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Fine needle aspiration cytology in male breast carcinoma
Pathology
ISSN: 0031-3025 (Print) 1465-3931 (Online) Journal homepage: http://www.tandfonline.com/loi/ipat20
Fine needle aspiration cytology in male breast carcinoma J.L. Slavin & L.I. Baird To cite this article: J.L. Slavin & L.I. Baird (1996) Fine needle aspiration cytology in male breast carcinoma, Pathology, 28:2, 122-124 To link to this article: http://dx.doi.org/10.1080/00313029600169703
Published online: 06 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipat20 Download by: [FU Berlin]
Date: 28 February 2017, At: 00:10
Pathology (1996), 28, pp. 122-124
FINE NEEDLE ASPIRATION CYTOLOGY IN MALE BREAST CARCINOMA J. L. SLAVIN AND L . I. BAIRD
Department of AnatomicaI Pathology, Heidelberg Repatriation Hospital, West Heidelberg, Vic
Summary A veterans' hospital-based retrospective, clinicopathological study was undertaken to evaluate fine needle aspiration cytology (FNAC) in the diagnosis of male breast carcinoma. Two hundred and forty histologically proven cases of breast carcinoma spanning a period of 17 yrs were identified and 13 of these were in males. Nine of these male patients had FNAC perforrfied and were reported by the same cytopathologist (L.I.B.). In 8 of these cases FNAC was diagnostic of carcinoma. No material from FNA was obtained for diagnosis from one of these patients. We concluded that FNA is a useful technique in the diagnosis of male breast carcinoma.
Keywords:Male breast carcinoma,fine needle aspiration cytology. Accepted 1 February1996 INTRODUCTION Fine needle aspiration cytology (FNAC) is an accepted, reliable and cost effective diagnostic technique with a well established role in the investigation of breast pathology. Male breast carcinoma is a relatively uncommon lesion, accounting for less than 1% of all cases of breast carcinoma, and consequently it has been the subject of few reports on the role of FNAC. 1-3 This retrospective study confirms the diagnostic usefulness of F N A C in the diagnosis of male breast carcinoma. MATERIALS AND M E T H O D S All cases coded as breast carcinomabetween the yrs t977 and 1994 were retrieved from the files of the Department of Anatomical Pathology at Heidelberg Repatriation Hospital. Cases of male breast carcinoma were selected and the cytologic material, reports and clinicopathologicaldetails, including age, presentation, site and size of the lesion, were obtained and recorded. This study is based on material from the Heidelberg Repatriation Hospital which serves a large war veteran population. RESULTS A total of 240 cases of histologically proven breast carcinomas were identified, of which 13 cases (5%) were in males. The age range for male breast carcinoma was 47-76 yrs with an average age at diagnosis of 67 yrs. All cases presented as an enlarging, painless, centrally located mass (all at least partly sub-areolar) with 5 cases producing nipple retraction, including one case with nipple ulceration.
In only one case was a family history of breast carcinoma obtained (affecting his mother and one of his sisters). None of the patients had a history of prostatic carcinoma or of exogenous hormone administration. Tumor size ranged from 6 m m up to 45 m m with an average size of 20 mm. In each case the contralateral breast was clinically normal. C Y T O L O G I C A L FEATURES F N A by a single clinician (Mr K. Millar) had been attempted in 9 of 13 cases, with rapid cytologic assessment to confirm the adequacy of the material obtained. Between 2 and 6 slides were prepared from each case with rapid H&E, Papanicolaou and Giemsa staining. No material was submitted from one of the cases as it was considered to be a :failed aspirate clinically and this aspirate was not repeated. Smears from 7 of the cases revealed a highly cellular pattern with numerous large irregular aggregates of crowded abnormal epithelial cells (Fig. 1) and separate isolated discohesive tumor cells. Nests and tubule formation were noted in some of the larger aggregates. Mitoses and necrotic material were not a feature. The remaining case was relatively less cellular with a few groups and clusters of abnormal epithelial cells. The population of abnormal cells showed nuclear enlargement, irregular nuclear borders and prominent nucleoli (Fig. 2). Seven of the cases were considered to be moderately to well differentiated and no large cell variants were noted. One case however showed marked diffuse
Fig. 1 Sheets, small groups and discohesive cells, as seen in FNAC of male breast carcinoma.
