High-grade fetal adenocarcinoma of the lung misdiagnosed as male breast carcinoma: a case report and literature review.

Background and aim: High-grade fetal adenocarcinoma of the lung (HG-FLAC) is a specific subtype of lung adenocarcinoma with a poor prognosis. A lack of understanding exists because of the rarity of this disease. This study aimed to present a case of HG-FLAC with multiple metastases misdiagnosed as male breast carcinoma at the initial diagnosis. Case presentation: The patient visited our hospital due to a month-long cough. The chest computed tomography (CT) scan revealed a mass in the left lung and chest wall, accompanied by enlargement of mediastinal lymph nodes. The magnetic resonance imaging indicated potential metastatic lesions in the brain and adrenal glands. The patient underwent a biopsy of the lesion in the right chest wall. The pathological and immunohistochemical findings indicated a high possibility of male breast cancer. However, the clinical features did not support this diagnosis. Therefore, a CT-guided percutaneous lung biopsy was performed, and the pathological examination finally indicated HG-FLAC. Conclusions: We presented a complex yet interesting case in which HG-FLAC was misdiagnosed as male breast cancer. Our interesting case may stimulate discussions about the methods to manage patients with HG-FLAC.

Trichorhinophalangeal syndrome type 1 (TRPS1) expression in male breast carcinoma.

Currently, there is a paucity of highly specific and sensitive markers to identify breast carcinoma in male patients. Immunohistochemical stains commonly used for unmasking primary breast carcinomas include estrogen receptor (ER) and GATA3. However, these markers are commonly expressed in carcinomas originating from other organ systems and can be reduced in breast carcinomas with higher histologic grades. Androgen receptor (AR) may be used to highlight primary male breast cancer, but this marker can also be expressed in other carcinomas. We evaluated TRPS1, a highly sensitive and specific marker for female breast carcinoma, in cases of male breast carcinoma. Through an institutional database search, we identified 72 cases of primary invasive breast carcinoma in male patients. Among ER/progesterone receptor (PR)-positive cancers, 97% showed intermediate or high positivity for both TRPS1 and GATA3. Among HER2-positive cancers, 100% showed intermediate or high positivity for TRPS1 and GATA3. One case of triple-negative breast cancer was collected, showing high positivity for TRPS1 and negativity for GATA3. AR staining was non-specific and heterogeneous: 76% showed high positivity, but the remaining 24% showed low or intermediate positivity. Additionally, among 29 cases of metastatic carcinoma to male breast tissue, 93% were negative for TRPS1, and the remaining 2 cases (7%), which were carcinomas from salivary gland primary tumors, were intermediate positive. TRPS1 is a sensitive and specific marker in the unmasking of male primary invasive breast carcinoma across different subtypes. Additionally, TRPS1 is not expressed in metastatic carcinomas of multiple primaries, with the exception of salivary gland primaries.

Nomogram for predicting preoperative axillary lymph node status in male breast carcinoma: a SEER population-based study.

Background: Sentinel lymph node biopsy (SLNB) has been recommended as a replacement for axillary lymph node dissection (ALND) in male breast carcinoma (MBC) with clinical axillary lymph node-negative (ALN-negative) as in the case of female. However, the morbidity after SLNB may also have short-term or long-term complications. To avoid unnecessary surgery, building a model which is able to assess the risk of lymph node metastasis is vitally significant. Methods: A retrospective review of the clinical and pathology data were carried out for patients diagnosed with MBC between 2010 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database. The cohort was divided into training and validation cohorts. A logistic regression model was used to construct the nomogram in the training cohort and then verified in the validation cohort. The receiver operating characteristic (ROC) curve, C-index, and calibration were used to evaluate the predictive ability of the nomogram. Results: Overall, 2,610 patients diagnosed with MBC were included in the study, of which 1,740 were in the training cohort and 870 were in the validation cohort. Logistic regression analysis indicated age at diagnosis, tumor location, tumor stage, pathological type, and histologic grade, were significantly related to axillary lymph node metastasis (ALNM). The area under the curve (AUC) of the nomogram was 0.846 (95% CI: 0.825-0.867) and C-index was 0.848 (95% CI: 0.807-0.889), demonstrating a notable prediction performance. The calibration curve for the nomogram was plotted and the slope was close to 1. The prognostic value of the nomogram was further validated in the validation cohort, with an AUC of 0.848 (95% CI: 0.819-0.877). Conclusions: A nomogram to predict ALNM was successfully established, especially for those who were of advanced age at diagnosis, had small tumor size, displayed low malignancy, and showed clinical ALN-negative, to avoid unnecessary axillary operation. The quality of life for patients is enhanced without conceding the overall survival rate.

Asynchronous bilateral male breast cancer. A rare case report.

