Male breast cancer found after persistent nipple discharge without a lump

What happened, in summary

A 69-year-old man sought care after a year of intermittent clear discharge from his right nipple. The discharge had initially appeared bloody, and he later developed nipple swelling and pain, but examination found no palpable breast mass, skin change, or enlarged axillary nodes. He had delayed discussing the symptom partly because of embarrassment about a condition commonly associated with women. An excisional biopsy identified two uncommon forms of male breast cancer: ductal carcinoma in situ and papillary carcinoma. The disease was classified as stage 0, pTisNxcM0. Because the posterior and superior margins were only 1 mm, he discussed central lumpectomy followed by radiation versus total mastectomy and chose a right total mastectomy. Four weeks later, the mastectomy was completed with sentinel lymph node biopsy. The nodes were negative, giving a revised classification of pTisN0cM0. Both breast lesions were strongly oestrogen- and progesterone-receptor positive, and he started tamoxifen 20 mg daily. Recovery was complicated by painful swelling at the mastectomy site at 2 and 3 months. Both episodes were postoperative haematomas that resolved after aspiration and drainage. Tamoxifen was stopped after 3 months because malaise and headache were intolerable. He continued guideline-based surveillance, and at 6 months there was no clinical evidence of recurrence on symptom review and breast examination.