FINE NEEDLE ASPIRATIONCYTOLOGY IN MALE BREAST CARCINOMA
123
TABLE 1 Case No.
Tumor size (ram)
1
2 3 4 5 6 7 8 9 10 11 12 13 Fig. 2
Malignant cells demonstrating nuclear enlargement and nucleoli.
cellular discohesion and more pleomorphism and was considered to be a poorly differentiated ductal carcinoma. All cases were initially treated by simple mastectomy with frozen section confirmation of the diagnosis. In 12 of the 13 cases axillary node sampling was also performed. Subsequent histological examination of the surgical specimens showed all cases to be invasive ductal carcinoma. Tumor size, node status and follow-up are presented in Table 1. All node positive patients died of disease. Of the 5 node negative patients, one died of disease and another had bone involvement diagnosed 12 yrs post mastectomy.
DISCUSSION This retrospective study based in a veterans' hospital showed male breast carcinoma as accounting for 5% of all breast carcinoma in the hospital. This figure is higher than previously reported in other more broadly based studies and probably reflects the nature of the veteran population the hospital serves. A range of histologic types of breast carcinoma have been reported in the male breast however ductal carcinoma, as in the female breast, is the commonest type. Node status has been shown to be an important prognostic indicator in male breast carcinoma, with a 10 yr survival rate of 79% for the node negative group and only 11% for the node positive groups. 4 In our study all node positive patients died of disease. Some risk factors for male breast carcinoma have been determined and include Klinefelter syndrome, a strong family history (male or female relatives with a history of breast carcinoma), exogenous estrogen administration and exposure to radiation. 1'57 The relationship between gynecomastia and male breast carcinoma is less clear and they may co-exist. The cytologic criteria used for the diagnosis of breast carcinoma in fine needle aspiration include marked cellularity, often with aggregates, and dispersed, discohesive, large cells with nuclear abnormalities. The cytologic differential diagnosis between gynecomastia and male breast carcinoma is usually clear, however some difficulties arise in cases of gynecomastia with florid epithelial hyperptasia which may produce a celhdar smear and some epithelial changes? "9 Cell cohesiveness, the presence of myoepithelial cells and the absence of individual, single malignant cells help to
6 45 20 10 20 20 20 10 13 20 30 30 25
Node status
N/A
Follow-up DOD 9 yrs DOD 2yrs DOD 4 yrs DOD 4 yrs DOD 1 yr DOD 1 1/2 yr~, DOD 1/2 yr DF 15 yrs DF 9 yrs DF 3 yrs DOD 5 yrs BM at 12 yrs DF at 2 yrs
DOD=died of disease; DF=disease free; BM=bone metastasis; N/A=no nodes sampled.
separate gynecomastia from carcinoma. Nuclear pleomorphism can be seen in gynecomastia, and at times makes the distinction between gynecomastia and carcinoma very difficult. In these cases with nuclear atypia a biopsy should be considered. The aspirates in this study were performed on palpable breast masses that were clinically apparent carcinomas. They were confirmed at frozen section prior to definitive surgical treatment. Another, unusual, cause of male breast enlargement or a breast mass is the possibility of metastatic carcinoma. In particular prostatic adenocarcinorna is a recognized primary tumor that may produce intra-mammary metastases. Immunochemistry for prostatic specific antigen on material obtained by FNA has proved useful. 6'1°'11 FNAC is a useful tool for the diagnosis of male breast carcinoma and the cytologic criteria are identical to those seen in FNAC of the female breast. However additional pitfalls to keep in mind are the possibilities of metastatic tumors and of florid epithelial changes in gynecomastia which may mimic the increased cellularity seen in breast carcinoma. ~z,~3 ACKNOWLEDGEMENT Special thanks to Mr K. Millar (Senior Surgeon) who took an interest in developing the use of FNA within the hospital. Address for correspondence: J.L.S., Department of Anatomical Pathology, St Vincent's Hospital, Victoria Parade, Fitzroy, Vic 3065.
