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| Journal of the New Zealand Medical Association,
15-July-2005, Vol 118 No 1218
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Inflammatory breast cancer in a male
Michel Choueiri, Zaher Otrock, Ayman Tawil, Ihab El-Hajj,
Nagi El Saghir
Male breast cancer affects 1500 men each year
worldwide.1 Inflammatory breast cancer (IBC) is
an aggressive, rapidly proliferating manifestation of primary breast
carcinoma.2 Male IBC is very rare and our
review of the English literature yielded only six reports of eight
cases.1,3–7 Here, we present the case of
a man diagnosed with IBC after he presented with cervical lymphadenopathy,
swelling, and redness of the right anterior chest. A biopsy of the breast showed
infiltration of dermal lymphatics by tumour cells. His disease was aggressive
and he died 8 months after diagnosis.
Case reportA 56-year-old man presented to our
hospital (American University of Beirut Medical Center, Beirut, Lebanon) with
neck swelling, oedema, and warmth of the right anterior chest wall, and
gynaecomastia of 2 months duration. He was a 75 pack-years tobacco smoker. He
reported that an enlarged right cervical mass appeared 2 months prior to his
presentation. This mass was soon complicated by generalised, painless neck
swelling that rapidly spread involving the right arm and chest wall with
erythema and warmth. The right breast became painful and swollen. He then
developed a feeling of suffocation, myalgias, arthralgias, and dyspnoea on
exertion. He had no nipple discharge or bone pain.
On physical examination, the patient had a sensitive and
painful thickened skin with redness and warmth over the right chest wall, upper
abdomen, and upper arm. Both breasts were tender (especially on the right side)
but no masses could be felt. Oedema involved the right breast and right anterior
chest, and it extended to the right axilla. His right nipple was retracted. He
had generalised neck lymphadenopathy with a decrease in the range of motion of
the neck. He had no palpable axillary or inguinal lymph nodes.
His complete blood count, liver function tests, and
urinalysis were normal. Erythroid sedimentation rate was 97 mm/hour (reference
range 0–15 mm/hour). The mammogram showed severe skin-thickening and was
suspicious of a malignancy. Biopsy of the breast skin revealed plugs of poorly
differentiated adenocarcinoma within dermal lymphovascular channels. The dermal
stroma and overlying epidermis were free of tumour cell (Figure 1). At that
point, the diagnosis of an inflammatory breast carcinoma was made.
Figure 1. Breast skin with tumour thrombi within
lymphovascular channels in the dermis (arrow); haemotoxylin and oesinophil
stain; original magnification (x40). Inset shows a higher magnification (x100)
of the arrowed position
 Immunohistochemical stains showed tumour cells to be
negative for oestrogen and progesterone receptors. They showed no HER2/neu
overexpression. Almost all tumour-cell nuclei were positive for p53. Work-up was
positive for metastatic disease to the lungs and the left frontal lobe of the
brain.
Systemic chemotherapy using 5-Fluorouracil, Adriamycin, and
Cyclophosphamide was administered. However, he showed no response to
chemotherapy and refused further treatment. He was lost to follow-up for 3
months after which time he presented with generalised weakness, weight loss, and
respiratory failure—and he died 8 months after diagnosis.
DiscussionThe definition of IBC is somewhat
controversial. Clinically, the triad of erythema, peau d’orange, and rapid
onset makes the diagnosis of IBC.8
Pathologically, IBC is diagnosed as involvement of the dermal lymphatics by an
infiltrating carcinoma,9 causing oedema and
vascular congestion in the upper dermis and giving the clinical appearance of
erysipelas.3
Our patient did not present with a breast mass but, rather,
with skin changes that were clinically consistent with IBC. Pathologically, the
carcinoma infiltrated the dermal lymphatics. Thus, when a male presents with
inflammatory changes of the chest wall, the possibility of inflammatory breast
cancer should be entertained even in the absence of a breast mass.
IBC has been reported to account for 1%–6% of all
breast cancers (including males and females); IBC accounts for only about 1% of
breast cancers in males however. Therefore, male IBC is extremely
rare.4 Our review of the English literature
yielded six reports of only eight cases of male IBC from 1953 to
2001.1,3–7
Inflammatory carcinoma is the most aggressive variant of
breast cancer with a very poor outcome,10 and
the survival period from the onset of clinical symptoms ranges from 6 to 33
months.4 In our case, the period from the
appearance of clinical symptoms to death was 8 months.
Author information:
Michel B Choueiri, Resident, Department of Internal Medicine; Zaher K Otrock,
Research Fellow, Department of Internal Medicine; Ayman N Tawil, Associate
Professor, Department of Pathology and Laboratory Medicine; Ihab I
El-Hajj, Fellow, Department of Internal
Medicine; Nagi S El Saghir, Clinical Associate Professor, Department of Internal
Medicine, American University of Beirut Medical Center, Beirut,
Lebanon
Acknowledgement:
Informed consent for publication was given by the patient’s
family.
Correspondence: Nagi
El Saghir, MD, FACP, Clinical Associate Professor of Medicine, Division of
Hematology/Oncology, Department of Internal Medicine, American University of
Beirut Medical Center, PO Box 113-6044, Beirut, Lebanon. Fax: +961 1 744464;
email: nagi.saghir@aub.edu.lb
References:
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