Histiocytoid breast carcinoma: an apocrine variant of lobular carcinoma

Two cases of in situ and invasive histiocytoid breast carcinoma are described. The invasive components of both tumours showed architectural and cytological similarities to lobular carcinoma. The in situ components showed areas of classical lobular carcinoma in situ, areas of lobular carcinoma with apocrine features and areas with transitional features. It is concluded that histiocytoid carcinoma represents an apocrine variant of lobular carcinoma. Differentiation of this tumour from chronic sclerosing inflammation may be difficult in both primary and secondary lesions.     

Apocrine adenoma of the breast coexistent with invasive carcinoma

We describe a case of apocrine adenoma with simultaneous occurrence of invasive ductal carcinoma in the breast of a 53-year-old woman. Apocrine adenoma affecting the breast is very rare. The lesion is composed of back-to-back ducts and papillary fronds covered with apocrine cells, and it is sharply demarcated from the surrounding breast tissue. The patient presented with a palpable nodule with skin retraction in her right breast, where ultrasound examination identified a 5-mm hypoechogenic nodule. The ultrasound also revealed in the surrounding breast parenchyma an additional abnormal finding suggestive of carcinoma. Histologic examination of the excised specimen showed that the hypoechogenic nodule represented an apocrine adenoma in proximity to the invasive ductal breast carcinoma. This is the first report that describes the simultaneous occurrence of these two lesions in the same 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. This study was presented at the 25th Annual Meeting of the Clinical Electron Microscopy Society of Japan, Matsumoto, September 28–30, 1993.     

乳腺大汗腺癌的形态学与免疫表型特征

目的 观察乳腺大汗腺癌(apocrine carcinoma，AC)的形态学和免疫表型特征，并探讨其诊断标准。方法 对HE染色片中显示有大汗腺细胞学特点的30例乳腺癌标本进行组织学观察和免疫组化S—P法检测，并选取5例大汗腺化生(apocrine metaplasia，AM)及2例大汗腺腺病(apocrine adenosis，AA)和AA伴导管原位癌(DCIS)1例标本作对照组。使用的-抗包括GCDFP—15、Mucin—1、AR、ER、C—erbB-2、Ki-67。结果 ①8例被确定为AC，均为高核级，其中大汗腺导管原位癌(ADCIS)1例、ADCIS伴浸润性大汗腺癌(IAC)5例，IAC伴导管原位癌(DCIS)2例。镜下AC细胞的共同特征为：细胞大，胞界清，胞质丰富，深嗜伊红染，颗粒状；核大、圆，核仁常大而突出。依据胞质形态可分为：A型，胞质深伊红染，有数量不等的清晰颗粒；B型，胞质内大量细空虚的小泡，可聚呈泡沫状，类似组织细胞或皮脂腺细胞；C型，胞质浅染、均质，如细磨砂玻璃样；②8例AC与5例AM及2例AA均共同表达GCDFP—15、AR、Mucin—1及Ki-67；除1例外，ER均不表达；③AC的GCDFP—15的表达与大汗腺化生不同：前者呈胞质内弥漫颗粒或空泡状，表达有异质性；后者阳性颗粒聚成小球状团簇，位于细胞质的核上区。④AR平均阳性细胞数在Ac及AM分别为33．4％及93．8%；Ki-67平均阳性细胞数在AC及AM分别为52．4％及40％。结论 AC的诊断须具备3项标准：①HE细胞形态成分90％以上符合Ac型细胞；②GCDFP—15阳性，阳性细胞数占癌细胞总数50％以上；⑧AR阳性，阳性细胞数大于癌细胞总数20％。     

The significance of atypical apocrine cells in fine-needle aspirates of the breast

Apocrine metaplastic cells are frequently present in fine-needle aspirates (FNAs) of breast lesions, especially fibrocystic disease. Occasionally, apocrine cells may be atypical and present diagnostic difficulties. The morphologic features of six breast FNAs that contained atypical apocrine cells in breast aspirates. In the six abnormal cases, the large, pleomorphic, atypical apocrine cells were the predominant cell type and occurred singly and in syncytial tissue fragments. The cells had large, eccentric, vesicular nuclei and usually multiple macronucleoli. The histologic diagnoses in the cases were apocrine carcinoma (five cases) and atypical apocrine metaplasia (one case). In comparison, benign apocrine cells are relatively small and uniform and arranged in cohesive, orderly sheets. It is concluded that, in breast FNAs, the predominance of atypical apocrine cells, occurring singly and in syncytia, should raise the suspicion of carcinoma.     

