Pathology of Male Breast Lesions: Case Series and Literature Review

Abstract

Objective: Breast cancer is the most common cancer that causes death in women. Male breast cancers are rare and make up less than 1% of all breast cancers. Therefore, there are very few studies and no specific male standard protocol has been made. The current treatment approach and prognostic factors for male breast cancers have been removed from studies on women with breast cancer. In men, breast cancers are detected at an advanced age and at an advanced stage. Purpose of this study is to profile breast lesions detected in men and to evaluate cancer cases clinically and pathologically. Material and Methods: We present our 5-year experience by retrospectively examining male breast lesions including cases of gynecomastia and breast carcinoma. Results: Retrospectively between January 2015-January 2020 in our hospital; we detected 43 male breast lesions, including 6 invasive carcinomas, 1 intraductal papilloma, 3 pilomatrixoma, 1 lipomatosis and 32 gynecomastia. Malignant lesions were seen in the 4-8th decades. Malignant lesions were Grade II and Grade III. Tumour size was determined as the smallest 1.1 cm and the largest 3.0 cm. Different levels of hormone receptor expression were observed in each case. Conclusion: Since male breast tumours can often be confused with benign diseases, they can be ignored. Therefore, a more careful approach is required since it can be encountered with breast tumours that reach advanced stage during diagnosis. Although most of the lesions detected in men are benign, malignancy should be considered at the forefront in the presence of a mass in the breast at an advanced age.

Keywords

• Male Breast Carcinoma
• Male Breast Lesions
• Hormone Profile

Erkek Meme Lezyonlarının Patolojisi: Vaka Serisi ve Literatür Tarama

Abstract

Amaç: Meme kanseri, kadınlarda en sık görülen ve en sık ölüme neden olan kanserdir. Erkek meme kanserleri nadir görülür ve tüm meme kanserlerinin %1’den azını oluşturur. Nadir olması nedeniyle çok az çalışma vardır ve spesifik erkek standart protokolü yapılamamıştır. Erkek meme kanserleri ile ilgili güncel tedavi yaklaşımı ve prognostik faktörler meme kanserli kadınlara yapılan çalışmalardan çıkarılmıştır. Erkeklerde meme kanserleri daha ileri yaşta ve tanı anında ileri evrede saptanmaktadır. Bu çalışmada amaç erkeklerde saptanan meme lezyonlarının profilini çıkarmak, kanserli olguları klinik ve patolojik olarak değerlendirmektir. Gereç ve Yöntemler: Bu çalışmada, jinekomasti ve meme karsinom vakalarını da içeren erkek meme lezyonlarını retrospektif olarak inceleyerek 5 yıllık deneyimimizi sunuyoruz. Bulgular: Hastanemiz Ocak 2015-Ocak 2020 tarihleri arasında retrospektif olarak; 6 invaziv karsinom, 1 intraduktal papillom, 3 pilomatriksoma, 1 lipomatozis ve 32 jinekomasti olmak üzere toplam 43 erkek meme lezyonu tespit ettik. Malign lezyonlar 4- 8. dekadlarda görüldü. Malign lezyonlar Grade II ve Grade III olarak izlendi. Tümör boyutu en küçük 1,1cm en büyük 3,0 cm olarak tespit edildi. Her bir vakada farklı düzeyde hormon reseptör ekspresyonu izlendi. Sonuç: Erkek meme tümörleri sıklıkla jinekomasti gibi benign hastalıklar ile karışabildiği için, hasta ve hekimler tarafından göz ardı edilebilir. Bu yüzden tanı konduğu anda ileri evreye ulaşan meme tümörleri ile karşımıza çıkabildiği için daha dikkatli yaklaşım gerekmektedir. Erkeklerde tespit edilen lezyonların çoğu benign olmasına karşın ileri yaşta memede ele gelen kitle varlığında malignite ön planda düşünülmelidir.

