Inflammatory Breast Cancer in Men: A rare clinical case report and a literature review

Abstract

Introduction and importance: The initial misdiagnosis and delayed treatment for inflammatory breast cancer in men is brought about by its rarity and lack of readily available guidelines on pathways.

Case presentation: A 78-year-old male presented to the breast clinic with an abscess and was later diagnosed with inflammatory breast cancer. He presented with an abscess and was initially treated with antibiotics. Imaging showed a large left breast mass consistent with inflammatory carcinoma with axillary lymph node involvement. Patient was started on Tamoxifen as a bridge for surgery with no response. He eventually had a mastectomy and axillary clearance with the histology confirming the diagnosis and tumour emboli in the lymphatic vessels. Chemotherapy, radiation and dual hormone therapy were included in the adjuvant treatment plan. Two episodes of neutropenic sepsis led to completing only five out of six planned chemotherapy cycles.

Clinical discussion: A review of literature and the reported cases was done by the team to contribute to the little information published about the disease and its management. The presented to the breast clinic during the height of the SARS- CoV-2 pandemic. The global impact of SARS-CoV-19 made surgical teams find ways to lessen elective lists to give way for patients affected during the pandemic.

Conclusion: Very few cases of inflammatory breast cancer have been reported in men. The diagnosis can be missed leading to delay in management. Management can be challenging and complex.

Keywords: Case report on male inflammatory breast cancer; Delays in diagnosis for male breast cancer; Inflammatory breast cancer in men; Male breast cancer.

Fig. 1

Photos showing disease progression (all provided by the patient for use in literature and education): (a) Taken in March 2020. (b) Taken in June 2020, about three months from starting Tamoxifen. (c) Taken in August 2020.

Fig. 2

(a) Ultrasound at original presentation showing an excess of 50 mm abscess in the left retroareolar region that failed to yield any aspirate fluid. Clinical management was recommended. (b) Medio-Lateral Oblique mammographic view showing a well marginated round 60 mm mass with overlying skin thickening on the left breast. The appearances are consistent with an inflammatory left breast carcinoma.

Fig. 3

Photos taken on the day of surgery, five months since day of diagnosis.