A Case of Male Breast Cancer and a Literature Review

Abstract

Background: Breast cancer in men, similar to that in women, originates in the mammary gland epithelium (ducts), and although less common than in women, its incidence has increased in recent decades, accompanied by significant advances in understanding the disease as a distinct entity. It shares important similarities with its female counterpart, with significant progress in diagnosis and treatment.

Case presentation: In this report, we describe the clinical and imagenological characteristics of a 64-year-old man with metastatic adenocarcinoma to the skin. The patient presented with an ulcerative lesion on the right hemithorax, along the mid-clavicular line and anterior axillary line at the fifth intercostal space. The lesion had a soft, necrotic appearance, was prone to bleeding, and was referred by the patient as "resulting from trauma" a year ago, with progressive expansion and deepening, despite antibiotic use and cleansing of the wound. It invaded the surrounding skin, which appeared desquamated, erythematous with neovascularization, friable to the touch prone to bleeding with difficulty to achieve hemostasis, and multiple brownish nodular satellite lesions, with no other associated symptoms. A thoracic CT scan performed in the emergency department revealed a bilateral pleural effusion, predominantly on the right side, occupying 50% of the right lung space, along with an osteolytic lesion at the level of the manubrium of the sternum. A follow-up thoracic CT scan showed a pleural effusion occupying 80% of the right lung space, with a minor pneumothorax. The placement of an endopleural chest tube on the right side resulted in the extraction of 1800 ml of serosanguineous fluid, and pleural fluid culture did not reveal microorganisms or tumor cells, making the diagnosis of pulmonary adenocarcinoma less likely. A biopsy of the surrounding tissue yielded an invasive, poorly differentiated adenocarcinoma. Immunohistochemical staining was positive for estrogen and progesterone receptors, CK19, and negative for CK7, CK20, leading to the primary diagnosis of breast cancer based on clinical presentation and lesion location.

Conclusions: Breast cancer in men, while sharing similarities with its female counterpart, presents its own unique characteristics. The identification of these factors and education about the significance of this condition, along with the discovery of specific biomarkers and targeted therapies, have the potential to significantly improve the prognosis of male patients in the future.