Male invasive papillary breast cancer: mastectomy and tamoxifen with 2-year well status

What happened, in summary

This 87-year-old man presented with 3 months of spontaneous, clear discharge from the left nipple. He also had a firm 2 cm mass in the upper outer quadrant of the left breast. His family history was notable for breast cancer in a maternal aunt and 2 sisters. Examination did not show skin ulceration, nipple retraction, tethering, or enlarged axillary lymph nodes. Cytology from the nipple discharge was inconclusive, but core biopsy of the breast mass showed invasive adenocarcinoma. After counseling, he underwent mastectomy with axillary sentinel lymph node biopsy. Final pathology showed a grade 2 invasive papillary carcinoma measuring 19 mm, with clear surgical margins. No lymphovascular invasion was seen, and the single sentinel lymph node was negative for metastatic tumor. Immunohistochemistry showed that the tumor was strongly estrogen receptor-positive and did not show HER2 over-amplification. He recovered well after surgery and received adjuvant endocrine therapy with tamoxifen. Because of his strong family history, genetic counseling was offered, but he declined. The cancer was a localized male breast cancer treated with definitive surgery and hormone therapy rather than chemotherapy or radiation. At 2 years after surgery, he remained well. The case highlights that nipple discharge and a palpable breast mass in men need full diagnostic workup, even though male breast cancer is uncommon and symptoms can initially appear less typical than in female breast cancer. His course also shows why family history still matters in older male patients: although he declined genetic counseling, several close female relatives had breast cancer, and the clinical team considered inherited risk relevant enough to offer evaluation after treatment.