乳腺伴大汗腺分化的癌临床病理特征及预后分析

目的：探讨乳腺伴大汗腺分化的癌临床病理特点及影响其预后的因素。方法收集乳腺伴大汗腺分化的癌标本70例和同期诊断为非特殊型浸润性癌283例患者的临床病理资料,比较两组预后差异,并对患者年龄、肿瘤大小、淋巴结转移、组织学分级、分期、免疫组化等因素与预后的关系进行统计学分析。结果乳腺伴大汗腺分化的癌平均发病年龄(56．17±12．41岁)比非特殊型浸润性癌(52.77±11．07岁)高(P=0．039);与非特殊型浸润性癌相比,乳腺伴大汗腺分化的癌具有更低的腋窝淋巴结转移率,较低的ER、PR阳性率(P<0．05);乳腺伴大汗腺分化的癌患者与非特殊型浸润性癌患者相比,5年总生存率(P=0．221)和无病生存率(P=0．378)差异无统计学意义;单因素生存分析显示肿瘤大小、淋巴结转移、病理学分期、淋巴结外软组织浸润与乳腺伴大汗腺分化的癌患者预后有关(P<0．05),Cox多因素分析结果显示,淋巴结转移与乳腺伴大汗腺分化的癌患者不良预后有关(P<0．05)。结论乳腺伴大汗腺分化的癌与浸润性癌临床病理特征不同,但预后无统计学意义。淋巴结转移可作为乳腺伴大汗腺分化的癌患者预后不良的指标,早诊断、早治疗是改善其预后的关键。     

Fine-needle aspiration of apocrine hidrocystoma--a potential mimic of papillary neoplasms metastasizing to the skin

We report the cytologic features of a histologically confirmed apocrine hidrocystoma as seen in fine-needle aspirates. The main cytologic features were the presence of sparse pseudopapillae with mild to moderate atypia in a background of an amorphous navy blue material reminiscent of that seen in aspirates of colloid nodules of the thyroid gland. The pseudopapillae were mistaken for malignant metastatic deposits. It is suggested that the presence of pseudopapillae in aspirates obtained from cutaneous nodules might be a clue for a tentative diagnosis of benign tumors of epidermal adnexae, with the proviso that a primary malignant tumor be ruled out first.     

Encapsulated apocrine papillary carcinoma of the breast: Case report with clinicopathologic and immunohistochemical study

We describe a case of encapsulated papillary carcinoma (EPC), apocrine variant in a 50‐year‐old woman. The patient presented a cystic lesion in her right breast, measuring 8 cm in diameter, containing three solid papillary nodules. A fine‐needle aspiration showed isolated apocrine cells containing round nuclei, irregular nuclear membranes, fine chromatin, and prominent macronucleoli. The lesion was excised and showed a pure papillary apocrine carcinoma, which stained diffusely with GCDFP‐15 and androgen receptors. The lesion was totally devoid of myoepithelial cells (smooth muscle actyn, p63, calponin, and collagen IV stains were negative). With MIB1 the proliferative activity was 10%. To the best of our knowledge, this is the first report of EPC apocrine variant with cytologic and immunohistochemical study. This lesion must be included in the list of apocrine lesions of the breast. Diagn. Cytopathol. 2010. © 2010 Wiley‐Liss, Inc.     

