Cases Of Apocrine Carcinoma Research Articles

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 <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 >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.

Uroplakin II Expression in Breast Carcinomas Showing Apocrine Differentiation: Putting Some Emphasis on Invasive Pleomorphic Lobular Carcinoma as a Potential Mimic of Urothelial Carcinoma at Metastatic Sites.

Uroplakin II antibody is exclusively specific for urothelial carcinoma. Nonurothelial carcinoma has not been reported to be immunoreactive for uroplakin II. In the present study, we hypothesized that breast carcinoma showing apocrine differentiation, such as invasive pleomorphic lobular carcinoma (IPLC) and apocrine carcinoma (AC), stains positive for uroplakin II. We identified 6 cases of IPLC between 2000 and 2014 by searching a computerized pathological database. We randomly selected 10 cases of each classic invasive lobular carcinoma (cILC) and AC and five cases of apocrine metaplasia (AM) that coexisted in a surgically resected breast carcinoma specimen. Immunohistochemistry was performed for uroplakin II, GATA3, CK7, CK20, and other representative markers positive for urothelial carcinoma. All cases of IPLC, AC, and AM, except those of cILC, showed immunoreactivity for uroplakin II. Poorly differentiated urothelial carcinoma sometimes shows similar morphology to IPLC with the following immunophenotype: CK7+, CK20−, GATA3+, and uroplakin II+. In the present study, this immunophenotype was observed in all the cases of IPLC and AC. Therefore, when studying metastatic, poorly differentiated carcinoma showing the aforementioned immunophenotype, we should consider the possibility of it being IPLC in addition to metastatic urothelial carcinoma.

Abstract P3-05-01: Accurate assessment of HER2 status in “triple-negative” breast cancer requires both IHC and FISH testing

Abstract Introduction: Triple-negative invasive breast carcinoma (TNBC) does not over-express estrogen, progesterone receptors and HER2/neu. Approximately 15% breast cancers are “triple negative” and have poor overall survival with no targeted therapeutic options. HER2 positive patients also have a poor prognosis which is markedly improved with anti-HER2 therapy. ASCO/CAP guidelines have made substantial improvement in biomarker assessment by standardizing pre-analytic, analytic and post-analytic variables. Since 2009, we have performed HER2 fluorescence in situ hybridization (FISH) analysis in addition to immunohistochemistry (IHC) on all triple negative patients in an effort to accurately assess HER2 status. Materials and Methods: Pathology database at our institute was queried for triple negative breast cancer cases 2009-2012. 175 cases were identified with ER(SP1; Ventana)< = 1%, PR(1E2; Ventana)< = 1% and HER2 IHC (HercepTest® DAKO 2009-2011; 4B5-Ventana- 2012)< = 1+. FISH for Her2 was also performed on these cases. HER2/CEP17> = 2 was classified as HER2 positive. FISH for HER2 amplification was performed using the FDA-approved HER2 DNA Probe Kit (Vysis, Inc.). The hybridization results were recorded and analyzed by BioView Duet system (Allegro Plus Automated Scanner) with HER2 application software (BV-HER2-AF). Fisher's exact test was performed to correlate HER2 amplification with clinico-pathological parameters. Results: 175 breast cancers were classified as “triple-negative” by IHC between 2009-2012. The patients’ age ranged from 25 to 93 years old (mean = 58); 109 were Caucasian (62%), 33 African American (19%), 9 Asian (5%) and 4 Hispanic (2%). The majority of the cases (152, 86%) were invasive ductal carcinoma. The rest include 9 cases of medullary carcinoma, 3 cases of metaplastic carcinoma, 3 cases of apocrine carcinoma, 2 cases of papillary carcinoma and 2 cases of invasive lobular carcinoma. 34 had regional lymph node (axillary) metastasis (19%) and 9 had distant metastasis (5%). 23 of the 175 “triple-negative” cases (13%) showed HER2 amplification by HER2 FISH analysis (HER2/CEP17> = 2). 14.9% (20/134) TNBC cases were FISH positive 2009-11 (HercepTest®, DAKO) and 7.3% (3/41) cases were FISH positive in 2012 (4B5, Ventana). 14 of the 23 patients were Caucasian (61%), 4 African American (17%), 2 Asian and 1 Hispanic. 20 of the 23 cases (87%) had invasive ductal carcinoma, of which 18 (78%) were poorly differentiated. 8 of the 23 cases (35%) had lymph node metastasis and 1 case had distant metastasis. No statistically significant correlation was observed between the HER2 gene amplification and clinicopathological factors analyzed, including race (P = 1), age (P = 1), tumor size (P = 0.6), pathologic stage (P = 0.6), lymph node status (P = 0.08), and Ki-67 index (P = 0.8 with 20% cutoff; P = 0.1 with 70% cutoff). Conclusion: In this cohort, 13% TNBC were re-classified as HER2 positive by performing HER2 FISH test in addition to immunohistochemistry analysis. Rate of FISH positivity in TNBC declined over the four year study period. No clinicopathological variables are correlated with HER2 FISH amplification. These data suggest that dual testing of HER2 should be considered routinely in TNBC for accurate classification to guide therapy. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-05-01.

