Male breast cancer: A multicenter study in Aragon over 27 years.

INTRODUCTION: Male breast cancer accounts for 1% of all breast cancers. Its low frequency leads to a lack of awareness, resulting in significant diagnostic delays. Additionally, this limits the available evidence, which primarily uses diagnostic-therapeutic algorithms based on women. OBJECTIVES: To analyze the prevalence, clinical presentation, anatomical and pathological characteristics, and prognosis of male breast cancer using one of the largest series available. Secondarily, to compare our data with studies conducted in women. MATERIALS AND METHODS: A multicenter, observational, descriptive, retrospective study was conducted in the autonomous community of Aragon, Spain, from 1995 to 2022 including men with a pathological diagnosis of breast cancer. RESULTS: A total of 148 patients were included, with a prevalence of 1%. The most common clinical presentation was a palpable retroareolar mass. Invasive ductal carcinoma was the most frequent type (88.89%), and luminal B was the predominant subtype (47.76%). Surgery was the most utilized treatment; mastectomy was performed in 90.34% and AL in 46.89%. At diagnosis, 52.46% had extramammary involvement. The recurrence rate was 24.1%, and the mortality attributed to the disease was 14.6%. CONCLUSIONS: There is a high rate of metastatic involvement at diagnosis, a high percentage of mutilating surgeries, and a high number of recurrences compared to available studies on males. Additionally, a worse prognosis is observed compared to breast cancer in women, despite these tumors having a less aggressive molecular subtype. These findings highlight the importance of conducting studies focused on men to develop specific protocols.

Misleading images of ductal carcinoma in situ: 4 lymph nodes with metastasis.

Since sentinel lymph node examination became routine, findings of benign ectopic breast tissue in lymph nodes have increased. We report images of ductal carcinoma in situ (DCIS) in four lymph nodes in a 76-year-old woman with bilateral breast carcinoma. The right lumpectomy showed intermixed invasive lobular and ductal carcinoma, plus DCIS. 19 nodes were isolated in the axillary lymphadenectomy, 4 of which displayed solid and cribriform DCIS. Myosin and p63 immunohistochemical techniques were positive, suggesting an erroneous diagnosis of "metastatic DCIS". A further three cases of DCIS in lymph nodes have been previously reported, all with a distinct layer of myoepithelial cells with actin, myosin or p63. Biologically, these images of DCIS in lymph nodes are not credible and three major hypotheses have been proposed to explain these findings: Iatrogenic Mechanical Transport, Revertant DCIS, and primary DCIS of lymph nodes. We consider the first one the most plausible explanation. Our case is unique as several, rare findings are simultaneously observed. More new cases, together with additional immunohistochemical techniques and molecular testing on previous cases, are needed to find a definitive explanation of this histologic finding.

[Multicentric secretory carcinoma of the breast: Case report and review of the literature]. / Carcinoma secretor de mama multicéntrico: a propósito de un caso y revisión de la literatura.

Secretory carcinoma of the breast is a rare entity, characterized by the presence of intra- and extracellular, eosinophilic and acelular secretions. They are negative for hormone receptors and do not express human epidermal growth factor receptor HER-2/neu. However, the clinical outcome is favorable. Multicentricity is very unusual. We report a case of a 32-year-old woman with a multicentric secretory carcinoma of the breast. The main pathological features are discussed together with a review of the pertinent literature.

[Spondylodiscitis and sacroiliitis due to Streptococcus agalactiae in adults: clinical case and literature review]. / Espondilodiscitis y sacroileítis por Streptococcus agalactiae en adultos: caso clínico y revisión de la literatura.

INTRODUCTION: Streptococcus agalactiae is a well-known pathogen related with infection in newborns, and in women during pregnancy and the puerperium. In recent years it has been described as a causal agent in invasive disease in immunodepressed adults and those with other severe underlying pathologies. METHODS: We describe a case of S. agalactiae spondylodiscitis and concomitant bilateral sacroiliitis in an adult with no known underlying diseases. A systematic review of the related literature was performed (MEDLINE and EMBASE, up to December 2003). RESULTS: The literature search retrieved only 33 cases of spondylodiscitis (predominance in men, 55-70 years old) and 13 cases of sacroiliitis (higher frequency in women, 30-40 years old) due to S. agalactiae. Simultaneous involvement of both locations of the axial skeleton is unusual. CONCLUSION: Spondylodiscitis and sacroiliitis due to S. agalactiae is uncommon. S. agalactiae is an emerging pathogen in adults outside of the gestational and perinatal period. This micro-organism produces spondylodiscitis in the adult population over 50 years old. In contrast, sacroiliac involvement is described mainly in women in the reproductive age.

[Paratesticular leiomyosarcoma. Review and update]. / Leiomiosarcoma paratesticular. Revisión y puesta al día.

