Department of Pathology, Weill Cornell Medicine, New York, NY.
Department of Pathology, Hackensack University Medical Center, Hackensack, NJ.
Am J Surg Pathol. 2020 Jan;44(1):68-76. doi: 10.1097/PAS.0000000000001340.
Papillary lesions of the male breast (PLMB) are uncommon. To date, PLMB have been reported as individual case reports and in relatively small series. We reviewed cases of PLMB diagnosed at our medical center over a 19-year (2000-2019) period. A total of 117 cases were identified, with an age range of 7 months to 88 years. These cases included 3 of papillary ductal hyperplasia, 5 intraductal papillomas, 1 adenomyoepithelioma, 5 atypical papillomas (ie, papillomas with atypia), 51 papillary ductal carcinoma in situ, 14 encapsulated papillary carcinomas, 38 solid papillary carcinomas, and 8 invasive papillary carcinomas. Malignant papillary neoplasms, including invasive and noninvasive ones, had a mean size of 1.3 cm (range: 0.3 to 4.4 cm), and all were ER and HER2. Fifty-four percent (19/35) of carcinomas were treated with excision alone, 46% (16/35) underwent mastectomy, and 63% (22/35) had axillary lymph node sampling. Only one case had metastatic involvement of axillary lymph nodes. Of the cases with follow-up, no (0/8) invasive carcinoma showed distant metastasis or proved fatal, and no (0/23) noninvasive papillary carcinoma recurred. Two notable cases of PLMB were encountered: one of a 7-month-old boy with NF1 mutation and florid papillary hyperplasia, and another of a 57-year-old man with Klippel-Feil syndrome and bilateral solid papillary carcinoma, invasive and oligometastatic on one side and noninvasive on the other. On the basis of this study of PLMB cases, the largest to date, and review of literature, we conclude that PLMB span a broad clinicopathologic spectrum, and that both invasive and noninvasive papillary carcinomas have relatively good prognosis.
男性乳腺的乳头状病变（PLMB）并不常见。迄今为止，PLMB 仅以个案报告和相对较小的系列形式报道。我们回顾了在过去 19 年（2000-2019 年）期间在我们医疗中心诊断的 PLMB 病例。共发现 117 例，年龄范围为 7 个月至 88 岁。这些病例包括 3 例乳头状导管增生、5 例导管内乳头状瘤、1 例腺肌上皮瘤、5 例非典型乳头状瘤（即有异型性的乳头状瘤）、51 例导管原位癌、14 例囊内乳头状癌、38 例实体性乳头状癌和 8 例浸润性乳头状癌。恶性乳头状肿瘤，包括浸润性和非浸润性，平均大小为 1.3cm（范围：0.3-4.4cm），均为 ER 和 HER2 阳性。54%（19/35）的癌仅行切除术治疗，46%（16/35）行乳房切除术，63%（22/35）行腋窝淋巴结取样。仅有 1 例病例出现腋窝淋巴结转移。在有随访的病例中，无（0/8）例浸润性癌发生远处转移或死亡，无（0/23）例非浸润性乳头状癌复发。我们遇到了两例值得注意的 PLMB 病例：一例为 7 月龄 NF1 突变伴明显乳头状增生的男孩，另一例为 57 岁 Klippel-Feil 综合征伴双侧实性乳头状癌的男性，一侧为浸润性和寡转移，另一侧为非浸润性。基于这项迄今最大的 PLMB 病例研究和文献复习，我们得出结论，PLMB 具有广泛的临床病理谱，浸润性和非浸润性乳头状癌的预后均相对较好。
