Ren#{233}

Gilles, MD Alvian
#{149} Lesnik, MD #{149}Jean-Marc Guinebreti#{232}re, MD Anne
#{149} Tardivon, MD
Jacques Masselot, MD #{149}Genevieve Contesso, MD . Daniel
#{149} Vanel, MD

Apocrine Carcinoma:
Clinical and Mammographic Features’

PURPOSE: To describe the mammo- POCRINEcarcinoma (AC) is a rare or ipsilateral (n = 1) breast cancer
graphic features of apocrine carci- breast tumor (1-3). Recently, 1-14 years previously (mean, 8 years).
noma and assess the patterns of cal- Kopans et al (4) reported a series of 10 Two of those four women had inva-
cifications associated with these women with diffusely scattered calci- sive carcinoma with apocrine features.
lesions. fications on mammograms. The calcifi- In all cases, the diagnosis of AC was
MATERIALS AND METHODS: Cimi- cations were of “mixed form” because based on criteria defined by Azzopardi
they displayed features considered (1). All tumors except one ductal carci-
cal and mammographic features from
typical of both benign and malignant noma in situ were invasive AC that
17 patients with apocrine carcinoma
were retrospectively reviewed. Spe- processes. In each case, apocrine ranged from 15 to 55 mm in diameter
metaplastic transformation of the tu- (mean, 12 mm). Two patients had
cia! attention was paid to the pres-
ence of mixed form, diffusely scat- mon cells was demonstrated at histo- multifocal AC.
tered microcalci.fications on logic analysis. The authors suggested The patients had been referred for
mammograms. a possible role of apocrine metaplasia clinical (n = 10), mammographic
in the genesis of these calcifications. If (n = 2), or both clinical and mammo-
RESULTS: Patients were referred for this were true, one might hypothesize graphic (n = 5) anomalies. Findings at
clinical (n = 10), mammographic a greater tendency for unusual calcifi- clinical examination included a pal-
(n = 2), or both clinical and mammo- cations in association with AC. The pable breast mass (n = 12), multiple
graphic (n = 5) abnormalities. Find- purposes of this study were to (a) de- breast masses (n = 1), or bloody nipple
ings at clinical examination included scribe the mammographic features of discharge (n = 2); two patients had
a palpable breast mass (n 12), mul- histologically proved AC and (b) assess normal findings. The mammograms
tiple breast masses (n = 1), and the patterns of calcifications associated showed areas of opacity (n = 14) or
bloody nipple discharge (n = 2); two with these lesions. isolated microcalcifications (n = 3)
patients had normal findings. Four- (Tables 1, 2). Of the 14 patients with
teen patients had opacities at mam- an opacity (Fig 1), 10 also had micro-
mography. These opacities were as- MATERIALS AND METHODS
calcifications. Two women had mul-
sociated with microcalcifications in tiple opacities that were correlated
From 1979 to 1992, 23 patients were
10 cases. Three patients had micro- treated at our institution for histologically with multifocal AC at histologic re-
calcifications without opacities; one proved AC. Clinical and mammographic view. Among the three patients with
of those three patients exhibited a data from 17 of these 23 patients were re- isolated microcalcifications (Fig 2), one
mixed form of diffusely scattered cal- viewed by two radiologists (R.G., AL.).
exhibited the mixed form of diffusely
cffications. Mammograms were not available in the
scattered calcifications described by
six remaining patients. Age, history of
CONCLUSION: Clinical and mam- breast cancer, and results of clinical exami-
Kopans et al (Fig 3) and two had clus-
mographic features of apocrine carci- nation were recorded for all patients. All tered linear calcifications (Fig 2).
noma do not differ from those of in- screen-film mammograms were reviewed, In the patient with the mixed form
vasive ductal carcinoma. and particular attention was paid to the of diffusely scattered calcifications,
presence of the mixed form of diffusely intraductal AC was diagnosed at his-
Index terms: Breast, calcification, 00.329,
scattered calcifications described by Ko- topathologic analysis. The calcifica-
pans et al (4). tions were located inside the ductal
00.815 Breast
#{149} neoplasms, 00.329, 00.815
Breast neoplasms, diagnosis, 00.329, 00.815 All histologic slides were reviewed, and
proliferation and in benign cysts
the diagnosis of AC was based on criteria
around the tumor.
Radiology 1994; 190:495-497 defined by (1). Carcinomas
Azzopardi are
considered to be apocnine if they are com-
posed of more than 80% recognizable apo- DISCUSSION
cnine-type cells, which are defined by an
abundant acidophilic granular cytoplasm There are notable discrepancies in
with vesicular nuclei and prominent the literature regarding the differen-
I From the Departments of Radiology (R.G., nucleoli. tial diagnosis of AC and breast carci-
AL., AT., J.M., DV.) and Histopathology C noma with apocrine metaplasia. The
0MG., G.C.), Institut Gustave Roussy, 94805 reported prevalence of AC ranges
Villejuif Cedex, France. Received June 8, 1993; RESULTS
revision requested July 12; revision received
The 17 women ranged in age from
August 8; accepted August 18. Address reprint
requests to R.G. 33 to 88 years (mean, 57 years). Four
C RSNA, 1994 women had had controlateral (n = 3) Abbreviation: AC = apocrine carcinoma.
 from 0.4% (1) to 60% (5). According to istic microcalcifications on mammo- the secretory activity of apocrine
Azzopardi (1), only carcinoma with grams, whereas of microcalci-
clusters metaplastic transformation of the tu-
more than 80% recognizable apo- fications are associated with malignant mor cells (4).
crime-type cells are AC. In contrast, disease (9-13). Because 50% of non-
Haagensen et al (5) consider all breast palpable breast cancer is detected as a
carcinomas with apocrine features to result of microcalcifications on mam- Table 1
be AC. At our institution, AC is diag- mograms, the description reported by Characteristics of Opacities in
nosed on the basis of Azzopardi’s cri- Kopans et al (4) caused a diagnostic Patients with AC
teria. dilemma for radiologists (12,14,15). No. of
AC was first termed “juvenile These troublesome mammographic Patients
carcinoma” because the patients were patterns were thought to be due to Characteristics (a = 14)
young women (6). In our study, as in
Density
others, the age distribution of women Homogeneous 9
with AC does not appear to differ Heterogeneous 5
from that of women with invasive Borders
carcinoma (7,8). Most of our patients Ill defined 9
Weildefined 5
had a palpable mass. The time at Number
which this retrospective study was Single 12
conducted could partially account for Multiple 2
Associated with microcalcifica-
the low ratio of isolated mammo-
tions 10
graphic anomalies. The prognosis of
AC has been reported to be equal to
that of nonapocrine ductal carcinoma;
however, because of the rarity of
these tumors, definitive conclusions Table 2
cannot be made (2,3). Appearance of Microcalcifications in
Recently, Kopans et al (4) drew our Patients with AC
attention to the mixed form of dif- No. of
fusely scattered calcifications associ- Characteristics Patients
ated with breast cancer with apocrine
Microcalcifications and opacity
features. It is not known how often (n = 10)
such calcifications occur with other Inside the opacity 7
forms of benign and malignant breast Outside the opacity I
disease. It is generally accepted that Both inside and outside the
Figure 1. Mammogram of a 59-year-old opacity 2
diffusely scattered microcalcifications
woman shows a spiculated opacity in the left Microcalcifications alone (n = 3)
are associated with benign disease, breast. The patient was clinically asymptom- Clustered and linear 2
the notable exception being extensive atic. Invasive AC was diagnosed at histologic Mixed form, diffusely scattered 1
comedocarcinoma with its character- examination.

