Triple negative apocrine breast carcinoma has better prognosis despite poor response to neoadjuvant chemotherapy

Background: Apocrine carcinoma is a rare subtype of invasive ductal breast cancer that shows apocrine differentiation and largely with triple negative immunohistology. Triple negative breast cancers are known to have a more aggressive clinical course. However, unlike the most other types, it is reported that triple negative apocrine carcinoma has a better prognosis. Due to scarcity of reported studies, our knowledges for its clinical behavior, prognosis and response to therapy are very limited. Methods: In this study, we retrospectively retrieved 41 triple negative apocrine carcinoma cases from our breast cancer database with an average follow up 32.8 months.Results: It was found that triple negative apocrine carcinoma had poorer response to neoadjuvant therapy, but better prognosis compared with other non-apocrine types of triple negative breast cancer. Meanwhile, triple negative apocrine carcinoma has a low proliferative nature as indicated by its low Ki67 index. Analysis of SEER database showed that chemotherapy did not improve breast cancer specific survival in TNAC patients. Conclusions: Our results suggest that triple negative apocrine carcinoma is a special subtype of triple negative breast cancer for which de-escalation of chemotherapy should be considered.

Cutaneous Adnexal Carcinoma with Apocrine Differentiation: A Challenging Diagnosis and Personalized Treatment with mTOR Inhibitor in a Very Rare Disease

Cutaneous adnexal carcinoma with apocrine differentiation is a rare neoplasm arising from cutaneous adnexa, especially of the head and neck and trunk region. Because of its rarity, the diagnosis is challenging and often impossible to distinguish from metastatic cutaneous adenocarcinoma of the breast. The standard of care remains surgery for resectable disease. To date, univocal guidelines for metastatic disease are lacking, particularly regarding systemic therapy. We report a clinical case of a patient diagnosed with cutaneous adnexal adenocarcinoma with apocrine differentiation of the left axilla with lymph node and bone metastasis. We started with carboplatin and paclitaxel chemotherapy regimen, with good response. After progression, we performed a next-generation sequencing analysis (by the Foundation One CDx test) to identify genomic alteration in cancer-related genes. We found PIK3CA and KRAS mutations. Due to this result, the patient started a second-line treatment with a personalized therapy including an mTOR inhibitor, everolimus, and, to date, he is still under treatment. To our knowledge, this is the first case of a patient responding both to chemotherapy and to a personalized treatment with an mTOR inhibitor. It is important to support the value of genomic screening in this rare neoplasm.

Nodular Hidradenoma Case of Rare Localization

Hidradenoma is a rare benign adnexal sweat gland tumor with eccrine or apocrine differentiation. In the skin, it is usually in the form of a solitary skin nodule. The treatment is complete surgical resection with healthy margins, given the high rate of recurrence and the possibility of malignant transformation. We report a case.

Expression features of androgen receptor in special subtypes of breast cancer

Purpose The important role of the androgen receptor (AR) in invasive carcinoma of no specific type (NST) has been increasingly recognised. However, only a few studies have been reported in special subtypes of breast cancer. Thus, we aim to investigate the AR expression and its expression features in special subtypes of breast cancer. Methods This study collected clinicopathological data of 718 special subtypes of breast cancer from Tianjin Medical University Cancer Institute and Hospital. Immunohistochemical staining of AR and other biomarkers was performed. Results If the threshold of AR is ≥ 1%, the positive rate of AR in specific subtypes of breast cancer is 77.9% (559/718) of cases. Compared with the threshold of AR is ≥ 10%, the positive percentage of AR in each subtype of breast cancer increases about 10%. The positive expression rate of AR in carcinomas with apocrine differentiation is highest, and the coloration intensity is much stronger than that of other subtypes. The positive expression rate of AR is lowest in metaplastic carcinomas, almost negative; the positive expression rate of AR in invasive lobular carcinomas (ILCs), invasive micropapillary carcinomas (IMPCs), invasive papillary carcinomas (IPCs), and is mucinous carcinomas about 70.0%–80.0%. Conclusions The expression features of AR in special subtypes of breast cancer vary in different subtypes, and to some extent, AR may be a useful biomarker for clinical diagnosis. Routine testing of AR has a certain guiding significance for clinical work. In addition, AR is expected to treat carcinomas with apocrine differentiation as a target.

Periocular Sebaceous Carcinoma With Apocrine Differentiation: A Case Report and Review of the Literature

A 61-year-old man presented with a dome-shaped tumor in the right eyelid. Histology revealed a cutaneous neoplasm with lobular growth pattern. It was composed of large basaloid cells, cells with sebaceous differentiation, and glandular structures with apocrine features. The immunohistochemical study revealed diffuse expression of CK7, EMA, and androgen receptors in the neoplastic cells. Gross cystic disease fluid protein-15 highlighted the luminal cells, consistent with apocrine differentiation. These findings fit with a sebaceous carcinoma with focal glandular apocrine differentiation (“sebo-apocrine” carcinoma). Metastasis to regional lymph nodes were diagnosed 12 months after the surgical procedure. After 3 years of follow-up, the patient is alive, with evidence of persistent locoregional metastasis, but no evidence of distant metastasis. Most cutaneous adnexal tumors present only one cell type of differentiation, but hybrid/combined tumors can occur. Despite “sebo-apocrine” tumors are not unexpected, due to their common origin in the follicular-sebaceous apocrine unit, they are very rarely reported.