Advertisment CMED
Home Print this page Email this page Users Online: 172
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 37-39  

"Pure" invasive apocrine carcinoma of the breast with psammoma bodies


Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication13-Apr-2012

Correspondence Address:
Kavita Mardi
12-A, Type V Quarters, IAS Colony, Kasumpti, Shimla, Himachal Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.95020

Rights and Permissions
  Abstract 

Pure apocrine carcinomas are rare, morphologically distinct type of invasive of breast carcinomas, and represent about 0.5% of all invasive breast cancers. Existence of psammoma bodies (PBs) is extremely rare. Cytological, histological and immunohistochemical features of a case of apocrine carcinoma of the breast with PBs is described in a 56-year-old female. This report emphasizes the rarity of this lesion and supports currently held beliefs about the formation of PBs.

Keywords: Apocrine carcinoma, breast, FNA, invasive


How to cite this article:
Mardi K, Sharma S. "Pure" invasive apocrine carcinoma of the breast with psammoma bodies. Clin Cancer Investig J 2012;1:37-9

How to cite this URL:
Mardi K, Sharma S. "Pure" invasive apocrine carcinoma of the breast with psammoma bodies. Clin Cancer Investig J [serial online] 2012 [cited 2017 May 23];1:37-9. Available from: http://www.ccij-online.org/text.asp?2012/1/1/37/95020


  Introduction Top


Pure apocrine carcinomas of breast are an extremely rare variant of invasive breast carcinomas. [1] Even rarer is the existence of numerous psammoma bodies (PBs) in these tumors. We report one such rare case in a 56-year-old female.


  Case Report Top


A 56-year-old female presented to the surgical outpatient department with painless lump in the right breast since 2 years. On clinical examination, there was a hard, mobile, nontender lump in the upper outer quadrant of the breast. Ultrasonography revealed an irregular cystic mass with indistinct margins in the right breast. Ultrasonography-guided fine-needle aspiration (FNA) of the breast lump was done, and the smears were moderately cellular and composed of large, polygonal cells with abundant cytoplasm that stained basophilic with May-Grunwald-Giemsa stain. Eccentrically placed nuclei were round or oval and vesicular, with variably prominent, mostly single, nucleoli. Cell clusters showed irregular margins and cellular overlapping, and mild-to-moderate nuclear atypia were present. Occasional binucleate and multinucleate forms and cells with marked atypia were seen. Single cells were noted, and dissociated bare nuclei were seen in the background. While most of the cells showed well-defined cell margins, a few cells that showed indistinct cell margins resembled histiocytes [Figure 1]. All the cells were of apocrine type, with no admixture of non-apocrine ductal or inflammatory cells. A cytologic report of apocrine carcinoma was prepared, and the patient underwent a right modified radical mastectomy with axillary clearance. On serial sectioning of the mastectomy specimen, a cystic solid growth measuring 4 cm × 3 cm × 1.5 cm was identified. Solid portion of the growth was gray-white with tan brown areas of hemorrhage. Microscopic examination revealed round-to-polygonal tumor cells with abundant granular eosinophilic cytoplasm and round nucleus with variably prominent nucleolus arranged in solid sheets, nests, glands and papillae. There were abundant PBs throughout the tumor [Figure 2]. Prominent apocrine snouts were identified in the luminal aspects of tumor cells [Figure 3]. The tumor cells were immunohistochemically positive for GCDFP-15 protein and negative for estrogen and progesterone receptors. Final diagnosis of invasive apocrine carcinoma (IAC) of breast with modified Bloom Richardsons grade I, score 5, was rendered.
Figure 1: Cytology smears revealing tumor cells with abundant granular-to-foamy
basophilic cytoplasm (Giemsa, 40?)


Click here to view
Figure 2: Microphotograph revealing numerous psammoma bodies in apocrine carcinoma (H&E, 20×)

Click here to view
Figure 3: Higher magnifi cation showing apocrine snouts of tumor cells and psammoma bodies (H&E, 40×)

Click here to view



  Discussion Top


Apocrine phenotype in breast is common and can be seen in a broad spectrum of lesions, ranging from simple cyst to infiltrating carcinoma. Pure apocrine carcinomas are a rare, morphologically distinct type of invasive breast carcinomas and represent about 0.5% of all invasive breast cancers. [1] By definition, IACs show cytologic and immunohistochemical features of apocrine cells, as characterized by an abundant, granular eosinophilic cytoplasm in more than 90% of the tumor cells. Adherence to a strict definition is necessary, since apocrine differentiation can be identified in up to one-third of all invasive carcinomas. There is no difference in the clinical and mammographic features, size and site of apocrine carcinomas and non-apocrine carcinomas. Bilaterality is also rare in apocrine carcinomas. Apocrine carcinomas are usually composed of two types of cells, which are variably intermingled. [2] Type A cell has abundant granular intensely eosinophilic cytoplasm and round nuclei with prominent nucleoli. These granules are Periodic Acid Schiff(PAS) positive after diastase digestion. When these cells predominate, the tumor mimics granular cell tumors. These types of apocrine carcinomas are sometimes referred to as myoblastomatoid. Type B cells show abundant foamy, vacuolated cytoplasm, resembling histiocytes and sebaceous cells. Nuclei of these cells are similar to type A cells. Apocrine carcinomas predominantly composed of type B cells resemble histiocytic proliferation. [2] In the present case, FNA predominantly showed type B cells and histopathological examination predominantly revealed type A cells. The apocrine tumor cells are typically GCDFP-15 positive and bcl-2 protein negative. Androgen receptors are usually positive in these tumors.

