Male occult breast cancer with axillary lymph node metastasis as the first manifestation

Abstract

Rationale:Occult breast cancer (OBC) is extremely rare in males with neither symptoms in the breast nor abnormalities upon imaging examination.Patient concerns:This current case report presents a young male patient who was diagnosed with male OBC first manifesting as axillary lymph node metastasis. The physical and imaging examination showed no primary lesions in either breasts or in other organs.Diagnoses:The pathological results revealed infiltrating ductal carcinoma in the axillary lymph nodes. Immunohistochemical (IHC) staining was negative for estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK)20 and thyroid transcription factor-1 (TTF-1), positive for CK7, gross cystic disease fluid protein-15 (GCDFP-15), epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), and suspicious positive for human epidermal receptor-2 (Her-2). On basis of IHC markers, particularly such as CK7, CK20 and GCDFP-15, and eliminating other malignancies, male OBC was identified in spite of negativity for hormone receptors.Interventions:The patient underwent left axillary lymph node dissection (ALND) but not mastectomy. After the surgery, the patient subsequently underwent chemotherapy and radiotherapy.Outcomes:The patient is currently being followed up without any signs of recurrence.Lessons:Carefully imaging examination and pathological analysis were particularly essential in the diagnosis of male OBC. The guidelines for managing male OBC default to those of female OBC and male breast cancer.

Male occult triple-negative breast cancer

“…Therefore, the presence of both ER and PR plays an important role in determining whether the primary disease behind the metastatic axillary lymph node is breast cancer. However, even if both ER and PR are negative, breast cancer cannot be eliminated 5. The final diagnosis in our case was confirmed after consulting several consultant pathologists and performing immunohistochemistry staining for CK7 and GCDFP-15.…”

“…Systemic physical examination and comprehensive imaging should be performed to identify the primary origin. MRI is a useful tool to evaluate occult lesions that are not found on physical examination or imaging by ultrasound and CT scan, but it did not identify any lesions in either breast 5. The frequency of ER and PR positivity in male breast cancer is higher than in female breast cancer 2.…”

“…The final diagnosis in our case was confirmed after consulting several consultant pathologists and performing immunohistochemistry staining for CK7 and GCDFP-15. In metastatic breast cancer, CK7 is usually expressed in more than 90% of cases, whereas GCDFP-15 has a specificity of 90% in the diagnosis of breast cancer 5. On the basis of all the above results, the patient was diagnosed with male occult breast cancer.…”

“…Breast cancer in men is very rare, representing less than 1% of all male cancers 1. Occult breast cancer is usually discovered due to the presence of axillary metastases without any lesions in either breast 5–7. It accounts for 0.3%–1% of all cases of breast cancer, so little is known about this disease, and the literature is limited to case reports or case series 8.…”

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

“…[3–5] Unlike FBC, which has a bimodal age distribution, MBC has a unimodal distribution with a peak incidence at 71 years, which is approximately 10 years later than that in FBC. [6] Cases usually occur from ages 40 to 78 years, [7] and our case was in this range.…”