References 1. Crichlow RW. Carcinoma of the male breast. Surg Gynecol Obstet 1972; 134:1011-9 2. Bhagat P, Kline TS. The male breast and malignant neoplasms. Diagnosis by aspiration biopsy cytology. Cancer 1990; 65: 2338-41. 3. Gupta RK, Naren S, Simpson J. The role of fine needle aspiration cytology (FNAC) in the diagnosis of breast masses in males. Eur J Surg Oncol 1988; 14: 317-20. 4. I-Ieller KS, Rosen PP, Schottenfeld D et al. Male breast cancer. A clinicopathologic study of 97 cases. Ann Surg 1978; 188: 60-5. 5. Schottenfeld D, Lilienfeld AM, Diamond H. Some observations on the epidemiology of breast cancer among males. Am J Public Health 1963; 53: 890-7. 6. Wilson SE, Hutchinson WB. Breast masses in males with carcinoma of the prostate. J Surg Oncol 1967; 8: 105-12.
124
SLAVINAND BAIRD
7. Demeter JG, Waterman NG, Verdi GD. Familial male breast carcinoma. Cancer 1990; 65: 2342-3. 8. Ronne R, Ramzy I, Northcutt A. Gynecomastia: cytologic features and diagnostic pitfalls in aspiration biopsies. Acta Cytol 1986; 30: 589. 9. Chang AR. Fine needle aspiration cytology in a case of florid gynaecomastia. Cytopathology 1990; t: 357-61. 10. Keshgenian AA, Kline TS. Immunoperoxidase demonstration of prostatic acid phosphatase. Am J Clin Pathol 1984; 82: 586-9.
Pathology (1996), 28, May 11. Green LK, Klima M. The use of immunohistochemistry in metastatic prostatic adenocarcinoma to the breast. Hum Pathol 1991; 22: 242-6. 12. Lilleng R, Paksoy N, Bural G e t al. Assessment of fine needle aspiration cytology and histopathology for diagnosing male breast masses. Acta Cytol 1995; 39: 877-81. 13. Das DK, Junaid TA, Matthews SB et al. Fine needle aspiration cytology diagnosis of male breast lesions. Acta Cytol 1995; 39: 870~6.
ISSN: 0031-3025 (Print) 1465-3931 (Online) Journal homepage: http://www.tandfonline.com/loi/ipat20
Fine needle aspiration cytology in male breast carcinoma J.L. Slavin & L.I. Baird To cite this article: J.L. Slavin & L.I. Baird (1996) Fine needle aspiration cytology in male breast carcinoma, Pathology, 28:2, 122-124 To link to this article: http://dx.doi.org/10.1080/00313029600169703
Published online: 06 Jul 2009.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipat20 Download by: [FU Berlin]
Date: 28 February 2017, At: 00:10
Pathology (1996), 28, pp. 122-124
FINE NEEDLE ASPIRATION CYTOLOGY IN MALE BREAST CARCINOMA J. L. SLAVIN AND L . I. BAIRD
Department of AnatomicaI Pathology, Heidelberg Repatriation Hospital, West Heidelberg, Vic
Summary A veterans' hospital-based retrospective, clinicopathological study was undertaken to evaluate fine needle aspiration cytology (FNAC) in the diagnosis of male breast carcinoma. Two hundred and forty histologically proven cases of breast carcinoma spanning a period of 17 yrs were identified and 13 of these were in males. Nine of these male patients had FNAC perforrfied and were reported by the same cytopathologist (L.I.B.). In 8 of these cases FNAC was diagnostic of carcinoma. No material from FNA was obtained for diagnosis from one of these patients. We concluded that FNA is a useful technique in the diagnosis of male breast carcinoma.
