Literature review and case report of bilateral intracystic papillary carcinoma associated with an invasive ductal carcinoma in a male breast

Encapsulated Papillary Carcinoma of the Breast: A Review of Clinicopathologic Characteristics, Molecular Mechanisms, and Patient Management

Encapsulated papillary carcinoma (EPC) represents a distinct entity within the spectrum of breast papillary tumors, typically manifesting as a retroareolar mass. This rare subtype can be effectively visualized using ultrasound and magnetic resonance imaging, which reveal characteristic cystic-solid nodules. Histopathologically, EPC is defined by a papillary tumor structure with a well-defined fibrous capsule, devoid of myoepithelial cells both within and around the capsule. Immunohistochemical staining for myoepithelial markers is essential to confirm the absence of these cells, thereby validating the diagnosis of EPC. At the molecular level, EPC exhibits feature similar to estrogen receptor-positive invasive ductal carcinoma (IDC), with a biological behavior that lies between ductal carcinoma in situ (DCIS) and IDC. Generally, EPC has a favorable prognosis, associated with minimal recurrence and metastatic potential. Therapeutic strategies for EPC may parallel those for DCIS, including surgical excision. Adjuvant radiotherapy is recommended following surgery for patients with concurrent DCIS or those who have undergone breast-conserving therapy. In cases with associated IDC, management prioritizes the treatment of the invasive component. High-grade EPC often requires systemic therapies due to its poorer prognosis and increased risk of lymph node involvement.

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

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.

An Update on the General Features of Breast Cancer in Male Patients-A Literature Review

Male breast cancers are uncommon, as men account for less than 1 percent of all breast carcinomas. Among the predisposing risk factors for male breast cancer, the following appear to be significant: (a) breast/chest radiation exposure, (b) estrogen use, diseases associated with hyper-estrogenism, such as cirrhosis or Klinefelter syndrome, and (c) family health history. Furthermore, there are clear familial tendencies, with a higher incidence among men who have a large number of female relatives with breast cancer and (d) major inheritance susceptibility. Moreover, in families with BRCA mutations, there is an increased risk of male breast cancer, although the risk appears to be greater with inherited BRCA2 mutations than with inherited BRCA1 mutations. Due to diagnostic delays, male breast cancer is more likely to present at an advanced stage. A core biopsy or a fine needle aspiration must be performed to confirm suspicious findings. Infiltrating ductal cancer is the most prevalent form of male breast cancer, while invasive lobular carcinoma is extremely uncommon. Male breast cancer is almost always positive for hormone receptors. A worse prognosis is associated with a more advanced stage at diagnosis for men with breast cancer. Randomized controlled trials which recruit both female and male patients should be developed in order to gain more consistent data on the optimal clinical approach.