Histopathology of the Male Breast: Eleven Years Experience of the Vanderbilt Breast Consultation Service
ME Sanders, SA Manning, JA Smith, JF Simpson, DL Page. Vanderbilt University, Nashville, TN
Background: Male invasive breast cancer (IBC) is rare with an incidence of 1% among all breast cancers. Atypical ductal hyperplasia (ADH) in men is extremely rare. Where as gynecomastia, a benign enlargement of the male breast as a result of proliferation of the glandular component, is common, being temporarily present in 30-50% of healthy men. Diagnoses of ductal carcinoma in situ (DCIS) as well as ADH are indications for total mastectomy in men. Given the prevalence of gynecomastia and the rarity of ADH in males, strict criteria for diagnosis of ADH must be applied.
Design: The authors report the variety of male breast pathology seen in consultation by the Vanderbilt Breast Consultation Service over an approximately 11 year period from December 1997 to September 2009.
Results: Cases from 79 males averaging 52 years of age (range 13-99 yrs) were received in consultation. Eight IBC (6 intermediate grade no special type, 1 low grade no special type, and 1 special type pure invasive cribriform carcinoma), 14 cases of ductal carcinoma in situ (9 low grade, 4 intermediate grade, and 1 high grade with Paget's disease), 42 cases of ADH (3 involving papillomas), 13 cases of gynecomastia without atypical hyperplasia, and 2 benign stromal lesions (myofibroblastoma and cellular leiomyoma) were diagnosed. All but the stromal lesions and 3 of the invasive cancers showed at least focal background gynecomastia. IBC and DCIS each showed a non-overlapping bimodal age distribution (average ages 33 and 71 years, respectively) where as the diagnosis ADH showed a uniform distribution with age (13-82 yrs).
Conclusions: The most frequent male breast lesion seen in consultation was ADH arising in a background of gynecomastia. The same histologic criteria used for diagnosis of ADH in the female breast should be rigidly applied to avoid unnecessary mastectomy. The uniform age distribution for ADH in contrast to the bimodal distribution of carcinomas suggests ADH is an important marker of risk which differs with age. Male breast cancer is rare even in a consultation setting (less than 1 case per year). The histopathology of these lesions is identical to their female counterparts.
Monday, March 22, 2010 1:00 PM
Poster Session II # 41, Monday Afternoon