Axillary lymph node metastasis as the first manifestation of male occult breast cancer

Abstract

Rational:Occult breast cancer (OBC) is an extremely rare breast cancer and is defined by the presence of axillary metastasis without a primary tumor in the breasts or any abnormality on radiologic examination.Patient concerns:This case report presents a 49-year-old man who was diagnosed with male OBC, which first manifested as an axillary lymph node metastasis followed by the emergence of infraclavicular lymph node metastasis. Neither the breast nor other organs had any abnormality.Diagnosis:The pathological examination revealed metastatic adenocarcinoma. Immunohistochemical (IHC) staining results were positive for estrogen receptor (ER), progesterone receptor (PR), and gross cystic disease fluid protein-15 (GCDFP-15); and negative for human epidermal receptor-2 (Her-2) 1+, cytokeratin (CK) 7, CK20, and thyroid transcription factor-1 (TTF-1).Interventions:The patient underwent left axillary lymph node dissection but not a mastectomy. After the operation, the patient subsequently underwent chemotherapy, radiotherapy, and endocrinotherapy.Outcomes:Currently, he has been followed-up for >4 years without any signs of recurrence.Lessons:Careful physical and imaging examinations combined with pathological analysis are essential in the diagnosis of male OBC. Early surgery remains the primary treatment.

Rare axillary cancer of unknown primary originating from the breast of a 64‑year‑old male patient: A case report and literature review

“…Twelve articles published from 2008 to 2020 and reporting cases of CUP of breast cancer origin were identified (27,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) (Table I). The mean age of the patients was 59,23 years (range 29 to 83).…”

“…Despite mammography is considered the gold standard for the breast cancer diagnosis, in four cases it was not recommended by the surgeons (29,34,37,39) and in another two studies the patient rejected it (32,38). US was performed in 9 out of 13 cases (27,(31)(32)(33)(35)(36)(37)(38), while breast MRI was planned for only 4 patients (27,35,37). A complete work-up with the association of US, mammography and breast MRI has been realized in only three case reports (27)(28)(29)(30)(31)(32)(33)(34)(35).…”

“…US was performed in 9 out of 13 cases (27,(31)(32)(33)(35)(36)(37)(38), while breast MRI was planned for only 4 patients (27,35,37). A complete work-up with the association of US, mammography and breast MRI has been realized in only three case reports (27)(28)(29)(30)(31)(32)(33)(34)(35). Therefore, it is possible to assume that more accurate and diagnostic process would be desirable to define a diagnosis of CUP.…”

“…Considering the c-erbB-2 mutation, three tumors were Her2 positive with score 3+ (29,31,36); some authors reported a positive determination for Her2 with lower score while He et al (37), referred about a Her2 positivity with score 2+ but the florescent in situ hybridization (FISH) test was not reported. Wang et al (33) had not mentioned Her2 verify and Rigakos et al (39) had not detailed the Her2 positivity. Lack of the FISH analysis and Her2 determination has precluded any possible adjuvant treatment with Trastuzumab.…”

A challenging diagnosis of occult breast cancer in men: a case report

“…The breast MRI let the physician discover hidden lesions in 59% of cases that have not been observed with other imaging modalities (12,15). In this review, any patient presented hidden lesions when studied with ultrasound, CT-scan, MRI, or PET-CT scan (2,8,10). Also, when patients underwent surgery, a primary tumor in the pathology of the specimen was only found in three cases (4,11,12), which represents the challenge of the diagnosis.…”