Shioya Akihiro, Kadoguchi Rie, Guo Xin, Ukihashi Mayumi, Noguchi Miki, Inokuchi Masafumi, Yamada Sohsuke
Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan.
Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan.
SAGE Open Med Case Rep. 2020 Jun 7;8:2050313X20932005. doi: 10.1177/2050313X20932005. eCollection 2020.
A 60-year-old male presented with a history of a relatively hard and cystic right chest mass that had gradually increased in size, with subsequent skin erosion, exudate and hemorrhage. The cytologic specimens from a cyst fluid contained a large number of sheet-like or papillary clusters of atypical cuboidal to columnar epithelial cells with loss of myoepithelial components, in a severely inflammatory background with scattered siderophages. We first interpreted it as a carcinoma, but could not completely exclude out the possibilities of benign. Tumor extirpation was performed, and a gross examination of the neoplasm revealed a giant, cystic and partly solid papillary-projected tumor lesion, with a gray-whitish cut surface, associated focally with skin invasion, measuring approximately 9 × 7 cm with a 6 × 4 cm solid area in diameter. On a microscopic examination, solid parts of the tumor were predominantly composed of the intracystic proliferation of mildly atypical epithelial cells with absence of two-cell patterns in a papillary or papillotubular growth fashion, only partly involving the dermis to epidermis. Immunohistochemistry showed that the carcinoma cells were specifically positive for estrogen and progesterone receptors, whereas negative for p63, S-100 protein and several neuroendocrine markers. Therefore, we finally made a diagnosis of invasive intracystic carcinoma of the male breast. We should be aware that owing to its characteristic cytological features, cytopathologists might be able to make a correct diagnosis of that, based on multiple and adequate samplings, even though a core biopsy would be the absolute minimum assessment.
一名60岁男性患者，右胸有一质地较硬的囊性肿块，肿块大小逐渐增大，随后出现皮肤糜烂、渗出及出血。囊肿液的细胞学标本中可见大量片状或乳头状的非典型立方上皮细胞至柱状上皮细胞团簇，肌上皮成分缺失，背景为严重炎症，有散在含铁血黄素巨噬细胞。我们最初将其诊断为癌，但不能完全排除良性的可能性。遂行肿瘤切除，大体检查发现肿瘤为巨大的囊性且部分实性的乳头状突出病变，切面呈灰白色，局部与皮肤浸润有关，大小约9×7cm，其中实性区域直径为6×4cm。显微镜检查显示，肿瘤的实性部分主要由轻度非典型上皮细胞在囊内增殖形成，呈乳头状或乳头管状生长方式，无双细胞模式，仅部分累及真皮至表皮。免疫组化显示，癌细胞雌激素和孕激素受体呈特异性阳性，而p63、S-100蛋白及几种神经内分泌标志物呈阴性。因此，我们最终诊断为男性乳腺浸润性囊内癌。我们应注意，由于其特征性的细胞学表现，即使核心活检是绝对最低限度的评估，细胞病理学家基于多次充分取样也可能对其做出正确诊断。
