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| | | Year : 2010 | Volume : 53 | Issue : 4 | Page : 853-854 | | | Cavernous lymphangioma of the male breast | | | Purnima Malhotra1, Anju Bansal1, Chintamani2, Sunita Saxena1
1 Institute of Pathology, Safdarjang Hospital campus, Post box 4909, New Delhi - 110029, India
2 Department of Surgery, Safdarjang Hospital, New Delhi - 110029, India
Click here for correspondence address and email | Date of Web Publication | 27-Oct-2010 | | |      | | How to cite this article:
Malhotra P, Bansal A, Chintamani, Saxena S. Cavernous lymphangioma of the male breast. Indian J Pathol Microbiol 2010;53:853-4 |
Sir,
Lymphangioma of the male breast is rare with only two cases described in literature. [1],[2] We report a 60-year-old male with lymphangioma of the breast. A 60-year-old male presented with a nodule in the region of left breast, which was present since childhood and had gradually increased to its present size of 7×7×5 cm [Figure 1]. There was no history of nipple discharge. Physical examination revealed a well-circumscribed, firm, and nontender lump located largely in the upper outer quadrant. The nipple was located at the medial end of the lump and was not fixed or retracted. There was no axillary lymphadenopathy.
A clinical diagnosis of carcinoma breast was entertained. Fine needle aspiration cytology (FNAC) from the breast lesion yielded blood-stained fluid from multiple sites. Smears showed lymphocytes and a few macrophages against a hemorrhagic background. A diagnosis of vascular malformation was suggested. The patient subsequently had excision biopsy of the lump.
Macroscopically, the lump measured 7×7×5 cm. It was nodular and soft in consistency. Cut surface revealed cystically dilated interconnected spaces filled with blood-stained straw-colored fluid. Microscopically, the tumor was composed of numerous irregularly branching and elongated cavernous spaces lined by a single layer of flattened endothelial cells, and containing brightly eosinophilic lymphatic fluid [Figure 2] and [Figure 3]. These were surrounded by meshwork of collagen interspersed with lymphoid tissue, focally organized as nodules. Adipose tissue and thin incomplete fascicles of smooth muscle were interspersed. No breast tissue was identified admixed with the tumor. Histological diagnosis of cavernous lymphangioma was conveyed. The patient has been under follow-up for 1 year and is alive without any complaint or recurrence.  | Figure 2: Photomicrograph showing thin-walled branching channels with lymphoid nodules in the interstitium (H and E, ×100)
Click here to view |  | Figure 3: Higher magnification showing an irregularly branching channel lined by endothelium with proteinaceous fluid in the lumen (H and E, ×200)
Click here to view |
 Discussion | |  |
Carcinoma is found in 50-75% of male patients presenting with a breast lump. Based on the size of the lesion and age of the patient, a clinical diagnosis of carcinoma was considered.
Lymphangioma is a congenital malformation of the lymphatic system with a majority of the lesions being located in the neck, followed by axilla and mediastinum. Ninety percent of the lesions are diagnosed by the second year and clinical presentation in old age is rare. Sporadic cases of lymphangioma have been reported in female breast with sizes ranging from 2 to 25 cm [3],[4],[5].
Lymphangioma of the male breast is an exceedingly rare lesion. To the best of our knowledge only two cases have been reported in literature. Both the lesions were present since birth with clinical presentation at 4 months and 6 years of age. [1],[2] Both these cases were found in the upper outer quadrant, which is the most frequent location based on the normal lymphatic drainage of breast toward the axilla.
FNAC in combination with radiological techniques may prove to be a useful adjunct to diagnosis of cystic lesions of the breast. Cases diagnosed on FNAC could be followed by serial sonograms to check for complications and growth. This would reduce the incidence of surgical exploration. The differential diagnosis of cystic masses in male breast must be widened to include lymphangioma.
| References | | |
| 1. | Kangesu T. Cystic hygroma of the breast in childhood. Br J Clin Pract 1990;44:787-88. 
[PUBMED] | | 2. | Chiba T, Ibrahim M. Cavernous lymphangioma of the breast case report of an infant. Nippon Geka Hokan 1995;64 : 23-6.
[PUBMED] | | 3. | Torcasio A, Veneroso S, Amabile MI, Biffoni M, Martino G, Monti M, et al. Cystic hygroma of the breast: A rare lesion. Tumori 2006,92 : 347-50.
[PUBMED] | | 4. | de Guerke L, Baron M, Dessogne P, Callonnec F, d'Anjou J. Cystic lymphangioma of the breast. Breast J 2005;11 : 515-6.
| | 5. | Waqar SN, Khan H, Mekan SF, Kayani N, Raja AJ. Cystic breast lymphangioma. J Pak Med Assoc 2004;54:531-3.
[PUBMED] |
Correspondence Address:
Purnima Malhotra
Scientist C, Institute of Pathology, Safdarjang Campus, Post box 4909, New Delhi-110029
India
DOI: 10.4103/0377-4929.71997 PMID: 21045444
[Figure 1], [Figure 2], [Figure 3] | |
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