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Apocrine Metaplasia

Etiology: • Secondary to an irregular response by breast tissue to hormonal stimuli

Pathogenesis: • May be due to relative or absolute excess of estrogen, decrease in progesterone, or abnormal response to either hormone by breast tissue

Epidemiology: • 60-90% of breasts at autopsy • Reproductive age women

General Gross Description: • "Blue-dome" cysts which may be quite large • Firm gray-white fibrous tissue

General Microscopic Description: • Cysts containing inspissated secretions which may calcify • Cysts may also contain macrophages; lined by flattened epithelium • Apocrine metaplasia with columnar epithelium containing small nuclei and brightly eosinophilic cytoplasm

Clinical Correlations: • About 10% of women have clinically evident disease • May be associated with tenderness and irregular nodularity which varies during the menstrual cycle • Microcalcifications may be demonstrable on mammogram • May be associated with epithelial hyperplasia or sclerosing adenosis although those entities should be reported separately • Cysts and fibrosis do not elevate risk for breast carcinoma

References: • Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease 5th edition. W.B. Saunders, Philadelphia, 1994, pp. 1093-4.