.7%) and HER2-positive rate was lower in elderly (10.5%, y-o; 12.8%, p-m; 18.6%, p<0.001). As for surgery, the rate of breast conserving surgery (BCS) was lower in elderly (46.4%, y-o; 55.0%, p-m; 59.6%), and the rate of no surgery for axilla was higher in elderly (18.4%, y-o; 5.9%, p-m; 4.8%, p<0.001). Irradiation after BCS was performed only in 41.3% of elderly patients, whereas y-o and p-m were 75.9%, 83.0%, respectively. Adjuvant chemotherapy was performed only in 10.8% of elderly patients, y-o and p-m were 31.8%, 46.2%, respectively. Half of elderly patients (49.8%) who underwent chemotherapy were given CMF or oral 5FU. As for hormone therapy, Tamoxifen was used more frequently in elderly (18.1%, y-o; 10.6%, p-m; 9.7%). The 5 years-survival analysis is shown in Table.Table238PTableAge≧7565-7455-64Distant disease-free survival (%)93.194.393.1Overall survival (%)84.393.794.4Breast cancer-specific survival (BCSS) (%)94.296.795.9Other disease death (%)48.035.820.6 ConclusionsElderly patients suffered from more advanced disease at the time of diagnosis. Irradiation after BCS and primary systemic chemotherapy was more frequently omitted in the elderly patients. Overall, BCSS was similar among ages, but the rate of other causes of death was higher in elderly patients. Legal entity responsible for the studyThe authors. FundingJapanese Breast Cancer Society. DisclosureAll authors have declared no conflicts of interest.

Invasive apocrine carcinoma of the breast: Myth or fact?

Invasive apocrine carcinoma of the breast: Myth or fact?

The role of histopathologic testing on apocrine carcinoma of the breast

Background: Apocrine carcinoma is a rare primary breast tumor characterized by the apocrine morphology. The purpose of this article is to report a review of cases with apocrine carcinoma and draw physicians' attention to the benefits of immunphenotypic techniques in cases with suspected apocrine morphology in diagnosing this uncommon breast tumor.Methods: In this study, authors report a case series of 15 cases with apocrine carcinoma from totally 4123 breast cancer cases. Data collected between years 2008 and 2016 from Istanbul School of Medicine department of surgery archive by analyzing surgical approach to cases and immunphenotypic features of tumors according to the date of examining in our pathology department.Results: In this study, Androgen, “gross cystic disease fluid protein-15” (GCDFP-15), estrogen (ER), progesterone (PR) and Her-2 neu receptor status supported evidence of apocrine carcinoma has been reviewed. As a result, HER-2 neu, GCDFP-15, androgen receptor positivity in general are useful in the diagnosis of apocrine carcinoma. In addition of these data our study revealed that GCDFP-15 positive patients are more prone to have local recurrence and distant metastases.Conclusions: We briefly describe and discuss the molecular features and new diagnostic biomarkers for this rare mammary malignancy. The importance of comprehensive profiling is highlighted due to synergistic and potentially antagonistic molecular events in the individual patients.

Multiplex PCR analysis of apocrine lesions shows frequent PI3K-AKT pathway mutations in both benign and malignant apocrine breast tumors.

Pathological diagnosis of intraductal apocrine lesions can be challenging, because even benign apocrine lesions often show atypical cytology, and immunohistochemistry is of little assistance. A new diagnostic method for apocrine lesions is desirable. The mutations present in apocrine lesions have not been well studied. We performed a MassARRAY multiplex polymerase chain reaction (PCR) study of benign and malignant apocrine lesions, which included 152 mutations of 18 genes. We found that four of 11 benign lesions showed AKT1 or PIK3CA mutations, one of four noninvasive apocrine carcinomas showed a FBX4 mutation, two of 15 invasive apocrine carcinomas showed a PIK3CA mutation, and one invasive apocrine carcinoma showed both PIK3CA and TP53 mutations. The mutation frequency did not differ significantly between benign and malignant lesions (p = 0.683). We demonstrated that both benign and malignant apocrine lesions may contain mutations of genes in the PI3K-AKT pathway, this pathway could be a good therapeutic target of these diseases.

