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Authors East EG, Gast KM, Kuzon WM, Roberts E, Zhao L, Jorns JM
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Journal Histopathology
Publish Date 2017 Jun 28
PubMed ID 28657118

Gender dysphoria is a diagnosis wherein an individual identifies as the opposite gender. Management of patients seeking female-to-male (FTM) transition includes hormonal therapy and surgical intervention, including mastectomy. We aim to characterize the immunohistologic findings in resection specimens from FTM patients.We reviewed 68 cases (67 patients, 1 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 [TDLUs], and presence of histologic findings). Significant histologic findings were present in 51/68 (75.0%) cases and included one case (1.5%) of flat epithelial atypia. Fibrocystic changes were the most common finding (27/68, 39.7%), followed by gynecomastoid change, fibrotic stage, (22/68, 32.4%) and fibroadenomatoid change (11/68, 16.2%). Fibrocystic change was associated with increased TDLUs and gynecomastoid change was associated with lower body mass index and decreased TDLUs. Gynecomastoid change showed a moderate proportion of luminal epithelial cells with strong intensity staining via estrogen receptor, progesterone receptor and androgen receptor immunohistochemistry and a 3-layered epithelium via cytokeratin 5/6 immunohistochemistry.We identified gynecomastoid change at a significantly higher rate than previously reported in female patients. We support the continued gross and histologic evaluation of FTM specimens in light of identification of atypia in one case. This article is protected by copyright. All rights reserved. Copyright © 2017 The Board of Regents of the University of Wisconsin System