Breast Cancer Suspicion in a Transgender Male-to-Female Patient on Hormone Replacement Therapy Presenting with Right Breast Mass: Breast Cancer Risk Assessment and Presentation of a Rare Lesion

Abstract

There has been an increasing use of hormonal therapy among male-to-female (MtF) transgender individuals. This long-term hormone replacement therapy (HRT) renders MtF individuals a unique patient subgroup in terms of breast cancer risk. This case describes a MtF transgender who presented with a breast lesion concerning for malignancy following hormonal replacement therapy. The patient additionally had a strong family history of breast cancer. Final pathology revealed lobular hyperplasia in the setting of gynecomastia and pseudoangiomatous stromal hyperplasia (PASH). Both pathology findings are rare in biological females, let alone in the setting of hormone replacement therapy in a MtF individual. While the number of reported cases of suspicious breast lesions in this population remains scarce, it presents both a diagnostic and therapeutic challenge due to the nature of the treatment course and the lack of research in this recently growing subgroup of patients.

Mammary Myofibroblastoma in a Transgender Patient on Feminizing Hormones: Literature Review and Case Report

“… 24 , 28 One case of each of the following types was also identified: secretory breast carcinoma, 29 one case of poorly differentiated carcinoma in lymph nodes (with probable but unconfirmed breast origin), 18 and one case of metastatic breast cancer of unknown tumor type. 26 The three cases of benign breast tumors included a case of lobular hyperplasia with focal pseudoangiomatous stromal hyperplasia, 30 two cases of fibroadenoma, 31 , 32 and one case of angiolipoma. 33 …”

A rare case of breast cancer in a transgender woman

“…This paucity of data is at least in part due to a lack of evidence-based consensus breast cancer screening recommendations offered to transgender women, poor subject follow-up, as well as barriers to care faced by the community, which include historical marginalization, reluctance to disclose, and lack of provider experience and resources [4 , 5] . These factors often lead to late diagnosis and advanced stage of invasive breast cancer at the time of diagnosis [6] .…”

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: An Uncommon Finding in an Uncommon Patient

“…These interactions could increase the level of progesterone that could stimulate PASH growth. A hormonal etiology is also supported by the higher PASH prevalence in premenopausal woman (the majority of whom are actively taking oral contraceptive pills) [16], in 24% to 47% of men with gynecomastia [17] and by reported case of PASH in a transgender male during hormone therapy [18] or during pregnancy [19]. PASH affects pre-menopausal women or menopausal women in hormone replacement therapy (HRT).…”