Surgical Pathology Criteria

Apocrine Carcinoma of the Breast

Differential Diagnosis

 

Apocrine Carcinoma Secretory Carcinoma
Large vesicular nuclei with prominent nucleoli Low grade nuclei with inconspicuous nucleoli
Cytoplasm granular, eosinophilic Cytoplasm granular or clear and vacuolated
PASd may show granular cytoplasmic staining PASd shows abundant cytoplasmic mucin
No predilection for young patients Most cases <30 years
Many show aggressive behavior Excellent prognosis

 

Histiocytoid Carcinoma Apocrine Carcinoma of the Breast
Amphophilic to weakly eosinophilic cytoplasm Intensely eosinophlic cytoplasm
Cytoplasm vacuolated, occasionally granular Cytoplasm granular
Indistince cytoplasmic borders Sharp cytoplasmic borders
Small nuclei and nucleoli Large vesicular nuclei with prominent nucleoli
Appears to have more aggressive behavior than usual carcinoma Appears to have better behavior than usual carcinoma in some series
Some consider histiocytoid carcinoma to be a variant of breast carcinomas with apocrine features

 

Lipid Rich Carcinoma Apocrine Carcinoma
Cytoplasm clear to multivacuolated Cytoplasm nearly uniformly granular
Cytoplasm at most focally eosinophilic Cytoplasm nearly uniformly eosinophilic
Scant PASd positivity in cells Frequently PASd positive
Fat stains positive Fat stains negative
GCDFP15 variable/weak GCDFP15 strong positive

 

Apocrine Carcinoma Oncocytic Carcinoma
GCDFP15 strong diffuse positive GCDFP15 negative
Anti-mitochondrial stain weak, focal Anti-mitochondrial antibody stain strong, diffuse
Indistinguishable on H&E stain; clinical significance of difference unknown

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