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Breast
Histopathologic Diagnoses
Benign Lesions
Apocrine Metaplasia
Apocrine Metaplasia
Lauren Q. Chang Sen, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Apocrine metaplasia (AM)

            • Definitions

              • Change in morphology of epithelium lining breast ducts to a secretory epithelium with granular, eosinophilic cytoplasm, single nucleolus
                • ER/PR(-), Bcl-2(-), AR(+)
                • Usually found lining dilated acini, clustered microcysts
              • Distinguish from columnar cell hyperplasia: Tall columnar epithelium, absent or inconspicuous nucleoli, ER(+), Bcl-2(+)
              • Papillary apocrine metaplasia: Cysts lined by multiple layers of apocrine-type epithelium forming papillary projections
                • Complex papillary AM: Microscopically forms secondary spaces with arches, may abut each other

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Chang Sen LQ et al: Upgrade rate and imaging features of atypical apocrine lesions. Breast J. 23(5):569-578, 2017
                                          2. Gao Y et al: Apocrine metaplasia found at MR biopsy: Is there something to be learned? Breast J. 23(4):429-435, 2017
                                          3. Asirvatham JR et al: Atypical apocrine adenosis: Diagnostic challenges and pitfalls. Arch Pathol Lab Med. 140(10):1045-51, 2016
                                          4. Hou Y et al: Surgical follow-up results for apocrine adenosis and atypical apocrine adenosis diagnosed on breast core biopsy. Ann Diagn Pathol. 24:4-6, 2016
                                          5. diFlorio-Alexander RM et al: Breast MRI-detected cystic apocrine metaplasia: imaging features with microvessel analysis and histologic correlation. AJR Am J Roentgenol. 204(1):211-8, 2015
                                          6. Calhoun BC et al: Atypical apocrine adenosis diagnosed on breast core biopsy: implications for management. Hum Pathol. ePub, 2014
                                          7. Schnitt SJ et al. Biopsy Interpretation of the Breast. 2nd ed. Philadelphia: Lippincott William & Wilkins. 54-5; 211-2; 328-9, 2013
                                          8. Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
                                          9. O'Malley FP et al: An update on apocrine lesions of the breast. Histopathology. 52(1):3-10, 2008
                                          10. Wells CA et al: Non-operative breast pathology: apocrine lesions. J Clin Pathol. 60(12):1313-20, 2007
                                          11. Berg WA: Sonographically depicted breast clustered microcysts: is follow-up appropriate? AJR Am J Roentgenol. 185(4):952-9, 2005
                                          12. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                          13. Kushwaha AC et al: Mammographic-pathologic correlation of apocrine metaplasia diagnosed using vacuum-assisted stereotactic core-needle biopsy: our 4-year experience. AJR Am J Roentgenol. 180(3):795-8, 2003
                                          14. Warner JK et al: Apocrine metaplasia: mammographic and sonographic appearances. AJR Am J Roentgenol. 170(5):1375-9, 1998
                                          15. Page DL et al: Papillary apocrine change of the breast: associations with atypical hyperplasia and risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 5(1):29-32, 1996
                                          16. Seidman JD et al: Atypical apocrine adenosis of the breast: a clinicopathologic study of 37 patients with 8.7-year follow-up. Cancer. 77(12):2529-37, 1996
                                          17. Tavassoli FA et al: Intraductal apocrine carcinoma: a clinicopathologic study of 37 cases. Mod Pathol. 7(8):813-8, 1994
                                          18. Carter DJ et al: Atypical apocrine metaplasia in sclerosing lesions of the breast: a study of 51 patients. Mod Pathol. 4(1):1-5, 1991
                                          19. Haagensen DE Jr: Is cystic disease related to breast cancer? Am J Surg Pathol. 15(7):687-94, 1991
                                          20. Yates AJ et al: Apocrine carcinoma and apocrine metaplasia. Histopathology. 13(2):228-31, 1988
                                          21. Wellings SR et al: Apocrine cystic metaplasia: subgross pathology and prevalence in cancer-associated versus random autopsy breasts. Hum Pathol. 18(4):381-6, 1987
                                          22. Wellings SR et al: An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. J Natl Cancer Inst. 55(2):231-73, 1975
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Apocrine metaplasia (AM)

