Zahir Muhammad Nauman, Minhas Khurram, Shabbir-Moosajee Munira
Department of Oncology, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi 74800, Pakistan.
Department of Pathology and Microbiology, Aga Khan University, Stadium Road, PO BOX: 3500, Karachi 74800, Pakistan.
BMC Clin Pathol. 2014 Apr 27;14:16. doi: 10.1186/1472-6890-14-16. eCollection 2014.
Carcinoma of the male breast is responsible for less than 1% of all malignancies in men but the incidence is rising. Invasive ductal carcinoma is the most common histological subtype while invasive lobular carcinoma is responsible for only 1.5% of the total cases of which pleomorpic lobular carcinoma is an extremely rare variant. We report the case of a gentleman with node positive, pleomorphic lobular carcinoma of the breast.
An elderly gentleman with a past history of type 2 diabetes and long term ethanol use presented to us with a self-discovered palpable lump in the left breast. Physical examination revealed bilateral gynaecomastia along with a well circumscribed subareolar mass and palpable lymphadenopathy in the ipsilateral axilla. The breast nodule revealed atypical cells on fine needle aspiration biopsy and the patient underwent a modified radical mastectomy after systemic surveillance was negative for metastatic disease. The lesion was reported as grade III pleomorphic lobular carcinoma with a lack of E-cadherin expression on immunohistochemistry and the neoplastic cells exhibited strong positivity for estrogen receptor in the absence of Her2 gene amplification. Six out of the eleven dissected regional lymph nodes showed evidence of disease. The patient completed 4 cycles of adjuvant chemotherapy without evidence of recurrent disease and was subsequently lost to follow up.
Although invasive lobular carcinomas comprise 12% of all female breast cancers, they are very rare in males due to lack of acini and lobules in the normal male breast. Pleomorphic lobular carcinoma, an aggressive variant of ILC is even rarer in males. Chronic consumption of ethanol by our patient may have resulted in some degree of hepatic impairment with resultant hyperestrogenism. This in theory may have been the cause of his gynaecomastia, resultant breast cancer and is a plausible explanation for development of the invasive lobular subtype in a male. The prognosis and clinicopatholocial features of pleomorphic lobular carcinoma in men are less clearly defined due to its rarity. Additional studies are hence necessary to improve our understanding of this disease in males.
男性乳腺癌占男性所有恶性肿瘤的比例不到1%，但其发病率正在上升。浸润性导管癌是最常见的组织学亚型，而浸润性小叶癌仅占所有病例的1.5%，其中多形性小叶癌是一种极其罕见的变异型。我们报告一例患有淋巴结阳性的乳腺多形性小叶癌的男性患者。
一位有2型糖尿病病史且长期饮酒的老年男性因自行发现左侧乳房可触及肿块前来就诊。体格检查发现双侧乳腺增生，同时乳晕下有一个边界清晰的肿块，同侧腋窝可触及肿大淋巴结。细针穿刺活检显示乳腺结节有非典型细胞，在全身检查未发现转移性疾病后，患者接受了改良根治性乳房切除术。病变报告为III级多形性小叶癌，免疫组化显示E-钙黏蛋白表达缺失，肿瘤细胞在无Her2基因扩增的情况下雌激素受体呈强阳性。11个切除的区域淋巴结中有6个显示有病变。患者完成了4个周期的辅助化疗，无复发疾病迹象，随后失访。
尽管浸润性小叶癌占所有女性乳腺癌的12%，但由于正常男性乳房中缺乏腺泡和小叶，它们在男性中非常罕见。多形性小叶癌是浸润性小叶癌的一种侵袭性变异型，在男性中更为罕见。我们的患者长期饮酒可能导致了一定程度的肝功能损害，进而导致雌激素过多。从理论上讲，这可能是他乳腺增生、继而患乳腺癌的原因，也是男性发生浸润性小叶癌亚型的一个合理的解释。由于其罕见性，男性多形性小叶癌的预后和临床病理特征尚不清楚。因此，需要更多的研究来提高我们对男性这种疾病的认识。