OBJECTIVES: To present one case of paratesticular leiomyosarcoma, a rare tumor which has been reported in 5 cases only in our country. To review the management of this type of tumor. METHODS: A 73-year-old male presenting with a 4 cm mass adjacent to the right testicle underwent excision of the mass, spermatic cord and testicle through an inguinal approach. RESULTS: The tumor was classified as a grade 3 leiomyosarcoma, with positive immunohistochemical staining for desmin and smooth muscle actin. After this pathology report we did not consider adjuvant oncological treatment. Tumor relapse has not appeared so far. CONCLUSIONS: Radical surgery is the only feasible and successful treatment for paratesticular sarcomas, with the exception of rabdomyosarcoma, because they are radio and chemoresistant. The inguinal approach is the ideal and obligatory one, including excision of the spermatic cord and adjacent testicle. Long-term periodic follow-up visits are mandatory because relapses may occur even long time after diagnosis. In case of relapse, surgery is again the only tool we have to control this type of tumor. Currently radiotherapy is recommended in cases of local recurrence after surgery. 5-year survival rates are around 75%, and 10-year 50%.

[Adrenal spindle cell angiosarcoma. Report one case]. / Angiosarcoma suprarrenal de células fusiformes. A propósito de un caso.

OBJECTIVES: To report a new case of spindle cell angiosarcoma of the adrenal gland. METHODS: We reviewed 22 cases previously published of this rare entity, analyzing at the same time both clinical and pathologic findings of this infrequent sarcoma of urological localization. The epithelioid variety is the most common, which makes our spindle cell type case rarer, if possible. RESULTS: 59-year-old male without significant previous medical history presenting at the emergency department with sudden onset of pain in the left hemithorax after several months of discomfort in the area. Diagnostic imaging tests showed a heterogeneous mass dependent of the left kidney. After performing radical nephrectomy and adrenalectomy, pathologic and immunohistochemical studies offered the diagnosis. CONCLUSIONS: Despite the rarity of these tumors it should be taken into consideration in the differential diagnosis of every adrenal tumor. Complete surgical excision is the treatment of choice, adding systemic chemotherapy as adjuvant therapy; radiotherapy is reserved as a second line after excision of recurrences if there are.

[Foamy carcinoma of the prostate]. / Carcinoma espumoso de la próstata.

OBJECTIVES: We report the first case of prostatic foamy gland carcinoma in the Spanish literature. METHODS: Case of a 69-year-old male who consulted for PSA elevation up to 101 ng/ml. Transrectal ultrasound showed a heterogeneous gland with a hipoechogenic area in the right lobe and possible capsular disruption. Six ultrasound guided needle biopsies were performed. The samples from the right lobe were reported as Gleason 6 foamy cell prostatic adenocarcinoma. RESULTS: Prostatic foamy cell carcinoma is a rare tumor, and so are its bibliographic references. Its cells lack of prominent nucleus and nucleoli. They show a plentiful and xanthomatous cytoplasm, with abundant intracytoplasmic pink secretions characteristically. It may be mistaken with low grade adenocarcinomas, and it is essential to differentiate it from the clear cell prostatic adenocarcinoma, prostatic adenosis, and even from benign prostatic hyperplasia. It usually has an intermediate grade, with a Gleason score greater than 4.

[Testicular leukemic infiltration]. / Infiltración leucémica testicular.

OBJECTIVES: To remind that despite its low incidence, leukemic relapse in the testicles worsens the prognosis of this haematopoietic neoplasia. METHODS/RESULTS: We report the case of a 20-year-old male suffering from acute lymphoblastic leukemia in complete remission after induction and maintenance treatment, who suffered a leukemic relapse in both testicles. Diagnosis was made by ultrasound and confirmed after bilateral testicular biopsies. The patient died due to fungal infection after new treatment with systemic chemotherapy and bone marrow transplantation. CONCLUSIONS: It is necessary to suspect the existence of leukemic cells within the testicles in patients with this disease, mainly acute lymphoblastic leukemia, who present with acute testicular symptoms. Testicular biopsy confirms the diagnosis. Treatment is systemic, with testicular radiation to eradicate the leukemic reservoir. Despite the achievement of local disease control, this situation worsens the prognosis.

[Prostatic ductal carcinoma]. / Carcinoma ductal prostático.

OBJECTIVES: We presented one case of prostatic adenocarcinoma of ductal origin, known as endometrial adenocarcinoma before. The first case was published in 1967 by Mellicow. Since then we could only recover 8 cases by spanish authors. METHODS/RESULTS: 61-year-old patient presenting with urethral bleeding, PSA 12 ng/cc, and an exophytic urethral mass. Histology was compatible with ductal adenocarcinoma of the cribiform type. Radical prostatectomy was carried out with good outcome at six months follow up. CONCLUSIONS: Prostatic ductal adenocarcinoma is a rare tumor, accounting for 0.2-5% of prostatic tumours. Its behaviour is variable, similar to the acinar cell type. Strikingly, there are scarce references to this tumor type; accordingly to the statistics of incidence it should have been referred more often, which would help to its study in terms of outcomes, treatment, and prognosis.