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Breast Lesions/Neoplasms in Men

  • Filippo Borri
  • Alessandro Bombonati
Chapter

Abstract

Male breast pathologies are quite uncommon, especially the malignant ones; while gynecomastia is a very frequent condition in overweight or hormone-dysfunctional men, male breast carcinoma in very uncommon. The lack of casuistry and information, along with lack of a “culture of prevention,” lead male breast cancer to a high rate of mortality despite the low incidence. In this chapter, all the most frequent pathological conditions of the male breast will be illustrated, together with explanatory pictures and hints for histological and cytological description. Some very rare conditions are also reported, such as myofibroblastoma, adenomyoepithelioma, Paget disease, and metaplastic changes in benign and neoplastic tissue. Moreover, we envision this part of the atlas as having the purpose of highlighting male breast pathologic conditions and their correlation with biological and environmental risk factors, and try to provide useful elements to understand pathophysiologic mechanisms underpinning these pathologies.

Keywords

Gynecomastia Papilloma Fibroadenoma Ductal carcinoma in-situ Invasive ductal carcinoma 

References

  1. 1.
    Tavassoli FA. Male breast lesions. In: Tavassoli FA, editor. Pathology of the breast. 2nd ed. New York: McGraw-Hill; 1999.Google Scholar
  2. 2.
    González CC, Romero Manteola EJ. Intraductal metachronic papilloma: clinical case. Arch Argent Pediatr. 2015;113(6):e314–6.PubMedGoogle Scholar
  3. 3.
    Durkin ET, Warner TF, Nichol PF. Enlarging unilateral breast mass in an adolescent male: an unusual presentation of intraductal papilloma. J Pediatr Surg. 2011;46(5):e33–5.CrossRefGoogle Scholar
  4. 4.
    De Vries FEE, Walter AW, Vrouenraets BC. Intraductal papilloma of the male breast. J Surg Case Rep. 2016;2016(2):rjw014.CrossRefGoogle Scholar
  5. 5.
    Shim JH, Son EJ, Kim EK, Kwak JY, Jeong J, Hong SW. Benign intracystic papilloma of the male breast. J Ultrasound Med. 2008;27(9):1397–400.CrossRefGoogle Scholar
  6. 6.
    Reid-Nicholson MD, Tong G, Cangiarella JF, Moreira AL. Cytomorphologic features of papillary lesions of the male breast: a study of 11 cases. Cancer. 2006;108(4):222–30.CrossRefGoogle Scholar
  7. 7.
    Nguyen C, Kettler MD, Swirsky ME, Miller VI, Scott C, Krause R, et al. Male breast disease: pictorial review with radiologic-pathologic correlation. Radiographics. 2013;33:763–79.CrossRefGoogle Scholar
  8. 8.
    Sara AS, Gottfried MR. Benign papilloma of the male breast following chronic phenothiazine therapy. Am J Clin Pathol. 1987;87:649–50.CrossRefGoogle Scholar
  9. 9.
    Munitiz V, Illana J, Sola J, Piñero A, Rios A, Parrilla P. A case of breast cancer associated with juvenile papillomatosis of the male breast. Eur J Surg Oncol. 2000;26(7):715–6.CrossRefGoogle Scholar
  10. 10.
    Pacilli M, Sebire NJ, Thambapillai E, Pierro A. Juvenile papillomatosis of the breast in a male infant with Noonan syndrome, café au lait spots, and family history of breast carcinoma. Pediatr Blood Cancer. 2005;45(7):991–3.CrossRefGoogle Scholar
  11. 11.
    Burga AM, Fandare O, Lininger RA, Tavassoli FA. Invasive carcinomas of the male breast: a morphologic study of the distribution of histologic subtypes and metastatic patterns in 778 cases. Virchows Arch. 2006;449:507–12.CrossRefGoogle Scholar
  12. 12.
    Murray MP, Brogi E. Benign proliferative lesions of the male breast. In: Hoda SA, Brogi E, Koerner FC, Rosen PP, editors. Rosen’s breast pathology. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2014. p. 957.Google Scholar
  13. 13.
