Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 6, Num. 4, 2010, pp. 590-591

Journal of Cancer Research and Therapeutics, Vol. 6, No. 4, October-December, 2010, pp. 590-591

Letter to the Editor

Mucinous carcinoma of the male breast

Subhashish Das, Prabhakar Kalyani

Department of Pathology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India

Correspondence Address: Subhashish Das, C/o Dr. Kalyani R., H. No. 127/13, "Sri Ganesh", 4th main, 4th cross, P.C. Extension, Kolar - 563 101, Karnataka, India, daspathology@gmail.com

Code Number: cr10149

PMID: 21358113

DOI: 10.4103/0973-1482.77094

Sir,

A 35-year-male with a history of slow growing, painless lump in the right breast since 2 years was presented. On examination the lump was found to be firm, nodular, non-tender and measured 4×3 cms. Axillary lymph nodes were not palpable. Systemic examination was normal.

The routine investigations were normal. Aspiration was done using a 22-G needle and a 10-cc syringe. The aspirate was mucoid. Multiple smears were prepared and stained with Hematoxylin and Eosin (H&E), May-Grunwald-Giemsa stain and Meyers mucicarmine stain. The smears were highly cellular. The tumor cells were arranged as 3-D balls, pseudo-papillary structures and angulated papillae entangled in pools of mucin [Figure - 1]. The tumor cells had clear to eosinophilic cytoplasm with the nuclei having fine chromatin and indistinct nucleoli. Abundant extracellular mucin, confirmed with mucicarmine stain, was observed.[Figure - 2] Cytomorphologically a diagnosis of mucinous carcinoma (Grade 2 was made).

Mastectomy specimen received measured 12×6×3 cms. Nipple and areola were normal. Cut-section showed a circumscribed gray white nodule 4×3×1 cms. The cut-surface was translucent with ill-defined margins. No lymph nodes were identified. Histopathological examination showed features of mucinous carcinoma with tumor cells arranged in a variable pattern of cell balls, pseudo-papillae, cohesive clusters and singly with the retraction spaces around the tumor cell showing abundant mucin. [Figure - 3]. The neoplastic cells were positive for estrogen (ER) and progesterone receptors (PR). Post-operative period was uneventful and the patient is having a regular follow-up.

Male breast carcinoma accounts for less than 1% of all breast cancers. ^[1] Mucinous carcinoma constitutes not more than 0.5% among the histological variants, commonest being the infiltrating duct carcinoma (80.5%). ^[1] If more than 90% of the tumor area consists of mucinous element, a diagnosis of pure mucinous carcinoma is considered which has a better prognosis. ^[1] In their study, Bhagat et al^[2] found 14 cases of malignant mammary tumor in men of which only one case of mucinous carcinoma was reported. Visfeldt et al, ^[3] had found five cases of mucinous carcinoma out of 187 male breast carcinoma. High-risk genetic factors for male breast cancer include BRCA2 mutations, Klinefelter syndrome, hormonal imbalances, radiation exposure and family history. ^[4]

Majority of the mammary mucinous tumors in men are ER-positive, which, however, does not correlate with a better prognosis and are often associated with a higher stage of the disease. ^[5] Additional immunohistochemical features of male breast cancer include over expression of p ⁵³ and Erb-B2, which are associated with survival and cell proliferative activities. ^[5] Worse prognosis in men is due to anatomic factors (i.e., paucity of breast tissue and close tumor proximity to skin and nipple, facilitating dermal lymphatic spread and early regional and distant metastasis) and delayed diagnosis. ^[5] Modified radical mastectomy, combined with sentinel-node biopsy, is the standard treatment.

References

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