1
|
Tian C, Alvarado R, Kim T, Slostad J. Male ductal carcinoma in situ: diagnosis and management of a rare disease in men. BMJ Case Rep 2024; 17:e256608. [PMID: 38499353 PMCID: PMC10952870 DOI: 10.1136/bcr-2023-256608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Ductal carcinoma in situ is very rare in male patients, accounting for approximately 5%-7% of all male breast cancers. We present a case of a man in his early 70s who presented with bloody nipple discharge and gynaecomastia and was subsequently diagnosed with ductal carcinoma in situ (DCIS). We discuss his management with surgical resection and the consideration of adjuvant treatment. We also review the existing literature on the presentation, diagnosis and management of DCIS in men.
Collapse
Affiliation(s)
- Changtai Tian
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Rosalinda Alvarado
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas Kim
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica Slostad
- Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
2
|
Chichura A, Attai DJ, Kuchta K, Nicholson K, Kopkash K, Pesce C, Yao K. Male Breast Cancer Patient and Surgeon Experience: The Male WhySurg Study. Ann Surg Oncol 2022; 29:6115-6131. [PMID: 35876929 PMCID: PMC9310362 DOI: 10.1245/s10434-022-12135-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about the experience of the male breast cancer patient. Mastectomy is often offered despite evidence that breast-conserving surgery (BCS) provides similar outcomes. METHODS Two concurrent online surveys were distributed from August to October 2020 via social media to male breast cancer (MBC) patients and by email to American Society of Breast Surgeon members. The MBC patients were asked their opinions about their surgery, and the surgeons were asked to provide surgical recommendations for MBC patients. RESULTS The survey involved 63 MBC patients with a mean age of 62 years (range, 31-79 years). Five MBC patients (7.9 %) stated that their surgeon recommended BCS, but 54 (85.7 %) of the patients underwent unilateral, and 8 (12.7 %) underwent bilateral mastectomy. Most of the patients (n = 60, 96.8 %) had no reconstruction. One third of the patients (n = 21, 33.3 %) felt somewhat or very uncomfortable with their appearance after surgery. The response rate was 16.5 % for the surgeons. Of the 438 surgeons who answered the survey, 298 (73.3 %) were female, 215 (51.7 %) were fellowship-trained, and 244 (58.9 %) had been practicing for 16 years or longer. More than half of surgeons (n = 259, 59.1 %) routinely offered BCS to eligible men, and 180 (41.3 %) stated they had performed BCS on a man with breast cancer. Whereas 89 (20.8 %) of the surgeons stated that they routinely offer reconstruction to MBC patients, 87 (20.3 %) said they do not offer reconstruction, 96 (22.4 %) said they offer it only if the patient requests it, and 157 (36.6 %) said they never consider it as an option. CONCLUSIONS The study found discordance between MBC patients' satisfaction with their surgery and surgeon recommendations and experience. These data present an opportunity to optimize the MBC patient experience.
Collapse
Affiliation(s)
- Anna Chichura
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Department of Surgery, Pritzker School of Medicine at University of Chicago, Chicago, IL, USA
| | - Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kyra Nicholson
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Department of Surgery, Pritzker School of Medicine at University of Chicago, Chicago, IL, USA
| | - Katherine Kopkash
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Department of Surgery, Pritzker School of Medicine at University of Chicago, Chicago, IL, USA
| | - Catherine Pesce
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Department of Surgery, Pritzker School of Medicine at University of Chicago, Chicago, IL, USA
| | - Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. .,Department of Surgery, Pritzker School of Medicine at University of Chicago, Chicago, IL, USA.
