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.
Article: Carcinoma of the male breast.[show abstract] [hide abstract]
ABSTRACT: The natural history and current management of carcinoma of the breast in men is reviewed. Articles published from 1942 to 1992 on the natural history, clinical manifestations, diagnosis, and treatment of carcinoma of the breast in men were identified using CANCERLINE and MEDLINE. Carcinoma of the breast affects approximately 1000 men per year in the United States; 300 men per year will die of metastatic disease. The mean age at diagnosis is 59 years. The causes of breast cancer in men are unknown. The most common clinical manifestation of breast cancer in men is a painless, firm subareolar mass or a mass in the upper outer quadrant of the breast. Diagnosis can be confirmed by fine-needle aspiration or surgical biopsy. Infiltrating ductal carcinoma is the predominant histologic type. Treatment is similar to that of women with breast cancer. Men with axillary nodal metastasis should receive adjuvant systemic combination chemotherapy or tamoxifen, or both, after primary surgical treatment. Because most men with carcinoma of the breast have estrogen- and progesterone-receptor-positive tumors, distant metastatic disease should be treated initially with hormonal therapies. The epidemiology, prognostic factors, survival by stage, pattern of metastasis, and response to treatment in men are similar to those in women with breast carcinoma. The data suggest, however, that breast cancers in men are more likely to respond to hormonal manipulation.Annals of internal medicine 12/1992; 117(9):771-7. · 16.73 Impact Factor
[show abstract] [hide abstract]
ABSTRACT: Male breast cancer is an uncommon disease although the incidence has increased over the past 25 years. As with many other rare "orphan" diseases, male breast cancer is understudied. The rarity of the disease precludes prospective randomized clinical trials. In addition, few researchers and minimal funding have focused on breast cancer in men, but further work is clearly needed to better understand this disease. It shares many similarities with breast cancer in women; yet some clear differences have emerged. In this article, the latest information on the epidemiology, biology, and treatment of male breast cancer is reviewed.The Oncologist 09/2005; 10(7):471-9. · 3.91 Impact Factor
Article: Cancer of the breast in men.[show abstract] [hide abstract]
ABSTRACT: As knowledge grows about breast cancer in men, it becomes apparent that the disease is strikingly similar to that seen in women. Although rare, as is cancer in most vestigial organs, all indications are that it shares a common etiology and a similar natural history with breast cancer in females and that apparent differences between the diseases in the two sexes are minor or illusory. The poor prognosis of men in the past promises to yield to better public and professional education about the value of prompt recognition and treatment. Fortunately, the lessons learned from treatment of women are also applicable to men, and in comparable stages men prove equally curable.CA A Cancer Journal for Clinicians 41(6):339-54. · 101.78 Impact Factor
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Pathology Research International
Volume 2010, Article ID 871369, 3 pages
Pleomorphic LobularCarcinomain a Male Breast:
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, firstname.lastname@example.org
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.
Carcinoma arising in the male breast is a rare occurrence.
The overall incidence in men is only 1% of that in women,
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
. 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 . Approximately 85% of primary male breast
carcinoma is invasive ductal carcinoma of the “no special
type” subtype . Carcinomas of the male breast grossly
and microscopically are remarkably similar to those seen in
females . The predominant histological type, in males,
with scattered reports of infiltrating lobular carcinoma ,
all of them were classical type except for single case of
pleomorphic infiltrating lobular carcinoma .
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
2Pathology Research International
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.
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 . This subtype demonstrates an
infiltrative pattern identical to that of the classical lobular
carcinoma; however, the nuclear features show greater pleo-
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
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
Pathology Research International3
demonstrate loss of16q and gain of 1q,in themajority of the
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 .
The authors declare that they have no conflict of interest.
The study was approved by the ethical committee.
 I. A. Jaiyesimi, A. U. Buzdar, A. A. Sahin, and M. A. Ross,
“Carcinoma of the male breast,” Annals of Internal Medicine,
vol. 117, no. 9, pp. 771–777, 1992.
 S. H. Giordano, “A review of the diagnosis and management
of male breast cancer,” Oncologist, vol. 10, no. 7, pp. 471–479,
 P. K. Chantra, M. S. Shiroshi,G. J. So, J. S. Wollman,and L. W.
Bassett, in Diagnosis of Diseases of the Breast, L. W. Bassett, V.
P. Jackson,K. L. Fu, and Y. S. Fu, Eds., pp. 531–556, Saunders,
Philadelphia, Pa, USA, 2nd edition, 2005.
 W. L. Donegan, “Cancer of the breast in men,” CA: A Cancer
Journal for Clinicians, vol. 41, no. 6, pp. 339–354, 1991.
 P. E. Goss, C. Reid, M. Pintilie, R. Lim, and N. Miller, “Male
breast carcinoma: a review of 229 patients who presented to
the Princess Margaret Hospital during 40 years: 1955–1996,”
Cancer, vol. 85, no. 3, pp. 629–639, 1999.
 B. Maly, A. Maly, I. Pappo, K. Meir, and O. Pappo, “Pleomor-
phic variant of invasive lobular carcinoma of the male breast,”
Virchows Archiv, vol. 446, no. 3, pp. 344–345, 2005.
 S. Ferlicot, A. Vincent-Salomon, J. M´ edioni et al., “Wide
metastatic spreading in infiltrating lobular carcinoma of the
breast,”European JournalofCancer, vol.40,no.3,pp. 336–341,
 N. Weidner and J. P. Semple, “Pleomorphicvariant of invasive
lobular carcinoma of the breast,” Human Pathology, vol. 23,
no. 10, pp. 1167–1171, 1992.
 A. Wahed, J.Connelly, andT. Reese, “E-cadherin expression in
ductal carcinoma,” Annals of Diagnostic Pathology, vol. 6, no.
6, pp. 349–351, 2002.
 J. Palacios, D. Sarri´ o, M. C. Garc´ ıa-Macias, B. Bryant, M.
E. Sobel, and M. J. Merino, “Frequent E-cadherin gene
inactivation by loss of heterozygosity in pleomorphic lobular
carcinoma of the breast,” Modern Pathology, vol. 16, no. 7, pp.
 Y.-Y. Chen, E.-S. S. Hwang, R. Roy et al., “Genetic and
phenotypic characteristics of pleomorphic lobular carcinoma
in situ of the breast,” American Journal of Surgical Pathology,
vol. 33, no. 11, pp. 1683–1694, 2009.
 G. Turashvili, K. Bouchalova, J. Bouchal, and Z. Kolar,
“ExpressionofE-cadherin andc-erbB-2/HER-2/neu oncopro-
tein in high-gradebreastcancer,”Ceskoslovensk´ aPatologie, vol.
43, no. 3, pp. 87–92, 2007.