My Male Breast Cancer (part 1), by Dr. Nat Pernick

On 9 April 2025, I underwent a double mastectomy and right sided sentinel node dissection for right sided male breast cancer. This is the first of a series of essays where I share my experience from a pathologist’s perspective.

See the link to the full essay with images on our blog here.

Cancer precursor lesions project

Breast cancers with precursor lesions (part 6j)

This essay is part of Dr. Pernick’s Cancer Precursor Project that discusses how different types of cancer arise. Part 6 discusses breast cancer. 

Part 6j discusses additional breast malignancies without known precursors, including metaplastic carcinoma and its variants (fibromatosis-like and low grade adenosquamous), which are triple negative carcinomas. 

See the link to the full essay with images on our blog here.

Fibromatosis-like metaplastic carcinoma: spindle cell tumor with irregular infiltrative margins (contributed by Kristen E. Muller, D.O.)

Low grade adenosquamous metaplastic carcinoma: infiltrative glands and squamous cell nests within a fibrotic and cellular spindle stroma surrounded by lymphoid aggregates (contributed by Paula S. Ginter, M.D.)

Breast cancers with precursor lesions (part 6k)

This essay discusses triple negative breast cancer, which accounts for approximately 16% of invasive breast cancers.

These tumors should primarily be classified by their histologic type, as histology more accurately predicts behavior than the triple negative label alone. The absence of ER, PR and HER2 expression does not confer a distinct gross or microscopic appearance, nor does it define clinical behavior.

See the link to the full essay with images on our blog here.

Invasive lobular breast carcinoma infiltrates in cords and single cells which are strongly ER positive (contributed by Julie M. Jorns, M.D.)

Invasive ductal breast carcinoma, low grade, with small tubules and nests showing diffuse strong PR staining (contributed by Julie M. Jorns, M.D.)

Breast carcinoma cells have intense tumor staining for HER2 that completely surrounds the cell membrane, which can be detected at low power (contributed by Emily S. Reisenbichler, M.D.)

Breast cancers with precursor lesions (part 6l)

This essay discusses 4 forms of triple negative breast cancer: medullary carcinoma, as well as 3 head and neck tumor types that rarely appear in the breast: adenoid cystic carcinoma, polymorphous adenocarcinoma and tall cell carcinoma with reverse polarity.

See the link to the full essay our blog here.

Adenoid cystic carcinoma of the breast has an extensive cribriform architecture and an infiltrative growth pattern (contributed by Gary Tozbikian, M.D.)

Salivary gland polymorphous adenocarcinoma: monomorphic cells grow in trabeculae and single file rows, mimicking an invasive lobular carcinoma (contributed by Emily S. Reisenbichler, M.D.)

Tall cell carcinoma of the breast with reverse polarity: circumscribed solid epithelial nodules embedded in fibrous stroma; foamy histiocytes are present in some epithelial nodules (contributed by Koorosh Haghayeghi M.D., Sonja Chen M.D. and Yihong Wang M.D.)

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Nat Pernick, M.D. | nat@pathologyoutlines.com