Incidence of Apocrine Cells inFine-Needle Aspiratesof Gynecomastia:A Study of 100 CasesRaj K. Gupta, M.D., F.I.A.C.,* Sarla Naran, B.Sc., C.M.I.A.C.,Sharda Lallu, B.Sc., C.M.I.A.C., and Robert Fauck, C.T. (I.A.C.)

While the presence of apocrine cells in fibrocystic conditions of thefemale breast is a common finding in a fine-needle aspirate (FNA)of the breast, such a finding in gynecomastia has only beenreported recently in a single case report. This study was under-taken in 100 cases with adequate cellular samples which had beendiagnosed as gynecomastia from aspirates which were obtainedusing a 22-gauge needle and a 5-ml syringe maintaining negativepressure. The material was collected as needle and syringe wash-ings in 30% ethyl alcohol in physiologic saline and the cytologicpreparations were made on 3-mm Schleicher and Schuell filtersand were stained by the Papanicolaou method. In 3 of the 100cases, sheets of apocrine cells were noted in addition to clusters ofhyperplastic ductal cells. The findings were further confirmedhistologically in cell blocks which were made in the 3 cases. Basedon our findings, it was concluded that apocrine cells in gyneco-mastia are found in about 3% of cases, and such a finding shouldbe regarded as nonneoplastic, thus avoiding the need of surgicalexcision. Diagn. Cytopathol. 2000;22:286–287.© 2000 Wiley-Liss, Inc.

Key Words:gynecomastia; apocrine cells; breast; fine-needle as-piration

The prevalence of apocrine cells in the fibrocystic conditionof the female breast is not uncommon, while in a malebreast such a presence is usually not found. The absence ofapocrine in the male breast seems quite feasible because ofthe absence of lobular structures from the male breast,including the pathologically enlarged male breast, or gy-necomastia, in which fibrous and ductal elements with vary-ing degrees of epithelial hyperplasia are present. The ex-ceptionally rare cases of apocrine metaplasia ingynecomastia which have been noted in surgical specimens

are probably due to lobular development,1–5 with prolifera-tive fibrocystic changes and apocrine metaplasia of lobularducts.

In a recent communication,6 a case of monolateral gy-necomastia with apocrine cells was described for the firsttime in a fine-needle aspiration (FNA) sample. This studywas designed with the aim of reviewing 100 cases of gy-necomastia with cellular aspirate samples to determine theincidence of apocrine cells and whether any incriminatingfactor could be identified to explain their presence.

Materials and MethodsThe aspirate was obtained using a disposable 10-ml syringeand a 22-gauge disposable needle, using multiple passes inthe breast abnormality, and maintaining negative pressure.The aspirated material was collected as needle and syringewashings in 30% ethyl alcohol in physiologic saline. Filterpreparations were made on 3-mm Schleicher and Schuellfilters and stained by the Papanicolaou method. Addition-ally, in the 3 cases with apocrine cells, cell blocks weremade after centrifugation, fixed, embedded, cut at 5mm,and stained with hematoxylin-eosin. No smears were made,and no other staining was done.

Pertinent clinical information in the 3 cases was obtainedby reviewing the charts and asking clinicians for details ofmedication and other investigations. These are summarizedin Table I.

ResultsCytohistologic FindingsPapanicolaou-stained filter preparations and hematoxylin-eosin-stained sections of cell blocks demonstrated clustersof ductal cells, occasional macrophages, fibrofatty tissue,and many sheets of apocrine cells with faintly granulareosinophilic cytoplasm with a round nucleus and nucleous(Fig. 1A,B). No immunostaining for anti-gross cystic dis-

Cytology Unit, Department of Laboratory Services, Wellington Hospitaland School of Medicine, Wellington, New Zealand.

*Correspondence to: Raj K. Gupta, M.D., F.I.A.C., Cytology Unit,Department of Laboratory Services, Wellington Hospital, Wellington, NewZealand.

Received 28 September 1999; Accepted 18 November 1999

286 Diagnostic Cytopathology, Vol 22, No 5 © 2000 WILEY-LISS, INC.

ease fluid protein (GCDFP-15) was done6 due to the non-availability of this marker in our department. Furthermore,in our opinion the light microscopic appearances of apo-crine cells in the cytohistologic preparations were felt to bequite distinctive.

DiscussionApocrine metaplasia in gynecomastia has very rarely beendocumented in biopsy specimens and localized in lobular ordialated ducts.1,7,8 This condition was most likely due tolobular development1–5 with fibrocystic changes. In a recent

case report,6 for the first time a case of gynecomastia withapocrine cells was diagnosed by FNA and it was believedthat spironolactone may have had some role as the causativeagent, since the patient was on spironolactone for cardio-vascular disease.

None of the 3 patients in this study were on any type ofmedication or exposed to any incriminating agent that couldexplain the clinical presentation. Neither did we find anypregnancy-like changes akin to those seen in the femalemammary gland,8,9 characterized by large foamy cells, orany neoplastic cystic lesion of epidermal appendages10 inany of the cases presented herein.

In conclusion, we feel that apocrine metaplasia in gy-necomastia is seen in about 3% of cases, and such a findingshould be regarded as nonneoplastic, thus avoiding the needof surgical excision. Also, based on our findings it is feltthat cases of gynecomastia with apocrine cells need notalways be associated with the use of medications or expo-sure to any other incriminating agents.

References1. Banik S, Hale R. Fibrocystic disease in the male breast. Histopathol-

ogy 1988;12:214–216.

2. Bannayan GA, Hajdu SI. Gynecomastia: clinicopathologic study of351 cases. Am J Clin Pathol 1972;57:431–437.

3. McClure J, Banerjee SS, Sandilands DG. Female type cystic hyper-plasia in a male breast. Postgrad Med J 1985;61:441–443.

4. Rosen PP, Oberman HA. Atlas of tumor pathology: tumors of themammary gland. Washington, DC: Armed Forces Institute of Pathol-ogy; 1993. p 282–285.

5. Sloane JP. Biopsy pathology of the breast. London: Chapman & Hall;1985. p 258–263.

6. Pacchioni D, Sapino A, Cassoni P, Bussaloti G. Apocrine cells in a fineneedle aspirate of gynecomastia (a case report). Acta Cytol 1997;41:1329–1331.

7. Haagensen CD. Disease of the breast. New York: W.B. Saunders;1986. p 70.

8. Page LD, Anderson TJ. Diagnostic histopathology of the breast.Edinburgh: Churchill Livingstone; 1987. p 30.

9. Corval P, Michaud A, Menard J, Freifeld M, Mahoudeau J. Antian-drogenic effect of spirolactones: mechanism of action. Endocrinology1975;97:52–57.

10. Malhotra R, Bhawan J. The nature of pigment in pigmented apocrinehidrocystoma. J Cutan Pathol 1985;12:106–109.

Table I. Summary of Findings in the 3 Cases of Gynecomastia With Apocrine Cells

CaseAge(yr) Clinical findings FNA diagnosis

Histologicconfirmation

1 25 Slightly painful monolateral gynecomastia of1-mo duration

Gynecomastia withapocrine cells

Cell block

Medications—none2 39 Bilateral gynecomastia of a few weeks. Mild

off-and-on painGynecomastia with

apocrine cellsCell block

Medication—none3 62 Painful monolateral gynecomastia of 2-mo

durationGynecomastia with

apocrine cellsCell block

Medications—none

Fig. 1. A: Papanicolaou-stained filter preparations in a case of gyneco-mastia, showing a field with clusters of epithelial cells (left) and apocrinecells (right) (3280). B: Another field in the same case, with sheets ofapocrine cells (3280).

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