Although uncommon, diseases of the male breast engender a tremendous emotional response. Fortunately, most diseases present with a mass and are easily detected. Unlike the female breast, only ducts but no lobules are present. Most masses are examples of benign gynecomastia. An excisional biopsy is usually performed and sent to the pathologist. In addition, a fine needle aspiration may be performed with the pathologist using a small needle to aspirate a small sample of cells from the mass. After smearing the cells on a slide, staining it, and examining it under a microscope, a diagnosis can often be rendered. Sometimes, this can spare the patient an invasive surgical procedure.
Gynecomastia is enlargement of the male breast. Male breast cancer is extraordinarily rare and is associated with an aggressive clinical course.
Breast diseases in males--a morphological review of 150 cases.
Gill MS, Kayani N, Khan MN, Hasan SH.
Department of Pathology, Aga Khan University Hospital, Karachi.
J Pak Med Assoc 2000 Jun;50(6):177-9 Abstract quote
OBJECTIVE: This study was carried out to observe the prevalence breast diseases of males in our setup.
METHOD: All cases of male breast disease diagnosed from 1991-97.
RESULTS: One hundred and fifty (150) cases of male breast diseases were diagnosed. Age of the patients ranged from 4 to 90 years, with mean age 38.75 years (median = 33 years). Gynecomastia was the most common pathological abnormality of the male breast (58.66%). Most of the patients presented in the 3rd decade of life. Amongst the malignant conditions, infiltrating ductal carcinoma was most prevalent (82%). Most of the patients with malignancy presented in the 5th and 6th decades of life.
CONCLUSION: Gynecomastia was the most prevalent male breast disorder, followed by infiltrating ductal carcinoma. Our findings correspond with that of world literature.
Fine needle aspiration cytology in the management of male breast masses. Nineteen years of experience.
Joshi A, Kapila K, Verma K.
Department of Pathology, All-India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Acta Cytol 1999 May-Jun;43(3):334-8 Abstract quote
OBJECTIVE: To determine the utility and accuracy of fine needle aspiration cytology (FNAC) as well as its sensitivity, specificity and predictive value in the diagnosis of male breast masses.
STUDY DESIGN: Data on male breast FNAC done between 1978 and 1997 were retrieved from the records of the cytopathology laboratory. FNAC diagnoses were categorized as positive, negative, inconclusive or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity, diagnostic accuracy and predictive values of FNAC were calculated using standard statistical methods.
RESULTS: Five hundred seven of 13,175 patients undergoing breast FNAC were males. Of them, 393/507 had satisfactory aspirates. Of these, 70 were positive (13.8%), 295 were negative (58%), and 29 were inconclusive (5.7%). A total of 114 FNACs (22.5%) were unsatisfactory. Histopathology was available in 97/507 cases. There were no false positive or false negative diagnoses. FNAC had a sensitivity, specificity and diagnostic accuracy of 100% for male breast lesions.
CONCLUSION: This large study shows that FNAC is a very accurate tool for diagnosis of male breast lesions. It is highly sensitive and specific, with good cytohistologic correlation. FNAC should therefore be an integral part of the primary assessment of breast lumps in males.
CLINICAL VARIANTS CHARACTERIZATION GENERAL
Configuration and localization of the nipple-areola complex in men.
Beer GM, Budi S, Seifert B, Morgenthaler W, Infanger M, Meyer VE.
Division for Hand, Plastic and Reconstructive Surgery, Burn Center, University Hospital Zurich, and Institute of Biostatistics, University of Zurich, Switzerland.
Plast Reconstr Surg 2001 Dec;108(7):1947-52; discussion 1953 Abstract quote
The causes of bilateral absence of the nipple-areola complex in men are seldom congenital, but attributable rather to destruction as a result of trauma, or after mastectomy in female-to-male transsexuals and in male breast cancer, or after the correction of extreme bilateral gynecomastia. Such a bilateral loss becomes a major reconstructive challenge with respect to the configuration and localization of a new nipple-areola complex.
Because there is very little information available in the literature, we carried out a cross-sectional study on the configuration and localization of the nipple-areola complex in men.A total of 100 healthy men aged 20 to 36 years were examined under standardized conditions.
The first part of the study dealt with the configuration of the nipple-areola complex (dimensions, round or oval shape). The second part concentrated on the localization of the complex on the thoracic wall with respect to anatomic landmarks and in correlation to various parameters such as weight and height of the body, circumference of the thorax, length of sternum, and position in the intercostal space.
Of the 100 subjects examined, 91 had oval and seven had a round nipple-areola complex. An asymmetry between the right and the left side was found in two cases. The mean ratio of the horizontal/vertical diameter of an oval nipple-areola complex was 27:20 mm and the mean diameter for a round nipple-areola complex was 23 mm. The center of the nipple-areola complex was in the fourth intercostal space in 75 percent and in the fifth intercostal space in 23 percent of the subjects. To localize the nipple-areola complex on the thoracic wall de novo, at least two reproducible measurements proved to be necessary, composed of a horizontal line (distance from the midsternal line to the nipple = A) and a vertical line (distance from the sternal notch to the intersection of line A, = B). The closest correlation for the horizontal distance A was given by the circumference of the thorax: A = 2.4 cm + [0.09 x circumference of thorax (cm)], (r = 0.68). The best correlation to calculate the vertical distance B was found using the distance A and the length of the sternum: B = 1.2 cm + [0.28 x length of sternum (cm)] + [0.1 x circumference of thorax (cm)], (R = 0.50).In cases of bilateral absence, we recommend creating an oval nipple-areola complex in men. T
he appropriate localization can be calculated by means of two simple equations derived from the circumference of the thorax and the length of the sternum.
SPECIAL STAINS/IMMUNOHISTOCHEMISTRY CHARACTERIZATION PSA
Immunohistochemical localization of prostate-specific antigen in ductal epithelium of male breast. Potential diagnostic pitfall in patients with gynecomastia.
Gatalica Z, Norris BA, Kovatich AJ.
Division of Surgical Pathology, John Sealy Hospital, University of Texas Medical Branch, Galveston 77555-0588, USA.
Appl Immunohistochem Mol Morphol 2000 Jun;8(2):158-61 Abstract quote
Enlargement of the male breast is frequently encountered in the course of adjuvant antiandrogen therapy for advanced prostate carcinoma. The clinical differential diagnosis in this setting includes hormonal imbalance-induced gynecomastia, primary breast carcinoma, and metastasis of prostatic carcinoma. Biopsy of the lesion with the identification of prostate-specific antigen (PSA) plays an important role in establishing the correct diagnosis. Recent studies showed that female mammary epithelium may be a significant source of PSA, but its expression in male breasts has not been sufficiently studied.
We found that normal and hyperplastic duct epithelium in gynecomastia exhibited focal, strong (+3) PSA immunoreactivity in 5 of 18 cases (28%). In contrast, no PSA reactivity was found in eight cases of male breast carcinoma. No reactivity was seen with antiprostatic acid phosphatase (PsAP) antibody, in either benign or malignant epithelium.
Frequent expression of PSA in gynecomastia may, in an appropriate clinical setting, cause confusion with metastatic prostatic carcinoma. The lack of immunoreactivity for PsAP in male breast epithelium indicates its usefulness in the differential diagnosis.
See Female Breast
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