Invasive Ductal Carcinoma of Breast in 55-Years Old Male: A Rare Case Report from Pakistan

Invasive Ductal Carcinoma of Breast in 55-Years Old Male: A Rare Case Report from Pakistan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Invasive Ductal Carcinoma of Breast in 55-Years Old Male: A Rare Case Report from Pakistan Shahid Aziz, Faisal Rasheed, Samra Bibi, Adil Shahzad, Sidra Riaz, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7099539/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Breast cancer in a male is rare condition comprising less than 1% of all male cancers and breast cancers. Its incidence rate is less than 1 per 100,000 men, with a mean age of diagnosis at 67 years. Case presentation We present a case of 55-year-old normotensive and normoglycemic man with a four-months history of mild pain and lump in the left breast. Physical examination revealed a hard lump with overlying skin changes suggestive of malignancy. Incisional biopsies confirmed invasive ductal carcinoma, grade II with ER-positive, PR-negative and HER2/neu-negative status. Imaging studies showed lobulated mass in the left breast with axillary lymphadenopathy, renal calculus and benign lytic lesions. Initial treatment included Adrim and Cyclomide injections whilst residual invasive carcinoma remained persistent after nine weeks during follow-up. Thus, the patient was treated with second-line neoadjuvant therapy including Tab Tamoxifen with subsequent investigations indicating stability. The patient was stable and follow-up was advised. Conclusion This case highlights the unique aspects and challenges of diagnosing and treating male breast cancer emphasizing the importance of early diagnosis, hormone receptor status for treatment planing and ongoing research to manage male breast cancer effectively. Breast cancer male clinical features mastectomy histopathology invasive ductal carcinoma Figures Figure 1 Figure 2 Background Male breast cancer, though infrequent, presents distinctive characteristics compared to its more common occurrence in females. Statistics indicate that it comprises less than 1% of all male cancers [ 1 ] and approximately 1% of all breast cancers [ 2 ] with an estimated incidence rate of less than 1 per 100,000 men, contributing to 0.1% of cancer-related deaths in males [ 3 , 4 ]. On average, male breast cancer manifests between the ages of 60 and 70 [ 5 ], with a mean age of 67 [ 6 ], suggesting a slightly older age at diagnosis compared to women [ 7 ]. Male breast cancer is more common in older than younger men with a higher probability of its spread to axillary lymph nodes [ 8 ]. Most of the symptomatic patients diagnosed with breast cancer have a low survival rate [ 9 ]. Early and effective clinical diagnostics are unfortunately not yet available. Estrogen receptor-α (ER), progesterone receptor (PR), HER2, androgen receptor, and BRCA2 represent extensively studied biomarkers for this purpose [ 10 ]. Invasive ductal carcinoma (92.6%) is the most prevalent subtype of male breast cancer as compared to lobular carcinoma and among those patients, HER2 positivity was 21.6% and ER and PR positivity was 96.4% and 71.4%, respectively [ 11 ]. Here we present the case of a 55-year-old male with a four-month history of mild pain and a lump in the left breast. Case description The 55-years old normotensive and normoglycemic male patient with no other co-morbidity presented to his primary health care practitioner at a tertiary care hospital with mild pain and a lump in the left breast for four months. He had no history of bacterial and viral infections including Hepatitis B or C, any addiction, or allergic reactions to any medicine. On physical examination, the physician detected a hard lump having a size of 2×1.5 cm in the upper quadrant of the left breast. The lump was fixed to the underlying structure; the overlaying skin was red, edematous, and darkly ulcerated. No palpable bilateral axillary lymph nodes or lumps in the contralateral breast were found during examination. The patient was admitted (blood pressure 162/102 mmHg, heart beats 75 per min, SpO 2 99%) to rule out malignancy. The incisional biopsies were taken under local anesthesia for histopathological examination. The patient was vitally stable (blood pressure 108/74 mmHg, heart beats 83 per min, SpO 2 98%) and discharged with prescribed treatment including Tab Augmentin 1 gm BD and Nuberol Fort BD (for five days) followed by Pregabalin 75 mg BD (for 7 days), Mecobalamin 500 mcg BD and Cap Esomeprazole 40 mg OD (for 15 days) and wound dressing change on alternative days. The patient was advised for follow-up with histopathology reports. The biopsy specimens appeared under the microscope as gray brown tissues with fat collectively measuring 1.3×1×0.5 cm. The histopathological examination described them as invasive ductal carcinoma of histological and nuclear grade II with no lymphovascular invasion. The patient was advised for further investigations including complete blood picture, liver and renal functions tests, immunohistochemical examinations (ER, PR, HER2/neu), two-dimensional echocardiogram ( 2D echo) and bone scan as well as computed tomography (CT) scan of chest, abdomen and pelvis. Pre-treatment blood tests The patient's blood tests revealed macrocytic anemia characterized by a low red blood cell (RBC) count and raised mean corpuscular volume (MCV), which indicated larger than normal red blood cells. Furthermore, there were also signs of liver dysfunction, evidenced by increased levels of alanine transaminase (ALT) and alkaline phosphatase (AP, Table 1 ). Table 1 Patients blood tests results pre- and post-anti-cancer treatment : Summary of patient's blood picture as well as liver and renal function tests pre-/post-anti-cancer treatment along with corresponding reference ranges for each parameter. Complete Blood Picture Results Units Reference Ranges Pre-treatment Post-treatment HB 13.6 10.9 g/dL 13.0-16.5 HCT 40.9 34 % 40–52 RBC 3.88 3.5 ×10E6/µl 4.5-6.0 MCV 105.4 98 Fl 80–100 MCH 35.1 32 Pg 27–34 MCHC 33.3 32 g% 30–35 WBC 6.5 3.9 ×10e3/µl 4.0–11.0 Neutrophils% 53 65 % 40–75 Lymphocytes% 39 17 % 20–45 Monocytes 6 14 % 2–10 Eosinophils% 2 03 % 01–06 Basophils% 0 01 % 0–1 Platelets 165 268 ×10e3/µl 150–400 Liver Function Test S. Total Bilirubin 0.5 0.34 mg/dl 0.1-1.0 ALT 55 55 U/L < 40 AP 169 111 U/l 39–117 Renal Function Test Urea 35 26 mg/dl 17–49 Creatinine 1.0 0.82 mg/dl 0.4–1.3 Immunohistochemical analysis Immunohistochemical examination revealed ER-positivity (proportion of nuclei stained: 45%, proportion score: 4, intensity score: 3, total 7/8), PR-negativity (proportion of nuclei stained: 0%, proportion score: 0, intensity score: 0, total 0/8), and HER2/neu-negativity (membrane staining score 0). 