What happened, in summary

This 77-year-old man presented with bloody nipple discharge and a lump in the left breast that had been present for 6 weeks. He had no trauma history and no notable family history. On examination, clinicians felt a cord-like mass beneath the areola extending into the upper outer quadrant of the breast, without skin or nipple abnormality. Mammography and ultrasound were both highly suspicious for malignancy. Cytology from the nipple discharge showed atypical epithelial cells, and core biopsy of the breast mass showed invasive adenocarcinoma. He was treated with mastectomy and sentinel lymph node biopsy. Final histology showed grade 2 invasive ductal carcinoma with clear surgical margins and no lymphovascular invasion. A single sentinel lymph node was retrieved and was negative for metastatic carcinoma. Immunohistochemistry showed that the tumor was estrogen receptor-positive. HER2 status was not described for this patient. After surgery, he was prescribed adjuvant tamoxifen. The case is best understood as localized, node-negative male breast cancer treated with surgery and endocrine therapy; the clinical text does not give a formal numeric stage. He remained well 4 years after surgery. His presentation reinforces that bloody nipple discharge in a man should prompt cancer evaluation, especially when accompanied by a palpable subareolar or upper-outer-quadrant mass. It also shows that sentinel lymph node biopsy and tamoxifen can be part of treatment for hormone receptor-positive male breast cancer. The clinical course also illustrates a typical male breast cancer pathway: discharge and a palpable subareolar mass led to imaging, cytology, core biopsy, mastectomy, sentinel node staging, and then endocrine therapy because the tumor was hormone receptor-positive.