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Journal of Case Reports
Fine Needle Aspiration Cytology of Mastitis in a Male Breast
Agrawal Y, Karki S, Dahal M
Department of Pathology, BPKIHS, Dharan, Nepal.
Corresponding Author:
Dr. Yamuna Agrawal
Email: yamunaagrawal@yahoo.com
Received: 27-FEB-2015 Accepted: 04-JUNE-2015 Published Online: 05-JUL-2015
DOI: http://dx.doi.org/10.17659/01.2015.0074
Abstract
Introduction: Mastitis, a benign clinical entity of inflammation of breast parenchyma, is exceedingly rare in males with only few cases reported so far.  Case Report: A 37-year-old male, presented with history of lump and discharging nipple of right breast for ten days. On examination the right breast had a well-defined 2x1 cm2 lump at subareolar region. Ultrasound showed an ill-defined heterogenous predominantly hypoechoic area with fine internal echo and no vascularity just beneath the nipple area. Cytosmears showed benign ductal epithelial cells arranged in sheets and clusters intermixed with inflammatory cells composed of neutrophils, lymphocytes, macrophages most of them showing phagocytic activity along with numerous multinucleated giant cells, thus revealing overall cytomorphologic features of mastitis. Conclusion: Mastitis in a male breast is extremely rare. The awareness of this benign entity established on fine needle aspiration will avoid unnecessary surgery.
Keywords : Mastitis, Breast Diseases, Nipples, Fine Needle Biopsy, Inflammation.
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Introduction

Mastitis is a benign clinical entity characterized by inflammation of breast parenchyma usually common among females [1].  It is exceedingly rare in males with only few cases reported in literature so far [2]. Clinically the breast is tender to touch; there may be a subcutaneous swelling. Most of the cases are associated with nipple discharge which may be bloody or non-bloody. Sometimes it can mimic carcinoma breast particularly in elderly people [1]. The cytologic findings have been described only recently in the cytopathology literature. Fine needle aspiration (FNA) cytologic findings are based mainly on a small number of case reports in the English literature [3].

Case Report

A 37-year-old male, presented to the surgery outpatient clinic with history of painful lump over the right breast for ten days. On milking the breast there was pus like discharge from the nipple. There was no history of intake of any drugs for last few months or trauma for last few weeks. He is a chronic smoker with six pack year cigarette exposure and chronic alcoholic beverage consumer. On examination the breast was warm and tender. The swelling was well-defined 2x1 cm2 lump at subareolar region which was firm and mobile.  Skin overlying the mammary gland was normal except area surrounding the areola that was erythematous, warm and tender. The nipple was normal in position without retraction or swelling. The draining lymph nodes were normal. The left breast was normal on clinical examinations. His vitals and other systemic examinations were non-significant. His serological markers for HIV, HBV and HCV were negative. His blood sugar was within normal limit. Ultrasound of the lump showed an ill-defined heterogenous predominantly hypoechoic area of 1.88x1.62 cm2 with fine internal echoes. There was no vessel within the lump that was suggestive of infective pathology.  Fine needle aspiration yielded pus like aspirate. The patient was treated with empirically with antibiotics and anti-inflammatory drugs awaiting the cytopathological reports.

    Cytosmears showed benign ductal epithelial cells arranged in sheets and clusters intermixed with mixed inflammatory cells composed of neutrophils, lymphocytes, macrophages most of them showing phagocytic activity along with numerous multinucleated giant cells. Thus revealing overall cytomorphologic features of mastitis.  Patient significantly improved with the empirical treatment on follow up visits and was counseled regarding the benign nature of lump and advised to avoid smoking.

Discussion

The lesions involving the male breast are relatively uncommon, with only few conditions like nipple adenoma, mammary duct ectasia, leiomyosarcoma of nipple, phyllodes tumor, cystic hyperplasia have been reported in the literature, the more usual being gynaecomastia and carcinoma [4]. Our case presented with painful discharging gynaecomastia as reported by Lilleng et al. the largest case series on the same gender. Only eight cases showed inflammation/abscess in the large series of 809 cases of male breast lesions by Lilleng et al. [5]. Male breast lesion is uncommon entity of which inflammatory lesion are far more uncommon.