2D Echo The echocardiogram of the patient found regular features including normal sized cardiac chambers, preserved left ventricular systolic function, no regional wall motion abnormality, normal in structure and function appearance of valve and right side of heart, grade I diastolic dysfunction (E/A reversal); no clots or pericardial effusion were seen (Table 2 ). Table 2 Summary of 2D Echo findings : Assessment of cardiac health and function. Echo Measurements Normal Values (MM) Patient Results LV End Diastolic 35–55 47 LV End Systolic 25–41 36 Septal Thickness End Diast 12 11 Left Atrium 19–40 33 Aortic Root 20–37 30 Ejection Fraction 54–75% 60% Radiological Assessment CT chest, abdomen and pelvis CT scans revealed a significant lobulated, enhancing mass lesion in the outer half of the left breast, measuring 4.2 × 1.7 × 3.8 cm. This lesion, with spiculated margins, abutted the pectoralis muscle posteriorly and involved the overlying skin, causing thickening and retraction. Moderate soft tissue stranding was noted in the surrounding subcutaneous fat. Multiple enlarged axillary lymph nodes (level I and II) on the left side, measuring 8.9 mm in short axis with loss of fatty hilum, were observed, while the right breast appeared normal with a few lymph nodes in the right axilla maintaining intact fatty hila. Additionally, bilateral apical pleural thickening and a small calcified granuloma in the right lower lobe with minimal surrounding fibrosis were noted. No suspicious lung nodules, significant mediastinal, or hilar lymphadenopathy were present. The cardiovascular structures, including the aorta and pulmonary vasculature, appeared normal with no pericardial or pleural effusion detected. In the abdomen, the liver was normal in size and texture with a small calcified granuloma in segment VI, and the gallbladder showed no abnormalities. The pancreas and spleen were of normal size and texture, and no focal lesions were identified. The kidneys were normal in size, shape, and texture, though a large calculus was noted at the lower pole of the left kidney, measuring 1.1 × 1.6 cm, with associated perinephric fat stranding. There was no evidence of hydronephrosis, cysts, or masses in the kidneys, and the adrenal glands were normal. The gut loops and ileocecal junction appeared normal with no signs of wall thickening or dilatation, and the urinary bladder and prostate gland were also normal. Degenerative changes were seen in the visualized spine, with two tiny lytic areas in the right 4th and 5th ribs and a lytic lesion in the right ilium at the SI joint, all with well-defined sclerotic margins. In conclusion, the CT scan revealed a left breast mass involving the overlying skin and underlying muscle with left axillary lymphadenopathy, classified as T4N1/2Mx. A left renal calculus was also noted. Additionally, tiny lytic lesions with well-defined sclerotic rims were observed in the right 4th and 5th ribs and the right iliac bone, likely benign; however, considering the known malignancy, a bone scan was suggested for further evaluation. No hepatic or lung metastases were found. Bone scan The whole body was scanned with 20.0 mCi of Tc-99m MDP administered intravenously. The static images were acquired in both anterior and posterior projections at 2.5 hours post-injection followed by SPECT/CT of chest (Fig. 1 ). The whole body scans revealed multifocal degenerative changes in shoulders, elbow, wrist, knee, ankle joints and dorsolumbar spin. The rest of the skeleton showed bilaterally symmetrical and normal tracer distribution (Fig. 2 ). The scan was negative for skeleton metastasis. Treatment The patient was treated with anti-cancer drugs including injections Adrim 110 mcg and Cyclomide 1100 mcg as first-line therapy. The treatment response was assessed again after nine weeks by follow-up biopsy. The histopathological examination revealed residual invasive carcinoma and the patient was subsequently treated with second-line neoadjuvant therapy including Tab Tamoxifen 10 mg BD, Pregabalin 50 mg OD and Methylcobalamin 500 mcg followed by several investigations including complete blood picture and liver and renal functions tests (Table 1 ). The patient was stable and advised for regular follow-up with investigations. After treatment, there have been notable changes in the patient's health markers. The treatment has led to a decrease in hemoglobin, hematocrit, and RBC count, which indicated that the patient was experiencing anemia, a common side effect. Additionally, the white blood cell count had dropped suggesting that the patient was dealing with leukopenia due to the treatment's impact on bone marrow. The platelet count had increased possibly also as a response to the treatment. The ALT level remained high indicating ongoing liver stress, while the AP level had improved but was still slightly above normal. Kidney function had improved, with both urea and creatinine levels decreasing and staying within the normal range. These results highlighted the need for ongoing monitoring and support, particularly to manage anemia and leukopenia, while also showing encouraging signs of stable or improving liver and kidney function (Table 1 ). Discussion Around 42% of male breast cancer cases are diagnosed at advanced stages III or IV [ 12 ] likely due to the fact that males do not seek medical care for breast lumps as quickly as women do. Most men are unaware that they also can develop breast cancer which may lead to delay to recognize sign and symptoms associated with this cancer. Furthermore, male breast cancer is still stigmatized as feminine disease-causing shame and embarrassment in some men upon diagnosis. In some communities, confessing to suffering from any ailment linked to femininity can bring about ridicule from the rest of the society hence leading to acts of ostracism. This discourages men from approaching health facilities for medical attention