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Clinicopathological findings in female‐to‐male gender‐affirming breast surgery
Author(s) -
East Ellen G,
Gast Katherine M,
Kuzon William M,
Roberts Emily,
Zhao Lili,
Jorns Julie M
Publication year - 2017
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13299
Subject(s) - medicine , atypia , immunohistochemistry , pathology , nuclear atypia , mastectomy , cytokeratin , body mass index , progesterone receptor , proliferative index , biopsy , surgical oncology , proliferation index , breast cancer , estrogen receptor , cancer
Aims Gender dysphoria is a diagnosis whereby an individual identifies as the opposite gender. The management of patients seeking female‐to‐male ( FTM ) transition includes hormonal therapy and surgical intervention, including mastectomy. The aim of this study was to characterize the immunohistological findings in resection specimens from FTM patients. Methods and results We reviewed 68 cases (67 patients, one with re‐excision) of FTM breast tissue resection by collecting clinical data, reviewing breast imaging and pathology reports (gross fibrous density, specimen weight, and number of cassettes submitted), and reviewing pathology slides [number of tissue pieces submitted, number of terminal duct lobule units ( TDLU s), and the presence of histological findings]. Significant histological findings were present in 51 of 68 (75.0%) cases, including one case (1.5%) of flat epithelial atypia. Fibrocystic changes were the most common finding (27/68, 39.7%), followed by gynaecomastoid change, fibrotic stage, (22/68, 32.4%), and fibroadenomatoid change (11/68, 16.2%). Fibrocystic change was associated with increased numbers of TDLU s, and gynaecomastoid change was associated with lower body mass index and decreased numbers of TDLU s. Gynaecomastoid change showed a moderate proportion of luminal epithelial cells with strong‐intensity immunohistochemical staining for oestrogen receptor, progesterone receptor, and androgen receptor, and a three‐layered epithelium demonstrated by the use of cytokeratin 5/6 immunohistochemistry. Conclusions We identified gynaecomastoid change at a significantly higher rate than previously reported in female patients. We support the continued gross and histological evaluation of FTM specimens in light of the identification of atypia in one case.