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CASE REPORT
Year : 2022  |  Volume : 11  |  Issue : 1  |  Page : 81-84

Rarest of the rare-male triple negative breast cancer


1 Department of Medical Oncology, Sriramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
2 Department of Pathology, Sriramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India

Date of Submission16-Feb-2021
Date of Decision01-Apr-2021
Date of Acceptance01-Apr-2021
Date of Web Publication23-May-2022

Correspondence Address:
Dr. Ravi C Ambalathandi
Department of Medical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_17_21

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  Abstract 


Breast cancer in males is rare. Luminal A is the predominant subtype in male breast cancer. Clinical data on triple negative breast cancer in male patients is sparse. This case report will add to the literature on male breast cancers. This is a rare case of a 60-year-old male patient who was diagnosed to have locally advanced breast cancer of triple negative (basal-like) subtype. He received eight cycles of neoadjuvant chemotherapy. He later underwent modified radical mastectomy followed by adjuvant radiotherapy and 6 months of adjuvant capecitabine. He is on regular follow-up for the past 3 years.

Keywords: Breast cancer, male, TNBC


How to cite this article:
Polavarapu H, Ambalathandi RC, Reddy R R, Balasubramanian A, Meenakshisundaram M. Rarest of the rare-male triple negative breast cancer. J NTR Univ Health Sci 2022;11:81-4

How to cite this URL:
Polavarapu H, Ambalathandi RC, Reddy R R, Balasubramanian A, Meenakshisundaram M. Rarest of the rare-male triple negative breast cancer. J NTR Univ Health Sci [serial online] 2022 [cited 2022 Jun 26];11:81-4. Available from: https://www.jdrntruhs.org/text.asp?2022/11/1/81/345801




  Introduction Top


Male breast cancer (MBC) accounts for less than 1% of all breast cancers.[1] The incidence of MBC varies on a worldwide basis, with the highest rates in some sub-Saharan countries. Worldwide, the female to male incidence ratio is 122:1.[2]

The majority of cases is infiltrating ductal carcinoma, with a high rate of hormone receptor–positive tumors {estrogen receptor (ER) 80%–90%, progesterone receptor (PR) 73%–81%}. HER2/neu-positivity reports are inconsistent. Initially, HER2/neu positivity was reported as equivalent to female breast cancer but more recently noted at 5%–15% in different studies.[3],[4]

This is a rare case of a basal-like invasive carcinoma of the breast in a male with good survival. Clinical data on TNBC in male patients is sparse.


  Case Report Top


A 60-year-old man was evaluated for mass in left arm pit. The patient was a teetotaler, with no family history of breast cancer and no history of liver disease, gonadal dysfunction, or gynecomastia.

On examination, two discrete irregular mobile masses were felt in the pectoral group of left axilla, one measuring 4 × 2 cm and the other of size 3 × 2 cm. The chest wall and nipple areolar complex was normal. The contralateral axilla was normal.

Ultrasound of the bilateral breast and axilla revealed a hypoechoic mass in the left axillary tail measuring 4 × 2 cm and few lymph nodes which were fixed to each other with diffuse cortical thickening and loss of fatty hilum, measuring 2.5 × 1.5 cm.

He was evaluated with core needle biopsy from the mass which indicated infiltrating ductal carcinoma. Immunohistochemistry was negative for ER, PR, and HER2/neu but diffusely positive for androgen receptor (AR), shown in [Figure 1].
Figure 1: H and E, 40×, Section showing fibrocollagenous tissue infiltrated by atypical cells arranged in nests and few in glandular pattern showing pleomorphism, increased ratio, irregular membrane, atypical mitotic figures, invasive mammary carcinoma b IHC, 40×, estrogen receptor negative c IHC, 40×, progesterone receptor negative d IHC, 40×, HER2neu Negative

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He was staged with Positron Emission Tomography and Computed Tomography (PET CT) scan, which revealed a left axillary tail mass (43 × 33 mm, SUV max-7.96) with enlarged Fluorodeoxyglucose (FDG)-avid lymph nodes in left axilla Level I (27 × 17 mm, SUV max-5.40), shown in [Figure 2]. There were no other sites of abnormal FDG uptake. The clinical stage according to findings and reports is cT2N2AM0- stage III A.
Figure 2: PET CT scan showing enlarged FDG avid mass in left axillary tail and lymph nodes in left axilla level I

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He received neoadjuvant chemotherapy with four cycles of adriamycin and cyclophosphamide followed by four cycles of docetaxel (4 AC-4 Taxane). He had good response to chemotherapy with tumor size decreased to 1.5 × 1.5 cm and no palpable nodes.

Patient underwent left modified radical mastectomy. Histopathological examination revealed Grade 3 invasive ductal carcinoma, not otherwise specified, with negative margins with pathological staging of ypT1 (1 × 1 cm) ypN2a (6 out of 12 nodes showed metastatic deposits).

He was also given adjuvant radiotherapy followed by 6 months of adjuvant capecitabine chemotherapy and is on regular follow-up for 3 years.


