Pleomorphic lobular carcinoma of the male breast with axillary lymph node involvement: a case report and review of literature

Abstract

BackgroundCarcinoma of the male breast is responsible for less than 1% of all malignancies in men but the incidence is rising. Invasive ductal carcinoma is the most common histological subtype while invasive lobular carcinoma is responsible for only 1.5% of the total cases of which pleomorpic lobular carcinoma is an extremely rare variant. We report the case of a gentleman with node positive, pleomorphic lobular carcinoma of the breast.Case presentationAn elderly gentleman with a past history of type 2 diabetes and long term ethanol use presented to us with a self-discovered palpable lump in the left breast. Physical examination revealed bilateral gynaecomastia along with a well circumscribed subareolar mass and palpable lymphadenopathy in the ipsilateral axilla. The breast nodule revealed atypical cells on fine needle aspiration biopsy and the patient underwent a modified radical mastectomy after systemic surveillance was negative for metastatic disease. The lesion was reported as grade III pleomorphic lobular carcinoma with a lack of E-cadherin expression on immunohistochemistry and the neoplastic cells exhibited strong positivity for estrogen receptor in the absence of Her2 gene amplification. Six out of the eleven dissected regional lymph nodes showed evidence of disease. The patient completed 4 cycles of adjuvant chemotherapy without evidence of recurrent disease and was subsequently lost to follow up.ConclusionsAlthough invasive lobular carcinomas comprise 12% of all female breast cancers, they are very rare in males due to lack of acini and lobules in the normal male breast. Pleomorphic lobular carcinoma, an aggressive variant of ILC is even rarer in males.Chronic consumption of ethanol by our patient may have resulted in some degree of hepatic impairment with resultant hyperestrogenism. This in theory may have been the cause of his gynaecomastia, resultant breast cancer and is a plausible explanation for development of the invasive lobular subtype in a male. The prognosis and clinicopatholocial features of pleomorphic lobular carcinoma in men are less clearly defined due to its rarity. Additional studies are hence necessary to improve our understanding of this disease in males.

Invasive lobular carcinoma of the male breast – a systematic review with an illustrative case study

“…Cases with mixed morphology or lobular carcinoma in situ were excluded. Additionally, as Zahir et al3 recently published a complete review of pleomorphic lobular carcinoma in the male breast, this subtype was also excluded from the present study. Eighteen cases of ILC in men were identified in the published literature since 2000; these are tabulated in Table 1, including age, presentation, risk factors, laterality, e-cadherin status, metastatic disease, treatment, and outcome 2,4–15.…”

Carcinoma en cuirasse caused by pleomorphic lobular carcinoma of the breast in a man

“… 6 However, HER2 gene amplification appears to be variable in male PLC cases. 4 In this patient, the apocrine subtype was suspected, associated with significantly more genomic alterations than the nonapocrine type. 6 …”

“… 3 PLC is an uncommon highly aggressive subtype, with few reported cases in men. 4 PLC often presents at an advanced stage, is likely to be larger with more positive lymph nodes at time of diagnosis, and carries an increased risk of lymphovascular invasion and distant metastases. 5 Cytologically, it is characterized by enlarged nuclei, prominent nucleoli, increased hyperchromasia, frequent mitotic figures, and eosinophilic cytoplasm.…”

Invasive lobular carcinoma: a rare presentation in the male breast

“…There may be associated skin changes, including nipple retraction, ulceration, or fixation of the mass to the skin or underlying tissue. The left breast is involved slightly more often than the right, and <1% are bilateral 11. Axillary adenopathy is typically palpable in advanced cases.…”