A secretory carcinoma of the breast, associated with axillary node metastasis, unilateral gynaecomastia, and chronic active hepatitis, occurred in a 66 year old man. Although secretory carcinoma of the breast usually occurs in children and adult women, our case shows that it can rarely occur in the elderly male. (J Clin Pathol 1998;51:545-547) Keywords: breast; secretory carcinoma; gynaecomastia Secretory carcinoma of the breast is a rare neoplasm first described in children and called "juvenile carcinoma."1 Later it was also found in female adults, although the median age (the second decade) of secretory carcinoma of the breast is younger than that of the usual breast cancer.2 On the other hand, breast carcinoma is an uncommon neoplastic condition among men, accounting for no more than 1% of all breast carcinomas, 3 and to our knowledge only six secretory carcinomas of the breast have been reported, all in men less than 25 years of age.2 4-9 Here, we report a case of secretory carcinoma of the breast in a 66 year old man (the oldest known secretory carcinoma of the breast in a male) associated with axillary node metastasis, unilateral gynaecomastia, and chronic active hepatitis.
Case reportA 66 year old Japanese man presented with a recently enlarging tumour in the subareolar region of the left breast. The tumour was noticed three years before and the clinical impression was of gynaecomastia as he had hepatitis C virus (HCV) positive chronic active hepatitis. At the ages of 62 and 65 years, he had had two operations for hepatocellular carcinoma. On the first occasion the histology was of poorly diVerentiated (sarcomatous) type, while on the second occasion it was of well differentiated (trabecular) type. At the time of the breast presentation, follow up examination of the liver showed a solitary tumour. Segmentectomy (S4) of the liver and removal of the breast tumour were performed simultaneously. Computed tomography and ultrasonography showed no other tumour anywhere in the body, including the thyroid. As the breast tumour showed infiltrative growth and tumour cells were present in the surgical margin, the patient had a modified radical mastectomy with axillary node dissection. The right breast had no tumour. The patient was free from local recurrence or metastases eight months after the surgery.
Histological findingsThe breast tumour resected in the first operation was 3.0 × 3.0 × 2.6 cm, relatively circumscribed and markedly firm, with a greyishwhite cut surface. The tissues were fixed in 10% buVered formalin. Microscopically, the tumour was separated by hyalinising fibrosis and showed partial infiltration of the margin. The tumour cell arrangement was microcystic and papillary. Tumour cells and microcystic spaces contained abundant secretion, which usually stained pale pink with haematoxylin and eosin, and they mimicked thyroid follicles (fig 1).Immunohistochemistry was performed by the streptavidin-biotin method using the following antibodies: keratin, epithelial membrane antigen (EMA), lactalbu...