Keywords

• Erkek Meme Karsinomu
• Erkek Meme Lezyonları
• Hormon Profili

References

1. Referans 1. Mansel R, Webster D, Sweetland H. The male breast. Benign disorders and diseases of the breast. 3era edicion. Elsevier 2009; 25-272.
2. Referans 2. Mieritz MG, Christiansen P, Jensen MB, Joensen UN, Nordkap L, Olesen IA, Bang AK, Juul A, Jørgensen N. Gynaecomastia in 786 adult men: clinical and biochemical findings. Eur J Endocrinol 2017; 176(5): 555-566.
3. Referans 3. Bowers SP, Pearlman NW, Mclntyre RCF, Finlayson CA, Huerd S. Cost effective management of gynecomastia. American Journal of Surgery 1998; 176 (6): 638-641.
4. Referans 4. Schanz S, Schreiber G, Zitzmann M, Krapohl BD, Horch R, Köhn FM. S1 guidelines: Gynecomastia in adults. JDDG 2017; 4: 465–472.
5. Referans 5. Johansen Taber KA, Morisy LR, Osbahr 3rd AJ, Dickinson BD. Male breast cancer: risk, diagnosis, and management (Review). Oncol Rep 2010; 24: 1115-1120.
6. Referans 6. White J, Kearins O, Dodwell D, Horgan K, Hanby AM, Speirs V. Male breast carcinoma: increased awareness needed. Breast Cancer Res 2011; 13(5): 219.
7. Referans 7. Humphries MP, Jordan VC, Speirs V. Obesity and male breast cancer: provocative parallels. BMC Medicine 2015; 13: 134.
8. Referans 8. Anderson WF, Jatoi I, Tse J, Rosenberg PS. Male breast cancer: a population-based comparison with female breast cancer. J Clin Oncol 2010; 28(2): 2329.

9. Referans 9. Thomas DB, Jimenez LM, McTiernan A, et al. Breast cancer in men: risk factors with hormonal implications. Am J Epidemiol 1992; 135(7): 734–48.
10. Referans 10. Ruddy KJ, Winer EP. Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship. Ann Oncol 2013; 24(6): 1434-43.
11. Referans 11. Voınea OC, Cı̂rstoıu MM, Ion D, Sajın M, Dumıtru AV, Patrascu OM, Jınga DC, Nıca AE. Histology of Male Breast Lesions. Series of Cases and Literature Review. MAEDICA – a Journal of Clinical Medicine 2018; 13(3): 196-201.
12. Referans 12. LadizinskiB,Lee KC,Nutan FNU, Higgins HW, FedermanDG. Gynecomastia: etiologies, clinical presentations, diagnosis, and management. South Med J 2014; 107(1): 44-9.
13. Referans 13. Kapoor A, Narayanan R, Tandon A, Santosh AK. Pilomatricoma: An unusual cause of lump in a male breast.J Clin Ultrasound 2018; 46(3): 209-211.
14. Referans 14. Vagios I, Nonni A, Liakea A, Constantinidou A, Kontos M. Intraductal papilloma of the male breast: a case report and review of the literature. Journal of Surgical Case Reports 2019; 2: 1–4.
15. Referans 15. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population based study. Cancer 2004; 101(1): 51–57.
16. Referans 16. C Perou, T Sorlie, MB Eisen, et al. Molecular portraits of human breast tumors. Nature 2000; 406: 747–752.
17. Referans 17. Weir J, Zhao YD, Herman T, Algan O. Clinicopathologic features and radiation therapy utilization in patients with male breast cancer: a national cancer database study. Breast Cancer 2018; 12: 1178223418770687.
18. Referans 18. Cardoso F, Bartlett JMS, Slaets L et al. Characterization of male breast cancer: results of the EORTC10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol2018; 29(2): 405–417.
19. Referans 19. André S, Pereira T, Silva F, et al. Male breast cancer: Specific biological characteristics and survival in a Portuguese cohort. Mol Clin Oncol 2019; 10(6): 644-654.
20. Referans 20. Arce-Salinas C, Riesco-Martinez MC, Hanna W, Bedard P, Warner E. Complete response of metastatic androgen receptor-positive breast cancer to bicalutamide:case report and review of the literature. J Clin Oncol 2016; 34(4): e21–4