The enigmatic nature of apocrine breast lesions

Epithelial cells of fetal breast glandular structures, at the third trimester of pregnancy (28 weeks), produce GCDFP-15, in the absence of specific apocrine morphology. Apocrine epithelium of the breast may be a normal process of differentiation rather than a result of metaplasia, and it has been demonstrated that it is estrogen-receptor, progesterone-receptor and bcl-2 negative, but androgen-receptor (AR) positive. The significance of AR expression in apocrine epithelium is uncertain. Apocrine epithelium is seen in a wide spectrum of breast entities, ranging from benign lesions to invasive carcinoma. Breast cancer accounts 32% of all cancer cases among women and is the most common type of cancer in women. Little is known about breast carcinogenesis. Widely, it is accepted that breast cancer, like most other type of cancer, is being developed through the accumulation of genetic aberrations. Apocrine epithelium may reflect instability of the breast epithelium, creating an environment favouring further oncogenic alterations. In the last decade, several lines of evidence support the idea that some breast benign epithelial apocrine lesions are clonal lesions and may be considered as truly pre-malignant or precursors of breast carcinoma. Apocrine changes in many cases do not present any diagnostic difficulty; on the other hand, apocrine proliferations with cytologic atypia can be particularly difficult and challenging. The purpose of this study is to collect and highlight the areas of consensus in the literature as well as the controversial areas concerning the apocrine epithelium of the breast.     

Fine-needle aspiration of inflammatory carcinoma of the breast

Inflammatory carcinoma of the breast is an uncommon clinicopathologic entity which is characterized by a distinctive clinical appearance and poor prognosis. Histopathologically, it is characterized by plugging of dermal lymphatics with tumor emboli. Because this lesion usually does not form a discrete palpable mass, it is not as amenable to diagnosis by fine-needle aspiration (FNA) as other breast lesions. In the following, we report our experience with establishing the diagnosis of inflammatory carcinoma by FNA. Three patients underwent FNA for confirmation of clinically suspected inflammatory carcinoma. All aspirations were performed by a cytopathologist and required multiple passes to obtain diagnostic material. Aspirates were paucicellular and contained fragments of fibrous or adipose tissue. Malignant cells were predominantly distributed in tight, three-dimensional clusters and were identifiable as tumor cells based on large size, nuclear irregularity, and increased nuclear to cytoplasmic ratio. Unlike aspirates from conventional breast carcinoma, individual dispersed cells and cellular discohesiveness were not prominent features. Subsequent histologic material from these patients revealed the characteristic tumor emboli plugging dermal lymphatics. We conclude that in the appropriate setting, the diagnosis of inflammatory carcinoma can be established by FNA. Diagn Cytopathol 1996;15:363–366. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration of low grade adenosquamous carcinoma of the breast

Low-grade adenosquamous carcinoma is an unusual variant of mammary carcinoma. This malignancy generally presents as a palpable mass without mammographic microcalcifications, and fine-needle aspiration may be the initial technique selected for diagnosis. To our knowledge, the cytologic findings associated with this neoplasm have not been reported. We report a case of low-grade adenosquamous carcinoma of the breast in a 57-yr-old woman, initially studied by fine-needle aspiration cytology and confirmed by excisional biopsy. The aspiration biopsy smears were characterized by low cellularity and small disoriented clusters containing uniform cells of small to medium size. Bipolar cells were not seen in the background. The diagnostic features and differential diagnosis of this unusual neoplasm are reviewed. Diagn Cytopathol 1996;14:321–324. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of metastatic ovarian carcinoma to the breast

Metastatic ovarian carcinoma to the breast is rare. It represents a diagnostic challenge to the cytologist. It usually signifies a progressive widespread metastatic ovarian tumor with a poor prognosis. This report evaluates the breast fine-needle aspiration (FNA) cytomorphologic features of six cases of metastatic ovarian carcinoma and compares them to those reported in the literature. The cytologic features included hypercellularity, abundant papillary fragments, and necrotic background. The tumor cells showed high nuclear/cytoplasmic ratio, anisonucleosis, prominent nucleoli, and psammoma bodies in cases of serous papillary carcinoma. In addition, the clear-cell carcinoma had prominent finely vacuolated and clear cytoplasm, multinucleated giant cells, and papillary fragments with hobnail nuclei. Recognition of these unusual patterns in a breast FNA cytology should raise the suspicion of a metastatic ovarian tumor. Direct comparison between the breast FNA cytology and the original primary ovarian tumor should confirm the diagnosis. The proper diagnosis of metastatic ovarian cancer to the breast will prevent unnecessary surgical treatment and ensure the appropriate therapy. Diagn Cytopathol 1996;15:1–6. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration of metastatic renal-cell carcinoma masquerading as primary breast carcinoma