    Nielsen BB. Fibroadenomatoid hyperplasia of the male breast. Am J Surg Pathol. 1990;14(8):774–7.CrossRefGoogle Scholar
  14. 14.
    Uchida T, Ishii M, Motomiya Y. Fibroadenoma associated with gynaecomastia in an adult man. Case report. Scand J Plast Reconstr Surg Hand Surg. 1993;27(4):327–9.CrossRefGoogle Scholar
  15. 15.
    Shin SJ, Rosen PP. Bilateral presentation of fibroadenoma with digital fibroma-like inclusions in the male breast. Arch Pathol Lab Med. 2007;131(7):1126–9.PubMedGoogle Scholar
  16. 16.
    Adibelli ZH, Yildirim M, Ozan E, Oztekin O, Kucukzeybek B. Fibroadenoma of the breast in a man associated with adenocarcinoma of the rectum and polyposis coli. JBR-BTR. 2010;93(1):12–4.PubMedGoogle Scholar
  17. 17.
    Lemmo G, Garcea N, Corsello S, Tarquini E, Palladino T, Ardito G, et al. Breast fibroadenoma in a male-to-female transsexual patient after hormonal treatment. Eur J Surg Suppl. 2003;588:69–71.Google Scholar
  18. 18.
    Ansah-Boateng Y, Tavassoli FA. Fibroadenoma and cystosarcoma phyllodes of the male breast. Mod Pathol. 1992;5(2):114–6.PubMedGoogle Scholar
  19. 19.
    LeWinn EB. Gynecomastia during digitalis therapy; report of eight additional cases with liver-function studies. N Engl J Med. 1953;248(8):316–20.CrossRefGoogle Scholar
  20. 20.
    Hilton DA, Jameson JS, Furness PN. A cellular fibroadenoma resembling a benign phyllodes tumour in a young male with gynaecomastia. Histopathology. 1991;18:476–7.CrossRefGoogle Scholar
  21. 21.
    Amira RA, Sheikhb SS. Breast hamartoma: a report of 14 cases of an under-recognized and under-reported entity. Int J Surg Case Rep. 2016;22:1–4.CrossRefGoogle Scholar
  22. 22.
    Karihtala P, Rissanen T, Touminen H. Male malignant phyllodes breast tumor after prophylactic breast radiotherapy and bicalutamide treatment: a case report. Anticancer Res. 2016;36(7):3433–6.PubMedGoogle Scholar
  23. 23.
    Ashutosh N, Virendra K, Attri PC, Arati S. Giant male fibroadenoma: a rare benign lesion. Indian J Surg. 2013;75(Suppl 1):353–5.CrossRefGoogle Scholar
  24. 24.
    McHoney M, Munro F, Mackinlay G. Mammary duct ectasia in children: report of a short series and review of the literature. Early Hum Dev. 2011;87(8):527–30.CrossRefGoogle Scholar
  25. 25.
    Aydin R, Baris Gul S, Polat AV. Detection of duct ectasia of mammary gland by ultrasonography in a neonate with bloody nipple discharge. Pediatr Neonatol. 2014;55(3):228–30.CrossRefGoogle Scholar
  26. 26.
    Robertson KE, Kazmi SA, Jordan LB. Female-type fibrocystic disease with papillary hyperplasia in a male breast. J Clin Pathol. 2010;63(1):88–9.CrossRefGoogle Scholar
  27. 27.
    McClure J, Banerjee SS, Sandilands DG. Female type cystic hyperplasia in a male breast. Postgrad Med J. 1985;61(715):441–3.CrossRefGoogle Scholar
  28. 28.
    Bigotti G, Kasznica J. Sclerosing adenosis in the breast of a man with pulmonary oat cell carcinoma: report of a case. Hum Pathol. 1986;17(8):861–3.CrossRefGoogle Scholar
  29. 29.
    Berna JD, Arcas I, Ballester A, Bas A. Adenomyoepithelioma of the breast in a male. AJR Am J Roentgenol. 1997;169(3):917–8.CrossRefGoogle Scholar
  30. 30.
