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A 94-year-old man presented with a painless, asymptomatic left axillary mass that grew over 25 years. The pat Q4 ient denied personal or family history of skin or breast cancer. The smooth pink pedunculated vascular mass measured 3.6 cm 3 2.1 cm (Fig 1 ½F1 ½F2 Q5). Biopsy revealed glandular structures with luminal decapitation elements and micropapillary structures. The glandular components infiltrated the surrounding fibroadipose and breast tissue. Tumor cells had clear cytoplasm and high-grade features (including pleomorphic hyperchromatic nuclei, numerous mitoses, and atypical forms) and stained positive for gross cystic disease fluid protein 15 (GCDFP-15). Adjacent adnexal structures were normal. The mammogram was negative for breast masses. Computed tomography scan of the chest revealed multiple pulmonary nodules. Primary apocrine adenocarcinoma with metastasis was diagnosed. Question 1: What is the diagnosis? A. Breast cancer B. Seborrheic keratosis C. Primary apocrine adenocarcinoma D. Syringoma E. Merkel cell carcinoma Answers:A. Breast cancer e Incorrect. Breast cancer would most likely be visible on a mammogram and is rare in men. In addition, the histopathology does not support breast cancer.