PMC3919946_01
Diagnostic imaging. (A) Ultrasound imaging identified a lobulated, solid tumor measuring >=3 cm of the left mammary gland. (B) Computed tomography of the chest indicated a mass lesion in the apocrine carcinoma region of the left mammary duct exhibiting heterogeneous and moderately enhanced microcalcifications.
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Ultrasound imaging demonstrated a lobulated solid tumor ~40x30 mm containing multiple stippled calcifications in the left mammary gland (Fig. 1A). A computed tomography scan displayed a heterogeneously hypodense mass lesion in the left gland and indicated multiple enlarged lymph nodes in the left axilla (Fig. 1B).
Macroscopic images. (A) The predominant lesion of the tumor was white and solid, measuring 61x27 mm and was associated with a cutaneous ulcer. (B) The tumor exhibited an extensive area of necrosis.
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Macroscopic investigations identified the lesion as white and solid, measuring 61x27 mm, which exhibited an extensive area of necrosis (Fig. 2A and B).
Cancer cells formed nests and exhibited keratinization. (A and C) The histological analysis showed structures comprising of predominantly solid and nest patterns, with keratinization (H&E; magnification, x100). The tumor cells were positive for (B) cytokeratin 5/6 (magnification, x100) and (D) P63 (magnification, x100).
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The lesion exhibited moderate glandular lumen formation and comedo-like necrosis (Figs. 3A and 4B), which extended into the surrounding ducts and infiltrated the adipose tissue and skin. The lesion exhibited squamous features (Fig. 3A-D) with a histological grade of three and was negative for the expression of ER, PgR and HER2; the tumor was a triple-negative breast cancer.
Areas exhibiting apocrine features within the tumor cells. (A) Hematoxylin and eosin staining identified that the areas with apocrine features were abundant in eosinophilic cytoplasm. (B) Gross cystic disease fluid protein-15 was positive in the areas exhibiting apocrine features. (C) The androgen receptor was expressed in the cytoplasm and the nucleus of the tumor cells, which exhibited apocrine features.
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The lesion exhibited moderate glandular lumen formation and comedo-like necrosis (Figs. 3A and 4B), which extended into the surrounding ducts and infiltrated the adipose tissue and skin. The androgen receptor (AR) was expressed in the cytoplasm and/or the nucleus within the tumor cells (Fig. 4A-C); thus, the tumor appeared to exhibit apocrine features.