|Ahead of print publication
Tubular carcinoma of male breast
NG Kamble, Sunil Yogiraj Swami
Department of Pathology, S.R.T.R. Government Medical College, Beed, Maharashtra, India
|Date of Submission||19-Oct-2019|
|Date of Decision||17-Jan-2020|
|Date of Acceptance||20-Apr-2020|
Sunil Yogiraj Swami,
Bhagwanbaba Chowk, Gitta - Road, Shepwadi, Ambajogai, Beed - 431 517, Maharashtra
Source of Support: None, Conflict of Interest: None
Tubular carcinoma [TC] is a special type of breast carcinoma with favorable prognosis, composed of distinct, well differentiated angular tubular structures (90% or more according to WHO) with open lumina, lined by a single layer of epithelial cells. This pattern is better described as a necklace formed by a string of beads. 2 - 6% of all malignant breast tumors. TC is often multifocal or multicentric [20 - 55%]. Here we present a case report of TC of breast in a 76 years old male.
Keywords: Breast, carcinoma, male, tubular
| Introduction|| |
Carcinoma of a breast is rare in men accounting for 0.6% of all breast cancers and <1% of malignancies in men. Tubular carcinoma (TC) of the male breast is a rare neoplasm that may have a biological behavior comparable to its counterpart in females. Despite the advent of sophisticated diagnostic methods, fine-needle aspiration cytology (FNAC) remains a critical diagnostic modality in the workup of breast masses in a developing country.
| Case Report|| |
A 71-year-old male presented with swelling of size 1.5 cm × 1.5 cm over the left side of the chest for 6 months. The swelling was immobile, nontender, and firm in consistency with a smooth surface. FNAC [Figure 1] revealed cellular smears with atypical cells arranged in three-dimensional (3D) balls, clusters, and at places in angulated tubules in the background without bare nuclei. Cytological impression was suggestive of atypical lobular hyperplasia with advice of biopsy to rule out ductal carcinoma with tubular features/TC. Modified radical mastectomy was performed [Figure 2] and received on gross tissue mass of size 10 cm × 4 cm × 1.3 cm. Histopathology [Figure 3] revealed tumor tissue composed of lobules of well-defined tubular structures with open lumina and lined by a single layer of cells. These tubules were separated by thin fibrous septa, with infiltration of tumor cells in the surrounding parenchyma. These features were consistent with tubular variant of invasive ductal carcinoma/TC.
|Figure 1: (a and b) Fine-needle aspiration cytology: Cellular smears with groups and individually scattered atypical epithelial cells|
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|Figure 2: (a and b) Gross and cut sections: MRM specimen showing tissue mass of size 10 cm × 4 cm × 1.3 cm with lymph nodes with cut sections of tumor tissue proper|
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|Figure 3: (a and b) Section showing groups and tubules of ductal epithelial cells separated by thin fibrous septa with infiltration in the surrounding parenchyma|
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| Discussion and Conclusion|| |
TC of the breast is an uncommon histological subtype of invasive breast cancer that accounts for approximately 1% to 5% of invasive breast carcinomas.
Several risk factors for male breast carcinoma have been proposed, such as familial and genetic factors, radiation exposure, Klinefelter's syndrome, hormonal imbalance, undescended testis, obesity, orchitis, and orchiectomy. No such risk factors were noted in the present case.
A painless lump beneath the areola, usually discovered by the patient himself, is the most common presenting symptoms in the male breast carcinoma. Tumor size is usually <3 cm in diameter but associated with nipple retraction, discharge, and fixation of breast tissue to skin and muscles. Approximately half of the men with breast carcinoma have palpable axillary lymph nodes.
FNAC can be effectively used in male patients to differentiate malignant from nonmalignant diseases. In the present case, smears were cellular with atypical cells arranged in 3D balls and clusters without lining of myoepithelial cells. At places shows cells arranged in angulated tubules in the background without bare nuclei. These cytological features were suggestive of ductal carcinoma with tubular features. Biopsy revealed lobules of well-defined tubular structures with open lumina and lined by a single layer of cells. These tubules were separated by thin fibrous septa, features consistent with TC.
TC is defined as a well-differentiated invasive carcinoma with regular cells arranged in well-defined tubules (typically one layer thick) surrounded by an abundant fibro-hyaline stroma, classified as pure TC or mixed TC. The term pure TC is assigned to tumors with a tubular composition of ≥90%, a low nuclear grade, and no mitoses, whereas mixed TC has a tubular composition of ≥75%.
Pure TC of the breast is a well-differentiated and distinct histologic subtype of invasive carcinoma, accounting for <2% of all breast carcinomas and is associated with an excellent prognosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]