Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY.
Am J Surg Pathol. 2020 Aug;44(8):1092-1103. doi: 10.1097/PAS.0000000000001493.
To date, the apocrine variant of lobular carcinoma in situ (AP-LCIS) has been cursorily described as a subtype of lobular carcinoma in situ (LCIS). We retrospectively reviewed 34 cases of AP-LCIS (including 23 associated with invasive lobular carcinoma) to fully characterize it. AP-LCIS typically presented with screen-detected calcifications in older women (mean age: 65 y) and was characterized by distended terminal duct lobular units with relatively large "pleomorphic" cells, central necrosis, and calcifications. AP-LCIS cells exhibited abundant eosinophilic occasionally granular cytoplasm, hyperchromatic nuclei, and prominent nucleoli. Synchronous classic and/or florid LCIS was identified in 24/34 (70%) AP-LCIS, and in 9/11 (82%) pure AP-LCIS. Most (68%) cases of AP-LCIS were estrogen receptor-positive (50% strongly), 35% were progesterone receptor-positive, 26% were human epidermal growth factor 2-positive, 18% demonstrated high-proliferation rate (Ki67: >15%), and 90% were androgen receptor-positive. Aurora kinase A, immunoreactive in 38% of AP-LCIS cases, was not significantly associated with recurrence, development of invasion, or nodal positivity (P>0.05). Compared with conventional (nonapocrine) pleomorphic lobular carcinoma in situ (P-LCIS), aurora kinase A was expressed in a significantly greater proportion of P-LCIS (100%). AP-LCIS and P-LCIS did not otherwise differ in clinicopathologic features. Next-generation sequencing utilizing the Oncomine Comprehensive Panel v2, performed on 27 AP-LCIS cases, showed no specific molecular findings. In a mean follow-up of 57 months, 2 (of 11, 18%) pure AP-LCIS cases recurred (2 both in situ and invasive) and none metastasized or proved fatal. AP-LCIS should be regarded as another high-grade LCIS similar to P-LCIS in many respects, and pending additional studies should be managed similarly.
迄今为止，大汗腺癌型乳腺原位癌（AP-LCIS）被简要地描述为乳腺原位癌（LCIS）的一个亚型。我们回顾性分析了 34 例 AP-LCIS（包括 23 例与浸润性小叶癌相关）病例，以全面描述其特征。AP-LCIS 通常表现为老年女性（平均年龄：65 岁）筛查发现的钙化灶，其特征是扩张的终末导管小叶单位，伴有相对较大的“多形性”细胞、中央坏死和钙化。AP-LCIS 细胞表现为丰富的嗜酸性颗粒状细胞质、深染核和明显的核仁。在 34 例 AP-LCIS 中，24 例（70%）同时存在经典型和/或明显型 LCIS，9 例（82%）为单纯 AP-LCIS。大多数（68%）AP-LCIS 患者雌激素受体阳性（50%强阳性），35%孕激素受体阳性，26%人表皮生长因子 2 阳性，18%增殖率高（Ki67：>15%），90%雄激素受体阳性。在 38%的 AP-LCIS 病例中，有丝分裂激酶 A 呈免疫反应性，但与复发、浸润发展或淋巴结阳性无显著相关性（P>0.05）。与传统（非大汗腺癌）多形性小叶癌（P-LCIS）相比，有丝分裂激酶 A 在 P-LCIS 中表达的比例显著更高（100%）。AP-LCIS 和 P-LCIS 在临床病理特征方面没有其他差异。对 27 例 AP-LCIS 病例进行的下一代测序（Oncomine Comprehensive Panel v2）没有发现特定的分子发现。在平均 57 个月的随访中，2 例（11 例中的 2 例，18%）单纯性 AP-LCIS 病例复发（2 例原位和浸润性），无转移或死亡。AP-LCIS 应被视为另一种与 P-LCIS 在许多方面相似的高级别 LCIS，在等待进一步研究的同时，应进行类似的处理。
