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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.

Apocrine change in sclerosing adenosis



These high power views show the concerning nuclear pleomorphisn commonly seen in these lesions. 'Mouse-over' for second image.

Apocrine change in sclerosing adenosis


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.


Apocrine change in sclerosing adenosis


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.


Apocrine change in sclerosing adenosis - Her-2 immunostain Apocrine change in sclerosing adenosis - Ki67 immunostain

Summary




See also... Apocrine metaplasias on this site.

Reference:

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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