Sirs, we have recently encountered an interesting case of an invasive male breast carcinoma of the solid papillary variant that displayed extensive and strong CD34 immunopositivity. We think that this finding makes this case unique in the literature since, to our knowledge, there is no reported case of male or female breast carcinoma (invasive or in situ) displaying CD34 positivity.The patient was a 71-year-old man with a mass in his left breast measuring 2.32.0 cm in diameter. He had no family history of breast cancer, neither gynecomastia nor liver cirrhosis. He did not receive estrogenic medication and did not have a previous history of prostate cancer.On gross examination, the excised tumor had a grayish-white cut surface and solid texture. It was located near the overlaying skin with a relatively smooth border. On microscopic examination, the tumor consisted of solid nodules of neoplastic cells with the presence of a rich delicate network of fibrovascular stroma distributed in an arborizing pattern throughout the tumor. Formation of fibrovascular cores was evident in some areas giving a solid papillary configuration (Fig. 1). Remnants of cystic areas were identified in peripheral locations. Tumor cells were relatively large and round with a moderate amount of cytoplasm and moderately polymorphic nuclei with one or more prominent nucleoli. Mitoses were focally moderate in number. Large areas of necrosis and hemorrhage were evident. Although the tumor nodules were relatively circumscribed, there were foci showing infiltration of the adjacent tissue. Immunohistochemically the absence of myoepithelial cells (SMA, monoclonal, 1:150; Dako) and basic membranes (laminin, monoclonal, 1:40, Novocastra) confirmed the invasive character of the tumor.Tumor cells were diffusely positive for cytokeratins AE1/AE3 (monoclonal, 1:20; Novocastra), Cam 5,2 (monoclonal, 1:40; Novocastra), and cytokeratin 7
The immunophenotype of periductal connective tissue stroma in gynaecomastia appears to parallel the phenotype of normal breast stroma. In male breast carcinoma the stromal cell immunophenotype is similar to that of its female counterpart showing myofibroblastic differentiation. However alpha-SMA+ and CD34- are not specific to malignancy because such findings are also encountered in reactive fibrosis.
A total of 30 archival cases of male breast carcinoma were studied immunohistochemically for the expression of CD34 antigen. An obvious CD34 staining was found in three cases. By adding the original CD34-positive case, recently published as unique CD34-stained male breast carcinoma, the number of positive cases comes to four. This case was classified as an invasive papillary carcinoma of solid conformation, whereas the three other cases were invasive ductal carcinomas, not otherwise specified. The aim of this study is to establish whether the CD34 positivity, observed in the case of papillary subtype, was a case-specific finding. CD34 expression in the male breast carcinoma, according to our findings, seems to be neither a feature presented exclusively by a singular case nor a specific immunophenotype characterising a special type. The presence or preservation of CD34 antigen in four totally male breast carcinomas may be considered as a novel finding that supports a relationship between these tumours and the progenitor CD34-positive stem cells, committed to the organogenesis of mammary gland. In this context we hypothesise an origin of male breast carcinoma from the stem cells expressing or not the CD34 antigen according to their stage of differentiation.
The patella is rarely affected by Paget disease of bone. The authors report a 54-year-old lady with ipsilateral knee and hip pain, initially misdiagnosed as patella stress fracture and early degenerative hip arthritis, who was later found to have Paget disease of the patella with ipsilateral femoral head bone marrow edema.
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