This report details a fine-needle aspiration biopsy performed in the investigation of two right breast nodules in a patient with previous history of lumpectomy for infiltrating ductal carcinoma in the same breast 3 years before. Because the cytology was atypical for a mammary carcinoma and cells did not match the morphology of the previous breast carcinoma, a tissue biopsy was recommended, revealing the presence of metastasis from a previously silent primary renal-cell carcinoma. This report illustrates not only how metastatic lesions in the breast can masquerade clinically as a primary carcinoma but also the necessity for the cautious approach to interpreting the fine-needle aspiration biopsy of these lesions. Furthermore, essential guidelines necessary to distinguish primary from metastatic lesions in the breast are presented. Diagn. Cytopathol. 1998;18:343–345. © 1998 Wiley-Liss, Inc.     

An update on apocrine lesions of the breast

Apocrine change occurs in a spectrum of benign lesions in the female breast and is also demonstrated in a subgroup of in situ and invasive carcinomas. Recent research has focused on the molecular phenotype of both benign and malignant apocrine lesions. This review will briefly summarize the morphological characteristics and risk associations of the spectrum of apocrine proliferations, but will focus on the updated molecular studies of both in situ and invasive apocrine carcinomas.     

Fine-needle aspiration of well differentiated small-cell duct carcinoma of the breast

Historically, fine-needle aspiration of the female breast has been accepted as a useful modality in the diagnosis of ductal as well as other types of breast carcinoma. However, cases of well differentiated small-cell duct carcinoma can be problematic. The differential diagnoses include fibrocystic disease, papillary neoplasia, fibroadenoma, and lobular carcinoma. Retrospectively, 16 cases of well differentiated small-cell duct carcinoma have been identified in the case files of Truman Medical Center/University of Missouri-Kansas City. Patient's ages ranged from 29–81 yr, with the mean being 56.2 yr. The overall cytologic features consisted predominately of a hypercellular specimen with cohesive and rarely discohesive cells with no demonstrable nuclear atypia. For well differentiated small-cell duct carcinoma, the mean nuclear diameter was greater than that of a red cell (6–8 μm). For the well differentiated small-cell duct carcinoma group, the mean nuclear diameter was 9.86 μm; for fibrocystic disease, 12.86 μm; for papillomas, 8.28 μm; for fibroadenomas, 9.48 μm; and for lobular carcinoma, 11.88 μm. From our data, it appears that specific attention to the clinical presentation, cytologic pattern, and nuclear diameters are useful discriminators for well differentiated small-cell duct carcinoma. Diagn. Cytopathol. 16:226–229, 1997. © 1997 Wiley-Liss, Inc.     

The challenge of apocrine proliferations of the breast: A morphologic approach

Apocrine phenotype in breast is common and can be seen in a broad spectrum of lesions ranging from simple cyst to infiltrating carcinoma. The majority of apocrine lesions of the breast are benign in nature and do not represent a diagnostic challenge; however, there are a few that can cause diagnostic problems, such as the case of apocrine proliferations with atypia and low-grade apocrine ductal carcinoma in situ. Furthermore, the role of atypical apocrine proliferations in the pathway to infiltrating carcinoma is still uncertain, and studies with long-term clinical follow-up are necessary to clarify and understand the significance of these apocrine lesions of the breast. The purpose of this article is to review the most recent literature concerning apocrine lesions, with emphasis on borderline apocrine proliferations.     

Fine-needle aspiration cytodiagnosis of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare breast cancer with a good prognosis. Its morphology is identical to its counterpart in the salivary glands. In this brief report, two cases of ACC of the breast are presented in which the diagnosis was established on a fine-needle aspiration cytology (FNAC) and correlated with subsequent examination of cell blocks of aspirate and tissue. The cytodiagnostic criteria for ACC of the breast are discussed. Diagn Cytopathol 1996;14:328–330. © 1996 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of the canine apocrine sweat gland carcinoma

Tumors of apocrine sweat glands are uncommon in comparison to tumors of sebaceous glands in dogs. Animals older than 8?years of age are most likely to develop these tumors. The authors report a case of apocrine sweat gland carcinoma in a 2-year-old crossbred dog that was diagnosed by fine-needle aspiration cytology. The technique was shown to be helpful for the correct diagnosis and treatment approach. However, despite being time consuming, the histopathological study remains the method of choice for accurate classification of the disease.