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Breast carcinomas in men account for < 1% of all subtypes and most belong to the infiltrating duct variety of the “not otherwise specified” type.1 To date, only 15 cases of the rare subtype of secretory carcinoma have been reported in men.2 The youngest patient was a 6 year old boy3 and oldest a 66 year old man.4 We present a case of secretory carcinoma in a 19 year old man whose tumour cells were vimentin positive and oestrogen and progesterone receptor negative.
The patient presented to a private clinic in rural Northern India with a painful, rapidly progressing lump in the right breast of two years duration. A lumpectomy was performed at a local hospital. Three months after surgery, two small lumps reappeared on the right chest wall, which were excised and sent to our hospital for histopathology. Two nodules measuring 4 × 2 × 2 cm and 2 × 2 × 2 cm were received. Cut sections were greyish yellow and densely fibrous.
Microsections showed an infiltrating tumour with tumour cells arranged in microcystic and cribriform patterns separated by scant fibroconnective stroma (fig 1). The tumour cells were round to polygonal with abundant pale to clear amphophilic cytoplasm. The nuclei were large and central with stippled chromatin (fig 2). Pink amphophilic secretions were seen in the lumina of microcysts (fig 2) and focally within the cells. The intracellular and extracellular secretions were periodic acid Schiff (diastase resistant) and mucicarmine positive. Immunohistochemistry for the oestrogen receptor (ER ID5; Immunotech, Marseille, France), progesterone receptor (PR 105; Immunotech), and vimentin (Dako, Glostrup, Denmark) was performed. The tumour cells were universally oestrogen receptor and progesterone receptor negative, but were vimentin positive (100% positivity).
Mc Diwitt and Stewart first described breast tumours in children with a favourable prognosis (1966) and named them juvenile carcinomas.5 This was later replaced by the term secretory carcinoma by Tavassoli.5 De Bree et al have recently reviewed secretory carcinoma in men and reported a median age of 17 years, with the tumour size ranging from 1.2 to 4 cm.2 They also noticed that lymph node metastases were frequent in tumours less than 2 cm, unlike secretory carcinomas in women. Hence, secretory carcinomas in men appear to be more aggressive.2 The tumour in our patient was also an aggressive one because an early recurrence was seen.
Very few authors have performed immunohistochemical studies on secretory carcinomas of male breasts.3 These tumours are said to be epithelial membrane antigen, cytokeratin, carcinoembryonic antigen (polyclonal), S-100, and α lactalbumin positive.
Although traditionally vimentin expression has been associated with mesenchyme and mesenchymal tumours, many epithelial malignancies are vimentin positive, including those of the breast.6 Vimentin expression has been studied extensively in female breast tumours (predominantly in infiltrating ductal carcinomas) and is associated with biological aggressiveness.6 The role of vimentin positivity in male breast carcinomas needs to be explored. It is unclear whether vimentin positivity in our case is related to the aggressiveness of the tumour and larger studies are needed to investigate this possibility.