Experience of Saint-Louis Hospital in cancer breast in men: review of characteristics of 44 cases and search for the expression androgen receptor

Abstract

Background: Male breast cancer (MBC) is rare
with a poor outcome, mainly due to late diagnosis.
Data are missing with only small retrospective studies. Few studies mentioned HER2 status or provide
data on androgen receptor in MBC. A better
understanding of biological and histological characteristics could improve the management.
Objective: To provide a description of the clinical
and pathological features of 44 men with breast cancer, including immunohistochemistry (IHC) analysis
for oestrogen receptor (ER), progesterone receptor
(PR), androgen receptor (AR), HER2 status and
Ki67 proliferation index. Methods: Forty four
male patients with breast cancer were treated in
Saint Louis Hospital between 1984 and 2010. All
histological specimens were reviewed by breast dedicated pathologists, and IHC was performed for ER,
PR, AR, HER2 status and Ki67. We retrospectively
analyzed clinical and histological characteristics,
treatment procedures, and outcomes. Results:
Median follow up was 70.6 months. The mean age
was 64.7 years. The average time between the first
symptom and the diagnosis was 18.2 months.
Infiltrative ductal carcinoma was the main histological subtype (89%). Tumor grade was low (SBR III
for 25%). 100% of tumors were positive for ER,
84% for PR, 24% for AR. Only one patient had an
overexpression of HER2. The Ki67 proliferation
index was high (>30%) for 15% of patients. Among
8 patients overexpressing AR, 50% had a highly
proliferant tumor, and 75% had node involvement.
All patients underwent mastectomy and axillary dissection followed by radiotherapy for 70% of them,
50% received chemotherapy and 77% hormonal
therapy (tamoxifen 65%, aromatase inhibitors 35%).
Six patients underwent locoregional recurrence
(15%,) and 12 developed distant metastasis (30%).
Conclusion: This series reports IHC profile including AR and HER2 status in MBC. The HER2
over expression seems to be a very rare event in male
breast cancers. In our study, AR overexpression was
associated with an aggressive behaviour. Further
data would be granted to elucidate its role in hormonal control of men breast cancer growth and development.