Expression of androgen receptors and inhibin/activin α and βA subunits in breast apocrine lesions

The importance of androgens and their receptors inhibin and activin remains unknown for mammary epithelial cells. We investigated the role of these hormones in breast apocrine lesions (BAL) using immunohistochemistry to study androgen receptors (AR) and the inhibin/activin alpha and betaA subunits. Forty-two cases of BAL were evaluated, including 22 cases of fibrocystic disease (FCD) showing prominent apocrine changes, 10 intraductal papillomas with extensive apocrine metaplasia, 5 cases of apocrine carcinoma in situ (CIS), and 5 cases of apocrine carcinoma. Fifty non-apocrine lesions were included as controls: 20 cases of FCD, 5 cases of DCIS, and 25 cases of invasive ductal carcinoma. AR was more frequently expressed in BAL than in non-apocrine lesions (p=0.001). AR expression was not related to tumor progression. AR showed a significant positive correlation with betaA subunits (r=0.832, p<0.001), and an inverse correlation with alpha subunits (r=-0.233). The alpha and betaA subunits demonstrated a significant inverse correlation with each other (r=-0.271, p=0.0048). As the expression of the alpha and betaA subunits reflects inhibin and activin A, respectively, AR and activin A may be implicated in apocrine morphogenesis, but not in tumor progression.

A CASE OF APOCRINE CARCINOMA OF THE BREAST WITH A PREDOMINANT INTRADUCTAL COMPONENT

We experienced a case of apocrine carcinoma of the breast with a predominant intraductal component. The complaint patient was seen at the hospital because of nipple discharge. Cytology of the nipple discharge suggested ductal carcinoma of comedo type. The reddness, thickness, and irregularity of the ductal wall were observed by a duct endoscopy. Carcinoembryonic antigen (CEA) in the nipple discharge was 1000ng/ml. Immunohistochemical staining for CEA and anti-gross cystic disease fluid protein 15 (GCDFP-15) was positive. In a review of 75 cases of apocrine carcinoma of the breast previously reported in Japan, three cases had nipple discharge. Of four cases of apocrine carcinoma including ours, two cases had an invasive microcarcinoma and another two cases, non-invasive carcinoma, and all carcinomas mainly extended within the lactiferous duct. So long as endoscopic findings of the duct are concerned, this is the first report of apocrine carcinoma of the breast.

Electron microscopic studies of primary apocrine carcinoma of the breast

Three cases of apocrine carcinoma of the breast were investigated by light and electron microscopy. Histologically, the tumor cells were shown to have eosinophilic granular cytoplasm and occasional cytoplasmic snouts protruding into the lumen. Ultrastructurally, light and dark tumor cells were identified, and there were many lysosome-like dense bodies of various sizes and small dense granules grouped in the subapical region. Many mitochondria with incomplete cristae and numerous small vacuoles were distributed in the cytoplasm. Occasionally, intracytoplasmic lumen were visible in the tumor cells. These ultrastructural findings are quite similar to those found in normal apocrine sweat glands. However, the presence of an intraductal component of carcinoma suggests the origin to be mammary epithelial cells.

A CASE REPORT OF APOCRINE CARCINOMA OF THE BREAST WITH RAPID GROWTH AND METASTASIS

Many cases of mammary cancer, except for special types, show a relatively favorable prognosis, in comparison with carcinoma of other organs. However, we recently encountered a case showing rapid growth and metastasis in which the period between onset and death was short, 13 months. The patient, a 29-year-old woman, first noted a small finger-tip-sized mass in her left breast, and visited a nearby hospital. In spite of therapy by hormone injection in hospital, the mass increased. About 3 months after onset, she visited our hospital. On the basis of a diagnosis of malignant tumor following biopsy, surgery with radiotherapy was undertaken, but the patient died from remote systemic metastasis about 8 months after surgery, i.e., about 13 months after onset. The pathological diagnosis was apocrine carcinoma. The results obtained from this case suggested that some cases of apocrine carcinoma have the potential to be highly malignent, requiring careful attention to the treatment.