Ahmet Cem ESMER, Ahmet DAĞ, Mustafa BERKEŞOĞLU, Deniz TAZEOĞLU

Erkek Meme Kanseri: Tek Merkez Deneyimi

Amaç: Erkek meme kanseri (MBC), meme ve erkek kanserlerinin %1’inden azını oluşturan nadir bir hastalıktır. Bu yüzden MBC tedavi protokollerin çoğu kadınlar için meme kanseri tedavisi deneyiminden türetilmiştir. MBC, kadınlarda meme kanserinde olduğu gibi toplumsal farkındalık eksikliği nedeniyle genellikle ileri evrelerde saptanır. Bu çalışmada MBC ile ilgili klinik deneyimimizi güncel literatürle karşılaştırmayı amaçlanmıştır. Gereç ve Yöntem: Mersin Üniversitesi Tıp Fakültesi Hastanesinde Ocak 2008-Ocak 2018 tarihleri arasında meme kanseri tanısı alan 21 erkek hastanın dosyalarını retrospektif olarak incelenmiştir. Bulgular: Memede kitle nedeniyle kliniğimize 21 hasta başvurmuştur. Bu hastaların 17’sinde primer MBC ve 4’ün de ise metastatik meme kitlesi tespit edilmiştir. Primer MBC hastalarının 15’ine cerrahi tedavi uygulanırken ve 2 hasta neoadjuvan tedaviye yönlendirilmiştir. Çoğu cerrahi vakada basit mastektomi uygulanmıştır. 7 hasta direkt olarak aksiller lenf nodu diseksiyonu (ALND) uygulanırken ve 8 hastaya sentinel lenf nodu biyopsisi (SLNB) uygulanmıştır. 4 hastada SLNB pozitif gelmesi üzerine ALND uygulanmıştır. 24 aylık (6-96 ay arası) takipte hiçbir hastada lokal nüks gelişmediği gözlenmiştir. Sonuç: MBC’nin nadir olması, randomize klinik çalışmaları engellemektedir. MBC için klinik kararların çoğu, kadınlarda meme kanseri tedavisi deneyiminden türetilmiştir. MBC’yi daha iyi anlamak için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler:

Aksiller Lenf Nodu Diseksiyonu, Erkek Meme Kanseri, Segmental Mastektomi, Sentinel Lenf Nodu Biyopsisi

Male Breast Cancer: A Single-Center Experience

Objective: Male breast cancer (MBC) is a rare disease, accounting for less than 1% of breast and male cancers. Because of the low incidence, most of the clinical decisions for MBC have been derived from the experience of treatment of breast cancer in females. MBC is generally detected in advanced stages due to a lack of social awareness as it occurs in breast cancer in females. In this study, it was aimed to compare our clinical experience with MBC with current literature. Methods: This study retrospectively reviewed 21 men who were diagnosed with MBC between January 2008 and January 2018 at the Department of General Surgery of Mersin University School of Medicine, Mersin, Turkey. Results: Unilateral malign breast lesions were identified in 21 male patients that 17 are primary MBC and 4 metastatic breast lesions. 15 primary MBC patients underwent primary surgical treatment, and 2 patients were directed to neoadjuvant treatment. Simple mastectomies were performed in most surgical cases. 7 patients were directly addressed to axillary lymph node dissection (ALND), and sentinel lymph node biopsy (SLNB) was performed in 8 patients. 4 patients had tumor positivity in the settings of SLNB, and further ALND was performed subsequently in these cases. None of the patients developed local recurrence in the 24-month follow-up (range 6-96 months). Conclusion: The rarity of MBC precludes randomized clinical trials. Most of the clinical decisions for MBC have been derived from the experience of treatment of breast cancer in females. Further studies are needed to understand better MBC.

Keywords:

Axillary Lymph Node Dissection, Male Breast Cancer, Segmental Mastectomy, Sentinel Lymph Node Biopsy,

