Atypical Apocrine Adenosis of the Breast: Long-term Follow-up in 37 Patients

Fuehrer, Neil E.; Hartmann, Lynn C.; Degnim, Amy C.; Allers, Teresa; Vierkant, Robert A.; Frost, Marlene H.; Visscher, Daniel W.

doi:10.5858/arpa.2011-0225-oa

Cited by 31 publications

(19 citation statements)

References 8 publications

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“…The clinical significance and management of these atypical apocrine lesions, which do not qualify for DIN1c-3, is unclear because of lack of long-term follow-up studies. Fuehrer et al [39] found that only 5.4 % of women (2 of 37) with atypical apocrine adenosis (AAA) developed in situ or invasive carcinoma with an average follow-up of 14 years. There was, however, no evidence of apocrine differentiation of the subsequent tumors and no AAA in the surrounding breast parenchyma, and the authors concluded that AAA should not be regarded as a direct histologic precursor to breast carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Expression of C-KIT, CD24, CD44s, and COX2 in benign and non-invasive apocrine lesions of the breast

et al. 2016

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Benign apocrine metaplasia (AM) of the adult breast is a very common, but enigmatic lesion. It has been speculated that AM might be a precursor of malignancy or an indicator of a susceptibility of the breast tissue to develop neoplasia, mainly based on comparing the frequency of AM in breast cancer and non-breast cancer patients [1]. Studies using comparative genomic hybridization have supported this by showing similar molecular alterations in benign and malignant apocrine lesions [2]. Few studies, however, have compared expression of biomarkers involved in tumor progression in AM and progressively more advanced atypical apocrine lesions. The expression of C-KIT, COX2, CD24, and CD44s was evaluated by immunohistochemistry in formalin-fixed, paraffin-embedded material of 9 AM, 20 apocrine ductal intraepithelial neoplasia (DIN1c-3) and 40 atypical apocrine lesions (not qualifying for DIN1c-3) and compared to expression of the same biomarkers in adjacent normal ductal epithelium. Of the 66 apocrine lesions, 62 (94 %) did not express C-KIT compared to 4/63 (6 %) of the normal glands (Fisher's exact, p < 0.001). COX2 was expressed in a significantly higher proportion of apocrine lesions than of normal glands (49 vs. 14 %, p < 0.001), and the number of apocrine lesions positive for CD24 was found to be higher with increasing aggressiveness of the lesions (Spearman, p < 0.001). In conclusion, benign and non-invasive proliferative apocrine lesions of the breast display immuno-phenotypical characteristics previously ascribed mainly to malignant transformation. This could lend support to the theory that AM is an early step towards malignant transformation, albeit associated with slow progression to carcinoma.

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Section: Discussionmentioning

confidence: 99%

Expression of C-KIT, CD24, CD44s, and COX2 in benign and non-invasive apocrine lesions of the breast

et al. 2016

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“…In a series of 37 patients from the Mayo Clinic, 3 (8%) developed invasive carcinoma comparable to their benign breast disease cohort (7.8% of 9340 patients), suggesting that AAA may not be a precursor of breast carcinoma. 13 Although Seidman et al 10 reported an increased risk of carcinoma in older women, the Mayo Clinic study did not find an increased risk association with age. Nevertheless, AAA was more commonly seen in older women in the Mayo cohort as well.…”

Section: Commentmentioning

confidence: 93%

“…AAA comprised 0.4% of 9340 cases in a series from the Mayo Clinic. 13 Because of its rarity, long-term studies looking at clinical outcome and risk for invasive carcinomas are lacking. Sclerosing adenosis has a relative risk of 1.7 for invasive carcinoma, 14 and it is unclear how atypical apocrine change modifies this risk.…”

Section: Commentmentioning

confidence: 99%

Atypical Apocrine Adenosis: Diagnostic Challenges and Pitfalls

Asirvatham

Falcone

Kleer³

2016

Archives of Pathology &Amp; Laboratory Medicine

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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.

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“…In a long-term follow-up study of 37 patients with AASL from the Mayo Benign Breast Disease Cohort (1967–1991, average follow-up time of 14 years), Fuehrer et al 17 observed that when cases with concurrent ADH were excluded, the rate of subsequent carcinoma (DCIS or invasion) was low (5.4%) and the mean interval to cancer diagnosis was long (11.3 years). These two studies concluded that there was no definitive evidence to consider AASL a high risk or precursor lesion.…”

Section: Biological Significance Of Aamentioning

confidence: 99%

Apocrine lesions of the breast: part 1 of a two-part review: benign, atypical and in situ apocrine proliferations of the breast

D’Arcy¹,

Quinn

2018

J Clin Pathol

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Apocrine morphology is a common phenomenon encountered in everyday breast pathology practice, and is defined as cuboidal or columnar cells exhibiting abundant eosinophilic granular cytoplasm, prominent apical granules, a low nuclear-cytoplasmic ratio, and round nuclei with pale chromatin and prominent nucleoli. Apocrine morphology is recognised in benign, atypical and malignant lesions of the breast. The morphology of apocrine atypia and non-high-grade apocrine ductal carcinoma in situ (DCIS) is less well defined due to the relative rarity of these lesions. In part 1 of this two-part review, we focus on the morphological characteristics of benign, atypical and in situ apocrine lesions of the breast, summarise the available data to date regarding distinction of atypical apocrine proliferations from non-high-grade apocrine DCIS and the biological significance of apocrine atypia, and provide practical guidance on handling these difficult lesions. Part 2 of this review will focus on the concept of pure apocrine carcinoma with emphasis on its definition and molecular data, including the current understanding of the molecular apocrine signature in breast carcinoma. We complete the review with a synopsis on the utility of immunohistochemistry in the diagnosis of apocrine lesions of the breast.

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Atypical Apocrine Adenosis of the Breast: Long-term Follow-up in 37 Patients

Cited by 31 publications

References 8 publications

Expression of C-KIT, CD24, CD44s, and COX2 in benign and non-invasive apocrine lesions of the breast

Expression of C-KIT, CD24, CD44s, and COX2 in benign and non-invasive apocrine lesions of the breast

Atypical Apocrine Adenosis: Diagnostic Challenges and Pitfalls

Apocrine lesions of the breast: part 1 of a two-part review: benign, atypical and in situ apocrine proliferations of the breast

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