Thanh Nhan Hospital MALE BREAST CANCER: CASE REPORT Dr Vinh Nguyen Thanh- Dr Thao Hoang Thi Ha Noi/2017

ABSTRACT Male breast cancer is rare, accounting less than 1 % of all cancer in males. The incidence rate tends to increase. Median age to be diagnosed with breast cancer at an older age than women about 10 years ( 67-71 years old). Treatment methods: surgery, chemotherapy, radiotherapy and endocrine therapy.

CASE STUDY Male, 74 years old. No medical history. He presented a mass in left breast many years. 3 months before he went to our hospital when it was hard and big. Examination: a 4,5cm tumor located on the left breast, hard, harder to move. No invade skin. No nipple drainage and axilla node possitive.

FNA: Carcinoma Abdominal ultrasound, chest X-ray: No metastasis. Patient was resected left breast and axilla nodes. Histological biopsy: Invasive ductal carcinoma, ER/PR (+), Her-2 neu: (-). 5/5 Nodes: (+). Surgical margin: (-). Left breast cancer T2N2M0 (stage IIIA).

Picture 1: after surgery ( modified radical mastectomy left breast)

Picture 2: Histology biology: Axillary node and breast tumor.

Discussion Risk factors: Klinefelter syndrome: (male, XXY): 40% Family history: breast cancer: 30% Orchitis: 6% Cryptorchidism: 10% Testicular removed: 11% Radiation: 20%.

Discussion Clinical:

Discussion Breast tumor is not pain accounts for 13%- 90% Unnormal nipple: 35% Unnormal drainage: 75% Skin ulcer: 27%

Discussion Histology: Approximately 84%-94% of breast cancers in men are invasive ductal carcinoma: Lobular cancers accounted for 1%: ER possitive 90%, PR possitive 81-96%

Discussion Breast Ultrasound: Unhomogeneous hypoechoic mass Thorny boder. Hypervascular. Hyperechoic margin. Micro-calcification

Mamography: A mass appear as brighter than the surrounding tissue Unregular boder. Micro-calcification

Discussion Cytology: Open biopsy or needle biopsy to the tumor: Gold criteria to diagnose.

Discussion Surgery is the main treatment method, especially in the early stage. Surgery includes removes all the breast and axillary nodes, with pectoral muscle if tumor invades. Lumpectomy and breast plastic surgery

Discussion Ajuvant chemotherapy has high effect in metastases breast cancer. FAC regimen includes: 5FU, Doxorubicin, Cyclophosphamid. CMF regimen includes: Cyclophosphamide, Methotrexate and 5FU.

Discussion Ajuvant radiotherapy include axillary nodes is the same in women. Indications for radiotherapy when the relapse risk is >15%. T4 or T3 disease ( possitive surgical margin or > 4 possitive nodes) Radiotherapy helps reduces locoregional reccurrence and improves overal survival.

Discussion Endocrine therapy plays a big role in male breast cancer because hormon receptor possitive accounts 90%. Tamoxifen is main hormon, the response rate is 25-80% in metastasis breast cancer. Differ from women: aromatase inhibitor is not effect because there are about 20% estrogen is established that is not depend on aromatase.

Discussion Prognosis factors: Tumor size, grade histology, and clinical stage, nodal characterize are important factors. Poor prognosis because male breast cancer often detect in late stage. Median overal survival is about 26,5 in metastasis stage.

Discussion Male breast cancer is rare, accounting less than 1 % of all cancer in males, so that male breast cancer screening doesn’t carry out. Cause to unknowable, male breast cancer often detect in late stage and delay treatment, so that the mordality rate increasingly.

THANKS FOR ATTENTION