Pleomorphic lobular carcinoma in a male breast: a rare occurrence.

Abstract

Carcinoma of male breast is uncommon as it accounts for 0.7% of total breast cancer. The pathology of male breast cancer is remarkably similar to that of cancers seen in women. The same histological subtypes of invasive cancer are present, although papillary carcinomas (both invasive and in situ) are more common and lobular carcinomas are less common. The predominant histological type, in males, as in females, reported in large series has been infiltrating ductal carcinoma with scattered reports of infiltrating lobular carcinoma, all of them of classical type except for a single case of pleomorphic infiltrating lobular carcinoma. Herein, we describe a case of pleomorphic lobular carcinoma occurring in male breast.

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SAGE-Hindawi Access to Research
Pathology Research International
Volume 2010, Article ID 871369, 3 pages
doi:10.4061/2010/871369
Case Report
Pleomorphic LobularCarcinomain a Male Breast:
ARareOccurrence
Bhatia Rohini,P.A.Singh, Misra Vatsala,Dhingra Vishal,
Singhal Mitali,and SharmaNishant
Department of Pathology, Moti Lal Nehru Medical College, Allahabad, 211001, India
Correspondence should be addressed to Dhingra Vishal, vishaldhingra9@yahoo.com
Received 19 May 2010; Accepted 28 September 2010
Academic Editor: Naila Kayani
Copyright © 2010 Bhatia Rohini et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Carcinoma of male breast is uncommon as it accounts for 0.7% of total breast cancer. The pathology of male breast cancer is
remarkably similar to that of cancers seen in women. The same histological subtypes of invasive cancer are present, although
papillary carcinomas (both invasive and in situ) are more common and lobular carcinomas are less common. The predominant
histological type, in males, as in females, reported in large series has been infiltrating ductal carcinoma with scattered reports of
infiltrating lobular carcinoma, all of them of classical type except for a single case of pleomorphic infiltrating lobular carcinoma.
Herein, we describe a case of pleomorphic lobular carcinoma occurring in male breast.
1.Introduction
Carcinoma arising in the male breast is a rare occurrence.
The overall incidence in men is only 1% of that in women,
whichtranslatestoalifetimeriskof0.11%(ascomparedwith
about 13% in women). Risk factors are similar to those in
women and include first-degree relatives with breast cancer,
decreased testicular function (e.g., Klinefelter syndrome),
exposure to exogenous estrogens, increasing age, infertility,
obesity, prior benign breast disease, exposure to ionizing
radiation, and residency in Western countries. Gynecomastia
does not seem to be a risk factor. From 4% to 14% of
cases in males are attributed to germline BRCA2 mutations.
Male breast cancer accounts for 0.7% of total breast cancer
[1]. Over the past 25 years, the incidence of male breast
cancer has risen by 26%, from 0.86 to 1.08 per 100,000
population [2]. Approximately 85% of primary male breast
carcinoma is invasive ductal carcinoma of the “no special
type” subtype [3]. Carcinomas of the male breast grossly
and microscopically are remarkably similar to those seen in
females [4]. The predominant histological type, in males,
reportedinlargeserieshasbeeninfiltrating ductalcarcinoma
with scattered reports of infiltrating lobular carcinoma [5],
all of them were classical type except for single case of
pleomorphic infiltrating lobular carcinoma [6].
2.Case Report
2.1. Clinical Details. A 55-year-old male presented with
left breast mass of approximately five-month duration.
There was no history of trauma, gynaecomastia, oestrogen
administration, or drug use. Physical examination revealed a
subareolarmassmeasuring 4×4cminsize. Swellingwasfirm
to hard and nontender. Overlying skin was free. There was
no palpable axillary lymph node. Lumpectomy of the breast
mass was done.
2.2. Pathological Findings. On macroscopic examination, the
specimen consisted of a firm grey white, circumscribed mass
measuring 3 × 2.5cm in size. Cut surface was white with a
few small areas of necrosis (Figure 1(a)).
On microscopic examination of the sections, hyper-
chromatic, pleomorphic cells with high nuclear cytoplas-
mic ratio, prominent nucleoli, and moderate amount of
eosinophilic cytoplasm were seen arranged in dyscohesive

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(a)(b)
(c) (d)
Figure 1: (a) Cut surface of the gross specimen shows circumscribed, grey white tumor with few small areas of necrosis. (b) Sections
from the tumor mass show hyperchromatic, pleomorphic cells in diffuse sheets. At place cells with targetoid appearance (arrow) are noted
[H & E x400]. (c) Higher magnification showing pleomorphic cells with PAS positive (arrow) intracytoplasmic mucin [PAS x400]. (d)
Immunohistochemistry for E-cadherin negative [Avodin Biodin, x100].
sheets. Manycellsshowed signet-ring formation andintracy-
toplasmic neo-lumina with targetoid appearance (Bull’s eye)
(Figure 1(b)). Some cells showed with PAS positive intra-
cytoplasmic mucin(Figure 1(c)). Immunohistochemistry for
E-cadherin was done and found to be negative (Figure 1(d)).
Radical mastectomy was done. Multiple sections pro-
cessed from the mastectomy specimen were free of tumor
cells. Axillary lymph nodes did not show any evidence of
malignancy. Patient was well one year after the mastectomy
but lost to follow up after that.
3.Discussion
Invasive lobular carcinoma is a distinct type of breast carci-
noma based on its characteristic histological pattern. These
tumors arise from the lobular and terminal duct epithelium.
Itoccursthroughouttheentire agerange ofbreastcarcinoma
in adult women and usually constitutes 10% of carcinomas.
Besides the classical invasive lobular other variant forms are
seen. Pleomorphic lobular carcinoma, which was defined
in 1992, in the female breast has a poorer prognosis than
its classical counterpart [7]. This subtype demonstrates an
infiltrative pattern identical to that of the classical lobular
carcinoma; however, the nuclear features show greater pleo-
morphism,increasedchromatinclumping,singleormultiple
prominent nucleoli, and usually abundant cytoplasm. The
degree of nuclear atypia may approach that which is found
in infiltrating ductal carcinoma, but the invasive pattern
characteristic of the classical lobular variant is always well
maintained. Weidner et al. have also reported a similar
pattern of growth in this tumor as that of a classical lobular
breast carcinoma, but it exhibited marked degree of nuclear
pleomorphismandabundantcytoplasm[8].Similarfindings
were noted in our case. It, also frequently, exhibits apocrine
differentiation, which, however, was not seen in our case.
Signet ring morphology is more common than the classical
counterpart and similar findings were noted in our case.
Immunohistochemical staining for E-cadherin may help
in diagnosis [9, 10]; its expression is lost in infiltrating
lobular carcinoma as seen in our case. Compared with
classical invasive lobular carcinoma, pleomorphic lobular
carcinoma shows significantly higher Ki67 index, lower
estrogen receptor and progesterone receptor expression,
and higher incidence of HER2 gene amplification. Both

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classicalinvasivelobularandpleomorphiclobularcarcinoma
demonstrate loss of16q and gain of 1q,in themajority of the
cases [11].
Pleomorphic lobular carcinoma is a very aggressive
tumor and is known to recur. Since grading of lobular carci-
noma is difficult, recognition of the pleomorphic subtype is
useful in identifying a lethal variant. Its behavior is assessed
on the basis of tumor size at presentation and the frequency
of nodal metastases [12].
ConflictofInterest
The authors declare that they have no conflict of interest.
Consent
The study was approved by the ethical committee.
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