Microcalcification can be observed in benign and malignant breast lesions, but PBs are rarely reported in breast lesions [3] and are usually a feature of papillary neoplasms. [4] Of invasive carcinomas of the breast, non-psammomatous calcifications are much more frequently observed, and can be abundant in some special types of tumors such as tubular carcinoma and solid invasive papillary carcinoma. Rarely, PBs are found in pure mucinous carcinomas of breast. [5],[6] Extensive search revealed a single case of apocrine carcinoma with psammomatous calcification in a male breast. [7] Calcium deposition has long been implicated in the pathogenesis of many degenerative diseases; hence the formation of PBs may be relevant in breast oncology. The presence of PBs in FNAC of clinically suspected breast lesions, which are cytologically negative for malignancy, warrants further histological confirmation.

The concentric calcific multilayering characteristic of PBs has a controversial origin. The most widely accepted hypothesis is deposition of layers of calcium and minerals over a nidus of a single necrotic cell. It has also been suggested that osteopontin protein produced by macrophages may play a role in the development of calcification in both psammomatous and non-psammomatous human neoplasms. [8]

IAC of the breast has a similar prognosis to infiltrating ductal carcinoma not otherwise specified. [9] While some studies show a slightly better prognosis for apocrine carcinoma, overall there is no statistical advantage when matched by stage and grade. The 6-year survival rate for moderate-to-high grade apocrine breast cancer is thought to be between 70% and 80%. There is some evidence to suggest that lymphatic invasion and lymph node metastasis is less likely for apocrine carcinoma than for non-specific invasive ductal carcinoma, but this is a relatively new finding, which has not been broadly confirmed. [10]

We report this case to highlight the existence of this unusual variant of pure apocrine carcinoma of breast. We imagine its biological behavior is likely to be the same as that of pure apocrine carcinoma, but further studies are required to determine any prognostic implications of this tumor variant.

 
  References Top

1.Celis JE, Gromova I, Gromov P, Moreira JM, Cabezón T, Friis E, et al. Molecular pathology of breast apocrine carcinomas: A protein expression signature specific for benign apocrine metaplasia. FEBS Lett 2006;580:2935-44.  Back to cited text no. 1
    
2.Eusebi V, Foschini MP, Bussolati G, Rosen PP. Myoblastoid carcinoma of the breast. A type of apocrine carcinoma of breast. Am J Surg Pathol 1995;19:553-62.  Back to cited text no. 2
[PUBMED]    
3.Pillai KR, Mani KS, Jayalal KS, Preethi TR, Somanathan T, Jayasree K. Psammoma bodies in fine needle aspiration cytology of the breast: A clinicopathological study of 30 cases. Diagn Cytopathol 2011;39:1-66.  Back to cited text no. 3
    
4.Pettinato G, Manivel CJ, Panioc L, Sparano L, Petrella G. Invasive micropapillary carcinoma of the breast clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior. Am J Clin Pathol 2004;121:857-66.  Back to cited text no. 4
    
5.Rao P, Lyons B. Pure mucinous carcinoma of the breast with extensive psammomatous calcification. Histopathology 2008;52:631-56.  Back to cited text no. 5
    
6.Pillai KR, Jayasree K, Jayalal KS, Mani KS, Abraham EK. Mucinous carcinoma of breast with abundant psammoma bodies in fine-needle aspiration cytology: a case report. Diagn Cytopathol 2007;35:230-3.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Bryant J. Male breast cancer: A case of apocrine carcinoma with psammoma bodies. Hum Pathol 1981;12:751-3.  Back to cited text no. 7
[PUBMED]    
8.Hirota S, Nakajima Y, Yoshimine T, Kohri K, Nomura S, Taneda M, et al. Expression of bone related protein messenger RNAs in human meningiomas: Possible involvement of osteopontin in development of psammoma bodies. J Neuropathol Exp Neurol 1995;54:698-703.  Back to cited text no. 8
[PUBMED]    
9.Japaze H, Emina J, Diaz C, Schwam RJ, Gercovich N, Demonty G, et al. 'Pure' invasive apocrine carcinoma of the breast: A new clinicopathological entity? Breast 2005;14:3-10.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.O'Malley FP, Bane A. An update on apocrine lesions of the breast. Histopathology 2008;52:3-10.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
  Introduction
  Case Report
  Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed3063    
    Printed130    
    Emailed0    
    PDF Downloaded175    
    Comments [Add]    

Recommend this journal