    Tamura G, Monma N, Suzuki Y, Satodate R, Abe H. Adenomyoepithelioma (myoepithelioma) of the breast in a male. Hum Pathol. 1993;24(6):678–81.CrossRefGoogle Scholar
  31. 31.
    Wahab TA, Uwakwe H, Gillibrand R, Fafemi O. Male breast adenomyoepithelioma- a case report and literature review. Afr J Cell Pathol. 2017;8:43–4.CrossRefGoogle Scholar
  32. 32.
    Omar LA, Rojanapremsuk T, Saluja K, Merchant KA, Sharma PB. Radiologic and histologic presentation of male mammary myofibroblastoma. Proc (Bayl Univ Med Cent). 2016;29(3):321–2.CrossRefGoogle Scholar
  33. 33.
    Akgül S, Kanbur N, Güçer S, Safak T, Derman O. The histopathological effects of tamoxifen in the treatment of pubertal gynecomastia. J Pediatr Endocrinol Metab. 2012;25(7–8):753–5.PubMedGoogle Scholar
  34. 34.
    Haibach H, Rosenholtz MJ. Prepubertal gynecomastia with lobules and acini: a case report and review of the literature. Am J Clin Pathol. 1983;80(2):252–5.CrossRefGoogle Scholar
  35. 35.
    Demirbilek H, Bacak G, Baran RT, Avcı Y, Baran A, Keleş A, et al. Prepubertal unilateral gynecomastia: report of 2 cases. J Clin Res Pediatr Endocrinol. 2014;6(4):250–3.CrossRefGoogle Scholar
  36. 36.
    Bannayan GA, Hajdu SI. Gynecomastia: clinicopathologic study of 351 cases. Am J Clin Pathol. 1972;57:431–7.CrossRefGoogle Scholar
  37. 37.
    De Pinho JC, Aghajanova L, Herndon CN. Prepubertal gynecomastia due to indirect exposure to nonformulary bioidentical hormonal replacement therapy: a case report. J Reprod Med. 2016;61(1–2):73–7.PubMedGoogle Scholar
  38. 38.
    Green L, Wysowski DK, Fourcroy JL. Gynecomastia and breast cancer during finasteride therapy. N Engl J Med. 1996;335:823.CrossRefGoogle Scholar
  39. 39.
    Caocci G, Atzeni S, Orrù N, Azzena L, Martorana L, Littera A, et al. Gynecomastia in a male after dasatinib treatment for chronic myeloid leukemia. Leukemia. 2008;22:2127–8.CrossRefGoogle Scholar
  40. 40.
    Tanriverdi O, Unubol M, Taskin F, Meydan N, Sargin G, Guney E, et al. Imatinib-associated bilateral gynecomastia and unilateral testicular hydrocele in male patient with metastatic gastrointestinal stromal tumor: a literature review. J Oncol Pharm Pract. 2012;18:303–10.CrossRefGoogle Scholar
  41. 41.
    Dickson G. Gynecomastia. Am Fam Physician. 2012;85(7):716–22.PubMedGoogle Scholar
  42. 42.
    Williams MJ. Gynecomastia. Its incidence, recognition and host characterization in 447 autopsy cases. Am J Med. 1963;34:103–12.CrossRefGoogle Scholar
  43. 43.
    Bojesen A, Gravholt CH. Klinefelter syndrome in clinical practice. Nat Clin Pract Urol. 2007;4(4):192–204.CrossRefGoogle Scholar
  44. 44.
    Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, et al. Imaging characteristics of malignant lesions of the male breast. Radiographics. 2006;26(4):993–1006.CrossRefGoogle Scholar
  45. 45.
    Mizutou A, Nakashima K, Moriya T. Large pseudoangiomatous stromal hyperplasia complicated with gynecomastia and lobular differentiation in a male breast. Springerplus. 2015;4:282.CrossRefGoogle Scholar
  46. 46.
    Zimmerman RL, Fogt F, Cronin D, Lynch R. Cytologic atypia in a 53-year-old man with finasteride-induced gynecomastia. Arch Pathol Lab Med. 2000;124(4):625–7.PubMedGoogle Scholar
  47. 47.
