33 Special Types of Invasive Breast Carcinoma: Diagnostic Criteria ...

commonly found in nonapocrine intraductal carcinomas, including comedo,
micropapillary, solid, and cribriform patterns. Apocrine carcinomas have nuclei that
are enlarged and pleomorphic when compared to the nuclei of benign apocrine cells.
Typically, nucleoli are large, prominent, and usually eosinophilic, although they
occasionally exhibit basophilia. Some examples have pleomorphic, deeply basophilic
nuclei in which little or no internal structure can be discerned. In these cells, nucleoli
are usually not evident. In most cases the cytoplasm exhibits eosinophilia that may be
homogeneous or granular, but cytoplasmic vacuolization or clearing occur and are
features associated with atypical apocrine proliferations and are most prominent in
apocrine carcinomas.
The tumor cells contain diastase-resistant, PAS-positive granules, which also stain
with toluidine blue and are red with the trichrome stain. Cytoplasmic iron granules, a
feature of benign apocrine cells, are variably present. Occasional cells may contain
mucicarmine-positive secretions, but most tumors are negative for mucin and alphalactalbumin
(26,27). Benign and malignant apocrine cells are strongly immunoreactive
for GCDFP-15. This marker was positive in 55% of carcinomas, including 75% of
those with apocrine histologic features, 70% of intraductal carcinomas, and 90% of
infiltrating lobular carcinomas that had signet ring cell features (19,24,25). Positive
staining was found in only 23% of carcinomas that did not have apocrine features and
in 5% of medullary carcinomas. Staining for GCDFP-15 has not been a useful
predictor of prognosis (25). Apocrine carcinoma cells contain abundant organelles,
including many variably sized mitochondria (20) that often have incomplete cristae,
and varying numbers of osmiophilic secretory granules (19,24,28,29). Many tumor
cells also contain empty vesicles of about the same size as the osmiophilic granules.
The prognosis of apocrine carcinoma, whether intraductal or invasive, is determined
mainly by conventional prognostic factors such as grade, tumor size, and nodal status
(22,30-32). Apocrine differentiation should be mentioned as a descriptive feature of
the lesion, but it does not have prognostic or therapeutic implications.
Reference (Secretroy Carcinoma):
1. McDivitt RW, Stewart FW. Breast carcinoma in children. J Am Med Assoc
1966;195:388-390.
2. Krauz T, Jenkins D, Grontoft O, Pollock DJ, Azzopardi JG. Secretory
carcinoma of the breast in adults: emphasis on late recurrence and metastasis.
Histopathol 1989;14:25-36.
3. Rosen PP, Cranor ML. Secretory carcinoma of the breast. Arch Pathol Lab Med
1991;115:141-144.
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