Rare axillary cancer of unknown primary originating from the breast of a 64‑year‑old male patient: A case report and literature review

Parisi,Simona; Gambardella,Claudio; Ruggiero,Roberto; Tolone,Salvatore; Iovino,Francesco; Lucido,Francesco Saverio; Fisone,Francesca; Volpe,Mariachiara Lanza; Cozzolino,Giovanni; Mongardini,Federico Maria; Brusciano,Luigi; Andrea,Ronchi; Docimo,Ludovico

doi:10.3892/ol.2024.14220

Rare axillary cancer of unknown primary originating from the breast of a 64‑year‑old male patient: A case report and literature review

Authors:
- Simona Parisi
- Claudio Gambardella
- Roberto Ruggiero
- Salvatore Tolone
- Francesco Iovino
- Francesco Saverio Lucido
- Francesca Fisone
- Mariachiara Lanza Volpe
- Giovanni Cozzolino
- Federico Maria Mongardini
- Luigi Brusciano
- Ronchi Andrea
- Ludovico Docimo
View Affiliations

Affiliations: Department of Advanced Science and Surgery, General, Mini‑Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I‑80138 Naples, Italy, Department of Translational Medical Science, School of Medicine, General, Mini‑Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, I‑80138 Naples, Italy, Mental and Physical Health and Preventive Medicine Department, Pathology Unit, Luigi Vanvitelli University of Campania, I‑80138 Naples, Italy
Published online on: January 5, 2024 https://doi.org/10.3892/ol.2024.14220
Article Number: 86
Copyright: © Parisi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Cancers of unknown primary (CUPs) are a heterogeneous group of tumors characterized by a difficult diagnosis. The primitive tumor remains unknown, whereas metastases are the most common manifestation. Occult male breast cancers are very rare types of CUPs. The present study describes the case of a 64‑year‑old man affected by a CUP of presumed mammary origin. The aim of the article and the present review was to focus on their management. To the best of our knowledge, only thirteen cases have been reported in the literature. Because no specific guidelines are available, various approaches have been applied, influencing the treatment and the prognosis of patients with CUP.

