Histopathologic Features of Breast Tissue From Transgender Men and Their Associations With Androgen Therapy.
Histopathologic Features of Breast Tissue From Transgender Men and Their Associations With Androgen Therapy.
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DOI：
10.1093/ajcp/aqac123
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发表时间：
2023-01-04
影响因子：
3.5
通讯作者：
Klein ME
中科院分区：
文献类型：
--
作者：
Wolters EA;Rabe KE;Siegel L;Butts J;Klein ME
评估接受性别确认双侧乳房切除术的变性男性（TM）乳腺组织的组织病理学特征与雄激素治疗（AT）的关系。我们回顾了2017年至2020年的374例变性双侧乳房切除术病例。其中，314例（84.4%）患者接受了术前AT。我们将这些与127例接受选择性乳房缩小术的顺性别女性进行了比较。与顺性别女性相比，接受AT的TM乳腺标本显示出较高的纤维组织总百分比（P <0.001），小叶密度降低（P = 0.004），小叶萎缩量较高（P <0.001），囊肿（P <0.001），顶浆腺化生（P <0.001），钙化（P <0.001），柱状细胞改变（P = 0.002）和肥大（P = 0.003）的发生率较低。 AT治疗每增加一个月，非顶泌腺囊肿的发生率降低2%（P = 0.02），导管增生的发生率降低5%（P = 0.007），小叶密度中位数降低0.14%（95%置信区间，-0.18 ~-0.05）。 在这项研究中，TM的乳腺标本，特别是有AT病史的乳腺标本，与顺性别女性相比，纤维组织比例更高，小叶更少，小叶萎缩程度更高。术前影像学或大体检查结果无法预测罕见的膀胱癌病例，支持对这些标本进行常规显微镜评价。
To assess the histopathologic features of breast tissue of transgender men (TM) undergoing gender-affirming bilateral mastectomies in relation to androgen therapy (AT). We reviewed 374 transgender bilateral mastectomy cases from 2017 to 2020. Of these, 314 (84.4%) patients received preoperative AT. We compared these with 127 cases of cisgender females undergoing elective breast reduction. Breast specimens from TM on AT, compared with cisgender women, showed a median higher gross percentage of fibrous tissue (P < .001), reduced lobular density (P = .004), higher amount of lobular atrophy (P < .001), and lower incidence of cysts (P < .001), apocrine metaplasia (P < .001), calcifications (P < .001), columnar cell change (P = .002), and atypia (P = .003). Each additional month of AT was associated with a 2% decrease in the odds of having nonapocrine cysts (P = .02), a 5% decrease in the odds of having usual ductal hyperplasia (P = .007), and a 0.14% decrease in median lobular density (95% confidence interval, –0.18 to –0.05). In this study, breast specimens from TM, particularly with a history of AT, had a higher proportion of fibrous tissue, fewer lobules, and a higher degree of lobular atrophy than cisgender females. Rare cases of atypia were not predicted by preoperative imaging or gross findings, supporting routine microscopic evaluation of these specimens.
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作者：
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