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Abstract
Purpose
Apocrine carcinoma of the breast is rare and there is confusion about the criteria of its histopathologic diagnosis. The purpose of this study is to investigate the clinical and pathologic characteristics of the disease.
Methods
9 patients diagnosed with apocrine carcinoma or apocrine carcinoma in situ and 1,009 patients diagnosed with non-apocrine carcinoma of the breast from April 1999 to March 2008 were retrospectively analyzed.
Results
The mean age of the patients with apocrine carcinoma was 52.3 year. 5 patients (55.6%) among 9 patients with apocrine carcinoma were postmenopausal. There were 2,1 and 6 patients with stage 0, I and II disease, respectively according the TNM stage. These demographic and clinical differences between the patients with apocrine carcinoma and non-apocrine carcinoma were not significant. Only four patients (44.4%) were preoperatively diagnosed with apocrine carcinoma or apocrine carcinoma in situ. By surgical biopsy, additional 5 patients were diagnosed as apocrine carcinoma. In the immunohistochemical study, Bcl-2 was positive in one (12.5%) of 8 patients. p53 was positive in 4 (44.4%) of 9 patients. Expressions of estrogen and progesterone receptor were positive only in two patients (22.2%) with weakly positive staining. Androgen receptor was positively expressed in all cases (100%) of apocrine carcinoma. Overexpression of c-erb-B2 was detected in four patients.
Conclusion
Treatment modality and prognosis of apocrine carcinoma are similar as non-apocrine carcinoma. But its preoperative diagnosis is more difficult than that of non-apocrine carcinoma and it shows different expression of hormone receptor. Further study is needed for the development of new hormonal therapy using androgen.
Figures and Tables
Fig. 1
Microscopic finding of apocrine carcinoma of the breast. Cell shows acidophilic cytoplasm with acidophilic granules, central to eccentric vesicular nuclei with prominent nucleoli. It may have grandular differentiation with apocrine snouts (H&E stain, ×200).
Fig. 2
Immunostain for androgen receptor. Sections of apocrine carcinoma in situ (A) and invasive apocrine carcinoma (B) show strong expression of androgen receptor (×200).
Table 2
Clinical characteristics of the patients with apocrine carcinoma
*Pre = premenopausal; †Post = postmenopausal; ‡FNA = fine needle aspiration cytology; §Core = core needle biopsy; ∥IDC = invasive ductal carcinoma; ¶IApo = invasive apocrine carcinoma; **ApoIS = apocrine carcinoma in situ; ††R = right; ‡‡L = left; §§PMAD = partial mastectomy with axillary node dissection; ∥∥MRM = modified radical mastectomy; ¶¶SM = simple mastectomy; ***PM = partial mastectomy with sentinel node biopsy; †††C = chemotherapy; ‡‡‡R = radiotherapy; §§§N = no adjuvant therapy.
Table 3
Pathology and immunohistochemical study of the apocrine carcinoma
*IApo = invasive apocrine carcinoma; †ApoIS = apocrine carcinoma in situ; ‡IDC = invasive ductal carcinoma with apocrine component; §A = absent; ∥P = present; ¶- = negative; **1 = weakly positive; ††2 = intermediately positive; ‡‡3 = strong positive; §§+ = positive, ∥∥assessment of c-erb-B2 overexpression; ¶¶0 = negative; ***1+ = negative; †††3+ = strongly positive.
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