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Authors: Dr Abdel Selim MBCHB , MS , PhD , FRCPath 1 and Dr Ghada Elayat MBChB, MSc, PhD2,3,
1. Dr A Selim
King’s College Hospital, Histopathology Department,
Denmark Hill, London, UK. Abdel.Selim@nhs.net
2. Dr G Elayat
Middlesex University, Department of natural science,
Hendon, London, UK
3. Tanta University, Faculty of Medicine, Pathology
Department, Tanta, Egypt G.Elayat@mdx.ac.uk
Abstract:
Apocrine metaplasia of the breast is a benign histological alteration characterised by the transformation of normal breast epithelial cells into cells with apocrine features. Although typically non-malignant, understanding this condition is essential for accurate diagnosis and patient management. This review aims to provide a comprehensive overview of apocrine metaplasia, including its histopathological characteristics, clinical significance, diagnostic approaches, differential diagnosis, molecular changes, ultrastructural characteristics, and management strategies. By synthesising current knowledge, this article aims to enhance awareness and facilitate informed decisionmaking among clinicians and researchers.
Keywords :: apocrine metaplasia, breast, histopathology, diagnosis, molecular changes, ultrastructural characteristics, management
INTRODUCTION
The breast is a complex organ composed of various cell types,
and benign proliferative changes can occur due to a myriad
of factors. Apocrine metaplasia is one such benign alteration
characterised by the transformation of breast epithelial cells
into cells with apocrine features [1]. While typically nonmalignant, understanding apocrine metaplasia is crucial for
accurate diagnosis and appropriate clinical management.
Histopathological Characteristics
Apocrine metaplasia is characterised histologically by the
presence of large, eosinophilic, granular cytoplasm and
prominent nucleoli in epithelial cells. These cells often exhibit
decapitation secretion, a distinctive feature of apocrine
differentiation. Immunohistochemical staining can further
confirm the presence of apocrine differentiation markers,
such as gross cystic disease fluid protein-15 (GCDFP-15) and
androgen receptor (AR) [2].
Molecular Changes
Recent research has shed light on the molecular alterations
underlying apocrine metaplasia. Dysregulation of various
signalling pathways, including the androgen receptor (AR)
pathway, has been implicated [3]. Overexpression of AR
and its downstream targets has been observed in apocrine
metaplasia, suggesting a potential role of androgen signalling
in the pathogenesis of this condition. Furthermore, alterations
in other signalling pathways, such as the PI3K/AKT/mTOR
pathway, have also been identified [4].
Ultrastructural Characteristics
Ultrastructural analysis using electron microscopy provides
valuable insights into the cellular architecture of apocrine
metaplastic cells. Apocrine metaplastic cells typically exhibit
abundant, irregularly shaped mitochondria, well-developed
endoplasmic reticulum, and numerous microvilli on the cell
surface [5]. Additionally, the presence of intracytoplasmic
lumina and secretory granules can be observed, reflecting the
apocrine nature of these cells.
Clinical Significance
Apocrine metaplasia is predominantly encountered in benign
breast lesions, including fibrocystic changes, sclerosing
adenosis, and papillomas. Although typically benign, apocrine
metaplasia can occasionally coexist with atypical hyperplasiaor in situ carcinoma, necessitating thorough histopathological
evaluation and clinical follow-up [6].
Diagnostic Approaches
The diagnosis of apocrine metaplasia relies on
histopathological examination of breast tissue obtained
via core needle biopsy or surgical excision. Additionally,
immunohistochemical staining for apocrine markers, such
as GCDFP-15 and AR, can aid in confirming the diagnosis [7].
Differential Diagnosis
Apocrine metaplasia must be distinguished from other breast
lesions exhibiting similar histological features, including
apocrine adenosis, apocrine carcinoma, and invasive
carcinoma with apocrine differentiation. Careful examination
of histological features and immunohistochemical staining
patterns is essential for accurate diagnosis and appropriate
clinical management [8].
Management Strategies
In most cases, apocrine metaplasia does not require
specific treatment and can be managed conservatively
with regular clinical follow-up. However, close monitoring
is recommended, particularly in cases where apocrine
metaplasia coexists with atypical hyperplasia or in situ
carcinoma. Surgical excision may be warranted in selected
cases for definitive diagnosis or symptomatic relief [9].
Citation:
A Selim. Exploring Apocrine Metaplasia of the Breast: A Short Review. Journal of Clinical Breast Cancer 2024
Journal Info
- Journal Name: Journal of Clinical Breast Cancer
- Impact Factor: 2.709**
- ISSN: 2996-1262
- DOI: 10.52338/jcbc
- Short Name: JCBC
- Acceptance rate: 55%
- Volume: 6 (2024)
- Submission to acceptance: 25 days
- Acceptance to publication: 10 days
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