Axillary metastasis as the first manifestation of male breast cancer: a case report
© Gu et al; licensee BioMed Central Ltd. 2008
Received: 20 August 2008
Accepted: 30 October 2008
Published: 30 October 2008
Breast cancer is very rare in men, and the occurrence of occult breast cancer which present axillary metastasis as the first manifestation is even rarer in men.
We report a 72-year-old male Han-Chinese patient who presented axillary metastasis as the first manifestation of breast cancer and got correctly diagnoses by histological examination. He underwent modified radical mastectomy and axillary dissection on 11 Apr 2006. The histopathologic examination showed that no tumor focus was found in his breast tissue, but two out of fifteen of axillary lymph nodes were invaded by infiltrating ductal carcinoma. The IHC stain showed that estrogen receptor (ER) and progestin receptor (PR) were negative, Human epidermal receptor (HER-2) oncoprotein (+++), P53 protein expressed (+++), Bcl-2 oncoprotein (+++), nm23 protein (++), proliferating cell nuclear antigen (PCNA) (+++) and multidrug-resistance protein (MRP) (++). After operation, he did not receive endocrine therapy, chemotherapy and radiotherapy because of his senility. He is alive without any residual or metastasis disease 29 months after being diagnosed.
This is the first case in our hospital that presents axillary metastases as the first manifestation of male breast cancer.
Breast cancer is very rare in men, accounting for less than 1% of all breast cancers and less than 1% of all cancers in men [1, 2]; and the occurrence of occult breast cancer is even rarer in men . We report a 72-year-old male Han-Chinese patient with occult breast cancer who was diagnosed by histological examination and Immunohistochemical (IHC) stain. It is the first male case of our hospital that presents axillary metastasis as the first manifestation of occult breast cancer.
Breast cancer is very rare in men. Epidemiological studies showed that the rate of male breast cancer is 0.5%–1%, in most western countries, and 6% or more in Tanzania and in Central Africa [1, 2]. The reasons for this geographic variability remain unclear. Recent epidemiologic data suggested that the incidence of male breast cancer has been steadily increasing . However, the pathogenesis of male breast cancer is still unclear. The epidemiologic risk factors may include prostate cancer and its endocrine therapy, gynecomastia, occupational exposures (e.g., electromagnetic fields, polycyclic aromatic hydrocarbons, and high temperatures), dietary factors (e.g., meat intake, fruit and vegetable consumption), and alcohol intake. Recently, the genetic factors got more attention by scientists [4, 5]. The mutations of BRCA1, BRCA2 and MMR gene may play very important roles in the onset of the male breast cancer; and other genetic factors involved could include AR gene, CHEK2 gene, cytochrome P45017 (CYP17), the XXY karyotype (Klinefelter syndrome), and the PTEN tumor suppressor gene associated with Cowden syndrome, and so on. The BRCA1 and BRCA2 germ-line mutation is known associated with the hereditary breast cancer ; and the MMR germ-line mutation (especially hMLH1) for the hereditary nonpolyposis colorectal carcinoma (HNPCC). Some researchers regarded the breast cancer, especially the male breast cancer, as a part of the tumor spectrum of HNPCC, and thought the breast cancer might be an extracolonic manifestation of HNPCC . Therefore, if a male patient with breast cancer is met with in clinic, we should attend not only to examine the breast focus, but also to inquire the patient about his family history and post history which is helpful for clinical diagnosis and therapy.
Occult breast cancer is even rarer in men. It usually presents lymph node metastasis of axilla, supraclavicular fossa and infraclavicular fossa as the first manifestation . In our case, the patient presented axillary lymph node metastasis as the first manifestation. The most common causes of axillary malignant lymph nodes include lymphoma and metastasis from breast cancer, lung cancer, melanoma, and squamous cell cancer. So, we should give our attention to take relevant examination to find focus and avoid misdiagnosis, if we meet with similar patients in clinic. Research shows that it is in approximately 50% cases with occult breast cancer the cancer focus still can not be found in the breast specimen . In our case, no tumor focus was found in breast specimen. The final diagnosis was made after many pathologists' consultation and a series of examinations for differential diagnosis. Hereby, the histological examination and IHC stain of metastasis focus is very important in the diagnosis of the occult breast cancer.