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Donegan WL, Redlich PN. Breast cancer in men. Surg Clin North Am. 1996 Apr;76(2):343-63. https://doi.org/10.1016/s0039-6109(05)70443-6
Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006 Feb 18;367(9510):595-604. https://doi.org/10.1016/S0140-6736(06)68226-3
Fisher B, Bauer M, Wickerham DL, Redmond CK, Fisher ER, Cruz AB, Foster R, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer. 1983 Nov 1;52(9):1551-7. https://doi.org/10.1002/1097-0142(19831101)52:9<1551::aid-cncr2820520902>3.0.co;2-3
D’Eredita G, Giardina C, Guerrieri AM, Berardi T. A further validation of subareolar injection technique for breast sentinel lymph node biopsy. Ann Surg Oncol. 2006 May;13(5):701-7. https://doi.org/10.1245/ASO.2006.04.027
Díaz Brito JA, Navarrete SV, Muñoz JA, Guardiola YS, Sánchez JG, Ruiz VV, et al. Sentinel node biopsy in early breast cancer at the Hospital Comarcal La Linea (Spain). Ecancermedicalscience. 2013 Sep 23;7:353. https://doi.org/10.3332/ecancer.2013.353
Cejalvo JM, Pascual T, Fernández-Martínez A, Brasó-Maristany F, Gomis RR, Perou CM, Muñoz M, Prat A. Clinical implications of the non-luminal intrinsic subtypes in hormone receptor-positive breast cancer. Cancer Treat Rev. 2018 Jun;67:63-70. https://doi.org/10.1016/j.ctrv.2018.04.015 Speirs V, Shaaban AM. The rising incidence of male breast cancer. Breast Cancer Res Treat. 2009 May;115(2):429-30. https://doi.org/10.1007/s10549-008-0053-y
Zygogianni AG, Kyrgias G, Gennatas C, Ilknur A, Armonis V, Tolia M, et al. Male breast carcinoma: epidemiology, risk factors and current therapeutic approaches. Asian Pac J Cancer Prev. 2012;13(1):15-9. https://doi.org/10.7314/apjcp.2012.13.1.015
Leone, J.P., Leone, J., Zwenger, A.O., Iturbe, J., Vallejo, C.T. and Leone, B.A. Prognostic significance of tumor subtypes in male breast cancer: a population-based study. Breast Cancer Res Treat. 2015;152:601–609 https://doi.org/10.1007/s10549-015-3488-y
Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat. 2004 Jan;83(1):77-86. https://doi.org/10.1023/B:BREA.0000010701.08825.2d
Cardoso F, Bartlett JMS, Slaets L, van Deurzen CHM, van Leeuwen-Stok E, Porter P, et al. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol. 2018 Feb 1;29(2):405-417. https://doi.org/10.1093/annonc/mdx651
Anderson WF, Jatoi I, Tse J, Rosenberg PS. Male breast cancer: a population-based comparison with female breast cancer. J Clin Oncol. 2010;28(2):232-239. https://doi.org/10.1200/JCO.2009.23.8162
Kiluk JV, Lee MC, Park CK, Meade T, Minton S, Harris E, Kim J, Laronga C. Male breast cancer: management and follow-up recommendations. Breast J. 2011 Sep-Oct;17(5):503-9. https://doi.org/10.1111/j.1524-4741.2011.01148.x
Gentilini O, Chagas E, Zurrida S, Intra M, De Cicco C, Gatti G, et al. Sentinel lymph node biopsy in male patients with early breast cancer. Oncologist. 2007 May;12(5):512-5. https://doi.org/10.1634/theoncologist.12-5-512
Flynn LW, Park J, Patil SM, Cody HS 3rd, Port ER. Sentinel lymph node biopsy is successful and accurate in male breast carcinoma. J Am Coll Surg. 2008 Apr;206(4):616-21. https://doi.org/10.1016/j.jamcollsurg.2007.11.005
Hill AD, Borgen PI, Cody HS 3rd. Sentinel node biopsy in male breast cancer. Eur J Surg Oncol. 1999 Aug;25(4):442-3. https://doi.org 10.1053/ejso.1999.0674
Cimmino VM, Degnim AC, Sabel MS, Diehl KM, Newman LA, Chang AE. Efficacy of sentinel lymph node biopsy in male breast cancer. J Surg Oncol. 2004 May 1;86(2):74-7. https://doi.org/10.1002/jso.20045
Albo D, Ames FC, Hunt KK, Ross MI, Singletary SE, Kuerer HM. Evaluation of lymph node status in male breast cancer patients: a role for sentinel lymph node biopsy. Breast Cancer Res Treat. 2003 Jan;77(1):9-14. https://doi.org/10.1023/a:1021173902253
Boughey JC, Bedrosian I, Meric-Bernstam F, Ross MI, Kuerer HM, Akins JS, et al. Comparative analysis of sentinel lymph node operation in male and female breast cancer patients. J Am Coll Surg. 2006 Oct;203(4):475-80. https://doi.org/10.1016/j.jamcollsurg.2006.06.014
Martin-Marcuartu JJ, Alvarez-Perez RM, Sousa Vaquero JM, Jimenez-Hoyuela García JM. Selective sentinel lymph node biopsy in male breast cancer. Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018 May-Jun;37(3):146-150. English, Spanish. https://doi.org/10.1016/j.remn.2017.09.004