We describe a rare case of asynchronous bilateral carcinoma of the mammary glands in a 66-year-old man. The patient was admitted to the Department of Dermatology and Venereology due to exacerbation of chronic eczema. During the examination, a 3×2-cm tumor with retraction of the mammilla was found in the right mammary gland. Mastectomy and regional lymphatic dissection were performed. Histological examination showed invasive ductal carcinoma, ER (+) 70%, PR (-), HER2 (-). Treatment included chemotherapy, radiotherapy, and hormone therapy. Three years later, the patient reported a lump in the left breast. The presence of a tumor formation was confirmed by mammography and ultrasound examination. A radical mastectomy with regional lymphatic dissection was performed. Histological examination showed invasive ductal carcinoma of the mammary gland, ER (3+) 80%, PP (2+) 60%, HER2 (+++), and Ki67 (+) 80%. Treatment with chemotherapy and radiation therapy was carried out. Five years after diagnosis of the second carcinoma, the patient is in a good general condition. Regardless of its rarity, the described case should draw doctors' attention to this pathology. Assessment of risk factors and periodic breast examination in men would allow early diagnosis, timely treatment, and better prognosis of the disease.

A systematic literature review of the management, oncological outcomes and psychosocial implications of male breast cancer.

BACKGROUND: Although male breast cancer (MBC) is a rare disease, accounting for <1% of all breast cancers, it has significant oncological, survival and psychosocial implications for patients. The aim of this study is to assess the latest literature in the diagnosis, management, oncological outcomes, and psychosocial impact of MBC. METHODS: A systematic literature review was conducted using the PRISMA guidelines (Moher et al., 2009) [1] to explore the management of MBC, with particular focus on investigative imaging, surgical management, oncological outcomes, survival, genetic screening and psychosocial effects. Electronic databases were searched for randomised control trials, cohort studies and case series involving more than 10 patients. Imaging and surgical techniques, local and distant disease recurrence, survival, genetic screening and psychosocial implications in the setting of MBC were assessed. RESULTS: The search criteria identified 199 articles, of which 59 met the inclusion criteria. This included 39,529 patients, with a mean age of 64.5 years (55-71), and a mean follow-up of 66.3 months (26.2-115). Mastectomy remains the most frequently used surgical technique, with an average of 89.6%. Loco-regional and distant recurrence rate was 10.1% and 21.4% respectively. Disease-free survival (DFS) at 5 and 10 years was 66.8% and 54.5% respectively. Disease-specific survival (DSS) at 5 and 10 years was 87.1% and 67.1% respectively. Overall survival (OS) at 5 and 10 years was 72.7% and 50.7% respectively. Genetic screening was conducted in 38.6% of patients of which 4.8% and 15.8% were found to be BRCA1 and BRCA2 carriers respectively. Psychosocial studies were conducted mainly using questionnaire and interview-based methodology focusing primarily on awareness of breast cancer in men, support available and impact on gender identity. CONCLUSIONS: This review demonstrates that men present with later stage disease with subsequent impact on survival outcomes. There remains a paucity of high-level evidence and prospective studies are required. There is a need for increasing awareness amongst the public and health care professionals in order to improve outcomes and reduce stigma associated with MBC.

Male Breast Cancer-Immunohistochemical Patterns and Clinical Relevance of FASN, ATF3, and Collagen IV.

BACKGROUND: Male breast carcinoma (male BC) is an uncommon neoplasia without individualized strategies for diagnosis and therapeutics. Low overall survival (OS) rates have been reported, mostly associated with patients' advanced stage and older age. Intratumoral heterogeneity versus homogeneity of malignant epithelial cells seems to be an important factor to consider for the development of combination therapies with curative intention. OBJECTIVE: In this preliminary study, we aim to provide valuable insight into the distinct clinicopathologic features of male BC. MATERIAL AND METHODS: In a series of 40 male BC patients, we evaluated by immunohistochemistry androgen receptor; activating transcription factor 3 (ATF3); p16; cyclin D1; fatty acid synthase (FASN); fatty acid transport protein 1 (FATP1); ß1, ß3, ß4, and ß6 integrins; collagen I and collagen IV; and their interactions. Kaplan-Meier survival curves and log-rank tests were assessed for statistical analysis. RESULTS: Homogeneous epithelial staining of p16, ATF3, ß6 integrin, FASN, and FATP1 was found to be significantly intercorrelated, and associated with high Ki67. These markers also stained tumor stromal fibroblasts. The prognostic analysis showed statistically significant associations of FASN with disease-free survival (DFS) and OS, as well as of ATF3 with OS and collagen IV with DFS. CONCLUSIONS: This study highlights, as a novel finding, the relevance of FASN, ATF3, and collagen IV immunophenotypes, which may have innovative application in the clinical management of male BC.

Intracystic papillary carcinoma of the male breast: Dilemmas in diagnosis and management.

