Abstract
BackgroundProstate carcinoma is among the most common solid tumors to secondarily involve the male breast. Prostate specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) are expressed in benign and malignant prostatic tissue, and immunohistochemical staining for these markers is often used to confirm the prostatic origin of metastatic carcinoma. PSA expression has been reported in male and female breast carcinoma and in gynecomastia, raising concerns about the utility of PSA for differentiating prostate carcinoma metastasis to the male breast from primary breast carcinoma. This study examined the frequency of PSA, PSAP, and hormone receptor expression in male breast carcinoma (MBC), female breast carcinoma (FBC), and gynecomastia.MethodsImmunohistochemical staining for PSA, PSAP, AR, ER, and PR was performed on tissue microarrays representing six cases of gynecomastia, thirty MBC, and fifty-six FBC.ResultsPSA was positive in two of fifty-six FBC (3.7%), focally positive in one of thirty MBC (3.3%), and negative in the five examined cases of gynecomastia. PSAP expression was absent in MBC, FBC, and gynecomastia. Hormone receptor expression was similar in males and females (AR 74.1% in MBC vs. 67.9% in FBC, p = 0.62; ER 85.2% vs. 68.5%, p = 0.18; and PR 51.9% vs. 48.2%, p = 0.82).ConclusionsPSA and PSAP are useful markers to distinguish primary breast carcinoma from prostate carcinoma metastatic to the male breast. Although PSA expression appeared to correlate with hormone receptor expression, the incidence of PSA expression in our population was too low to draw significant conclusions about an association between PSA expression and hormone receptor status in breast lesions.
Highlights
Primary carcinoma of the male breast accounts for less than 1% of cancers in men [1,2]
Immunohistochemistry Immunohistochemical staining for Prostate specific antigen (PSA), prostate-specific acid phosphatase (PSAP) and androgen receptor (AR), estrogen receptor (ER), and progesterone receptor (PR) were performed on 5-micron sections from tissue microarrays (TMAs) blocks
Of the two PSA-positive female breast carcinoma (FBC) cases, one was positive for AR, ER, and PR, and the other was negative for AR, ER and PR (Figure 1)
Summary
Primary carcinoma of the male breast accounts for less than 1% of cancers in men [1,2]. Metastatic malignancies may involve the male breast [1,3]. Incidence rates of metastasis to the breast as high as 6.6% have been reported when hematologic malignancies are included [5]. Prostatic carcinoma is among the most commonly reported solid tumors to secondarily involve the male breast [2]. Prostate carcinoma is among the most common solid tumors to secondarily involve the male breast. PSA expression has been reported in male and female breast carcinoma and in gynecomastia, raising concerns about the utility of PSA for differentiating prostate carcinoma metastasis to the male breast from primary breast carcinoma. This study examined the frequency of PSA, PSAP, and hormone receptor expression in male breast carcinoma (MBC), female breast carcinoma (FBC), and gynecomastia
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