Dear Editors: Lobular carcinoma of the male breast is extremely rare, with approximately 20 reported cases in the literature, all of the classic type [2, 4]. Herein, we describe a case of pleomorphic lobular carcinoma occurring in a male breast, with documentation of E-cadherin immunostaining. A 44-year-old Ashkenazi (Eastern European) Jewish man, with three children, presented with a left breast mass of approximately 4 months duration. There was no history of trauma, gynecomastia, liver disease, estrogen administration, or drug use. The patient’s family history was significant in that both of his grandmothers died of breast carcinoma. Physical examination revealed a firm mass localized beneath the nipple. There were no palpable axillary lymph nodes. Excisional biopsies of the breast mass were followed by mastectomy with axillary lymph node dissection. The specimen consisted of a firm, gray-white mass with poorly circumscribed margins, measuring 2.5×2.0 cm. Microscopic sections showed an infiltrating tumor composed of discohesive pleomorphic tumor cells. Few ducts were seen, one of which showed ductal carcinoma in situ, solid type, intermediate grade (Fig. 1). The tumor cells infiltrated in a classic single linear pattern with a concentric targetoid pattern around neoplastic and non-neoplastic ducts. Individual tumor cells were large, with eccentric nuclei with irregular nuclear borders and some enlarged nucleoli (Fig. 2). The cell cytoplasm was frequently eosinophilic and vacuolated with intracytoplasmic lumina (signetring cell appearance). Occasional multinucleated cells were observed. Few mitoses were seen. Neither necrosis nor calcifications were found. There was no evidence of gynecomastia. The nipple was normal. There were 13 axillary lymph nodes without metastases. Immunohistochemical studies demonstrated positive membrane staining for E-cadherin in the non-neoplastic ducts and in the intraductal carcinomatous component and complete loss of E-cadherin expression in the invasive component (Fig. 3). The Ki-67 proliferation index was positive in 5% of the tumor cells. Staining for gross cystic disease fluid protein (GCDFP-15)—the apocrine differentiation marker—was negative. The tumor cells were found to be positive for both estrogen and progesterone receptors and negative for Her-2/neu protein. Subsequent genetic screening for BRCA (tumor suppressor gene) mutations was negative in this patient. The diagnosis of pleomorphic invasive lobular carcinoma, grade 3, was made. The patient was treated with radiotherapy and chemotherapy and was alive and well, without evidence of recurrent or metastatic disease, 2 years after surgery. Carcinomas of the male breast, grossly and microscopically, are remarkably similar to those seen in females. As such, they can be in situ or invasive [5]. The predominant histological type in males, in all large series, has been infiltrating duct carcinoma, with scattered reports of infiltrating lobular carcinoma, all of the classical type, characterized by small, round, regular cells, arranged in single lines, with a targetoid pattern of infiltration. Pleomorphic lobular carcinoma, which was defined in 1992 in the female breast, has a poorer prognosis than its classic counterpart [1]. This subtype demonstrates an infiltrative pattern identical to that of classic lobular carcinoma; however, the nuclei show greater pleomorphism, increased chromatin clumping, increased mitotic activity, single or multiple prominent nucleoli, and, usually, abundant cytoplasm. The degree of nuclear atypia may approach that which is found in infiltrating duct carcinoma, but the invasive pattern characteristic of the classic lobular variant is always well maintained. Immunohistochemical staining for E-cadherin may help in the differential diagnosis. E-cadherin is an epitheliumspecific molecule involved in cell-to-cell adhesion. As such, B. Maly (*) . A. Maly . K. Meir . O. Pappo Department of Pathology, Hadassah University Hospital, Kiryat Hadassah, p.o.b.12000, 91120 Jerusalem, Israel e-mail: Maly_Bella@ yahoo.com Fax: +972-2-6426268
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Nov 4, 2023
Dominik Lisowski + 5