Intracystic papillary carcinoma (IPC) is a rare malignancy of the breast which is usually found in postmenopausal women. It is still rarer in males and may present with signs of a benign cystic lump. It is sub-classified into three equally prevalent groups considering treatment strategies: intracystic papillary carcinoma alone, intracystic papillary carcinoma with ductal carcinoma in-situ, and those with evidence of invasion. Even if a preoperative diagnosis is achieved, there are no specific guidelines for the treatment of IPC. Treatment modalities including the extent of surgical excision, lymph node dissection, radiation, and chemotherapy are determined by the grade and size of the lesion and sub-types. However, several reports and studies showed good prognosis with conservative surgery without axillary dissection in IPC not associated with carcinoma in situ or micro-invasion. We present a 40 years old male patient with IPC who was managed by modified radical mastectomy and adjuvant hormone therapy. A brief review of the literature and clinical characteristics, pathology, and treatment of IPC are discussed.

Colonic metastasis from infiltrating ductal breast carcinoma in a male patient: A case report.

INTRODUCTION: A colonic metastasis from infiltrating breast ductal carcinoma is a rare phenomenon in the literature, especially in a male. PRESENTATION OF CASE: We present a rare case of a 55-year-old male with a past medical history of breast cancer who presented with signs and symptoms of appendicitis. A computed tomography (CT) scan revealed acute appendicitis in addition to a 2.3 cm cecal mass that correlated with a hypermetabolic region on positron emission testing (PET) the previous year. Analysis of a previously biopsied axillary lymph node demonstrated infiltrating ductal carcinoma. After an appendectomy and a right hemicolectomy were performed, pathologic analysis of the specimen revealed metastatic ductal carcinoma to the cecum. DISCUSSION: Gastrointestinal metastases of breast carcinoma are rare with colonic metastases occurring in approximately 3% of these cases. At the time of diagnosis of these colonic metastases, the disease is often times multifocal in the gastrointestinal tract. Solitary gastrointestinal metastases are less common than both secondary primaries and benign processes. Biopsies obtained during colonoscopy are often non-diagnostic, mandating surgical excision and pathologic examination. CONCLUSION: Although colonic metastases from a primary breast ductal carcinoma are rare, a low level of suspicion must be maintained in a patient with such a history presenting with abdominal symptoms.

Carcinoma de mama masculina / Male breast carcinoma

El cáncer mamario en hombres es una enfermedad poco frecuente. Sólo representa 1 por ciento de todos los cánceres de mama y es responsable del 0,1 por ciento de las muertes por cáncer en el hombre. Su incidencia se ha incrementado en los últimos 25 años. Generalmente la forma de presentación de la enfermedad es una masa indolora, retroareolar, con retracción del pezón o no. La enfermedad en estadios avanzados (etapa III-IV) ocurre en más del 40 por ciento de los pacientes. La variedad histopatológica más frecuente es el carcinoma ductal infiltrante y el tratamiento de elección es la mastectomía radical modificada con vaciamiento axilar. El objetivo de este trabajo es la presentación de dos casos diagnosticados y tratados en el Hospital Salvador Allende, además de actualizar el tema(AU)

Breast cancer in men is a rare disease. It accounts only for 1 percent of all breast cancers and is responsible for 0.1 percent of cancer deaths in men. Its incidence has increased in the last 25 years. Generally speaking, the form of presentation of the disease is a painless mass, which is retroareolar, with retraction of the nipple or without it. The disease in advanced stages (stages III-IV) occurs in more than 40 percent of patients. The most frequent histopathological variety is the infiltrating ductal carcinoma and the treatment of choice is modified radical mastectomy with axillary dissection. The objective of this work is the presentation of two cases diagnosed and treated at Salvador Allende Hospital, in addition to updating the topic(AU)

Carcinoma de mama masculina / Male breast carcinoma

El cáncer mamario en hombres es una enfermedad poco frecuente. Sólo representa 1 por ciento de todos los cánceres de mama y es responsable del 0,1 por ciento de las muertes por cáncer en el hombre. Su incidencia se ha incrementado en los últimos 25 años. Generalmente la forma de presentación de la enfermedad es una masa indolora, retroareolar, con retracción del pezón o no. La enfermedad en estadios avanzados (etapa III-IV) ocurre en más del 40 por ciento de los pacientes. La variedad histopatológica más frecuente es el carcinoma ductal infiltrante y el tratamiento de elección es la mastectomía radical modificada con vaciamiento axilar. El objetivo de este trabajo es la presentación de dos casos diagnosticados y tratados en el Hospital Salvador Allende, además de actualizar el tema(AU)

Breast cancer in men is a rare disease. It accounts only for 1 percent of all breast cancers and is responsible for 0.1 percent of cancer deaths in men. Its incidence has increased in the last 25 years. Generally speaking, the form of presentation of the disease is a painless mass, which is retroareolar, with retraction of the nipple or without it. The disease in advanced stages (stages III-IV) occurs in more than 40 percent of patients. The most frequent histopathological variety is the infiltrating ductal carcinoma and the treatment of choice is modified radical mastectomy with axillary dissection. The objective of this work is the presentation of two cases diagnosed and treated at Salvador Allende Hospital, in addition to updating the topic(AU)

Invasive lobular carcinoma of the male breast: A rare histology of an uncommon disease.