View Figures

View References

1	Bochtler T, Löffler H and Krämer A: Diagnosis and management of metastatic neoplasms with unknown primary. Semin Diagn Pathol. 35:199–206. 2018. View Article : Google Scholar : PubMed/NCBI
2	Abbruzzese JL, Abbruzzese MC, Hess KR, Raber MN, Lenzi R and Frost P: Unknown primary carcinoma: Natural history and prognostic factors in 657 consecutive patients. J Clin Oncol. 12:1272–1280. 1994. View Article : Google Scholar : PubMed/NCBI
3	Pavlidis N and Pentheroudakis G: Cancer of unknown primary site. Lancet. 379:1428–1435. 2012. View Article : Google Scholar : PubMed/NCBI
4	Bochtler T and Krämer A: Does cancer of unknown primary (CUP) truly exist as a distinct cancer entity? Front Oncol. 9:4022019. View Article : Google Scholar : PubMed/NCBI
5	Pauli C, Bochtler T, Mileshkin L, Baciarello G, Losa F, Ross JS, Pentheroudakis G, Zarkavelis G, Yalcin S, Özgüroğlu M, et al: A challenging task: Identifying patients with cancer of unknown primary (CUP) according to ESMO guidelines: The CUPISCO trial experience. Oncologist. 26:e769–e779. 2021. View Article : Google Scholar : PubMed/NCBI
6	Tay J and Dewdney A: Cancers of unknown primary. Br J Hosp Med (Lond). 80:C70–C74. 2019. View Article : Google Scholar : PubMed/NCBI
7	Piga A, Gesuita R, Catalano V, Nortilli R, Cetto G, Cardillo F, Giorgi F, Riva N, Porfiri E, Montironi R, et al: Identification of clinical prognostic factors in patients with unknown primary tumors treated with a platinum-based combination. Oncology. 69:135–144. 2005. View Article : Google Scholar : PubMed/NCBI
8	Keller F, Psychogios G, Linke R, Lell M, Kuwert T, Iro H and Zenk J: Carcinoma of unknown primary in the head and neck: Comparison between positron emission tomography (PET) and PET/CT. Head Neck. 33:1569–1575. 2011. View Article : Google Scholar : PubMed/NCBI
9	Fizazi K, Greco FA, Pavlidis N and Pentheroudakis G; ESMO Guidelines Working Group, : Cancers of unknown primary site: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 26:S133–S138. 2015. View Article : Google Scholar
10	Gucalp A, Traina TA, Eisner JR, Parker JS, Selitsky SR, Park BH, Elias AD, Baskin-Bey ES and Cardoso F: Male breast cancer: A disease distinct from female breast cancer. Breast Cancer Res Treat. 173:37–48. 2019. View Article : Google Scholar : PubMed/NCBI
11	Ronchi A, Pagliuca F, Marino FZ, Accardo M, Cozzolino I and Franco R: Current and potential immunohistochemical biomarkers for prognosis and therapeutic stratification of breast carcinoma. Semin Cancer Biol. 72:114–122. 2021. View Article : Google Scholar : PubMed/NCBI
12	Conner JR and Hornick JL: Metastatic carcinoma of unknown primary: Diagnostic approach using immunohistochemistry. Adv Anat Pathol. 22:149–167. 2015. View Article : Google Scholar : PubMed/NCBI
13	Krämer A, Hübner G, Schneeweiss A, Folprecht G and Neben K: Carcinoma of unknown primary-an orphan disease? Breast Care (Basel). 3:164–170. 2008.PubMed/NCBI
14	National Cancer Registration and Analysis Service, . Routes to Diagnosis. Cancer of Unknown Primary. 2010.Available from:. http://ncin.org.uk/publications/data_briefings/routes_to_diagnosis_cancer_of_unknown_primary12–December. 2018
15	De Andrade JM, Marana HR, Filho JM, Murta EF, Velludo MA and Bighetti S: Differential diagnosis of axillary masses. Tumori. 82:596–599. 1996. View Article : Google Scholar : PubMed/NCBI
16	Gupta RK, Naran S, Lallu S and Fauck R: Diagnostic value of needle aspiration cytology in the assessment of palpable axillary lymph nodes. A study of 336 cases. Acta Cytol. 47:550–554. 2003. View Article : Google Scholar : PubMed/NCBI
17	Blanchard DK and Farley DR: Retrospective study of women presenting with axillary metastases from occult breast carcinoma. World J Surg. 28:535–539. 2004. View Article : Google Scholar : PubMed/NCBI
18	Baron PL, Moore MP, Kinne DW, Candela FC, Osborne MP and Petrek JA: Occult breast cancer presenting with axillary metastases. Updated management. Arch Surg. 125:210–214. 1990. View Article : Google Scholar : PubMed/NCBI
19	Galimberti V, Bassani G, Monti S, Simsek S, Villa G, Renne G and Luini A: Clinical experience with axillary presentation breast cancer. Breast Cancer Res Treat. 88:43–47. 2004. View Article : Google Scholar : PubMed/NCBI
20	Walker GV, Smith GL, Perkins GH, Oh JL, Woodward W, Yu TK, Hunt KK, Hoffman K, Strom EA and Buchholz TA: Population-based analysis of occult primary breast cancer with axillary lymph node metastasis. Cancer. 116:4000–4006. 2010. View Article : Google Scholar : PubMed/NCBI
21	Mann RM, Balleyguier C, Baltzer PA, Bick U, Colin C, Cornford E, Evans A, Fallenberg E, Forrai G, Fuchsjäger MH, et al: European society of breast imaging (EUSOBI), with language review by Europa Donna-The European breast cancer coalition. Breast MRI: EUSOBI recommendations for women's information. Eur Radiol. 25:3669–3678. 2015. View Article : Google Scholar : PubMed/NCBI
22	Stella GM, Senetta R, Cassenti A, Ronco M and Cassoni P: Cancers of unknown primary origin: Current perspectives and future therapeutic strategies. J Transl Med. 10:122012. View Article : Google Scholar : PubMed/NCBI
