Cytopathologic findings in breast masses in men with HIV infection

OBJECTIVE: To report the cytologic findings on 15 men with HIV infection who presented with breast masses and underwent fine needle aspiration (FNA). STUDY DESIGN: The cytopathology files of The Johns Hopkins Hospital (JHH) and the University of Texas Southwestern Medical Center (UTSW) were searched for cases of men with breast masses evaluated by FNA. The HIV status of these men was then ascertained. A total of 15 cases (9 at JHH, 6 at UTSW) of 259 (5.79%) were identified in which the patient was HIV seropositive. The pathologic diagnoses were reviewed, and the clinical history, along with the medication list at the time of FNA, was determined. RESULTS: The men ranged in age from 12 to 51 years (mean, 38). Breast masses were present on either the right (n = 6) or left (n = 7) side or were bilateral (n = 2). In all 15 cases, the masses were retroareolar, firm and tender. FNA showed a ductal and stromal proliferative process, often with focal cytologic atypia and numerous background naked myoepithelial nuclei, features consistent with a diagnosis of gynecomastia. Thirteen of these men were on drug regimens, which included indinivir, stavudine and saquinivir. Two of the men were on azidothymidine only. CONCLUSION: Gynecomastia, although rare in young men, was the sole cause of breast masses in HIVseropositive men in this study. It has been described as an extremely rare side effect of certain antiretroviral medications, including indinivir, stavudine and saquinivir. FNA is an important tool in determining the benign nature of these lesions and excluding other causes of breast masses in this patient population, such as infections, malignant lymphoma and breast carcinoma.