when they fall sick. Another possible reason could be that the tumor grows closer to the skin in males, which increases the probability of infiltration into the middle layer of the skin such as the dermis [ 13 ] which was also seen in this case. The men diagnosed with breast cancer have poor prediction, particularly at younger age, when it may be misdiagnosed due to gynecomastia [ 14 ]. Breast cancer in men is mostly diagnosed at an age of ~ 65 years [ 15 ]. In the present case, the patient was diagnosed at the age of 55 years and his treatment started approximately after two months. A research study by Hanna et al. (2020) indicated that a delay of four weeks in cancer treatment correlates with an increased mortality rate. Hence, early detection is imperative for the timely management of this cancer. Family history is a major risk factor for breast cancer [ 16 ] as are some genetic diseases including Klinefelter’s syndrome and Cowden’s disease [ 17 ]. In our case, the patient did not have a family history of breast cancer and he was not tested for genetic diseases due to financial constraints. There is no evidence that all men diagnosed with breast cancer need radiological assessment. However, it is important to examine the contralateral breast to look for suspicious lesion. Moreover, male patients who survive after breast cancer, have a higher tendency of developing secondary cancer [ 18 ]. The risk of cancer in the contralateral breast is as much as two to four times higher in men as compared to females [ 19 ]. Males have significantly less mammary parenchyma than women. Clinical correlation of blood tests results, radiological findings and histopathological analysis of percutaneous biopsies must be carried out for differential diagnosis [ 20 ]. For effective treatment, core needle biopsy is required to diagnose invasive breast cancer and to evaluate ER, PR and HER-2 status [ 21 ]. Receptors such as ER and PR play a significant role in male breast cancer. These receptors are expressed in 91% (ER) and 80% (PR) of male breast cancer cases [ 22 ]; in our case the cancer was ER-positive. Moreover, invasive ductal carcinoma is more frequent in male breast cancer with ER and PR positivity and shows unusual characteristics [ 23 ]. HER-2 overexpression is linked to the worst prognosis for breast cancer patients [ 24 ]. The expression levels of these receptors in both male and female is considered for treatment selection [ 25 ]. Recent studies revealed that ER and PR show sex-specific binding and that males have more expression of ER than females [ 26 ]. Furthermore, male breast cancer most commonly spreads to bones [ 27 ]. The treatment plans for male breast cancer are mostly inferred from data in women breast cancer [ 28 ]. Parameters such as tumor size, expression of ER, PR and HER-2 and age-related co-morbidities must be considered. Men diagnosed with breast cancer often present risk factors, such as chronic hepatopathies, that directly correlate with the development of the neoplasm. Some other factors including increased body mass index and abdominal obesity [ 29 ] and infertility [ 30 ] may also be related to breast cancer. Given the relatively smaller size of male mammary parenchyma, the preferred surgical intervention typically involves modified radical mastectomy. In our case, the surgeons removed only the abnormal area through incisional biopsies rather than whole breast. The patient was treated first with anti-cancer drugs later with neoadjuvant therapy containing Tamoxifen. As a result of ER-positive expression, endocrine interventions are needed with such anti-cancer drugs, but some male patients diagnosed with breast cancer do not tolerate Tamoxifen because of its side effects [ 31 ]. Tamoxifen is still considered as an optimal adjuvant therapy for male breast cancer along with endocrine responsive diseases. Knowledge on the impact of adjuvant chemotherapy regarding both rate and overall survival is not extensively explored [ 32 ]. Several studies have shown enhanced disease-free as well as overall survival when compared to historical controls through the use of adjuvant anthracycline-based therapies [ 33 ]. Conclusions We discuss a case of breast cancer in a 55-year-old male. The case underscores the importance of vigilance towards male breast pathology, particularly in the context of atypical presentations. The diagnostic journey, from clinical examination to histopathological confirmation and subsequent imaging, highlights the multidisciplinary approach necessary for accurate assessment and management. The rarity of male breast carcinoma, coupled with its potential for advanced disease at presentation, requires a thorough evaluation to guide personalized treatment strategies. Despite its low incidence and mortality rates in comparison to female breast cancer, understanding the unique aspects of male breast cancer remains crucial for optimizing diagnostic and therapeutic approaches. Further investigation into age-related differences in diagnosis and potential sex-specific nuances in disease progression is warranted to enhance patient outcomes and support for this understudied population. More research is needed to elucidate optimal management strategies and improve outcomes for individuals affected by this rare malignancy. Abbreviations BC Breast cancer IDC Invasive ductal carcinoma ILC Invasive lobular carcinoma ER Estrogen receptor PR Progesterone receptor CT Computer tomography LFTs Liver function tests RFTs Renal function tests Hb Hemoglobin WBC White blood cell count ALT Alanine transaminase, AST Aspartate transaminase, ALP Alkaline phosphatase RBC Red blood cell MCV Mean corpuscular volume Declarations Ethical approval This case report is a part of the MS research study approved by Ethical Review Committee (ERC)/Institutional Review Board (IRB) of Wah Medical College (No. WMC/ERC/IRB/053) and Ethics Committee (EC) of Pakistan Ordinance Factories (POF) Hospital (EC/POFH-28/10/2024), Wah Cantt, Pakistan. And certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent to participate Informed consent was obtained from patient to participate in the study. Consent to publish The informed consent was also obtained for publication of this case report and accompanying images used in this study. Competing interest The authors declare that they have no competing interests Funding Umer Zeeshan Ijaz is supported by UKRI MRC Grant No. MR/Z50628X/1 Author Contribution Shahid Aziz: Conceptualization, Investigation, Writing - Original Draft, Supervision and Project administration. Faisal Rasheed: Conceptualization, Methodology, Resources, Writing - Review & Editing and Project administration. Samra Bibi: Methodology, Investigation and Data Curation. Adil Shahzad: Methodology and Project administration. Sidra Riaz: Writing - Review & Editing. Haseeb Noor: Methodology, Formal analysis and Investigation. Umer Zeeshan Ijaz: Resources, Writing - Review & Editing and Funding acquisition. Simone König: Writing - Original Draft. Acknowledgement We acknowledge the cooperation of technical staff of tertiary care hospital during data acquisition. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7099539","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":502750880,"identity":"acd536b9-3ab0-40bb-a24c-17e241387aab","order_by":0,"name":"Shahid Aziz","email":"","orcid":"","institution":"National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shahid","middleName":"","lastName":"Aziz","suffix":""},{"id":502750881,"identity":"9f0f1c18-f94c-46b9-8fee-25826ecc9df6","order_by":1,"name":"Faisal Rasheed","email":"","orcid":"","institution":"Pakistan Institute of Nuclear Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Faisal","middleName":"","lastName":"Rasheed","suffix":""},{"id":502750882,"identity":"fefcc37a-39dd-497b-8cfb-4c14c8820f0e","order_by":2,"name":"Samra Bibi","email":"","orcid":"","institution":"Wah Medical College","correspondingAuthor":false,"prefix":"","firstName":"Samra","middleName":"","lastName":"Bibi","suffix":""},{"id":502750883,"identity":"9169c0a0-b7cd-44db-90a1-c7c195a4743b","order_by":3,"name":"Adil Shahzad","email":"","orcid":"","institution":"Air University","correspondingAuthor":false,"prefix":"","firstName":"Adil","middleName":"","lastName":"Shahzad","suffix":""},{"id":502750884,"identity":"0ab42064-1711-42f5-9a3f-26363f33e337","order_by":4,"name":"Sidra Riaz","email":"","orcid":"","institution":"Ministry of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Sidra","middleName":"","lastName":"Riaz","suffix":""},{"id":502750885,"identity":"d4ca24bd-87d1-4a6e-9ab8-50293b61eae1","order_by":5,"name":"Haseeb Noor","email":"","orcid":"","institution":"Farooq Hospital, Akhtar Saeed Medical College","correspondingAuthor":false,"prefix":"","firstName":"Haseeb","middleName":"","lastName":"Noor","suffix":""},{"id":502750886,"identity":"add4b5de-b810-424d-b544-282a71cd0873","order_by":6,"name":"Umer Zeeshan Ijaz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYBACgwMg8g8bAwN7A+MBJIkEAloMgFp4DjCQpAWIJRKI1XLt8LEPDAZ88vIzn1848ONPrZzBAeaHHxjb0nBruZ2WPAPoMMPG2TkFB3vbjhsbHGAzlmBsy8GjJccY5BfGZumchAO8DccStx1gMGNgbKvAoyX/M0iLfZvkmYSDf/6AtLB/I6AlhxmkJbFHgv3AYR62GqAWHpAtuB0mOTvNmCHBgC15Bk8Ow2HZtgPG9od5iiUSzuH2Pr908mOGD3+O2c5vP/7w4Zs/dXKS7e0bP3woS8apBQwSGI4BSR5Q7BxmYGBmwBcrcFADxOwPgEQdYbWjYBSMglEw4gAAs3tZJ8FdUUwAAAAASUVORK5CYII=","orcid":"","institution":"University of Glasgow","correspondingAuthor":true,"prefix":"","firstName":"Umer","middleName":"Zeeshan","lastName":"Ijaz","suffix":""},{"id":502750887,"identity":"a59dfa0e-1e0c-46f3-bfa1-11bad650332e","order_by":7,"name":"Simone König","email":"","orcid":"","institution":"University of Münster","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"","lastName":"König","suffix":""}],"badges":[],"createdAt":"2025-07-11 08:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7099539/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7099539/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89562302,"identity":"cb4d9666-4731-4a3c-9cf3-03443dd18fd0","added_by":"auto","created_at":"2025-08-21 10:24:29","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78394,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSPECT/CT of Chest. \u003c/strong\u003e(A) Transvers, (B) Sagittal, (C) Coronal slices of SPECT/CT images of male breast cancer patient showing incidental lytic lesions in right ribs and iliac bone alongside a left renal calculus.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7099539/v1/a2a6fe9ff777b355777e7522.jpg"},{"id":89562340,"identity":"0fcb58b1-889e-4643-b53d-eec1100a6b92","added_by":"auto","created_at":"2025-08-21 10:24:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":97294,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBone Scan with Tc-99m MDP:\u003c/strong\u003e(A) Whole-body bone scan acquired 2.5 hours post-injection of 20.0 mCi of Tc-99m MDP, with static images obtained in both anterior and posterior projections. (B) SPECT/CT of the chest performed after the whole-body scan. The whole-body scans revealed multifocal degenerative changes in the shoulders, elbows, wrists, knees, ankles, and dorsolumbar spine. The rest of the skeleton showed bilaterally symmetrical and normal tracer distribution. Additionally, the scan was negative for skeletal metastasis.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7099539/v1/4a5e1a8c2fefbbf9bb6391da.jpg"},{"id":89562421,"identity":"85e4b1ce-de00-4ebd-8acb-9e614b417948","added_by":"auto","created_at":"2025-08-21 10:24:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":863366,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7099539/v1/3f5b28e2-4419-4a95-a3ec-ab7cb1a9ab81.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Invasive Ductal Carcinoma of Breast in 55-Years Old Male: A Rare Case Report from Pakistan","fulltext":[{"header":"Background","content":"\u003cp\u003eMale breast cancer, though infrequent, presents distinctive characteristics compared to its more common occurrence in females. Statistics indicate that it comprises less than 1% of all male cancers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and approximately 1% of all breast cancers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] with an estimated incidence rate of less than 1 per 100,000 men, contributing to 0.1% of cancer-related deaths in males [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. On average, male breast cancer manifests between the ages of 60 and 70 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], with a mean age of 67 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], suggesting a slightly older age at diagnosis compared to women [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Male breast cancer is more common in older than younger men with a higher probability of its spread to axillary lymph nodes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost of the symptomatic patients diagnosed with breast cancer have a low survival rate [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Early and effective clinical diagnostics are unfortunately not yet available. Estrogen receptor-α (ER), progesterone receptor (PR), HER2, androgen receptor, and BRCA2 represent extensively studied biomarkers for this purpose [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Invasive ductal carcinoma (92.6%) is the most prevalent subtype of male breast cancer as compared to lobular carcinoma and among those patients, HER2 positivity was 21.6% and ER and PR positivity was 96.4% and 71.4%, respectively [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHere we present the case of a 55-year-old male with a four-month history of mild pain and a lump in the left breast.\u003c/p\u003e"},{"header":"Case description","content":"\u003cp\u003eThe 55-years old normotensive and normoglycemic male patient with no other co-morbidity presented to his primary health care practitioner at a tertiary care hospital with mild pain and a lump in the left breast for four months. He had no history of bacterial and viral infections including Hepatitis B or C, any addiction, or allergic reactions to any medicine. On physical examination, the physician detected a hard lump having a size of 2×1.5 cm in the upper quadrant of the left breast. The lump was fixed to the underlying structure; the overlaying skin was red, edematous, and darkly ulcerated. No palpable bilateral axillary lymph nodes or lumps in the contralateral breast were found during examination.\u003c/p\u003e\u003cp\u003eThe patient was admitted (blood pressure 162/102 mmHg, heart beats 75 per min, SpO\u003csub\u003e2\u003c/sub\u003e 99%) to rule out malignancy. The incisional biopsies were taken under local anesthesia for histopathological examination. The patient was vitally stable (blood pressure 108/74 mmHg, heart beats 83 per min, SpO\u003csub\u003e2\u003c/sub\u003e 98%) and discharged with prescribed treatment including Tab Augmentin 1 gm BD and Nuberol Fort BD (for five days) followed by Pregabalin 75 mg BD (for 7 days), Mecobalamin 500 mcg BD and Cap Esomeprazole 40 mg OD (for 15 days) and wound dressing change on alternative days. The patient was advised for follow-up with histopathology reports.\u003c/p\u003e\u003cp\u003eThe biopsy specimens appeared under the microscope as gray brown tissues with fat collectively measuring 1.3×1×0.5 cm. The histopathological examination described them as invasive ductal carcinoma of histological and nuclear grade II with no lymphovascular invasion. The patient was advised for further investigations including complete blood picture, liver and renal functions tests, immunohistochemical examinations (ER, PR, HER2/neu), two-dimensional echocardiogram \u003cb\u003e(\u003c/b\u003e2D echo) and bone scan as well as computed tomography (CT) scan of chest, abdomen and pelvis.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePre-treatment blood tests\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe patient's blood tests revealed macrocytic anemia characterized by a low red blood cell (RBC) count and raised mean corpuscular volume (MCV), which indicated larger than normal red blood cells. Furthermore, there were also signs of liver dysfunction, evidenced by increased levels of alanine transaminase (ALT) and alkaline phosphatase (AP, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003ePatients blood tests results pre- and post-anti-cancer treatment\u003c/b\u003e: Summary of patient's blood picture as well as liver and renal function tests pre-/post-anti-cancer treatment along with corresponding reference ranges for each parameter.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eComplete Blood Picture\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eResults\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eUnits\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eReference Ranges\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-treatment\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.0-16.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40–52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRBC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e×10E6/µl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.5-6.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80–100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27–34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCHC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40–75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocytes%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20–45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonocytes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2–10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEosinophils%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e01–06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasophils%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0–1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e×10e3/µl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e150–400\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiver Function Test\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS. Total Bilirubin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003emg/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1-1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt; 40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU/l\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39–117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRenal Function Test\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003emg/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17–49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003emg/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4–1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImmunohistochemical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eImmunohistochemical examination revealed ER-positivity (proportion of nuclei stained: 45%, proportion score: 4, intensity score: 3, total 7/8), PR-negativity (proportion of nuclei stained: 0%, proportion score: 0, intensity score: 0, total 0/8), and HER2/neu-negativity (membrane staining score 0).