Male breast carcinoma is a rare malignancy comprising less than 1% of all breast cancers. It is a serious disease with most patients presenting in advanced stages. Infiltrating ductal carcinoma is the most common histology while lobular carcinoma represents less than 1% of all these tumors. We report a case of locally advanced lobular carcinoma of breast in a 60 year old male.

Comportamiento clínico de cáncer de mama en hombres en una población latinoamericana / Clinical behavior of breast cancer in men in a Latin American population

El cáncer de mama en hombres es una enfermedad poco frecuente, en Colombia la incidencia estimada anual es de 1 caso por cada 1.000.000 de habitantes, lo cual es significativamente menor que en otros países. Objetivo: Describir la presentación clínica, histopatológica, tratamiento inicial y recaídas de pacientes de sexo masculino con diagnóstico de cáncer de mama en el Instituto Nacional de Cancerología entre el periodo 1996 a 2011. Resultados: La población del estudio fue de 27 pacientes. Los principales síntomas reportados por los pacientes fueron masa y dolor. La mayoría de los pacientes (89%) presentaban un estadio clínico localmente avanzado (IIIB y IV). El tipo histológico ductal NOS fue el más predominante (82%). Se encontró resultado de receptores hormonales en 22 de los 27 pacientes, de los cuales 19 (86%) eran positivos. El porcentaje de pacientes llevados a cirugía fue del 71% (20 pacientes), la técnica quirúrgica utilizada en 17 de los 20 pacientes fue la mastectomía radical modificada. En todos los pacientes sometidos a tratamiento quirúrgico fue realizado vaciamiento axilar y resección del CAP. La mediana de seguimiento de los pacientes fue de 8,9 meses. Dos pacientes presentaron recaída sistémica. Ninguno de los pacientes presentó recaída locorregional. Conclusión: Presentamos una serie de pacientes con cáncer de mama en hombres, lo cual es una entidad de baja incidencia. Nuestros pacientes se presentaron principalmente en estadio avanzado, en una proporción mayor a lo descrito en otras series latinoamericanas. Aunque la biología tumoral encontrada representa factores de buen pronóstico, no concuerda con el hecho de que la mayoría de tumores sean avanzados.

Breast cancer in men is a rare disease in Colombia, with an estimated annual incidence of 1 case per 1,000,000 habitants, which is significantly lower than in other countries. Objective: To describe the clinical presentation, histopathology, initial treatment and relapse of male patients diagnosed with breast cancer at the National Cancer Institute between 1996 and 2011. Results: The study population was 27 patients. The main symptoms reported by patients were mass and pain. Most patients (89%) had locally advanced clinical stage (IIIB and IV). NOS ductal histological type was the most prevalent (82%). Hormone receptor was found in 22 of 27 patients, of whom 19 (86%) were positive. The percentage of patients undergoing surgery was 71% (20 patients), and the surgical technique used in 17 of the 20 patients was modified radical mastectomy. Axillary dissection and resection of the CAP was performed on all patients who underwent surgical treatment. The median follow up of patients was 8.9 months. Two patients had systemic relapse. None of the patients had locoregional relapse. Conclusion: A case series is presented of male patients with breast cancer, which is a disease of low incidence. Our patients are mainly presented in advanced stages, a greater proportion than that described in other Latin American series. Although tumour biology found good prognostic factors, it is not consistent with the fact that most tumours are advanced.

Lymph Node and Skin Metastasis as a Manifestation of a Male Breast Carcinoma / 대한피부과학회지

Breast carcinoma in men is very rare but is a potentially life-threatening neoplasm. The most common form of clinical presentation is a painless, firm, retroareolar mass. However, in some cases, primary focus of the tumor may not be detected but present with metastatic lesions. We report a case of male breast carcinoma presented with axillary lymph node enlargement and subsequent erythematous infiltration of chest wall in a 60-year-old man. Histopathologic examination showed invasive ductal carcinoma of breast, and both estrogen and progesterone receptors were weakly positive.

A Case of Male Breast Carcinoma Manifested as a Subcutaneous Nodule on the Chest / 대한피부과학회지

Breast carcinoma in men is very rare but a potentially serious neoplasm. We report herein a case of male breast carcinoma presented with a mobile asymptomatic nodule on the chest in a 73-year-old man. Histopathologic diagnosis was invasive ductal carcinoma of a male breast.