Case report of invasive ductal carcinoma of the breast in a Pakistani male aged 55.

backgroundThe male breast cancer is a rare malignancy comprising for less than 1% of all breast cancers. The late and incorrect diagnosis of this cancer causes increased incidence rates of metastatic spread within patients. In Pakistan, the male breast cancer is frequently diagnosed at an average age of 55 to 58 years. Additionally, different risk factors including old age, hormonal imbalances, as well as family history showed association with this cancer. Moreover, recent literature showed that the neoadjuvant chemotherapy can result in pathologic complete responses in male breast cancer patients, yet its use in real-world practice is low, highlighting the gap in clinical implementation. Therefore, we present a clinical case report of male breast cancer to identify the critical importance of considering this malignancy in young males with breast masses and to discuss the unique challenges in their management. CASE PRESENTATION: We present the case of a 55-year-old normotensive and normoglycemic male office clerk with a four-months history of mild pain and lump in the left breast. He did not have a family history of breast cancer. Physical examination revealed a hard lump with overlying skin changes suggestive of malignancy. Incisional biopsies confirmed invasive ductal carcinoma, grade II with ER-positive, PR-negative and HER2/neu-negative status with no lymphovascular invasion. Imaging studies showed lobulated mass in the left breast with axillary lymphadenopathy in the ipsilateral axilla, renal calculus and benign lytic lesions. The patient was initially treated with planned neoadjuvant chemotherapy including four cycles of doxorubicin and cyclophosphamide scheduled over twelve weeks. However, a follow-up biopsy performed after nine weeks showed persistent invasive carcinoma. Consequently, the treatment plan was reevaluated subsequently. Because of the tumor’s ER-positive status and suboptimal response to neoadjuvant chemotherapy, the treatment plan was changed to endocrine therapy such as tamoxifen (10 mg twice daily). The patient was clinically stable during discharge and follow-up was advised.

conclusionThis case report of male breast cancer highlights the unique aspects and challenges of diagnosing and treating cancer emphasizing the importance of early diagnosis, hormone receptor status for treatment planning and ongoing research to manage cancer effectively. Moreover, it also highlights the necessity of imaging in such cases as clinical examination may fail to pick significant findings. Similarly, absence of lymphovascular invasion on biopsy is not always associated with absent lymph node involvement on imaging. Moreover, this case report also demonstrated the standard diagnostic and therapeutic pathways for a typical case of ER-positive invasive ductal carcinoma in a male patient. This clinical case report highlights the crucial in recognizing chemotherapy-resistant disease and supporting the clinicians in the timely initiation of the endocrine therapy.