STUDY OF MORPHOLOGY AND HORMONE RECEPTOR STATUS OF MALE BREAST LESIONS

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STUDY OF MORPHOLOGY AND HORMONE RECEPTOR STATUS OF MALE BREAST LESIONS

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 57

Abstract

BACKGROUND Male breast carcinoma is rare and therefore not detected on time. They also do not receive importance in studies. All male breast carcinomas received during the given period in Pathology Department at Government Medical College, Trivandrum were studied, graded, categorised, interpreted as per relevant standards and sub-typed according to their immunohistochemical profile. Appropriate statistical correlations have been applied. Hormonal study of these lesions helps to decide proper targeted chemotherapy for these cases and help in further treatment. In case of benign lesions like gynaecomastia, it can be useful in treating them with drug therapy so that patients can do away with unwanted surgeries and hassles. In view of the higher fatality rate, male breast cancers merit more serious study and early intervention. The objectives of this article are to study the clinico-pathological features of Male Breast Lesions and to assess the expression of Oestrogen Receptor and Progesterone Receptor in male breast lesions and also HER-2/neu in male breast carcinomas. MATERIALS AND METHODS The present study was of descriptive design and was conducted in the Department of Pathology, Medical College, Trivandrum. All male breast lesions were received in the Department of Pathology, Medical College, Trivandrum during the period from 2008 to 2013. Clinical details and macroscopic features of all male breast lesions received during the study period were studied as per proforma. Formalin-fixed, paraffin-embedded sections were stained with haematoxylin and eosin. Grading of the malignancy was done as per Nottingham modification of the Scarff-Bloom-Richardson’s grading system. Oestrogen Receptor (ER), Progesterone Receptor (PR) and HER-2/neu study was done in all cases of carcinoma breast and Oestrogen Receptor and Progesterone Receptor study was done in representative cases of gynaecomastia. Procedure for Immunohistochemistry is given in Appendix II. ER-PR nuclear stains and HER-2/neu will be categorised as positive or negative. The interpretation for ER-PR will be as per Allred Scoring guidelines and for HER-2/neu. The carcinoma cases were then subtyped according to the immunohistochemical profile. All data is entered in Microsoft Excel and proportions were calculated. RESULTS The present study included 368 male breast lesions received in the Department of Pathology, Medical College, Trivandrum. 354 cases were benign lesions and 14 cases were breast carcinoma. Of the benign lesions the maximum obtained were of Gynaecomastia 348 (98.3%). Other benign lesions included fat necrosis, acute and chronic inflammation. Histopathology showed majority of the cases (100 cases) to be in the intermediate stage of gynaecomastia. ER-PR study in 20 cases of gynaecomastia showed oestrogen receptor positivity in 14 cases (70%) with a mean score of 4.75. Progesterone receptor was positive in 18 cases (90%) with a mean score of 5.55. Among the 14 carcinoma patients, the mean age was found to be 65.5 years. In the present study, all cases were of infiltrating ductal carcinoma; 4 had positive margin status, the nipple and areola were involved in 5 cases and no vascular invasion was noted. Majority of the cases, 12 cases (85.71%) belonged to Grade II (Modified Bloom Richardson grading). In the 4 modified radical mastectomy specimens, the lymph node showed metastases in 2 cases (4/7 showed metastases and 1/10 showed metastases); 13 cases (92.8%) were found to be Oestrogen Receptor (ER) and Progesterone Receptor (PR) positive and all cases were HER-2/neu negative. By this panel of immunohistochemical markers, 13 cases (92.8%) were categorised as Luminal A (ER+, PR+, HER-2/neu-) and 1 case was ER, PR and HER-2/neu negative. CONCLUSION This study proposes to evaluate the clinico-morphological details of these rare lesions and correlate them with the histology, grade and hormone receptor status. Hormonal study of these lesions will help in advocating the proper targeted chemotherapy for these cases and help in adjunct treatment. The expression of hormonal status in benign lesions like gynaecomastia can be useful in treating these lesions with drug therapy, so patients can do away with unwanted surgeries and hassles. Also in view of the higher fatality rate, male breast cancers merit more serious study and early intervention.

Authors and Affiliations

Prema N. S, Jyotsna Nair

Keywords

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EP ID EP226171
DOI 10.14260/Jemds/2017/921
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