A 73-year-old man visited the Surgery department of our tertiary care hospital with complaints of lump in the right breast since eight years, insidious in onset and gradually progressive in nature. Lump had rapidly progressed in last six months to reach to the present size. It was not associated with pain, discharge or retracted nipple. There was no family history of breast carcinoma. Patient was hypertensive, on regular treatment since 10 years. On examination, 5x5 cm lump was palpable in the right breast. Fine needle aspiration was suggestive of marked epitheliosis with apocrine metaplasia. Incisional biopsy was suggestive of mucinous carcinoma following which right modified radical mastectomy was done. Grossly, a tumour was identified in the breast measuring 9.5x6.5x4.5 cm, cut section showed grey white and soft myxoid areas [Table/ Fig-1].Histology revealed an infiltrating tumour composed of trabeculae, nests, cribriform pattern and islands of cells with moderate amount of eosinophilic cytoplasm, round nuclei with mild anisonucleosis, prominent nucleoli and occasional mitotic figures in extracellular pools of mucin, constituting the mucinous carcinoma component. Also, seen were nodules and solid nests of malignant polygonal cells with moderate to abundant amount of granular eosinophilic cytoplasm, mildly pleomorphic vesicular nuclei and prominent nucleoli with <5 mitotic figures/10hpf in a desmoplastic stroma representing the IDC component of SBR (Scarff-Bloom-Richardson) grade II with apocrine differentiation [ A final diagnosis of mixed mucinous carcinoma of breast -60% mucinous component with 40% IDC component (SBR grade II) with apocrine differentiation was given. Patient was referred to oncology for adjuvant treatment. Post mastectomy radiotherapy 42.5 gray/ 16#/ 3.1 week to right chest wall followed by boost plan 10 gray/ 5#/ 1 week was given. Patient tolerated the therapy with grade 1 dermatitis. This was followed by hormonal treatment. Patient came for follow up for eight months which were uneventful.
DisCussionAlthough male breast carcinoma is an extremely rare tumour, its incidence shows an increasing trend and accounts for significant morbidity and mortality. It usually occurs in old age, with a peak incidence at around 60 years. In agreement with literature [1,2], our patient was aged 73. The underlying pathogenesis is not completely understood yet, but both genetic and hormonal causes have been described in literature. Associated genetic factors are BRCA2 mutations and Klinefelter syndrome. Hormonal causes include obesity, radiation exposure and testicular malignancies. Also prostate malignancies and gynaecomastia are described as suspected predisposing factors [2][3][4].[
