International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 6(10), May, 2014

Pages: 90-95

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MALE BREAST LESION PROFILE IN A TERTIARY CARE HOSPITAL IN WESTERN INDIA ON FINE NEEDLE ASPIRATION

Author: Raajul Jain, Smita A. Shah, Tarang B. Kadam, R. N. Gonsai, Karan Vala

Category: Healthcare

Abstract:Background: Male breast lesions are not very common. Usually male breast lesions are benign and affect the young male. Most common lesion is gynaecomastia. Male breast cancer accounts for a small proportion of breast cancers.Male breast cancer usually presents at an advanced stage. Objective: The aim of the study is to find out the incidence of male breast lesion in our setup and knowing the various pathologies afflicting male breast. Research and methodology:This is a retrospective study in which the computerised records in the department of cytopathology were analysed between January 2013 and October 2013.All breast lesions were analysed and male breast lesions were evaluated further for size, cytological diagnosis and histopathology work-up where available. Result: Most male breast lesions were benign. The most common lesion was gynaecomastia. Pre-operative diagnosis of male breast lesion in males is as desirable as in females. Cytology provides a reliable methodology for differentiating between benign and malignant lesions.

Keywords: Male breast cancer, Fine Needle Aspiration Cytology (FNAC).

Full Text:

INTRODUCTION

Male breast develops like a female breast till puberty. Due to absence of per- pubertal estrogenic stimulation, the normal male breast development ceases at this stage. Thus normal male breast mimics immature female breast1 . Breast lesions in males is relatively uncommon. A wide variation in the incidence range is seen in different geographical areas varying from 3.4 cases per 100,000 man years to 0.1 per 100,0001 . This study was undertaken to observe the prevalence and spectrum of lesions afflicting the male breast. In men, breast cancer is very rare. There are about 370 men diagnosed each year in the UK, compared with around 48,400 cases of breast cancer in women. That's about one man for every 130 women diagnosed2 . Like all cells of the body, a man's breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed than those of women and because they normally have lower levels of female hormones that affect the growth of breast cells. The Surveillance, Epidemiology, and End Results (SEER) registry contains a total of 5,494 cases of male breast cancer and 835,000 cases of female breast cancer diagnosed from 1973 through 2005 (Anderson WF, submitted for publication).

MATERIALS AND METHODS

A retrospective study was conducted in which the computer records were collected from January 2013 to October 2013 for the patients who came to the Cytology section of

the department of Pathology of B. J. Medical College, Civil hospital, Ahmedabad, Gujarat for breast lesions. Ours is a teaching post graduate institute which also serves as a referral centre for nearby states. Data was evaluated for male patients with respect to age,site of lesion, cytology report and follow upbiopsy reports where available. Follow up biopsy was not availablein all cases as many cases were conservatively managed or were operated at a different institute.Most of the malignant cases diagnosed in our centre are referred to the Gujarat Cancer Research Institute (GCRI) and were lost to follow up. Fine needle aspiration was done with the help of 22 or 23 gauge needle, fixed in absolute alcohol and stained with haematoxylin and Eosin and Pap smears were made.The biopsy specimens were fixed in 10 % buffered formalin and paraffin embedded sections were stained with routine haematoxylin and eosin stains. No special stain or imunohistochemistry was used.

RESULTS AND OBSERVATIONS

Of the total of 473 cases 30 were cases of male breast lesions. Male breast lesions comprised 6.34% of the total breast lesions. The age group of presentation was between 13-100 yrs. Most common age group is 30-50 yrs. Majority of lesions were benign.The most common lesion was gynaecomastia (46.67%). Mean age of presentation was 41.5yrs. Median age of presentation was 40 yrs.

DISCUSSION

Diagnosis of breast lesions by fine needle aspiration cytology has gained worldwide recognition3 . The present study evaluated 30 male breast lesions. 6.34 % cases of breast lesions in our study were found to be in males. The incidence reported byRanbeer etal.3 is 5.8 %. In the study by Joshi et al. 4 incidence is 3.9%. Mansoor et al. 5 (Saudi Arabia) reported an incidence of 6%, Gupta et al. 6 reported an incidence of 1.4% while Das et al. 7 reported an incidence of 7.3%