    Kornegoor R, Verschuur-Maes AH, Buerger H, van Diest PJ. The 3-layered ductal epithelium in gynecomastia. Am J Surg Pathol. 2012;36(5):762–8.CrossRefGoogle Scholar
  48. 48.
    Johnson RE, Hassan Murad M. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009;84(11):1010–5.CrossRefGoogle Scholar
  49. 49.
    Age-adjusted SEER incidence rates by cancer site, all ages, all races, male 1975–2013. https://seer.cancer.gov/csr/1975_2014/browse_csr.php?sectionSEL=4&pageSEL=sect_04_table.05.html. Accessed 18 Feb 2018.
  50. 50.
    Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.CrossRefGoogle Scholar
  51. 51.
    Bender PF, de Oliveira LL, Costa CR, de Aguiar SS, Bergmann A, Thuler LCS. Men and women show similar survival rates after breast cancer. J Cancer Res Clin Oncol. 2017;143(4):563–71.CrossRefGoogle Scholar
  52. 52.
    Javidiparsijani S, Rosen LE, Gattuso P. Male breast carcinoma: a clinical and pathological review. Int J Surg Pathol. 2017;25(3):200–5.CrossRefGoogle Scholar
  53. 53.
    Weiss JR, Moysich KB, Swede H. Epidemiology of male breast cancer. Cancer Epidemiol Biomark Prev. 2005;14(1):20–6.Google Scholar
  54. 54.
    Kanhai RC, Hage JJ, van Diest PJ, Bloemena E, Mulder JW. Short term and long term histologic effects of castration and estrogen treatment on breast tissue of 14 male-to-female transsexual in comparison with two chemically castrated men. Am J Surg Pathol. 2000;24:74–80.CrossRefGoogle Scholar
  55. 55.
    Leibowitz SB, Gaber JE, Fox EA, Loda M, Kaufman DS, Kantoff PW, et al. Male patients with diagnoses of both breast cancer and prostate cancer. Breast J. 2003;9(3):208–12.CrossRefGoogle Scholar
  56. 56.
    Lee UJ, Jones JS. Incidence of prostate cancer in male breast cancer patients: a risk factor for prostate cancer screening. Prostate Cancer Prostatic Dis. 2009;12(1):52–6.CrossRefGoogle Scholar
  57. 57.
    Brinton LA, Richesson DA, Gierach GL, Lacey JV Jr, Park Y, Hollenbeck AR, et al. Prospective evaluation of risk factors for male breast cancer. J Natl Cancer Inst. 2008;100:1477–81.CrossRefGoogle Scholar
  58. 58.
    Pritzlaff M, Summerour P, McFarland R, Li S, Reineke P, Dolinsky JS, Goldgar DE, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575–86.CrossRefGoogle Scholar
  59. 59.
    McLaughlin JK, Malker HS, Blot WJ, Weiner JA, Ericsson JL, Fraumeni JF Jr. Occupational risks for male breast cancer in Sweden. Br J Ind Med. 1988;45(4):275–6.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Age-adjusted SEER incidence rates by age, male breast, all races, male, 1975–2013 (SEER 9). https://seer.cancer.gov/csr/1975_2014/results_single/sect_01_table.12_2pgs.pdfAge. Accessed 18 Feb 2018.
  61. 61.
    Chau A, Jafarian N, Rosa M. Male breast: clinical and imaging evaluations of benign and malignant entities with histologic correlation. Am J Med. 2016;129(8):776–91.CrossRefGoogle Scholar
  62. 62.
    Schmitt F, Gerhard R, Stanley DE, Domanski HA. Breast. In: Domanski HA, editor. Atlas of fine needle aspiration cytology. London: Springer; 2014. p. 67–8.Google Scholar
  63. 63.
    Carder PJ, Speirs V, Ramsdale J, Lansdown MR. Expression of prostate specific antigen in male breast cancer. J Clin Pathol. 2005;58(1):69–71.CrossRefGoogle Scholar
  64. 64.
    Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006;367:595–604.CrossRefGoogle Scholar
  65. 65.
    Fentiman IS. Male breast cancer: a review. Ecancermedicalscience. 2009;3:140.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Hittmair AP, Lininger RA, Tavassoli FA. Ductal carcinoma in situ (DCIS) in the male breast: a morphologic study of 84 cases of pure DCIS and 30 cases of DCIS associated with invasive carcinoma--a preliminary report. Cancer. 1998;83(10):2139–49.CrossRefGoogle Scholar
  67. 67.
    Pal SK, Lau SK, Kruper L, Nwoye U, Garberoglio C, Gupta RK, et al. Papillary carcinoma of the breast: an overview. Breast Cancer Res Treat. 2010;122(3):637–45.CrossRefGoogle Scholar
  68. 68.
    O’Malley F, Visscher D, MacGrogan G, et al. Papilloma with ADH and DCIS. In: Lakhani S, Ellis I, Schnitt S, Tan P, van de Vijver M, editors. WHO classifications of tumors of the breast. 4th ed. Lyon: IARC Press; 2012. p. 101–2.Google Scholar
  69. 69.
    O’Sullivan ST, Mc Greal GT, Lyons A, Burke L, Geoghegan JG, Brady MP. Paget’s disease of the breast in a man without underlying breast carcinoma. J Clin Pathol. 1994;47:851–2.CrossRefGoogle Scholar
  70. 70.
    Sanchez AG, Villanueva AG, Redondo C. Lobular carcinoma of the breast in a patient with klinefelter's syndrome. A case with bilateral, synchronous, histologically different breast tumors. Cancer. 1986;57:1181–3.CrossRefGoogle Scholar
  71. 71.
    Chandrasekharan S, Fasanya C, Macneill FA. Invasive lobular carcinoma of the male breast: do we need to think of Klinefelter’s syndrome? Breast. 2001;10:176–8.CrossRefGoogle Scholar
  72. 72.
    Rohini B, Singh PA, Vatsala M, Vishal D, Mitali S, Nishant S. Pleomorphic lobular carcinoma in a male breast: a rare occurrence. Pathol Res Int. 2010;2010:871369.CrossRefGoogle Scholar
  73. 73.
    Flynn LV, Park J, Patil SM, Cody HS III, Port ER. Sentinel lymph node biopsy is successful and accurate in male breast carcinoma. J Am Coll Surg. 2008;206:616–21.CrossRefGoogle Scholar
  74. 74.
    Donegan WL, Redlich PN, Lang PJ, Gall MT. Carcinoma of the breast in males. Cancer. 1998;83(3):498–509.CrossRefGoogle Scholar
  75. 75.
    Sanguinetti A, Polistena A, Lucchini R, Monacelli M, Galasse S, Avenia S, et al. Male breast cancer, clinical presentation, diagnosis and treatment: twenty years of experience in our Breast Unit. Int J Surg Case Rep. 2016;20(Suppl):8–11.CrossRefGoogle Scholar
  76. 76.
    Barr JG, Clayton ESJ, Sotheran W. A case of metaplastic breast cancer in a man. J Surg Case Rep. 2013.  https://doi.org/10.1093/jscr/rjs047.
  77. 77.
    Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51–7.CrossRefGoogle Scholar
  78. 78.
    Wang-Rodriguez J, Cross K, Gallagher S, Djahanban M, Armstrong JM, Wiedner N, et al. Male breast carcinoma: correlation of ER, PR, Ki-67, Her2-neu, and p53 with treatment and survival, a study of 65 cases. Mod Pathol. 2002;15(8):853–61.CrossRefGoogle Scholar
  79. 79.
    Ciocca V, Bombonati A, Gatalica Z, Di Pasquale M, Milos A, Ruiz-Orrico A, et al. Cytokeratin profiles of male breast cancers. Histopathology. 2006;49:365–70.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pathology and Laboratory Medicine DepartmentEinstein Medical CenterPhiladelphiaUSA
  2. 2.Pathology DepartmentUniversity of RomeTor VergataItaly

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