Invasive breast carcinoma - IARC

Tumours of the male breast
K. Prechtel P. Pisani
F. Levi H. Hoefler
C. La Vecchia D. Prechtel
A. Sasco P. Devilee
B. Cutuli
Definition
Breast tumours occur much less frequently
in men than in women. The most
common male breast lesions are gynaecomastia,
carcinoma, and metastatic
cancers. Other benign or malignant
lesions also occur, but much more rarely.
Gynaecomastia
Definition
Gynaecomastia is a non-neoplastic,
often reversible, enlargement of the rudimentary
duct system in male breast tissue
with proliferation of epithelial and
mesenchymal components re s e m b l i n g
f i b roadenomatous hyperplasia of the
female breast.
Synonym
Fibrosis mammae virilis (no longer used).
Epidemiology
There are three typical, steroid dependent,
age peaks; neonatal, adolescent
(2nd/3rd decade) and the so-called male
climacteric phase (6th/7th decade).
T h e re is always relative or absolute
endogeneous or exogeneous estrogenism.
Gynaecomastia is frequent in
Klinefelter syndrome and also occurs in
association with liver cirrhosis, endocrine
tumours and certain medications {1263,
2572}.
Clinical features
Gynaecomastia generally involves both
breasts but is often clinically more distinct
in one. Nipple secretion is rare.
There is a palpable retroareolar nodule or
plaque like induration. Occasionally
there is aching pain.
Macroscopy
T h e re is generally circ u m s c r i b e d
enlargement of breast tissue which is
firm and grey white on the cut surface.
Histopathology
There is an increased number of ducts
lined by epithelial and myoepithelial
cells. The surrounding cellular, myxoid
stroma contains fibroblasts and myofibroblasts,
intermingled with lymphocytes
and plasma cells. Lobular structure s ,
with or without secretory changes, are
rare and mostly occur in response to
exogenous hormonal stimulation such as
transsexual estrogen therapy. This florid
phase is followed by an inactive fibrous
phase with flat epithelial cells and hyalinized
periductal stroma. An intermediate
phase with a combination of features
also occurs. Occasionally, duct ectasia,
apocrine or squamous metaplasia develop.
An increase in the amount of adipose
breast tissue alone may be called lipomatous
pseudogynaecomastia.
Immunoprofile
Patients with Klinefelter syndrome exhibit
elevated amounts of estrogen (ER) and
progesterone (PR) receptors but other
examples of gynaecomastia do not
demonstrate significant elevation {2215,
2666}.
In gynaecomastia induced by antiandrogen
therapy, but not in carcinoma of the
b reast, there may be strong focal
prostate specific antigen (PSA) immun
o reactivity in normal or hyperplastic
duct epithelium, while PSAP activity is
negative. These findings should not be
misinterpreted as indicating a metastasis
from a prostatic carcinoma {968}.
Prognosis and predictive factors
Recurrence of gynaecomastia is possible.
Atypical ductal epithelial hyperplasia
and carcinoma in situ are rarely seen in
cases of gynaecomastia but there is no
convincing evidence that gynaecomastia,
per se, is precancerous.
Carcinoma
Definition
C a rcinoma of the male breast is a rare
malignant epithelial tumour histologically
identical to that seen in the female bre a s t .
Both in situ and invasive carc i n o m a
o c c u r, at a ratio of about 1:25 {713}.
Fig. 1.164 Gynaecomastia of the male breast (left >
right).
ICD-O code 8500/3
Epidemiology
Male breast cancer is extremely rare,
representing less than 1% of all breast
cancers, and less than 1% of all cancer
deaths in men. Not surprisingly, therefore,
little is known about its epidemiology.
The incidence of and mortality from
male breast cancer have been reported
to be rising. Reviews of incidence trends
in Scandinavia {814} and mortality trends
in Europe {1551} give no support to the
existence of such upward tre n d s .
Mortality rates, for most countries, in the
late 1980s and 1990s tended to be lower
than those registered three decades earlier,
suggesting that advances in diagnosis
and treatment may have improved the
prognosis {1551}.
In the 1990s, mortality rates from male
breast cancer were around 2 per million
Fig. 1.165 Gynaecomastia of the male breast, with
proliferating ducts and periductal stroma.
110 Tumours of the breast