Keywords:Male breast carcinoma,fine needle aspiration cytology. Accepted 1 February1996 INTRODUCTION Fine needle aspiration cytology (FNAC) is an accepted, reliable and cost effective diagnostic technique with a well established role in the investigation of breast pathology. Male breast carcinoma is a relatively uncommon lesion, accounting for less than 1% of all cases of breast carcinoma, and consequently it has been the subject of few reports on the role of FNAC. 1-3 This retrospective study confirms the diagnostic usefulness of F N A C in the diagnosis of male breast carcinoma. MATERIALS AND M E T H O D S All cases coded as breast carcinomabetween the yrs t977 and 1994 were retrieved from the files of the Department of Anatomical Pathology at Heidelberg Repatriation Hospital. Cases of male breast carcinoma were selected and the cytologic material, reports and clinicopathologicaldetails, including age, presentation, site and size of the lesion, were obtained and recorded. This study is based on material from the Heidelberg Repatriation Hospital which serves a large war veteran population. RESULTS A total of 240 cases of histologically proven breast carcinomas were identified, of which 13 cases (5%) were in males. The age range for male breast carcinoma was 47-76 yrs with an average age at diagnosis of 67 yrs. All cases presented as an enlarging, painless, centrally located mass (all at least partly sub-areolar) with 5 cases producing nipple retraction, including one case with nipple ulceration.
In only one case was a family history of breast carcinoma obtained (affecting his mother and one of his sisters). None of the patients had a history of prostatic carcinoma or of exogenous hormone administration. Tumor size ranged from 6 m m up to 45 m m with an average size of 20 mm. In each case the contralateral breast was clinically normal. C Y T O L O G I C A L FEATURES F N A by a single clinician (Mr K. Millar) had been attempted in 9 of 13 cases, with rapid cytologic assessment to confirm the adequacy of the material obtained. Between 2 and 6 slides were prepared from each case with rapid H&E, Papanicolaou and Giemsa staining. No material was submitted from one of the cases as it was considered to be a :failed aspirate clinically and this aspirate was not repeated. Smears from 7 of the cases revealed a highly cellular pattern with numerous large irregular aggregates of crowded abnormal epithelial cells (Fig. 1) and separate isolated discohesive tumor cells. Nests and tubule formation were noted in some of the larger aggregates. Mitoses and necrotic material were not a feature. The remaining case was relatively less cellular with a few groups and clusters of abnormal epithelial cells. The population of abnormal cells showed nuclear enlargement, irregular nuclear borders and prominent nucleoli (Fig. 2). Seven of the cases were considered to be moderately to well differentiated and no large cell variants were noted. One case however showed marked diffuse
Fig. 1 Sheets, small groups and discohesive cells, as seen in FNAC of male breast carcinoma.
FINE NEEDLE ASPIRATIONCYTOLOGY IN MALE BREAST CARCINOMA
123
TABLE 1 Case No.
Tumor size (ram)
1
2 3 4 5 6 7 8 9 10 11 12 13 Fig. 2
Malignant cells demonstrating nuclear enlargement and nucleoli.
cellular discohesion and more pleomorphism and was considered to be a poorly differentiated ductal carcinoma. All cases were initially treated by simple mastectomy with frozen section confirmation of the diagnosis. In 12 of the 13 cases axillary node sampling was also performed. Subsequent histological examination of the surgical specimens showed all cases to be invasive ductal carcinoma. Tumor size, node status and follow-up are presented in Table 1. All node positive patients died of disease. Of the 5 node negative patients, one died of disease and another had bone involvement diagnosed 12 yrs post mastectomy.
DISCUSSION This retrospective study based in a veterans' hospital showed male breast carcinoma as accounting for 5% of all breast carcinoma in the hospital. This figure is higher than previously reported in other more broadly based studies and probably reflects the nature of the veteran population the hospital serves. A range of histologic types of breast carcinoma have been reported in the male breast however ductal carcinoma, as in the female breast, is the commonest type. Node status has been shown to be an important prognostic indicator in male breast carcinoma, with a 10 yr survival rate of 79% for the node negative group and only 11% for the node positive groups. 4 In our study all node positive patients died of disease. Some risk factors for male breast carcinoma have been determined and include Klinefelter syndrome, a strong family history (male or female relatives with a history of breast carcinoma), exogenous estrogen administration and exposure to radiation. 1'57 The relationship between gynecomastia and male breast carcinoma is less clear and they may co-exist. The cytologic criteria used for the diagnosis of breast carcinoma in fine needle aspiration include marked cellularity, often with aggregates, and dispersed, discohesive, large cells with nuclear abnormalities. The cytologic differential diagnosis between gynecomastia and male breast carcinoma is usually clear, however some difficulties arise in cases of gynecomastia with florid epithelial hyperptasia which may produce a celhdar smear and some epithelial changes? "9 Cell cohesiveness, the presence of myoepithelial cells and the absence of individual, single malignant cells help to
6 45 20 10 20 20 20 10 13 20 30 30 25
Node status
N/A
Follow-up DOD 9 yrs DOD 2yrs DOD 4 yrs DOD 4 yrs DOD 1 yr DOD 1 1/2 yr~, DOD 1/2 yr DF 15 yrs DF 9 yrs DF 3 yrs DOD 5 yrs BM at 12 yrs DF at 2 yrs
DOD=died of disease; DF=disease free; BM=bone metastasis; N/A=no nodes sampled.