44
.‘ .r.. :

2 3.
Figures 2, 3. (2) Mammogram of a 45-year-old woman demonstrates isolated clustered linear and irregular calcifications in the right breast.
The patient was clinically asymptomatic. Invasive AC was diagnosed at surgical biopsy performed after preoperative localization. (3) Mammo-
gram of a 46-year-old woman referred for a bloody nipple discharge of the left breast. The mammogram shows the mixed form of diffusely
scattered calcifications reported by Kopans et al (4). Intraductal AC was diagnosed at histologic analysis of the mastectomy specimen.

4qt; Radininoy
#{149} February 1994
 It must be stated that Kopans et al the 10 cases reported by Kopans et al, 7. Abati A, Kimmel M, Rosen PP. Apocrine
mammary carcinoma. Am J Clin Pathol
studied breast cancer with apocrine one was found in our series associ-
1990; 94:371-377.
features, while we studied AC. The ated with breast cancer.
However, the
8. Eusebi V, Millis R, Cattani M, Bossolati C,
difference between these two histo- pathologic explanation proposed by Azzopardi J. Apocrine carcinoma of the
logic entities is the ratio of tumoral Kopans et al does not appear to ac- breast. Am J Pathol 1986; 123:532-541.
cells with apocrine metaplasia (more count for this mammographic pattern. 9. Egan RL, Sweeney MB, Sewell CW. Intra-
mammary calcifications without an associ-
than 80% in AC vs less than 80% in Moreover, the mammographic pat- ated mass in benign and malignant dis-
breast cancer with apocrine features). terns of AC do not differ from those of eases. Radiology 1980; 137:1-6.
Because the AC diagnosed at our in- common invasive carcinomas. #{149} 10. Lanyi M. Microcalcifications in the breast
stitution contained at least 80% tu- a blessing or a curse? Diagn Imaging Clin
Med 1985; 54:126-145.
moral cells with apocrine metaplasia, Acknowledgments: We thank Lorna Saint-
11. Sickles E. Breast calcifications: mammo-
we anticipated finding mammo- Ange for editing the manuscript, Isabelle Lafont
graphic evaluation. Radiology 1986; 160:
for editorial assistance, and Arnaud Ch#{233}ronfor
graphic patterns comparable to those 289-293.
photography assistance.
described by Kopans et al. However, 12. Sickles E. Mammographic features of 300
consecutive nonpalpable breast cancers.
such was not the case; only one pa-
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