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Breast malignant, males, children

Male tumors

Male breast carcinoma - general


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 8 April 2014, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Epidemiology
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● Very rare
● Have higher risk for second primary (breast, stomach and melanoma, Breast Cancer Res 2007;9:R10)
● In US, males have 1% the rate of breast carcinoma of women; 1000-1500 new cases per year in US
● Mean age 60 years at diagnosis
● Histology similar to women, mostly ductal and most ER+
● Incidence may be increasing in US, Canada and UK (World J Surg Oncol 2008;6:58)

Risk factors
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● Breast carcinoma in first degree relatives
● BRCA2 > BRCA1 mutation carriers (J Natl Cancer Inst 2007;99:1811, Ann Saudi Med 2009;29:288)
● Older age
● Infertility
● Obesity
● Ionizing radiation
● Klinefelterís syndrome (50x risk)
● Estrogen treatment for prostate carcinoma or cirrhosis

Clinical features
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● Typically firm, painless mass in subareolar breast or upper, outer quadrant
● Nipple discharge in men is strongly suggestive
● Often presents at high stage since minimal breast substance (Saudi Med J 2009;30:1060)
● Axillary nodes in 50% at presentation
● Luminal A and B subtypes are most common (Breast Cancer Res 2009;11:R28)

Prognostic factors
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● Male patients with early stage disease may have poorer prognosis than similar stage female patients (Cancer 2007;109:1471)
● HER2+ patients have poorer survival stage by stage (Mod Pathol 2002;15:853, Am J Surg Pathol 2006;30:1292)
● Nodal metastases are an important, negative prognostic factor (Cancer Radiother 2009;13:103)
● Treatment is similar for men and women (US National Cancer Institute)

Case reports
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● 47 year old man with bilateral breast cancer and hypogonadism (World J Surg Oncol 2007;5:60)
● 54 year old man with synchronous bilateral male breast cancer (J Breast Cancer 2012;15:248)
● 59 year old man with pure mucinous carcinoma (Breast Cancer 2012;19:365)
● 75 year old man with intracystic papillary carcinoma (Arch Pathol Lab Med 1985;109:858)
● 76 year old man with oncocytic carcinoma (Arch Pathol Lab Med 1989;113:1396)
● 82 year old man with in situ and invasive lobular carcinoma (Hum Pathol 1989;20:1220)
● Tubulolobular carcinoma (Am J Surg Pathol 2005;29:980)

Treatment
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Similar to female breast cancer treatment:
● Surgery
● Sentinel node biopsy (J Am Coll Surg 2008;206:616)
● Radiation therapy
● Tamoxifen (Breast 2007;16 Suppl 2:S147)
● Adjuvant systemic therapy (Cancer 2005;104:2359)

Gross images
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Intracystic papillary carcinoma

Micro description
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● Similar to female tumors
● Invasive ductal carcinoma is most common, papillary is #2 (Virchows Arch 2006;449:507); invasive lobular / LCIS is rare

Micro images
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DCIS-various      DCIS and invasive carcinoma

       
Androgen receptor+  PSA+         Invasive ductal carcinoma (A),
                       solid papillary carcinoma (B)

       
Intracystic papillary DCIS

       
Nodal metastases   HER2+         p53+

       
Moderately differentiated ductal carcinoma

       
ER+           PR+           HER2 negative

       
Luminal B tumor     Various subtypes    Intracystic papillary carcinoma

Invasive lobular carcinoma

AFIP images:

DCIS-solid type after estrogen for prostate cancer

              
Invasive carcinoma with cribriform pattern

              
Intracystic papillary carcinoma        Cystic papillary carcinoma with invasion



Man with adenoid cystic carcinoma

Cytology description
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● Reliable but underutilized (Acta Cytol 2009;53:369)

Papillary tumors:
● Papillary clusters of epithelial cells with variable fibrovascular cores
● Also single epithelial cells with high N/C ratio and eccentric nuclei, hemosiderin-laden macrophages (Cancer 2006;108:222)

Cytology images
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Loosely cohesive malignant cells

Positive stains
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● ER (95%), PR (70%) and androgen receptors (Eur J Surg Oncol 2006;32:44)
● Ki-67 (20-40%)

Negative stains
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● p53, HER2 (usually, Arch Pathol Lab Med 2003;127:36)

Differential diagnosis
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● Gynecomastia with chemoradiation induced atypia (Arch Pathol Lab Med 2002;126:613, micro image)

Additional references
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eMedicine

End of Breast malignant, males, children > Male tumors > Male breast carcinoma - general


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