\u003c/p\u003e\u003cp\u003e\u003cb\u003e2D Echo\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe echocardiogram of the patient found regular features including normal sized cardiac chambers, preserved left ventricular systolic function, no regional wall motion abnormality, normal in structure and function appearance of valve and right side of heart, grade I diastolic dysfunction (E/A reversal); no clots or pericardial effusion were seen (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eSummary of 2D Echo findings\u003c/b\u003e: Assessment of cardiac health and function.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEcho Measurements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal Values (MM)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatient Results\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLV End Diastolic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35–55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLV End Systolic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25–41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeptal Thickness End Diast\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft Atrium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19–40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAortic Root\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20–37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEjection Fraction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54–75%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRadiological Assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCT chest, abdomen and pelvis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCT scans revealed a significant lobulated, enhancing mass lesion in the outer half of the left breast, measuring 4.2 × 1.7 × 3.8 cm. This lesion, with spiculated margins, abutted the pectoralis muscle posteriorly and involved the overlying skin, causing thickening and retraction. Moderate soft tissue stranding was noted in the surrounding subcutaneous fat. Multiple enlarged axillary lymph nodes (level I and II) on the left side, measuring 8.9 mm in short axis with loss of fatty hilum, were observed, while the right breast appeared normal with a few lymph nodes in the right axilla maintaining intact fatty hila. Additionally, bilateral apical pleural thickening and a small calcified granuloma in the right lower lobe with minimal surrounding fibrosis were noted. No suspicious lung nodules, significant mediastinal, or hilar lymphadenopathy were present. The cardiovascular structures, including the aorta and pulmonary vasculature, appeared normal with no pericardial or pleural effusion detected.\u003c/p\u003e\u003cp\u003eIn the abdomen, the liver was normal in size and texture with a small calcified granuloma in segment VI, and the gallbladder showed no abnormalities. The pancreas and spleen were of normal size and texture, and no focal lesions were identified. The kidneys were normal in size, shape, and texture, though a large calculus was noted at the lower pole of the left kidney, measuring 1.1 × 1.6 cm, with associated perinephric fat stranding. There was no evidence of hydronephrosis, cysts, or masses in the kidneys, and the adrenal glands were normal. The gut loops and ileocecal junction appeared normal with no signs of wall thickening or dilatation, and the urinary bladder and prostate gland were also normal. Degenerative changes were seen in the visualized spine, with two tiny lytic areas in the right 4th and 5th ribs and a lytic lesion in the right ilium at the SI joint, all with well-defined sclerotic margins.\u003c/p\u003e\u003cp\u003eIn conclusion, the CT scan revealed a left breast mass involving the overlying skin and underlying muscle with left axillary lymphadenopathy, classified as T4N1/2Mx. A left renal calculus was also noted. Additionally, tiny lytic lesions with well-defined sclerotic rims were observed in the right 4th and 5th ribs and the right iliac bone, likely benign; however, considering the known malignancy, a bone scan was suggested for further evaluation. No hepatic or lung metastases were found.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBone scan\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe whole body was scanned with 20.0 mCi of Tc-99m MDP administered intravenously. The static images were acquired in both anterior and posterior projections at 2.5 hours post-injection followed by SPECT/CT of chest (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The whole body scans revealed multifocal degenerative changes in shoulders, elbow, wrist, knee, ankle joints and dorsolumbar spin. The rest of the skeleton showed bilaterally symmetrical and normal tracer distribution (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The scan was negative for skeleton metastasis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTreatment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe patient was treated with anti-cancer drugs including injections Adrim 110 mcg and Cyclomide 1100 mcg as first-line therapy. The treatment response was assessed again after nine weeks by follow-up biopsy. The histopathological examination revealed residual invasive carcinoma and the patient was subsequently treated with second-line neoadjuvant therapy including Tab Tamoxifen 10 mg BD, Pregabalin 50 mg OD and Methylcobalamin 500 mcg followed by several investigations including complete blood picture and liver and renal functions tests (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The patient was stable and advised for regular follow-up with investigations.