A case of male inflammatory breast cancer
Int Canc Conf J
A case of male inflammatory breast cancer
Miki Hyakudomi 0 1
Toko Inao 0 1
Yoshimitsu Minari 0 1
Masayuki Itakura 0 1
Riruke Maruyama 0 1
Yoshitsugu Tajima 0 1
0 R. Maruyama Department of Pathology, Shimane University Faculty of Medicine , 89-1 Enya-cho, Izumo, Shimane 693-8501 , Japan
1 M. Hyakudomi (&) T. Inao Y. Minari M. Itakura Y. Tajima Department of Digestive and General Surgery, Shimane University Faculty of Medicine , Izumo , Japan
This report describes the case of an 85-year-old male with inflammatory breast cancer. The patient presented with diffuse erythema and induration over the right anterior chest wall. Ultrasonography and mammography demonstrated an ill-defined small mass, 8 mm in diameter, in the right breast with skin thickening. A core needle biopsy of the breast mass confirmed the presence of invasive ductal carcinoma. A skin biopsy revealed a diffuse tumor cell infiltration with dermal lymphatic emboli. These findings were compatible with the diagnosis of inflammatory breast cancer. The tumor cells were triple negative for estrogen receptor, progesterone receptor, and HER2/neu. His bone scintigraphy showed multiple bone metastases. Systemic chemotherapy using capecitabine was introduced, but it failed to control the disease. TS-1, as second-line systemic chemotherapy, also resulted in treatment failure. Third-line chemotherapy using docetaxel and cyclophosphamide was then administered and was effective. However, he developed pneumonia due to febrile neutropenia after two cycles of treatment and the chemotherapy was discontinued. The patient died of carcinomatous lymphangiosis 2 years and 3 months after the initial onset of the disease. Male inflammatory breast cancer is challenging because of its rarity, biological uncertainness, diagnostic difficulty, and the fact that it is associated with a very poor prognosis. The establishment of a reliable diagnostic and treatment strategy for male inflammatory breast cancer is therefore needed.
Inflammatory breast cancer; Docetaxel; Cyclophosphamide
Introduction
Male breast cancer accounts for less than 1 % of all breast
cancer, affecting mainly elderly patients, and is usually
discovered after it has progressed significantly [
1
].
Inflammatory breast cancer is a rare entity, accounting for
only 0.5–2 % of all invasive breast cancer, but it has a
dismal outcome [
2
]. Inflammatory breast cancer in men is
extremely rare, with only 9 cases having been reported [
3–
9
]. This report presents a case of male inflammatory breast
cancer along with a review of the literature.
Case report
An 85-year-old male presented with progressive erythema
and induration in the right anterior chest wall, which had
appeared 6 months earlier. He consulted a dermatologist
and was treated with antibiotics before consulting our
department. He had a history of hypertension and asthma.
There was no family history of breast or ovarian cancer.
A physical examination revealed diffuse erythema and
induration in the right anterior chest wall that spread to the
right axilla (Fig. 1). His right nipple was retracted, but no
masses could be felt. An enlarged lymph node was palpable
in his right axilla. Serum level of carcinoembryonic antigen
(CEA) was 16.7 ng/ml (normal range \5.0 ng/ml). All
other blood tests were within the normal range.
Mammography and ultrasonography demonstrated an
illdefined mass with spiculated margins located in the
retroareolar space, 8 mm in diameter, with cutaneous thickening
(Figs. 2, 3). Computed tomography (CT) revealed a
centrally located ill-defined mass in his right breast with skin
thickening and lymphatic edema from the right anterior
chest wall to axilla (Fig. 4). A core needle biopsy confirmed
the breast mass to be scirrhous carcinoma (Fig. 5). A skin
biopsy noted a diffuse tumor cell infiltration with tumor
embolism in the dermal lymphatics, which is characteristic
of inflammatory breast cancer (Fig. 6). His bone scan
showed multiple sites of increased uptake, being consistent
with metastatic disease. No space-occupying lesions were
recognized in the lung and liver. The disease was classified
as T4dN1M1 stage IV breast cancer. Immunohistochemical
stains showed the tumor cells to be negative for both the
estrogen receptor (ER) and progesterone receptor (PR).
There was no overexpression of human epidermal growth
factor receptor 2 (HER2/neu).
Systemic chemotherapy, along with bisphosphonate,
was administered using capecitabine 1800 mg/day in two
divided doses, with one cycle including 3 weeks of
treatment followed by 1 week without treatment. A total of 4
cycles were carried out, but this treatment failed to control
the disease. Second-line systemic chemotherapy was
introduced using TS-1 150 mg/day in two divided doses,
with one cycle including 4 weeks of treatment followed by
2 weeks without any treatment. A total of 4 cycles were
carried out, but this also failed to control the disease and
the serum level of CEA (...truncated)