acid-phosphatase and Gynecomastia

Prostate carcinoma is among the most common solid tumors to secondarily involve the male breast. Prostate specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) are expressed in benign and malignant prostatic tissue, and immunohistochemical staining for these markers is often used to confirm the prostatic origin of metastatic carcinoma. PSA expression has been reported in male and female breast carcinoma and in gynecomastia, raising concerns about the utility of PSA for differentiating prostate carcinoma metastasis to the male breast from primary breast carcinoma. This study examined the frequency of PSA, PSAP, and hormone receptor expression in male breast carcinoma (MBC), female breast carcinoma (FBC), and gynecomastia.. Immunohistochemical staining for PSA, PSAP, AR, ER, and PR was performed on tissue microarrays representing six cases of gynecomastia, thirty MBC, and fifty-six FBC.. PSA was positive in two of fifty-six FBC (3.7%), focally positive in one of thirty MBC (3.3%), and negative in the five examined cases of gynecomastia. PSAP expression was absent in MBC, FBC, and gynecomastia. Hormone receptor expression was similar in males and females (AR 74.1% in MBC vs. 67.9% in FBC, p = 0.62; ER 85.2% vs. 68.5%, p = 0.18; and PR 51.9% vs. 48.2%, p = 0.82).. PSA and PSAP are useful markers to distinguish primary breast carcinoma from prostate carcinoma metastatic to the male breast. Although PSA expression appeared to correlate with hormone receptor expression, the incidence of PSA expression in our population was too low to draw significant conclusions about an association between PSA expression and hormone receptor status in breast lesions.

Topics: Acid Phosphatase; Aged; Breast Neoplasms; Breast Neoplasms, Male; Carcinoma; Diagnosis, Differential; Female; Gynecomastia; Humans; Immunohistochemistry; Male; Middle Aged; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Protein Tyrosine Phosphatases; Receptors, Androgen; Receptors, Estrogen; Receptors, Progesterone; Receptors, Steroid; Tissue Array Analysis

Enlargement of the male breast is frequently encountered in the course of adjuvant antiandrogen therapy for advanced prostate carcinoma. The clinical differential diagnosis in this setting includes hormonal imbalance-induced gynecomastia, primary breast carcinoma, and metastasis of prostatic carcinoma. Biopsy of the lesion with the identification of prostate-specific antigen (PSA) plays an important role in establishing the correct diagnosis. Recent studies showed that female mammary epithelium may be a significant source of PSA, but its expression in male breasts has not been sufficiently studied. We found that normal and hyperplastic duct epithelium in gynecomastia exhibited focal, strong (+3) PSA immunoreactivity in 5 of 18 cases (28%). In contrast, no PSA reactivity was found in eight cases of male breast carcinoma. No reactivity was seen with antiprostatic acid phosphatase (PsAP) antibody, in either benign or malignant epithelium. Frequent expression of PSA in gynecomastia may, in an appropriate clinical setting, cause confusion with metastatic prostatic carcinoma. The lack of immunoreactivity for PsAP in male breast epithelium indicates its usefulness in the differential diagnosis.

Topics: Acid Phosphatase; Adolescent; Adult; Aged; Androgen Antagonists; Breast; Breast Neoplasms, Male; Diagnosis, Differential; Epithelium; Female; Gynecomastia; Humans; Immunohistochemistry; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms

Topics: Acid Phosphatase; Adenofibroma; Adult; Aged; Alkaline Phosphatase; Biopsy; Breast Diseases; Breast Neoplasms; Capillaries; Cell Division; Epithelial Cells; Epithelium; Female; Fibroblasts; Glucosephosphate Dehydrogenase; Glycerolphosphate Dehydrogenase; Gynecomastia; Histocytochemistry; Humans; L-Lactate Dehydrogenase; Male; Middle Aged; NADH, NADPH Oxidoreductases; Oxidoreductases; Staining and Labeling; Succinate Dehydrogenase

Topics: 17-Ketosteroids; Acid Phosphatase; Alkaline Phosphatase; Androgen Antagonists; Body Weight; Gonadotropins, Pituitary; Gynecomastia; Hemoglobinometry; Humans; Male; Prostatic Neoplasms; Testosterone