23	Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Köbrunner SH, Kaiser WA, Kerin MJ, et al: Magnetic resonance imaging of the breast: Recommendations from the EUSOMA working group. Eur J Cancer. 46:1296–1316. 2010. View Article : Google Scholar : PubMed/NCBI
24	Parisi S, Ruggiero R, Gualtieri G, Volpe ML, Rinaldi S, Nesta G, Bogdanovich L, Lucido FS, Tolone S, Parmeggiani D, et al: Combined LOCalizer™ and intraoperative ultrasound localization: First experience in localization of non-palpable breast cancer. In Vivo. 35:1669–1676. 2021. View Article : Google Scholar : PubMed/NCBI
25	Parisi S, Gambardella C, Ruggiero R, Tolone S, Lucido FS and Docimo L: Radiofrequency identification-RFID using LOCalizer-tag in non-palpable breast lump. Indian J Surg. 85:934–938. 2023. View Article : Google Scholar
26	Iovino F, Diana A, Carlino F, Ferraraccio F, Antoniol G, Fisone F, Perrone A, Marino FZ, Panarese I, Tathode MS, et al: Expression of c-MET in estrogen receptor positive and HER2 negative resected breast cancer correlated with a poor prognosis. J Clin Med. 11:69872022. View Article : Google Scholar : PubMed/NCBI
27	Takeyama H, Takahashi H, Tabei I, Fukuchi O, Nogi H, Kinoshita S, Uchida K and Morikawa T: Malignant neoplasm in the axilla of a male: Suspected primary carcinoma of an accessory mammary gland. Breast Cancer. 17:151–154. 2010. View Article : Google Scholar : PubMed/NCBI
28	Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J and Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ. 339:b27002009. View Article : Google Scholar : PubMed/NCBI
29	Kuninaka K, Takahashi R, Nakagawa Y and Nishimaki T: A case of HER2-positive male occult breast carcinoma with skin and lymph node metastases that exhibited complete response to trastuzumab monotherapy. Clin Case Rep. 5:591–593. 2017. View Article : Google Scholar : PubMed/NCBI
30	Sood N, Gupta R and Gupta S: Invasive solid papillary carcinoma: Report of the first case presenting as an occult breast carcinoma in a male. Indian J Pathol Microbiol. 63:S141–S142. 2020. View Article : Google Scholar : PubMed/NCBI
31	Gu GL, Wang SL, Wei XM, Ren L and Zou FX: Axillary metastasis as the first manifestation of occult breast cancer in a male patient. Breast Care (Basel). 4:43–45. 2009. View Article : Google Scholar : PubMed/NCBI
32	Wang WW, Chen L and Ouyang XN: Misdiagnosed male breast cancer with an unknown primary tumor: A case report. Oncol Lett. 8:190–192. 2014. View Article : Google Scholar : PubMed/NCBI
33	Wang X, Fan L, Yan W, Zhang Q, Bao S, Wang Y, Bao X and Liu L: Axillary lymph node metastasis as the first manifestation of male occult breast cancer: A case report. Medicine (Baltimore). 97:e137062018. View Article : Google Scholar : PubMed/NCBI
34	Zhang L, Zhang C, Yang Z, He M, Zhang L, Ezzat S and Liang X: Male occult triple-negative breast cancer with dermatomyositis: A case report and review of the literature. Onco Targets Ther. 10:5459–5462. 2017. View Article : Google Scholar : PubMed/NCBI
35	Hur SM, Cho DH, Lee SK, Choi MY, Bae SY, Koo MY, Kim S, Nam SJ, Lee JE and Yang JH: Occult breast cancers manifesting as axillary lymph node metastasis in men: A two-case report. J Breast Cancer. 15:359–563. 2012. View Article : Google Scholar : PubMed/NCBI
36	Gu GL, Wang SL, Wei XM, Ren L and Zou FX: Axillary metastasis as the first manifestation of male breast cancer: A case report. Cases J. 30:2852008. View Article : Google Scholar : PubMed/NCBI
37	He M, Liu H and Jiang Y: A case report of male occult breast cancer first manifesting as axillary lymph node metastasis with part of metastatic mucinous carcinoma. Medicine (Baltimore). 94:e10382015. View Article : Google Scholar : PubMed/NCBI
38	Xu R, Li J, Zhang Y, Jing H and Zhu Y: Male occult breast cancer with axillary lymph node metastasis as the first manifestation: A case report and literature review. Medicine (Baltimore). 96:e93122017. View Article : Google Scholar : PubMed/NCBI
39	Rigakos G, Vakos A, Papadopoulos S, Vernadou A, Tsimpidakis A, Papachristou D and Razis E: Cancer of unknown primary ultimately diagnosed as male breast cancer: A rare case report. Mol Clin Oncol. 5:263–266. 2016. View Article : Google Scholar : PubMed/NCBI
40	Varadhachary GR, Spector Y, Abbruzzese JL, Rosenwald S, Wang H, Aharonov R, Carlson HR, Cohen D, Karanth S, Macinskas J, et al: Prospective gene signature study using microRNA to identify the tissue of origin in patients with carcinoma of unknown primary. Clin Cancer Res. 17:4063–4070. 2011. View Article : Google Scholar : PubMed/NCBI
41	Pentheroudakis G, Pavlidis N, Fountzilas G, Krikelis D, Goussia A, Stoyianni A, Sanden M, St Cyr B, Yerushalmi N, Benjamin H, et al: Novel microRNA-based assay demonstrates 92% agreement with diagnosis based on clinicopathologic and management data in a cohort of patients with carcinoma of unknown primary. Mol Cancer. 12:572013. View Article : Google Scholar : PubMed/NCBI
42	Rosenwald S, Gilad S, Benjamin S, Lebanony D, Dromi N, Faerman A, Benjamin H, Tamir R, Ezagouri M, Goren E, et al: Validation of a microRNA-based qRT-PCR test for accurate identification of tumor tissue origin. Mod Pathol. 23:814–823. 2010. View Article : Google Scholar : PubMed/NCBI