A case of male inflammatory breast cancer

International Cancer Conference Journal, Jul 2013

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.

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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)


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Miki Hyakudomi, Toko Inao, Yoshimitsu Minari, Masayuki Itakura, Riruke Maruyama, Yoshitsugu Tajima. A case of male inflammatory breast cancer, International Cancer Conference Journal, 2013, pp. 183-187, Volume 2, Issue 3, DOI: 10.1007/s13691-013-0087-9