  Discussion Top


The risk of MBC is related to an increased lifelong exposure to estrogen (as with female breast cancer) or to reduced androgen. The strongest association is in men with Klinefelter syndrome (XXY); they have a 14- to 50-fold increased risk of developing MBC and account for about 3% of all MBCs. Also, men who carry a BRCA1 or, particularly, a BRCA2 mutation, have an increased risk of developing breast cancer. The following conditions have been reported to be associated with an increased risk of breast cancer in men: chronic liver disorders, such as cirrhosis, chronic alcoholism, and schistosomiasis; a history of mumps orchitis, undescended testes, or testicular injury; and feminization, genetically or by environmental exposure.[2]

The mean age of diagnosis is 67 years, compared to 62 years for women with breast cancer.[4] Compared with women, male patients tend to be older at the time of diagnosis (mean age 60–70 years) and have higher-stage disease and more lymph node involvement.[5] The most common presenting symptom of MBC is a painless lump. Other symptoms include nipple retraction, nipple ulceration, nipple bleeding, and nipple discharge.[3]

Triple negative breast cancer constitutes only 3.6% of MBC and has a greater risk of recurrence and mortality than hormone-positive breast cancer. Incidence of various subtypes of breast cancer is shown in [Table 1].[6]
Table 1: Incidence of Male Breast Cancer Subtypes in Various Studies

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According to the results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program in which 1054 patients were studied, 3 patients (0.3%) were triple negative. Information regarding outcomes in triple-negative subtype were not reported due to the smaller number of patients.[7]

In a study conducted by Gogia et al.,[8] 76 MBC patients were studied, among which seven (19%) were triple negative cancers. Out of seven triple negative patients, three patients presented with metastasis, three with locally advanced disease and one with early breast cancer.

Wu et al.[11] reported lower survival in males than females with the TNBC (2-year OS: 77.4%, P < 0.01), hormone receptor (HR)-positive/HER2-positive (2-year OS: 85.8%, P < 0.01) and HR-positive/HER2-negative subtypes (2-year OS: 93.8%, P < 0.01). Our patient is disease free at the end of 3 years. Survival rates of male breast cancer in multiple studies is depicted in [Table 2].
Table 2: Survival Rates of Male Breast Cancer in Various Studies

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The same guidelines used to make recommendations for treatment in women with breast cancer are followed in men. Tamoxifen rather than aromatase inhibitors is preferred as hormonal therapy in hormone receptor positive MBC.[14]


  Conclusion Top


This is an extremely rare case of MBC with basal molecular subtype. The patient is disease free at the end of 3 years and doing well.

Acknowledgment

The authors want to thank Dr. Arunan Murali, Professor, Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai-600116 for providing the support.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Weir HK, Thun MJ, Hankey BF, Ries LA, Howe HL, Wingo PA, et al. Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst 2003;95:1276-99.  Back to cited text no. 1
    
2.
DeVita VT, Jr., Lawrence TS, Rosenberg SA. Devita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. Philadelphia: Wolters Kluwer; 2019. p. 1301.  Back to cited text no. 2
    
3.
Ottini L, Palli D, Rizzo S, Federico M, Bazan V, Russo A. Male breast cancer. Crit Rev Oncol Hematol 2010;73:141-55.  Back to cited text no. 3
    
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Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet 2006;367:595-604.  Back to cited text no. 4
    
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Anderson WF, Jatoi I, Tse J, Rosenberg PS. Male breast cancer: A population-based comparison with female breast cancer. J Clin Oncol 2010;28:232-9.  Back to cited text no. 5
    
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Chavez-Macgregor M, Clarke CA, Lichtensztajn D, Hortobagyi GN, Giordano SH. Male breast cancer according to tumor subtype and race: A population-based study. Cancer 2013;119:1611-7.  Back to cited text no. 6
    
7.
Cardoso F, Bartlett JM, Slaets L, van Deurzen CH, van Leeuwen-Stok E, Porter P, et al. Characterization of male breast cancer: Results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol 2018;29:405-17.  Back to cited text no. 7
    
8.
Gogia A, Raina V, Deo SV, Shukla NK, Mohanti BK. Male breast cancer: A single institute experience. Indian J Cancer 2015;52:526-9.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: A population-based study. Cancer 2004;101:51-7.  Back to cited text no. 9
    
10.
Cutuli B, Le-Nir CC, Serin D, Kirova Y, Gaci Z, LemanskiC, et al. Male breast cancer. Evolution of treatment and prognostic factors. Analysis of 489 cases. Crit Rev Oncol Hematol 2010;73:246-54.  Back to cited text no. 10
    
11.
Wu Q, Li J, Zhu S, Wu J, Li X, Liu Q, et al. Poorer breast cancer survival outcomes in males than females might be attributable to tumor subtype. Oncotarget 2016;7:87532-42.  Back to cited text no. 11
    
12.
Sanguinetti A, Polistena A, Lucchini R, Monacelli M, Galasse S, Avenia S, et al. Male breast cancer, clinical presentation, diagnosis and treatment: Twenty years of experience in our breast unit. Int J Surg Case Rep 2016;20S (Suppl):8-11.  Back to cited text no. 12
    
13.
Wang F, Shu X, Meszoely I, Pal T, Mayer IA, Yu Z, et al. Overall mortality after diagnosis of breast cancer in men vs women. JAMA Oncol 2019;5:1589-96.  Back to cited text no. 13
    
14.
Hassett MJ, Somerfield MR, Baker ER, Cardoso F, Kansal KJ, Kwait DC, et al. Management of male breast cancer: ASCO guideline. J Clin Oncol 2020;38:1849-63.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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