The currently recommended surgical therapy in clinic is the modified radical mastectomy with axillary dissection. It was reported that male breast carcinomas have a higher positive rate of hormone receptor than the female breast carcinomas, and so the adjuvant hormonal therapy is theoretically very promising . In our case, although the tumor cells were negative for ER and PR, the expression results of PCNA, P53, Bcl-2, nm23, MRP and HER-2 protein were similar to other reports [1–4]. Because he was a septuagenarian, his families did not agree with him to undergo endocrine-therapy, chemotherapy and radiotherapy after operation. But the patient's prognosis seems well; he has survived with cancer-free for about 29 months after diagnosed, and he is still in follow-up.
The consent was obtained from the patient for publication of this case report and accompanying images. We have obtained consent for publication in print and electronically from the patient.
- Giordano SH: A review of the diagnosis and management of male breast cancer. Oncologist. 2005, 10 (7): 471-479. 10.1634/theoncologist.10-7-471.View ArticlePubMedGoogle Scholar
- Giordano SH, Buzdar AU, Hortobagyi GN: Breast cancer in men. Ann Intern Med. 2002, 137 (8): 678-687.View ArticlePubMedGoogle Scholar
- Namba N, Hiraki A, Tabata M, Kiura K, Ueoka H, Yoshino T, Tanimoto M: Axillary metastasis as the first manifestation of occult breast cancer in a man: a case report. Anticancer Res. 2002, 22 (6B): 3611-3613.PubMedGoogle Scholar
- Weiss JR, Moysich KB, Swede H: Epidemiology of male breast cancer. Cancer Epidemiol Biomarkers Prev. 2005, 14 (1): 20-26. 10.1158/1055-9965.EPI-05-0414.PubMedGoogle Scholar
- Lynch HT, Watson P, Narod SA: The genetic epidemiology of male breast carcinoma. Cancer. 1999, 86 (5): 744-746. 10.1002/(SICI)1097-0142(19990901)86:5<744::AID-CNCR4>3.0.CO;2-G.View ArticlePubMedGoogle Scholar
- Palli D, Falchetti M, Masala G, Lupi R, Sera F, Saieva C, D'Amico C, Ceroti M, Rizzolo P, Caligo MA, Zanna I, Ottini L: Association between the BRCA2 N372H variant and male breast cancer risk: a population-based case-control study in Tuscany, Central Italy. BMC Cancer. 2007, 7: 170-10.1186/1471-2407-7-170.PubMed CentralView ArticlePubMedGoogle Scholar
- Müller A, Edmonston TB, Corao DA, Rose DG, Palazzo JP, Becker H, Fry RD, Rueschoff J, Fishel R: Exclusion of breast cancer as an integral tumor of hereditary nonpolyposis colorectal cancer. Cancer Res. 2002, 62 (4): 1014-1019.PubMedGoogle Scholar
- Burga AM, Fadare O, Lininger RA, Tavassoli FA: Invasive carcinomas of the male breast: a morphologic study of the distribution of histologic subtypes and metastatic patterns in 778 cases. Virchows Arch. 2006, 449 (5): 507-512. 10.1007/s00428-006-0305-3.PubMed CentralView ArticlePubMedGoogle Scholar
- Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, Bassett LW: Imaging characteristics of malignant lesions of the male breast. Radiographics. 2006, 26 (4): 993-1006. 10.1148/rg.264055116.View ArticlePubMedGoogle Scholar
- Erhan Y, Zekioglu O, Erhan Y: Invasive lobular carcinoma of the male breast. Can J Surg. 2006, 49 (5): 365-366.PubMed CentralPubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.