Atypical Apocrine Adenosis: Diagnostic Challenges and Pitfalls.
Apocrine change in the breast is an extremely common finding. In most cases, the benign or malignant nature of the lesion is easily recognized. Apocrine adenosis is used to describe sclerosing adenosis with apocrine change. The term apocrine atypia is used when there is significant cytologic atypia in apocrine cells, characterized by a 3-fold nuclear enlargement, prominent/multiple nucleoli, and hyperchromasia. Atypical apocrine adenosis is diagnosed when apocrine adenosis and apocrine atypia are superimposed. However, there are no definite criteria to distinguish atypical apocrine adenosis from apocrine ductal carcinoma in situ. Immunohistochemical markers can be confounding and may lead to erroneous diagnoses. Atypical apocrine features in sclerosing lesions may be misinterpreted as invasive carcinoma if the underlying lesion is not recognized. In the absence of definite features of malignancy, the diagnosis of apocrine ductal carcinoma in situ may be extremely difficult. In the present article, we review atypical apocrine adenosis focusing on diagnostic challenges and their implications on clinical management.
From the Departments of Pathology and Laboratory Medicine (Drs Asirvatham and Kleer) and the Comprehensive Cancer Center (Dr Kleer), University of Michigan Hospital and Health Systems, Ann Arbor; and Department of Pathology, CEMIC University Hospital, Buenos Aires, Argentina (Dr Falcone).
Jaya Ruth
JR
Asirvatham
Maria Monica Garcia
MM
Falcone
Celina G
CG
Kleer
D001050:Apocrine Glands / Q000378:metabolism / Q000473:pathology*; D001940:Breast / Q000378:metabolism / Q000473:pathology*; D002352:Carrier Proteins / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D005348:Fibrocystic Breast Disease / Q000175:diagnosis* / Q000378:metabolism; D006023:Glycoproteins / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D026901:Membrane Transport Proteins; D008679:Metaplasia; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000378:metabolism
D002352:Carrier Proteins; D006023:Glycoproteins; D026901:Membrane Transport Proteins; C488892:PIP protein, human