Image of the Quarter (2013-2)
Apocrine metapalsia with atypia in sclerosing adenosis
50 year old woman - screen-detected rounded opacity - the core showed a fibroadenoma without atypia. This little fragment was also present in the biopsy.
The core shows sclerosing adenosis with superimposed apocrine metaplasia. 'Mouse-over' for closer view.
These high power views show the concerning nuclear pleomorphisn commonly seen in these lesions. 'Mouse-over' for second image.
Two high power views of atypia in this lesion. 'Mouse-over' for second image.
'Significant' atypia in apocrine lesions has been defined as variation of nuclear size of >3x. The presence af mitotic activity would also raise concerns.
These two views show Her-2 and Ki67 immunohistochemistry.
The lesion shows a low level expression of Her-2 protein and a low proliferation rate.
Increased expression of either/both has been described as a concerning feature in these lesions.
- Diagnosis - Apocrine metaplasia complicating sclerosing adenosis
- Atypia is present
- The risks associated with this lesion are not well defined
- Such a finding in a core biopsy would warrant the designation 'B3' (atypia)
- Current advice would recommend a diagnostic biopsy following a core showing these features because of the possibility of adjacent (apocrine) DCIS
See also... Apocrine metaplasias on this site.
Wells CA and El-Ayat GA. Non-operative breast pathology: apocrine lesions. J Clin Pathol 2007;60:1313–1320. doi: 10.1136/jcp.2006.040626
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