Korean J Radiol.  2015 Oct;16(5):1006-1011. 10.3348/kjr.2015.16.5.1006.

Sonography of Invasive Apocrine Carcinoma of the Breast in Five Cases

• Seo KJ
• An YY
• Whang IY
• Chang ED
• Kang BJ
• Kim SH
• Park CS
• Kim JS
• Hong H

• KMID: 2160767
• DOI: http://doi.org/10.3348/kjr.2015.16.5.1006

Abstract

OBJECTIVE
To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast.
MATERIALS AND METHODS
This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon.
RESULTS
All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases.
CONCLUSION
Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.

Keyword

Breast; Sonography; Invasive apocrine carcinoma

MeSH Terms

Aged
Apocrine Glands/pathology/ultrasonography
Breast Neoplasms/*diagnosis/pathology/ultrasonography
Carcinoma/*diagnosis/pathology/ultrasonography
Female
Humans
Middle Aged
Neoplasm Invasiveness
Positron-Emission Tomography
Receptor, ErbB-2/metabolism
Receptors, Estrogen/metabolism
Receptors, Progesterone/metabolism
Tomography, X-Ray Computed
Tumor Suppressor Protein p53/metabolism
Receptor, ErbB-2
Receptors, Estrogen
Receptors, Progesterone
Tumor Suppressor Protein p53

Figure

• 

  Fig. 1 Invasive apocrine carcinoma of breast in 73-year-old woman (case 1). A. Mediolateral oblique mammography showing irregularly shaped, hyperdense mass with partially indistinct margin. B. Sonography scan shows irregularly shaped, heterogeneous echotexture mass with microlobulated margin and combined posterior shadowing (BI-RADS category 4). C. MRI obtained before lumpectomy shows irregular shape and margin mass. This mass was seen as having homogeneous, low-signal intensity on T1- (T1WI) and T2-weighted images (T2WI) and showed rapid, heterogeneous enhancement during initial phase and wash-out except for anterior rim in delayed phase on dynamic contrast study (T1WI, T2WI, early, and delayed enhancement phases; clockwise direction). D. Entire tumor showed moderate FDG uptake (SUV = 3.2) on PET-CT. E. Lesion aspiration showed few irregular syncytial fragments composed of pleomorphic, malignant apocrine cells. Cells showed abundant granular cytoplasm and large, eccentric nuclei with irregular chromatin distribution. Note multiple prominent macronuclei (Papanicolaou, × 100). F. Microscopically, tumor showed irregular tumor nests infiltrating stroma. Note abundant eosinophilic cytoplasm and apocrine feature of tumor cells with definite nuclear pleomorphism, which is pathognomonic of apocrine carcinoma (H&E stain, × 100). G. Most tumor cells demonstrated prominent apocrine features as well as abundant eosinophilic, granular cytoplasm and marked nuclear pleomorphism (H&E stain, × 400). BI-RADS = Breast Imaging Reporting and Data System, FDG = fluorodeoxyglucose, H&E = hematoxylin and eosin, PET-CT = positron emission tomography-CT, SUV = standardized uptake value

• 

  Fig. 2 Invasive apocrine carcinoma of breast in 65-year-old woman (case 3). A. Mediolateral oblique mammography showing irregularly shaped, hyperdense mass with partially indistinct margin. B. Sonography showing irregular shape and heterogeneous echotexture mass with indistinct margin. Posterior enhancement with peritumoral edema is noted (BI-RADS category 4). BI-RADS = Breast Imaging Reporting and Data System

• 

  Fig. 3 Invasive apocrine carcinoma of breast in 48-year-old woman (case 5). A. Craniocaudal mammography showing asymmetry (arrow). B. Sonography showing irregularly shaped, heterogeneous echotexture mass with indistinct margin (BI-RADS category 4). BI-RADS = Breast Imaging Reporting and Data System

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