Painless breast lumps in older men

Introduction The appearance of a painless mass in the breast of an elderly male is one of the clinical diagnoses of male breast cancer. Male mammary cancer is a rare malignant tumor, accounting for 0.2% to 1.5% of all cancers in men, accounting for about 1% of breast cancer.

Cause

(1) Causes of the disease

The cause of breast cancer in men is not well understood and is currently considered to be related to the following factors.

1. Familial: In a report of male breast cancer at home and abroad, there is a considerable proportion of cases in the family, or a family history of breast cancer in women, or cases of other tumors in the family. It is suggested that the occurrence of male breast cancer is somewhat familial.

2. Endogenous estrogen increase: Compared with female breast cancer, male breasts have no physiological activity and lack excessive stimulation of ovarian hormones. However, there are many male breast development, endocrine abnormalities and liver function damage. Lacassegne confirmed (1932) that repeated injections of estrogen into male mice can induce breast cancer. When the liver is damaged, the liver's inactivation of estrogen is reduced, resulting in relatively excessive estrogen in the body, and increased mammary gland development in men. Some people think that male mammary gland development is a precancerous disease, which may lead to breast cancer.

3. Sexual chromosome abnormalities: In addition, studies have shown that some of the diseased patients have small testicles, fibrosis and vitreous changes. Increased urinary pituitary gonadotropin and a sex chromosome abnormality are called Klinefelter syndrome. In this case, the incidence of breast cancer is 20 times higher than that of normal men.

4. Others: exposure to radioactive materials, local damage to the breast, clinical use of estrogen, etc., can also induce breast cancer.

(two) pathogenesis

1. The location of the disease

Male breast cancer occurs mostly in the central region of the breast below the nipple areola, mainly unilateral, the left side is slightly more common than the right side, and both sides of the disease at the same time or successively onset are rare.

2. Pathological morphology

(1) Gross morphology: The naked eye sees a deep lumps, the border is unclear, hard and painless, and the average diameter is 3.1 cm. As the mass progresses, it can adhere to the skin, often with a nodular bulge, forming an ulcer, and can also spread to the deep and spread to the chest muscle.

(2) Histomorphology: The histopathological type of male breast cancer under optical microscope is basically the same as that of female breast cancer. It is more common in non-specific invasive cancer, accounting for 82%-86.5%. Invasive cancer can be divided into adenocarcinoma and hard cancer. Simple cancer, medullary carcinoma, papillary carcinoma, mucinous carcinoma, apocrine adenocarcinoma, etc. Many people believe that normal male breast cancer lacks lobular tissue, so lobular carcinoma does not occur. However, lobular carcinoma has also been reported in the literature in recent years.

The source of cells for male breast cancer is still controversial. It is worth mentioning that the detection of estrogen receptor (ER) and carcinoembryonic antigen (CEA) in cancer tissues by immunoenzyme technology is of great significance for guiding treatment and monitoring the recurrence of breast cancer. Male breast cancer can be divided into hormone-dependent and non-hormone-dependent as well as female breast cancer. It has been found that when a woman treats a disease with estrogen, the mammary gland forms a true leaflet with the same structure as a sexually mature woman's breast.

an examination

Needle aspiration cytology

Puncture the cells at the breast mass for pathological examination, showing severe hyperplasia and suspicious cancer cells.

2. ER measurement

Most male ER receptors are positive in male breast cancer.

3. Molybdenum target X-ray examination

It can be seen that the nipple invagination is funnel-shaped, and there are burr-like mass shadows in the areola area, and the dense area may have radial blood vessels or sediment-like calcification points.

Differential diagnosis

Should be identified with male mammary gland development. Male breast cancer patients are mostly elderly, unilateral mass, eccentricity of the mass, hard, no pain; needles to find cancer cells. Male mammary gland development is more common in adolescent and liver disease patients, mostly bilateral discs, tenderness; needle aspiration cytology is one of the important identification methods.

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