separate gynecomastia from carcinoma. Nuclear pleomorphism can be seen in gynecomastia, and at times makes the distinction between gynecomastia and carcinoma very difficult. In these cases with nuclear atypia a biopsy should be considered. The aspirates in this study were performed on palpable breast masses that were clinically apparent carcinomas. They were confirmed at frozen section prior to definitive surgical treatment. Another, unusual, cause of male breast enlargement or a breast mass is the possibility of metastatic carcinoma. In particular prostatic adenocarcinorna is a recognized primary tumor that may produce intra-mammary metastases. Immunochemistry for prostatic specific antigen on material obtained by FNA has proved useful. 6'1°'11 FNAC is a useful tool for the diagnosis of male breast carcinoma and the cytologic criteria are identical to those seen in FNAC of the female breast. However additional pitfalls to keep in mind are the possibilities of metastatic tumors and of florid epithelial changes in gynecomastia which may mimic the increased cellularity seen in breast carcinoma. ~z,~3 ACKNOWLEDGEMENT Special thanks to Mr K. Millar (Senior Surgeon) who took an interest in developing the use of FNA within the hospital. Address for correspondence: J.L.S., Department of Anatomical Pathology, St Vincent's Hospital, Victoria Parade, Fitzroy, Vic 3065.
References 1. Crichlow RW. Carcinoma of the male breast. Surg Gynecol Obstet 1972; 134:1011-9 2. Bhagat P, Kline TS. The male breast and malignant neoplasms. Diagnosis by aspiration biopsy cytology. Cancer 1990; 65: 2338-41. 3. Gupta RK, Naren S, Simpson J. The role of fine needle aspiration cytology (FNAC) in the diagnosis of breast masses in males. Eur J Surg Oncol 1988; 14: 317-20. 4. I-Ieller KS, Rosen PP, Schottenfeld D et al. Male breast cancer. A clinicopathologic study of 97 cases. Ann Surg 1978; 188: 60-5. 5. Schottenfeld D, Lilienfeld AM, Diamond H. Some observations on the epidemiology of breast cancer among males. Am J Public Health 1963; 53: 890-7. 6. Wilson SE, Hutchinson WB. Breast masses in males with carcinoma of the prostate. J Surg Oncol 1967; 8: 105-12.
124
SLAVINAND BAIRD
7. Demeter JG, Waterman NG, Verdi GD. Familial male breast carcinoma. Cancer 1990; 65: 2342-3. 8. Ronne R, Ramzy I, Northcutt A. Gynecomastia: cytologic features and diagnostic pitfalls in aspiration biopsies. Acta Cytol 1986; 30: 589. 9. Chang AR. Fine needle aspiration cytology in a case of florid gynaecomastia. Cytopathology 1990; t: 357-61. 10. Keshgenian AA, Kline TS. Immunoperoxidase demonstration of prostatic acid phosphatase. Am J Clin Pathol 1984; 82: 586-9.
Pathology (1996), 28, May 11. Green LK, Klima M. The use of immunohistochemistry in metastatic prostatic adenocarcinoma to the breast. Hum Pathol 1991; 22: 242-6. 12. Lilleng R, Paksoy N, Bural G e t al. Assessment of fine needle aspiration cytology and histopathology for diagnosing male breast masses. Acta Cytol 1995; 39: 877-81. 13. Das DK, Junaid TA, Matthews SB et al. Fine needle aspiration cytology diagnosis of male breast lesions. Acta Cytol 1995; 39: 870~6.