Ductal carcinoma in situ of the male breast: clinical radiological features and management in a cancer referral center

Abstract

Purpose To present an overview of the management of male patients with Ductal Carcinoma In Situ of the breast (male DCIS). Methods We retrospectively studied all male patients with a diagnosis of pure DCIS from January 1999 to December 2018: 20 patients were identified in our cancer referral center. We collected data regarding clinical presentation, age of onset, radiological features, receptor status of the neoplasm, histological type, and the follow-up of those patients. Results The median age was 62 years (range 21–80). All patients underwent surgery, in 15/20 (75%) cases a mastectomy was carried out. Two patients (10%) underwent endocrine treatment and 1/20 (5%) underwent radiotherapy. The receptor status for 15/20 patients was documented: 13/15 patients were ER+/Pr+. In 3 cases the Ki 67% was positive (i.e., > 20%). All cases were negative for Her2. The median follow-up time was 9.0 years (IQR 4.0–13.7). Only one patient had an ipsilateral recurrence with the finding of an infiltrating carcinoma in the same breast after 14 years. The 5-year disease-free survival was 92.9%. Conclusion Pure DCIS in men is an extremely rare disease: proper diagnosis and management allow an excellent prognosis.

Male ductal carcinoma in situ: diagnosis and management of a rare disease in men

“…There may also be a distinct pattern in hormone receptor expression in male DCIS. In a review of 15 patients by Nicosia et al , 87% had ER+ and PR+ tumours, and no detected instances of Her2+ tumours 14. Invasive male breast cancer has also similarly been found to be highly ER+ and PR+ 13…”

“…Given the paucity of cases in the literature, there have been no systematic studies or reviews to date that have focused on the management of DCIS in male patients 5 21. Current treatment plans reported in the literature are based on the management of female patients 14 22. Because most cases of DCIS in female patients are detected through screening mammograms, these screening studies may not be the most optimal for male patients that tend to present symptomatically.…”

“…Chemoprevention with endocrine therapy in women has also been shown to reduce the risk of ipsilateral or contralateral invasive breast cancer recurrence but has not shown impact on improvement in overall survival 5 10 11. In a retrospective study by Nicosia et al examining treatment of male DCIS, 75% of male patients underwent mastectomy while 25% underwent lumpectomy, with 10% of patients undergoing radiation therapy and 5% of patients receiving endocrine therapy 14. The value of adjuvant therapy with radiation or chemoprevention with endocrine therapy is unclear in men, especially when weighing the different pathological processes associated with its development and the side effects of treatment 5 10 11.…”

Radiological Features of Male Breast Neoplasms: How to Improve the Management of a Rare Disease

“…Patients with insufficient radiological images for retrospective image re-evaluation or whose images were not stored in the institution's picture archiving and communication (PACS) were excluded. Patients with male BC in situ were also excluded because they were the subject of our previous publication [11]. Other variables were collected: patients' risk conditions (where available, given the retrospective nature of the analysis of clinical records) such as familiarity (at least one first-degree relative with breast neoplasm), BRCA mutations, and testicular disease; age at surgery; and data regarding type and year of surgery, lymph node disease involvement at surgery, histologic type of neoplasm with G grading system associated (G1: low grade; G2: intermediate grade; G3: high grade), receptor patterns, follow-up information to calculate the disease-free survival (DFS) (we monitored the eventual occurrence of homoand contralateral locoregional disease recurrence, single-site or multiple-site metastasis, and death).…”

“…We summarized the US presentation patterns of male neoplasms in Table 3. (11) We analyzed the relationship between radiological aspects of the neoplasm and tumor receptor profile.…”