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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Apocrine Adenosis of the Breast

Definition

  • A haphazard proliferation of bland glands with apocrine differentiation

Alternate/Historical Names

  • Adenomyoepithelial Adenosis
  • Secretory Adenosis

Diagnostic Criteria

  • Variably sized open round glands
    • Eosinophilic granular secretion
  • Lumenal cells show apocrine differentiation
    • Tall columnar
    • Granular eosinophilic cytoplasm
    • Bland, basal nuclei
    • GCDFP15 positive
    • Occasional squamous metaplasia
  • Basal myoepithelial cells uniformly present
    • Flattened
    • Cytologically bland
    • Myoepithelial markers positive
  • Poorly circumscribed
    • Predominantly scattered through adipose tissue
    • Scant stroma
  • Most cases merge with adenomyoepithelioma

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: May 15, 2006

Supplemental studies

Immunohistology

  • Lumenal cells
    • EMA, GCDFP15 positive
  • Basal cells
    • Positive for myoepithelial markers
      • Actin, calponin, p63
  • Basement membrane demonstrable with laminin stain

Differential Diagnosis

 

Sclerosing Adenosis with Apocrine Metaplasia Apocrine Adenosis
Cellular, sclerotic stroma Stroma predominantly adipose
Lobular Haphazard
Small glands Variable, larger glands
Compressed lumens Open lumens
No association with adenomyoepithelioma Usually associated with adenomyoepithelioma

 

Apocrine Adenosis Microglandular Adenosis
Myoepithelial layer present, may be hyperplastic No myoepithelial cells
Variable size and shape of glands Uniform round glands
Apocrine lumenal differentiation and in some cases squamous metaplasia present No squamous or apocrine metaplasia
EMA and GCDFP15 positive EMA and GCDFP15 negative

 

Apocrine Adenosis Tubular Adenosis
Variable but round glands Tubules
Apocrine lumenal differentiation and in some cases squamous metaplasia present No squamous or apocrine metaplasia
Frequently merges with adenomyoepithelioma No association with adenomyoepithelioma

 

Apocrine Carcinoma Apocrine Adenosis
Large vesicular nuclei with prominent nucleoli Small bland nuclei
No myoepithelial layer Myoepithelial layer present

Clinical

  • Benign lesion

Grading / Staging / Report

  • Grading and staging are not applicable

Lists

Adenosis of the Breast

Breast Tumors and Lesions Exhibiting Reactivity for Muscle/Myoepithelial Markers

(Most benign lesions with an epithelial component will have a myoepithelial cell layer)

Bibliography

  • Eusebi V, Foschini MP, Betts CM, Gherardi G, Millis RR, Bussolati G, Azzopardi JG. Microglandular adenosis, apocrine adenosis, and tubular carcinoma of the breast. An immunohistochemical comparison. Am J Surg Pathol. 1993 Feb;17(2):99-109.
  • Eusebi V, Casadei GP, Bussolati G, Azzopardi JG. Adenomyoepithelioma of the breast with a distinctive type of apocrine adenosis. Histopathology. 1987 Mar;11(3):305-15.
  • Diaz NM, McDivitt RW, Wick MR. Microglandular adenosis of the breast. An immunohistochemical comparison with tubular carcinoma. Arch Pathol Lab Med. 1991 Jun;115(6):578-82.
  • Tavassoli FA, Bratthauer GL. Immunohistochemical profile and differential diagnosis of microglandular adenosis. Mod Pathol. 1993 May;6(3):318-22.
  • Kiaer H. Adenomyoepithelial adenosis. Am J Surg Pathol. 1987 Mar;11(3):235.
  • Kiaer H, Nielsen B, Paulsen S, Sorensen IM, Dyreborg U, Blichert-Toft M. Adenomyoepithelial adenosis and low-grade malignant adenomyoepithelioma of the breast. Virchows Arch A Pathol Anat Histopathol. 1984;405(1):55-67.
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