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Review
. 2017 Dec;96(51):e9312.
doi: 10.1097/MD.0000000000009312.

Male occult breast cancer with axillary lymph node metastasis as the first manifestation: A case report and literature review

Ruixin Xu  1 , Jianbin Li, Yingjie Zhang, Hongbiao Jing, Youzhe Zhu
Affiliations
Review

Male occult breast cancer with axillary lymph node metastasis as the first manifestation: A case report and literature review

Ruixin Xu et al. Medicine (Baltimore). 2017 Dec.

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A) Initial US revealed 3 hypoechoic swollen lymph nodes with clear boundaries; the largest mass was 4.3 cm × 2.3 cm in diameter. (B) Initial left breast US revealed hyperplasia of the mammary gland with a maximum scope of 18 mm × 18 mm.
Figure 2
Figure 2
Chest CT showed an enlarged lymph node in the infraclavicular region (arrow) after the first surgery. CT = computed tomography.
Figure 3
Figure 3
PET/CT scan of the entire body showed several lesions with increased uptake in the left axillary and infraclavicular regions (arrows) after the first surgery. PET/CT = positron emission tomography/computed tomography.
Figure 4
Figure 4
Postoperative HE (original magnification ×100 for A and ×200 for B) staining. HE = hematoxylin and eosin.
Figure 5
Figure 5
IHC staining (original magnification ×200) showing positivity for GCDFP-15. GCDFP-15 = gross cystic disease fluid protein-15, IHC = immunohistochemical.
Figure 6
Figure 6
IHC staining (original magnification ×200) showing positivity for CK7. CK = cytokeratin, IHC = immunohistochemical.
Figure 7
Figure 7
IHC staining (original magnification ×200) showing positivity for EMA. EMA = epithelial membrane antigen, IHC = immunohistochemical.
Figure 8
Figure 8
IHC staining (original magnification ×200) showing suspicious positivity for Her-2. Her-2 = human epidermal receptor-2, IHC = immunohistochemical.
See this image and copyright information in PMC

References

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