Exploring Collagen Parameters in Pure Special Types of Invasive Breast Cancer

One of the promising tools to evaluate collagen in the extracellular matrix is the second-harmonic generation microscopy (SHG). This approach may shed light on the biological behavior of cancers and their taxonomy, but has not yet been applied to characterize collagen fibers in cases diagnosed as invasive breast carcinoma (BC) of histological special types (IBC-ST). Tissue sections from 99 patients with IBC-ST and 21 of invasive breast carcinoma of no special type (IBC-NST) were submitted to evaluation of collagen parameters by SHG. Tissue microarray was performed to evaluate immunohistochemical-based molecular subtype. In intratumoral areas, fSHG and bSHG (forward-SHG and backward-SHG) collagen parameters achieved their lowest values in mucinous, papillary and medullary carcinomas, whereas the highest values were found in classic invasive lobular and tubular carcinomas. Unsupervised hierarchical cluster analysis and minimal spanning tree using intratumoral collagen parameters allowed the identification of three main groups of breast cancer: group A (classic invasive lobular and tubular carcinomas); group B (IBC-NST, metaplastic, invasive apocrine and micropapillary carcinomas); and group C (medullary, mucinous and papillary carcinomas). Our findings provide further characterization of the tumor microenvironment of IBC-ST. This understanding may add information to build more consistent tumor categorization and to refine prognostication.

Evaluation of androgen receptor expression in core needle biopsies and clinico-pathological factors in primary breast cancer.

e12023 Background: Immunohistochemistry (IHC) is used to determine breast cancer subtypes and to evaluate the ER, PgR, and HER2 expressions and the Ki-67 index value. The androgen receptor (AR) is frequently expressed in breast cancer but has not been standardized. IHC is recommended when using preoperative biopsy specimens to determine biomarker expressions. In this study, the differences in AR expression between core needle biopsy and matched surgical samples were investigated. The AR expression was evaluated as a predictor for neoadjuvant chemotherapy and grade of malignancy. Methods: Primary breast cancer patients (n = 363) who underwent surgery between March 2017 and December 2018 were divided into 3 groups; the core needle biopsy and matched surgical comparison group (n = 167), the neoadjuvant chemotherapy group (n = 54), and the without neoadjuvant chemotherapy group (n = 309). The AR expression was evaluated using IHC and the expression was divided into the negative, low ( &lt; 10%) and high (≥10%) groups. Breast cancer subtypes were categorized using the IHC data derived from ER/PgR, HER2 and Ki-67 (cutoff 20%) values. Results: 1. There was no difference between the ER, PgR and HER2 expressions in the comparison group. AR was significantly lower in the surgical specimens. 2. The pCR rate was significantly higher in the ER and PgR negative cases. AR and the Ki-67 value did not correlate with pCR. 3. The AR positive rate was 61.2% in invasive carcinoma cases. Apocrine carcinoma showed a 100% positive rate. 4. AR expression significantly correlated with positive ER and PgR, a lower Ki-67 value, negative p53, and a lower nuclear grade. Luminal A type showed a higher AR rate (78.2%) than the TN and HER2 types. The AR rate was significantly lower (17.1%) in the TN type cases. Conclusions: discordance in the AR expression between the core needle biopsies and matched surgical specimens was found. AR expression using IHC should be evaluated in core needle biopsies.

All Benign and Malignant Apocrine Breast Lesions Over-Express Claudin 1 and 3 and Are Negative for Claudin 4

Invasive apocrine carcinoma of the breast is an uncommon triple negative tumour that lacks a specific therapeutic target. Apocrine metaplasia of the breast shares common morphological features with apocrine carcinoma, and was previously found to consistently over-express claudin 1 and to lack claudin 4. This study was aimed at finding whether apocrine carcinoma, and other related apocrine breast lesions, have similar claudin profile. The immunohistochemical expression of claudin 1, 3 and 4 was studied in 11 cases of in situ and invasive apocrine breast carcinoma, 7 benign apocrine lesions and 45 consecutive morphologically non-apocrine triple negative breast carcinomas. All cases were also immunostained for Gross Cystic Disease Fluid Protein-15 (GCDFP-15), a marker for apocrine differentiation. Apocrine breast lesions maintained their expression pattern from benign through DCIS to invasive carcinoma; all showing strong expression of claudin 1 and 3 and absence of claudin 4. The same pattern of expression was seen in 2 out of the 45 morphologically non-apocrine tumours, but both showed strong positive staining for GCDFP-15. It is concluded that all benign and malignant apocrine lesions of the breast have a consistent pattern of claudin 1, 3 and 4 expression, suggesting the presence of a specific pathway for the development of invasive apocrine carcinoma. The over-expression of claudin 1 and 3 may have therapeutic implications as targets for managing apocrine cancers.