What happened, in summary

A 47-year-old man developed 1 month of swelling, redness, skin changes and nipple inversion in his right breast. Mammography showed a 2.4 cm spiculated nodule with nipple retraction and skin thickening. Initial biopsies showed gynecomastia and inflammation, but concern for cancer remained and he underwent a right simple mastectomy.

Pathology identified a 1.5 cm invasive metaplastic breast carcinoma with low-grade adenosquamous features. The tumour was ER 1%, PR negative and HER2 negative. Because a 1 cm axillary node was palpable, he underwent a metastatic work-up. Bone scan and brain MRI were negative. A mediastinal lesion led to thymectomy, but pathology showed a benign 2.5 cm thymic cyst rather than metastasis. The thymectomy was complicated by a pulmonary embolism, and axillary dissection was avoided because anticoagulation increased his procedural risk.

His breast cancer was Stage II. He then completed 4 cycles of dose-dense Adriamycin and cyclophosphamide, followed by 12 weekly cycles of Taxol, and received radiation to the right chest wall. Tamoxifen was not given because of his pulmonary embolism history and the tumour's very low ER expression.

At 2 years after surgery, he was doing well. He had occasional pain at the mastectomy site, controlled with medication, and his recent left-breast mammogram was negative.