Stage IIA male breast cancer: chemotherapy, mastectomy, endocrine therapy, and benign adrenal nodule

What happened, in summary

A 57-year-old man came to the emergency department in February 2024 with pain and a lump in his left breast. Ultrasound and CT showed a suspicious left breast mass with mild axillary lymph-node enlargement, along with an incidental left adrenal nodule. Biopsy in April 2024 confirmed grade 2 invasive ductal carcinoma, and the left axillary node biopsy was positive for metastatic carcinoma. Breast MRI showed a 2.7 cm irregular left retroareolar mass, while abdominal MRI could not confirm whether the adrenal nodule was benign. PET in May showed a hypermetabolic breast mass and a 2.3 cm hypermetabolic adrenal nodule, raising concern for distant spread. Treatment began with doxorubicin and cyclophosphamide every 14 days for 4 cycles, followed by weekly paclitaxel for 12 weeks with pegfilgrastim support. He then started tamoxifen. A December 2024 PET showed a strong response in the breast, but the adrenal nodule remained metabolically active, and a liver focus also required evaluation. In January 2025, he underwent radical left mastectomy, left sentinel node biopsy, and simple right mastectomy. Final pathology showed T1N1M0 / Stage IIA ER-positive, PR-positive, HER2-negative invasive ductal carcinoma. He started leuprolide after surgery and completed radiotherapy. Further imaging showed no suspicious liver lesion, but the adrenal nodule remained indeterminate. A left adrenalectomy in June 2025 showed a benign adrenal adenoma. He recovered well and was discharged with planned follow-up. Blood testing showed the adrenal lesion was not behaving like a pheochromocytoma or primary aldosteronism. The final benign adrenal result clarified that the suspicious PET activity had not represented breast cancer spread, keeping the confirmed breast cancer stage at IIA.