| |
Collapse
|
3
|
Arzanova E, Mayrovitz HN. Male Breast Cancer: Treatment Trends, Reported Outcomes, and Suggested Recommendations. Cureus 2021; 13:e18337. [PMID: 34725599 PMCID: PMC8555756 DOI: 10.7759/cureus.18337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022] Open
Abstract
Male breast cancer (MBC) is unfamiliar to most men, and its optimal treatment options are not well recognized by many treating physicians. The lack of MBC specific clinical trials contributes to the limitations of understanding MBC specific pathology, treatment options, and outcomes. This state-of-affairs contribute to perpetuating the use of treatment methods derived from our existing knowledge of female breast cancer (FBC). Previous studies demonstrate that men are often undertreated or disproportionately treated using more invasive surgical procedures even in the early stages of MBC. The purpose of this investigation was to thoroughly discuss current MBC treatment options, provide an evidence-based summary of their outcomes, note recent improvements, discuss important considerations and recommendations. Our goal is to aid the treatment decision process for patients and treating physicians.
Collapse
Affiliation(s)
- Evelina Arzanova
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| |
Collapse
|
4
|
Six factors justify the pathologic analysis of subcutaneous mastectomy specimens in patients with gynaecomastia. J Plast Reconstr Aesthet Surg 2014; 67:1760-1. [PMID: 24997504 DOI: 10.1016/j.bjps.2014.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/06/2014] [Accepted: 06/09/2014] [Indexed: 11/24/2022]
|
5
|
Senger JL, Chandran G, Kanthan R. Is routine pathological evaluation of tissue from gynecomastia necessary? A 15-year retrospective pathological and literature review. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jenna-Lynn Senger
- College of Medicine; Royal University Hospital, Saskatoon, Saskatchewan
| | - Geethan Chandran
- Department of Plastic Surgery, University of Saskatchewan; Saskatoon, Saskatchewan
| | - Rani Kanthan
- Department of Pathology & Laboratory Medicine, Royal University Hospital, Saskatoon, Saskatchewan
| |
Collapse
|
6
|
Senger JL, Chandran G, Kanthan R. Is routine pathological evaluation of tissue from gynecomastia necessary? A 15-year retrospective pathological and literature review. Plast Surg (Oakv) 2014; 22:112-116. [PMID: 25114624 PMCID: PMC4116310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To reconsider the routine plastic surgical practice of requesting histopathological evaluation of tissue from gynecomastia. METHOD The present study was a retrospective histopathological review (15-year period [1996 to 2012]) involving gynecomastia tissue samples received at the pathology laboratory in the Saskatoon Health Region (Saskatchewan). The Laboratory Information System (LIS) identified all specimens using the key search words "gynecomastia", "gynaecomastia", "gynecomazia" and "gynaecomazia". A literature review to identify all cases of incidentally discovered malignancies in gynecomastia tissue specimens over a 15-year period (1996 to present) was undertaken. RESULTS The 15-year LIS search detected a total of 452 patients that included two cases of pseudogynecomastia (0.4%). Patients' age ranged from five to 92 years and 43% of the cases were bilateral (28% left sided, 29% right sided). The weight of the specimens received ranged from 0.2 g to 1147.2 g. All cases showed no significant histopathological concerns. The number of tissue blocks sampled ranged from one to 42, averaging four blocks/case (approximately $105/case), resulting in a cost of approximately $3,200/year, with a 15-year expenditure of approximately $48,000. The literature review identified a total of 15 incidental findings: ductal carcinoma in situ (12 cases), atypical ductal hyperplasia (two cases) and infiltrating ductal carcinoma (one case). CONCLUSIONS In the context of evidence-based literature, and because no significant pathological findings were detected in this particular cohort of 452 cases with 2178 slides, the authors believe it is time to re-evaluate whether routine histopathological examination of tissue from gynecomastia remains necessary. The current climate of health care budget fiscal restraints warrants reassessment of the current policies and practices of sending tissue samples of gynecomastia incurring negative productivity costs on routine histopathological examination.
Collapse
Affiliation(s)
| | | | - Rani Kanthan
- Department of Pathology & Laboratory Medicine, Royal University Hospital, Saskatoon, Saskatchewan
| |
Collapse
|