Metastatic male breast cancer

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

Known case of advanced breast cancer. Currently on hormonal treatment (tamoxifen).

Patient Data

Age: 25 years
Gender: Male

A left retro-areolar breast mass lesion is seen inseparable and invading the underlying chest muscle wall with intramuscular (pectoralis major muscle) metastasis.
Enlarged left axillary and subpectoral lymph nodes.
Pulmonary metastatic nodules are seen vary in the size, the largest is noted in the lingula.
Multiple enlarged mediastinal and bilateral hilar lymphadenopathies as are seen, the largest prevascular and left hilar. 
Right-sided gynecomastia is noted. No significant right axillary lymph nodes.
No pleural effusion.
The liver is enlarged in size with innumerable variable-sized lesions disseminated in all segments of the liver, the largest in the segment VIII. The liver surface is nodular. No intrahepatic biliary ducts dilatation.
Multiple periaortic enlarged lymph nodes especially at the celiac group.
GB, CBD, portal vein, pancreas, spleen, adrenals, kidneys and opacified bowel loops are unremarkable.
No significant mesenteric, pelvic or inguinal lymph nodes.
Prostate, seminal vesicles and urinary bladder are unremarkable. No ascites.
Multiple destructive bony metastases are seen in the bones scan.

Case Discussion

Known case of advanced left breast cancer shows pulmonary, hepatic, lymphadenopathy and bone metastasis. On hormonal treatment (tamoxifen) currently.

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