BILATERAL MALE BREAST CANCER: CASE REPORT

Case report: A 60-year-old male patient, BMI = 27.7 kg / m2, complaining of right breast lump at self-examination. There was no family history of breast cancer, solid organ tumors or previous use of hormonal medication. Right retroareolar nodule measuring 18 x 18 x 10 mm and right axillar lymph node at level I of axilla measuring 9 x 8 x 7 mm were found at breast ultrasound (US). In the left breast, a retroareolar nodule was seen at 3 o’clock, measuring 9 x 7 x 6 mm, without left lymphadenopathy. Right breast core needle biopsy, identified an Invasive Ductal Carcinoma (IDC), G1, pT1c pN1a (sn), luminal A [RE 95%, RP 95%, HER2 negative (0/3 +), Ki-67 10 %], with a cribiform standard DCIS component, G1, measuring 0.8 cm. In a core needle biopsy, a IDC was found in the left breast, G2, pT1b pN0 (sn), luminal B [RE> 95%, RP 95%, HER2 negative (0/3 +) Ki-67 15% ]. The margins, skin and nipple were free of infiltration bilaterally. Preoperatively, the patient underwent chest radiography, echocardiography, total abdominal US, and bone scintigraphy without changes. Chest, abdomen and pelvic tomography scans showed no secondary implants. Bilateral total mastectomy was performed and adjuvant chemotherapy with (4AC-4T), followed by external beam radiotherapy (EBRT) at a dose of 50 Gy at 5 weeks (2 Gy day) in right plastron, supraclavicular fossa and axilla. Discussion: Bilateral breast cancer is rare in men (1.5 to 2.0%), being the least common synchronic tumor. It is associated with hypogonadism, hyperprolactinemia, gynecomastia and chromosomal abnormalities. The main complaint is painless, solid, subareolar lump. Risk factors are BRCA2 gene mutations (14%), radiation exposure, altered estrogen / progesterone ratio, and testicular disease. The diagnosis is similar to that of women, with positive mammography in 80-90% of cases and mastectomy superior to conservative therapies in early disease. Sentinel lymph node biopsy is acceptable and, if positive, requires adjuvant radiotherapy, while reducing the risk of recurrence and disease-specific survival. Adjuvant systemic therapy for men mirrors that of women, and in early staging tamoxifen is preferable to aromatase inhibitor. Conclusions: The rarity of breast cancer in men raises the importance of bilateral examination and the need to investigate synchronic disease and associated risk factors.