Malignant tumours of the male breast.
The cancer of the male breast is relatively rare and this is said to be in accord with the general rule that cancer seldom occurs in vestigeal organs. A review of the literature shows that the incidence varies from 0.08 to 6.4% of total breast cancers in the West and 0.06 to 4.06% in India,. The purpose of this paper is to analyse the clinical and pathological study of 20 cases of malignant tumours of the male breast observed during the period 1970-80 in patients admitted in the various units of the Rajendra Hospital attached to the Medical College, Patiala.
The total breast cancer cases in both sexes were 420, out of which 400 were females and 20 males; thus, malignant tumours of the male breast formed 4.76% of the total breast cancer cases. The majority of the cases were in the age groups of 51-60. The average age was 51 years. The youngest patient was 18 years old and the oldest 70 years old. Fourteen patients (70%) were Sikhs and six (30%) were Hindus. The percentage may be related to the population size of these two principal communities of this region. All patients belonged to middle income group.
Fifteen out of twenty cases (75%) presented with a mass in the breast; ulcerative growth was seen in three patients (15%) and pain and discharge from the nipple featured in only two patients which is in contrast with gynaecomastia where majority of cases present with pain. Ten patients (50%) reported within six months. Five patients (25%) sought medical advice after six months but within one year. Three patients (15%) came after one year but within two years while the remaining two patients (10%) came three years after the initial complaint. Average duration of illness was 12 months. Predominance of the right breast involvement was observed (55%) over the left breast (45%). The nipple and subareolar region of the central quadrant of the breast was involved in majority of the cases (75%) and the growth was fixed to the overlying skin and underlying muscles. Axillary lymph nodes were involved in 14 cases (70%) at the time of operation.
Radical mastectomy, the treatment of choice as advocated by several authors, was performed in 15 (70%) cases. Fourteen of these had post-operative irradiation in addition. Simple mastectomy and wide excision of the lump were performed in 5 (25%) cases as these cases were too old and were in poor condition to tolerate radical mastectomy and postoperative irradiation.
In majority of cases, the gross size of the growth varied from 1 to 6 cm. The average size was 3 cm. (See Fig. 1 on page 40A).
The incidence of various histopathology types according to the W.H.O. classification is shown in [Table 1.] Only one case out of twenty showed fibrosarcoma (See Fig. 2 on page 40A). Infiltrating carcinoma (undifferentiated) was the most common histopathological type among carcinomas of the male breast in this series. (65%). (See Figs. 3 and 4 on pages 40A and 40B).
The follow-up study of the cases has been poor and the available information is so scanty as to make it insignificant.
Relatively high incidence of male breast malignancy has been reported by Sen and Das Gupta as 4.7%, and Dutta et al. as 5.3% of total breast cancers. However, a somewhat lower incidence of male breast cancer has been observed by Somerville as 0.9 to 1.9%., Sirsat as 1.8%, Dubey and Agarwal as 2.6% and Kapur et al as 2.3% of total breast cancers. The present study showed 4.76% incidence.
The male breast cancer occurs relatively in older age as compared to the cancer of the female breast and more frequently during the 5th to 7th decades of life.,, , The youngest case of carcinoma of the male breast has been reported in a six year old male child by Hartman and Magrish. The average age in our series was 51 year's and the youngest patient was 18 years old.
Sirsat has reported a higher incidence of cancer of the male breast in Hindus than in Muslims and Christians. He further noted that the majority of the patients with cancer of the male breast (64.3%) reported for the treatment after six months of their noticing a lump in the breast. Haagensen, has observed that neglect or smaller size of the growth in males may be the reason for delayed reporting. Duration of illness varied from 2 months to 18 years in the study of Dutta et al. The average duration of illness was 12 months in the present study.
Predominance of right breast involvement has been reported,. However, Desouza et al have recorded predominantly left breast involvement. The nipple of the male breast is more commonly involved than in the female breast as the male mammary gland is so small that any growth must necessarily be nearer enough to the nipple to affect it sooner or later.,, Early involvement of the surrounding tissues is well known in the male due to conspicuous absence of fat and lobular tissue as compared to the female. In the present study, axillary lymph nodes were involved in 70% cases at the time of operation; similar observations have been made by other workers.,,,,
Haagensen has reported that the growths in the male breast cancer were relatively of smaller size. However, Tyagi et al have recorded 6.3 cm as an average size of the growth from the study on cancer of the male breast in contrast to the average size of 3 cm in our series.
Haagensen has observed that male breast carcinomas are more often well differentiated and that the papillary and intraductal types are more common in males. However, infiltrating carcinoma (undifferentiated) was the most commonest histological type seen in the present series (65%). Similar observations have been also reported.,,,
We thank Sh. O. P. Khosla, Photo-tine Officer of this institution for preparing the photomicrographs.