    The first description of both ductal dilatation and periductal inflammation was made by Bloodgood and the term duct ectasia was popularized by Haggenson in 1951 [1,6]. As it is more common in females, pregnancy and lactation were incriminated as a cause of the disease, but the condition was reported in virgins and males also. Some authors believe it is an involutional change of the breast ductal system due to the aging process.

    Among such cohort one to two thirds of patients are associated with smoking [2].  Smoking was common risk factor in our patient too. Smoking and squamous metaplasia may have a role in periductal mastitis [7]. Cigarette smoke may damage the ductal epithelium by its direct toxic effect or indirectly by influencing the blood flow and hormonal action on the duct epithelium [2]. Smoking predisposes to both aerobic and anaerobic infection than nonsmoker which may trigger these conditions [2,8].  There had been no clinical evidences regarding relationship between dose of smoke exposed and the periductal damage and amount of reversal of the damage on quitting smoking however the patient was advised to quit smoking thinking smoking related all the health insults may not progress beyond.

    Besides smoking immune mediated systemic inflammation is also associated with similar presentation however clinical features of such immune dysfunction were not found in our patient. Among twelve cases of periductal mastitis in male breast reported by Changsuk Park, et al. two cases were associated with HIV infection and Behcet’s disease, suggesting that immune factors may play a role in periductal mastitis [7].  Changsuk Park, et al. have also described a case of periductal mastitis  in a male breast associated with chemotherapy for lung cancer however there was no association of intake of any drug for last a few months by our patient.

Conclusion

Mastitis in a male breast is extremely rare. The awareness of this benign entity and diagnosis on fine needle aspiration should be made to avoid unnecessary surgery.

References
  1. Manimekhala P, Aruna L, Vasireddy Guvera, Sirisha O,  VijayaSreedhar V. A Rare Case of Periductal Mastitis in a Male. Sch J Med Case Reports. 2014;2(3):165-166.
  2. Al-Masad JK. Mammary duct ectasia and periductal mastitis in males. Saudi Med J.  2001;22(11):1030-1033.
  3. Javadzadeh B, Finley J, Williams HJ. Fine needle aspiration cytology of mammary duct ectasia: report of a case with novel cytologic and immunocytochemical findings.  Acta Cytol. 2001; 45:1027-1031.
  4. McClure J, Banerjee SS, Sandilands DG. Female type cystic hyperplasia in a male breast.  Postgrad Med J. 1985;61(715):441-443.
  5. Gupta N, Agrawal P, Saikia UN, Das A, Srinivasan R, Rajwanshi A, et al. Periductal mastitis in a male breast masquerading as lobular carcinoma on fine needle aspiration cytology. Diagn Cytopathol. 2012;40(5):455-458.
  6. Ashworth MT, Corcoran GD, Haqqani MT. Periductal mastitis and mammary duct ectasia in a male.  Postgrad Med J. 1985;61(717):621-623.
  7. Changsuk Park, Jung Im Jung, Bong Joo Kang, Ahwon Lee, Woo Chan Park, Seong Tai Hahn M. Periductal Mastitis in a Male Breast. J Korean Radiol Soc. 2006;55:305-308.
  8. Dixon JM, Ravisekar O, Chetty U, Anderson TJ. Periductal mastitis and duct ectasia: Different conditions with different aetiologies. Br J Surg. 1996;83(6):820-822.
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Y Agrawal, S Karki, M DahalFine Needle Aspiration Cytology of Mastitis in a Male Breast.JCR 2015;5:289-291
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Y Agrawal, S Karki, M DahalFine Needle Aspiration Cytology of Mastitis in a Male Breast.JCR [serial online] 2015[cited 2024 Mar 29];5:289-291. Available from: http://www.casereports.in/articles/5/2/Fine-Needle-Aspiration-Cytology-of-Mastitis-in-a-Male-Breast.html
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