Gynaecomastia is the predominant benign lesion in both the other studies and also in the studies by Joshi4 , Mansoor5 , Gupta6 , Das7 and Bannayan8 .The study by MS Gill et al. did not classify diseases as benign breast lesion which may be responsible for its such a high incidence. In our institute gynaecomastia was seen in the age group of 30-50 yrs. Gynaecomastia is caused by transitory hormone changes, as in puberty, often regresses after 1- 2 yrs. These factors share

in common increased estrogenic activity or decreased testosterone activity or both8 . The aetiopathological factors causing the gynaecomastia in adolescents are weight gain and fat deposition in the breast area, estrogen androgen imbalance in puberty, psychological stress, hypogonadism or abnormalities of pituitary(loss of blood supply, infection, steroid producing tumours), systemic causes such as adrenal genital syndrome, cirrhosis, renalfailure, thyrotoxicosis(estrogen and testosterone binding changed) or congenital (Klinefelter syndrome, androgen resistance etc.) or idiopathic8 . Causes of gynaecomastia in later years may be hormonally active tumours(Leydig cell tumour of testes, hCGsecreting germ cell tumours, lung carcinoma or others), cirrhosis, medications (digitalis, reserpine, dilantin and others) or idiopathic9 . Fine needle aspirates of gynaecomastia can have variable cellularity ranging from virtually acellular to richly cellular smears. Virtually acellular smears were seen in more mature lesions, where sclerosis had over taken proliferation. Duct cell clusters, myoepithelial cells and stromal cells were the three main components found in the smears7 . One very important clue is epithelial cohesiveness in these clusters which differentiate highly cellular smears with atypia from malignant lesions10,11 . The lesions where only benign cells were seen in a dispersed manner were termed as benign breast disease not otherwise specified. Male breast or chest wall lipoma is also seen which is similar to lipoma at any other location with variably cellular smear with fat cells. Schwannoma in breast is rare, accounting for 2.6% of schwannomas12. There are less than 30 cases reported in literature. Male breast schwannoma is rarer. Schwannoma is characterized cytologically by Antoni A areas which are fragments of cohesive cells. Samples from Antoni B areas often show mainly dispersed cells and myxoid at times cystic background. The most typical characteristicis the fibrillary appearance of the intercellular stroma. Nuclei tend to be long andslender with pointed ends often with a curved appearance11 . The male breast cancer were easily distinguished on cytology from gynaecomastia on the basis of high cellularity, dyscohesive cell groups with nuclear piling and anisonucleosis10.The absence of bipolar nuclei is an important clue in diagnosis of malignant lesions. In our study the follow up could not be possible in all cases because of the patients being referred to the cancer hospital.

CONCLUSION

Cytology provides good pre operative methodology for diagnosis in male breast cancer. Judicious use of cytology can minimise biopsies and frozen sections in case of male breast lesions.

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References:

REFERENCES

1. Gill MS, Kayani N, Khan MN, Hasan HS. Breast diseases in males- A morphological review of 150 cases.J Pak Med Assoc 2000;50;177-179.

2. “Breast Cancer in Men”. Cancer Research UK. 2007. Retrieved 2010-05-14.

3. RanbeerSingh, Anshu, Satish M. Sharma, NitinGangane. Spectrum of Male Breast lesions Diagnosed by Fine Needle aspiration Cytology: A 5- Year Experience at a Tertiary Care Rural Hospital in central India.DiagnCytopathol,Vol 40(2):113-117.

4. Joshi A, Kapila k, VermaK.Fine Needle Aspiration Cytology in the Management of Male breast Masses-Nineteen years of experience.ActaCytologica 1999;43:334-338.

5. MansoorI, Jamal A. The value of fine needle aspiration cytology in the diagnosis of male breast lesions. Kuwait Med J 2001;33:216- 219.

6. Gupta RK,Naran S, Dowle CS, Simpson JS. The diagnostic impact of needle aspiration cytology of the Breast on decision making with an emphasis on the aspiration diagnosisof male breast masses. DiagnCytopathol 1991; 7:637-639.

7. Das DK, Junaid TA, Mathews SB, Ajrawi TG, Ahmed MS, Madda JP. Fine needle aspiration cytology diagnosis of male breast lesions: A study of 185 cases. ActaCytol 1995; 39:871-876.

8. Bannayan GA, HajduSI.Gynaecomastia: Clinicopathologic study of 351 cases. Am J ClinPathol 1992; 57:431-437.

9. Coen P, Kulin H. Ballantine T, etal.An aromatase producing sex cord stromal tumour resulting in prepubertalgynaecomastia.NEngl J Med 1991; 324:317-322.

10. Bibbo M, Lang WR, Silverman JF.Breast. In: Bibbo M, editor.Text book of comprehensive cytopathology. 2nd ed. Philadelphia: W B Saunders Company; 1997.p 750-752.

11. Orell SR, Sterrett GF, Walter Max N-I, Whitaker D.Breast. In: Orell SR, Sterrett GF, Walters M N-I, Whitaker D, Lindholm K, editors. Manual and atlas of fine needle aspiration cytology.3rd ed. London: Churchill Livingstone; 1999.p 188-189.

12. VandanaDialani,Neely Hines, Yihong Wang, Priscilla Slanetz.Breast Schwannoma. Case Reports in Medicine;2011.

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Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
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A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
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A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
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A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
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A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
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A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
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A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
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A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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