Hittmair A P, Lininger R A, Tavassoli F A
Department of Pathology, University of Innsbruck, Austria.
Cancer. 1998 Nov 15;83(10):2139-49. doi: 10.1002/(sici)1097-0142(19981115)83:10<2139::aid-cncr12>3.0.co;2-f.
Ductal carcinoma in situ (DCIS) in the male breast is a rare disease that to the authors' knowledge has been investigated to date only in small numbers. Compared with DCIS in the female breast, distinct clinical and morphologic differences have been suggested.
The files of the Armed Forces Institute of Pathology (AFIP) were searched for cases of pure DCIS and DCIS associated with invasive carcinoma (DCISAIC) in male patients. A total of 280 cases of pure DCIS and 759 invasive mammary tumors were identified; 114 cases (including 84 pure DCIS and 30 DCISAIC) were studied for this preliminary report. All cases were reviewed and classified according to specific subtypes (papillary, cribriform, solid, micropapillary, and comedo) and grades of DCIS. Basic clinical data were extracted from the patients' charts.
Men with pure DCIS presented at a median age of 65 years, with a typically nodular, retroareolar, partially cystic mass that frequently was associated with a nipple discharge. The median duration of symptoms was 2 months for patients with pure DCIS and 6 months for patients with DCISAIC. Histologically, the predominant appearance of DCIS (in 74% of cases) was that of a papillary carcinoma often with a superimposed cribriform pattern. Intraductal extension beyond the main papillary lesion was common. It is interesting to note that the pure DCIS cases in this series were uniformly of either low or intermediate grade; high grade or comedocarcinomas were only observed within the group of DCISAIC. No significant morphologic differences between pure DCIS and DCISAIC were encountered, although DCISAIC did show relatively more cellular atypia with more frequent necrosis compared with pure DCIS.
DCIS in the male breast is a distinct lesion that occurs at an older age and displays a significantly different distribution of morphologic subtypes compared with its female counterpart. It presents most frequently as an intraductal papillary carcinoma, and less commonly as a nonpapillary cribriform, solid, or micropapillary DCIS. In the current study the majority of pure DCIS cases were low grade (AFIP Grade 1) with occasional cases displaying necrosis (AFIP Grade 2); high grade pure DCIS appears to be a rare lesion in the male breast. In contrast, DCIS associated with invasive carcinoma more frequently is of higher grade.
男性乳腺导管原位癌（DCIS）是一种罕见疾病，据作者所知，迄今为止仅有少量相关研究。与女性乳腺DCIS相比，已有研究提示两者在临床和形态学上存在明显差异。
检索武装部队病理研究所（AFIP）的档案，查找男性患者的纯DCIS及与浸润性癌相关的DCIS（DCISAIC）病例。共识别出280例纯DCIS和759例浸润性乳腺肿瘤；本初步报告研究了114例病例（包括84例纯DCIS和30例DCISAIC）。所有病例均根据DCIS的特定亚型（乳头状、筛状、实性、微乳头状和粉刺状）及分级进行复查和分类。从患者病历中提取基本临床数据。
纯DCIS男性患者的中位年龄为65岁，典型表现为乳晕后结节状、部分囊性肿块，常伴有乳头溢液。纯DCIS患者症状的中位持续时间为2个月，DCISAIC患者为6个月。组织学上，DCIS的主要表现（74%的病例）为乳头状癌，常伴有筛状结构。导管内延伸超出主要乳头状病变很常见。有趣的是，本系列中的纯DCIS病例均为低级别或中级别；高级别或粉刺癌仅在DCISAIC组中观察到。尽管与纯DCIS相比，DCISAIC确实显示出相对更多的细胞异型性和更频繁的坏死，但纯DCIS与DCISAIC之间未发现明显的形态学差异。
男性乳腺DCIS是一种独特的病变，发病年龄较大，与女性乳腺DCIS相比，其形态学亚型分布有显著差异。它最常表现为导管内乳头状癌，较少表现为非乳头状筛状、实性或微乳头状DCIS。在本研究中，大多数纯DCIS病例为低级别（AFIP 1级），偶有病例出现坏死（AFIP 2级）；高级别纯DCIS在男性乳腺中似乎是一种罕见病变。相比之下，与浸润性癌相关的DCIS更常为高级别。