\u003c/p\u003e\u003cp\u003eAfter treatment, there have been notable changes in the patient's health markers. The treatment has led to a decrease in hemoglobin, hematocrit, and RBC count, which indicated that the patient was experiencing anemia, a common side effect. Additionally, the white blood cell count had dropped suggesting that the patient was dealing with leukopenia due to the treatment's impact on bone marrow. The platelet count had increased possibly also as a response to the treatment. The ALT level remained high indicating ongoing liver stress, while the AP level had improved but was still slightly above normal. Kidney function had improved, with both urea and creatinine levels decreasing and staying within the normal range. These results highlighted the need for ongoing monitoring and support, particularly to manage anemia and leukopenia, while also showing encouraging signs of stable or improving liver and kidney function (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAround 42% of male breast cancer cases are diagnosed at advanced stages III or IV [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] likely due to the fact that males do not seek medical care for breast lumps as quickly as women do. Most men are unaware that they also can develop breast cancer which may lead to delay to recognize sign and symptoms associated with this cancer. Furthermore, male breast cancer is still stigmatized as feminine disease-causing shame and embarrassment in some men upon diagnosis. In some communities, confessing to suffering from any ailment linked to femininity can bring about ridicule from the rest of the society hence leading to acts of ostracism. This discourages men from approaching health facilities for medical attention when they fall sick.\u003c/p\u003e\u003cp\u003eAnother possible reason could be that the tumor grows closer to the skin in males, which increases the probability of infiltration into the middle layer of the skin such as the dermis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] which was also seen in this case. The men diagnosed with breast cancer have poor prediction, particularly at younger age, when it may be misdiagnosed due to gynecomastia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Breast cancer in men is mostly diagnosed at an age of ~\u0026thinsp;65 years [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the present case, the patient was diagnosed at the age of 55 years and his treatment started approximately after two months. A research study by Hanna et al. (2020) indicated that a delay of four weeks in cancer treatment correlates with an increased mortality rate. Hence, early detection is imperative for the timely management of this cancer.\u003c/p\u003e\u003cp\u003eFamily history is a major risk factor for breast cancer [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] as are some genetic diseases including Klinefelter\u0026rsquo;s syndrome and Cowden\u0026rsquo;s disease [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our case, the patient did not have a family history of breast cancer and he was not tested for genetic diseases due to financial constraints. There is no evidence that all men diagnosed with breast cancer need radiological assessment. However, it is important to examine the contralateral breast to look for suspicious lesion. Moreover, male patients who survive after breast cancer, have a higher tendency of developing secondary cancer [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The risk of cancer in the contralateral breast is as much as two to four times higher in men as compared to females [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMales have significantly less mammary parenchyma than women. Clinical correlation of blood tests results, radiological findings and histopathological analysis of percutaneous biopsies must be carried out for differential diagnosis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For effective treatment, core needle biopsy is required to diagnose invasive breast cancer and to evaluate ER, PR and HER-2 status [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Receptors such as ER and PR play a significant role in male breast cancer. These receptors are expressed in 91% (ER) and 80% (PR) of male breast cancer cases [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]; in our case the cancer was ER-positive. Moreover, invasive ductal carcinoma is more frequent in male breast cancer with ER and PR positivity and shows unusual characteristics [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHER-2 overexpression is linked to the worst prognosis for breast cancer patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The expression levels of these receptors in both male and female is considered for treatment selection [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Recent studies revealed that ER and PR show sex-specific binding and that males have more expression of ER than females [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Furthermore, male breast cancer most commonly spreads to bones [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe treatment plans for male breast cancer are mostly inferred from data in women breast cancer [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Parameters such as tumor size, expression of ER, PR and HER-2 and age-related co-morbidities must be considered. Men diagnosed with breast cancer often present risk factors, such as chronic hepatopathies, that directly correlate with the development of the neoplasm. Some other factors including increased body mass index and abdominal obesity [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and infertility [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] may also be related to breast cancer. Given the relatively smaller size of male mammary parenchyma, the preferred surgical intervention typically involves modified radical mastectomy. In our case, the surgeons removed only the abnormal area through incisional biopsies rather than whole breast.