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Pleomorphic lobular carcinoma of the male breast with axillary lymph node involvement: a case report and review of literature.

Zahir MN, Minhas K, Shabbir-Moosajee M - BMC Clin Pathol (2014)

Bottom Line: Chronic consumption of ethanol by our patient may have resulted in some degree of hepatic impairment with resultant hyperestrogenism.This in theory may have been the cause of his gynaecomastia, resultant breast cancer and is a plausible explanation for development of the invasive lobular subtype in a male.Additional studies are hence necessary to improve our understanding of this disease in males.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi 74800, Pakistan.

ABSTRACT

Background: Carcinoma of the male breast is responsible for less than 1% of all malignancies in men but the incidence is rising. Invasive ductal carcinoma is the most common histological subtype while invasive lobular carcinoma is responsible for only 1.5% of the total cases of which pleomorpic lobular carcinoma is an extremely rare variant. We report the case of a gentleman with node positive, pleomorphic lobular carcinoma of the breast.

Case presentation: An elderly gentleman with a past history of type 2 diabetes and long term ethanol use presented to us with a self-discovered palpable lump in the left breast. Physical examination revealed bilateral gynaecomastia along with a well circumscribed subareolar mass and palpable lymphadenopathy in the ipsilateral axilla. The breast nodule revealed atypical cells on fine needle aspiration biopsy and the patient underwent a modified radical mastectomy after systemic surveillance was negative for metastatic disease. The lesion was reported as grade III pleomorphic lobular carcinoma with a lack of E-cadherin expression on immunohistochemistry and the neoplastic cells exhibited strong positivity for estrogen receptor in the absence of Her2 gene amplification. Six out of the eleven dissected regional lymph nodes showed evidence of disease. The patient completed 4 cycles of adjuvant chemotherapy without evidence of recurrent disease and was subsequently lost to follow up.

Conclusions: Although invasive lobular carcinomas comprise 12% of all female breast cancers, they are very rare in males due to lack of acini and lobules in the normal male breast. Pleomorphic lobular carcinoma, an aggressive variant of ILC is even rarer in males. Chronic consumption of ethanol by our patient may have resulted in some degree of hepatic impairment with resultant hyperestrogenism. This in theory may have been the cause of his gynaecomastia, resultant breast cancer and is a plausible explanation for development of the invasive lobular subtype in a male. The prognosis and clinicopatholocial features of pleomorphic lobular carcinoma in men are less clearly defined due to its rarity. Additional studies are hence necessary to improve our understanding of this disease in males.

No MeSH data available.


Related in: MedlinePlus

Magnification; × 20: Negative E-cadherin immunostaining of tumor cells with positive internal control in skin adnexal structures.
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Figure 3: Magnification; × 20: Negative E-cadherin immunostaining of tumor cells with positive internal control in skin adnexal structures.

Mentions: Tumor cells were negative for E-cadherin immunostain (Figure 3) and thus based on morphology and immunprofile a diagnosis of invasive lobular carcinoma, pleomorphic variant was rendered. The neoplastic cells were strongly positive for estrogen receptor expression but only displayed weak positivity for expression of the progesterone receptor. Her2-Neu staining by immunohistochemistry revealed a score of +1 and the Ki-67 proliferative index was 20-25%.


Pleomorphic lobular carcinoma of the male breast with axillary lymph node involvement: a case report and review of literature.

Zahir MN, Minhas K, Shabbir-Moosajee M - BMC Clin Pathol (2014)

Magnification; × 20: Negative E-cadherin immunostaining of tumor cells with positive internal control in skin adnexal structures.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4008413&req=5

Figure 3: Magnification; × 20: Negative E-cadherin immunostaining of tumor cells with positive internal control in skin adnexal structures.
Mentions: Tumor cells were negative for E-cadherin immunostain (Figure 3) and thus based on morphology and immunprofile a diagnosis of invasive lobular carcinoma, pleomorphic variant was rendered. The neoplastic cells were strongly positive for estrogen receptor expression but only displayed weak positivity for expression of the progesterone receptor. Her2-Neu staining by immunohistochemistry revealed a score of +1 and the Ki-67 proliferative index was 20-25%.

Bottom Line: Chronic consumption of ethanol by our patient may have resulted in some degree of hepatic impairment with resultant hyperestrogenism.This in theory may have been the cause of his gynaecomastia, resultant breast cancer and is a plausible explanation for development of the invasive lobular subtype in a male.Additional studies are hence necessary to improve our understanding of this disease in males.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi 74800, Pakistan.

ABSTRACT

Background: Carcinoma of the male breast is responsible for less than 1% of all malignancies in men but the incidence is rising. Invasive ductal carcinoma is the most common histological subtype while invasive lobular carcinoma is responsible for only 1.5% of the total cases of which pleomorpic lobular carcinoma is an extremely rare variant. We report the case of a gentleman with node positive, pleomorphic lobular carcinoma of the breast.

Case presentation: An elderly gentleman with a past history of type 2 diabetes and long term ethanol use presented to us with a self-discovered palpable lump in the left breast. Physical examination revealed bilateral gynaecomastia along with a well circumscribed subareolar mass and palpable lymphadenopathy in the ipsilateral axilla. The breast nodule revealed atypical cells on fine needle aspiration biopsy and the patient underwent a modified radical mastectomy after systemic surveillance was negative for metastatic disease. The lesion was reported as grade III pleomorphic lobular carcinoma with a lack of E-cadherin expression on immunohistochemistry and the neoplastic cells exhibited strong positivity for estrogen receptor in the absence of Her2 gene amplification. Six out of the eleven dissected regional lymph nodes showed evidence of disease. The patient completed 4 cycles of adjuvant chemotherapy without evidence of recurrent disease and was subsequently lost to follow up.

Conclusions: Although invasive lobular carcinomas comprise 12% of all female breast cancers, they are very rare in males due to lack of acini and lobules in the normal male breast. Pleomorphic lobular carcinoma, an aggressive variant of ILC is even rarer in males. Chronic consumption of ethanol by our patient may have resulted in some degree of hepatic impairment with resultant hyperestrogenism. This in theory may have been the cause of his gynaecomastia, resultant breast cancer and is a plausible explanation for development of the invasive lobular subtype in a male. The prognosis and clinicopatholocial features of pleomorphic lobular carcinoma in men are less clearly defined due to its rarity. Additional studies are hence necessary to improve our understanding of this disease in males.

No MeSH data available.


Related in: MedlinePlus