                                                    • Definitions

                                                      • Change in morphology of epithelium lining breast ducts to a secretory epithelium with granular, eosinophilic cytoplasm, single nucleolus
                                                        • ER/PR(-), Bcl-2(-), AR(+)
                                                        • Usually found lining dilated acini, clustered microcysts
                                                      • Distinguish from columnar cell hyperplasia: Tall columnar epithelium, absent or inconspicuous nucleoli, ER(+), Bcl-2(+)
                                                      • Papillary apocrine metaplasia: Cysts lined by multiple layers of apocrine-type epithelium forming papillary projections
                                                        • Complex papillary AM: Microscopically forms secondary spaces with arches, may abut each other

                                                    IMAGING

                                                    • General Features

                                                      • Mammographic Findings

                                                        • Ultrasonographic Findings

                                                          • MR Findings

                                                            • Image-Guided Biopsy

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Chang Sen LQ et al: Upgrade rate and imaging features of atypical apocrine lesions. Breast J. 23(5):569-578, 2017
                                                                                  2. Gao Y et al: Apocrine metaplasia found at MR biopsy: Is there something to be learned? Breast J. 23(4):429-435, 2017
                                                                                  3. Asirvatham JR et al: Atypical apocrine adenosis: Diagnostic challenges and pitfalls. Arch Pathol Lab Med. 140(10):1045-51, 2016
                                                                                  4. Hou Y et al: Surgical follow-up results for apocrine adenosis and atypical apocrine adenosis diagnosed on breast core biopsy. Ann Diagn Pathol. 24:4-6, 2016
                                                                                  5. diFlorio-Alexander RM et al: Breast MRI-detected cystic apocrine metaplasia: imaging features with microvessel analysis and histologic correlation. AJR Am J Roentgenol. 204(1):211-8, 2015
                                                                                  6. Calhoun BC et al: Atypical apocrine adenosis diagnosed on breast core biopsy: implications for management. Hum Pathol. ePub, 2014
                                                                                  7. Schnitt SJ et al. Biopsy Interpretation of the Breast. 2nd ed. Philadelphia: Lippincott William & Wilkins. 54-5; 211-2; 328-9, 2013
                                                                                  8. Berg WA et al: Cystic breast lesions and the ACRIN 6666 experience. Radiol Clin North Am. 48:931-87, 2010
                                                                                  9. O'Malley FP et al: An update on apocrine lesions of the breast. Histopathology. 52(1):3-10, 2008
                                                                                  10. Wells CA et al: Non-operative breast pathology: apocrine lesions. J Clin Pathol. 60(12):1313-20, 2007
                                                                                  11. Berg WA: Sonographically depicted breast clustered microcysts: is follow-up appropriate? AJR Am J Roentgenol. 185(4):952-9, 2005
                                                                                  12. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                                                                  13. Kushwaha AC et al: Mammographic-pathologic correlation of apocrine metaplasia diagnosed using vacuum-assisted stereotactic core-needle biopsy: our 4-year experience. AJR Am J Roentgenol. 180(3):795-8, 2003
                                                                                  14. Warner JK et al: Apocrine metaplasia: mammographic and sonographic appearances. AJR Am J Roentgenol. 170(5):1375-9, 1998
                                                                                  15. Page DL et al: Papillary apocrine change of the breast: associations with atypical hyperplasia and risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 5(1):29-32, 1996
                                                                                  16. Seidman JD et al: Atypical apocrine adenosis of the breast: a clinicopathologic study of 37 patients with 8.7-year follow-up. Cancer. 77(12):2529-37, 1996
                                                                                  17. Tavassoli FA et al: Intraductal apocrine carcinoma: a clinicopathologic study of 37 cases. Mod Pathol. 7(8):813-8, 1994
                                                                                  18. Carter DJ et al: Atypical apocrine metaplasia in sclerosing lesions of the breast: a study of 51 patients. Mod Pathol. 4(1):1-5, 1991
                                                                                  19. Haagensen DE Jr: Is cystic disease related to breast cancer? Am J Surg Pathol. 15(7):687-94, 1991
                                                                                  20. Yates AJ et al: Apocrine carcinoma and apocrine metaplasia. Histopathology. 13(2):228-31, 1988
                                                                                  21. Wellings SR et al: Apocrine cystic metaplasia: subgross pathology and prevalence in cancer-associated versus random autopsy breasts. Hum Pathol. 18(4):381-6, 1987
                                                                                  22. Wellings SR et al: An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. J Natl Cancer Inst. 55(2):231-73, 1975