\u003c/p\u003e\u003cp\u003eThe patient was treated first with anti-cancer drugs later with neoadjuvant therapy containing Tamoxifen. As a result of ER-positive expression, endocrine interventions are needed with such anti-cancer drugs, but some male patients diagnosed with breast cancer do not tolerate Tamoxifen because of its side effects [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Tamoxifen is still considered as an optimal adjuvant therapy for male breast cancer along with endocrine responsive diseases. Knowledge on the impact of adjuvant chemotherapy regarding both rate and overall survival is not extensively explored [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Several studies have shown enhanced disease-free as well as overall survival when compared to historical controls through the use of adjuvant anthracycline-based therapies [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe discuss a case of breast cancer in a 55-year-old male. The case underscores the importance of vigilance towards male breast pathology, particularly in the context of atypical presentations. The diagnostic journey, from clinical examination to histopathological confirmation and subsequent imaging, highlights the multidisciplinary approach necessary for accurate assessment and management. The rarity of male breast carcinoma, coupled with its potential for advanced disease at presentation, requires a thorough evaluation to guide personalized treatment strategies. Despite its low incidence and mortality rates in comparison to female breast cancer, understanding the unique aspects of male breast cancer remains crucial for optimizing diagnostic and therapeutic approaches. Further investigation into age-related differences in diagnosis and potential sex-specific nuances in disease progression is warranted to enhance patient outcomes and support for this understudied population. More research is needed to elucidate optimal management strategies and improve outcomes for individuals affected by this rare malignancy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eBreast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eIDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eInvasive ductal carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eILC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eInvasive lobular carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eER\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eEstrogen receptor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003ePR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eProgesterone receptor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eComputer tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eLFTs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eLiver function tests\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eRFTs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eRenal function tests\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eWhite blood cell count\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eAlanine transaminase,\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eAspartate transaminase,\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eAlkaline phosphatase\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eRed blood cell\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eMCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 307px;\"\u003e\n \u003cp\u003eMean corpuscular volume\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case report is a part of the MS research study approved by Ethical Review Committee (ERC)/Institutional Review Board (IRB) of Wah Medical College (No. WMC/ERC/IRB/053) and Ethics Committee (EC) of Pakistan Ordinance Factories (POF) Hospital (EC/POFH-28/10/2024), Wah Cantt, Pakistan. And certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from patient to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe informed consent was also obtained for publication of this case report and accompanying images used in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eUmer Zeeshan Ijaz is supported by UKRI MRC Grant No. MR/Z50628X/1\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eShahid Aziz: Conceptualization, Investigation, Writing - Original Draft, Supervision and Project administration. Faisal Rasheed: Conceptualization, Methodology, Resources, Writing - Review \u0026amp; Editing and Project administration. Samra Bibi: Methodology, Investigation and Data Curation. Adil Shahzad: Methodology and Project administration. Sidra Riaz: Writing - Review \u0026amp; Editing. Haseeb Noor: Methodology, Formal analysis and Investigation. Umer Zeeshan Ijaz: Resources, Writing - Review \u0026amp; Editing and Funding acquisition. Simone K\u0026ouml;nig: Writing - Original Draft.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe acknowledge the cooperation of technical staff of tertiary care hospital during data acquisition.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data are available from the authors upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGucalp A, Traina TA, Eisner JR, Parker JS, Selitsky SR, Park BH, Cardoso F. Male breast cancer: a disease distinct from female breast cancer. Breast cancer research and treatment. 2019; 173: 37-48.\u003c/li\u003e\n\u003cli\u003eCuthrell KM, Tzenios N. Breast Cancer: Updated and Deep Insights. International Research Journal of Oncology. 2023; 6(1): 104-118.\u003c/li\u003e\n\u003cli\u003eMukherjee AG, Gopalakrishnan AV, Jayaraj R, Renu K, Dey A, Vellingiri B, Malik T. The incidence of male breast cancer: from fiction to reality\u0026ndash;correspondence. International Journal of Surgery. 2023; 109(9): 2855-2858.\u003c/li\u003e\n\u003cli\u003eDavhad V, Kathar MN, Sanap GA. REVIEW ON BREAST CANCER. 2023.\u003c/li\u003e\n\u003cli\u003eSpreafico FS, Cardoso-Filho C, Cabello C, Sarian LO, Zeferino LC, Vale DB. Breast cancer in men: clinical and pathological analysis of 817 cases. American journal of men\u0026apos;s health. 2020; 14(4): 1557988320908109.\u003c/li\u003e\n\u003cli\u003eMatheka M, Wasike R. Characteristics and treatment of breast cancer in men: a 12-year single-institution review. Annals of African Surgery. 2023; 20(3): 82-86.\u003c/li\u003e\n\u003cli\u003eLautrup MD, Thorup SS, Jensen V, Bokmand S, Haugaard K, Hoejris I, Christiansen P. Male breast cancer: a nation-wide population-based comparison with female breast cancer. Acta Oncologica. 2018; 57(5): 613-621.\u003c/li\u003e\n\u003cli\u003eKhan NAJ, Tirona M. An updated review of epidemiology, risk factors, and management of male breast cancer. Medical Oncology. 2021; 38(4): 39.\u003c/li\u003e\n\u003cli\u003eSahin SI, Balci S, Guler G, Altundag K. Clinicopathological analysis of 38 male patients diagnosed with breast cancer. Breast Disease. 2024; 43(1): 1-8. \u003c/li\u003e\n\u003cli\u003eChatterji S, Niehues JM, van Treeck M, Loeffler CML, Saldanha OL, Veldhuizen GP, Kather JN. Prediction models for hormone receptor status in female breast cancer do not extend to males: further evidence of sex-based disparity in breast cancer. NPJ Breast Cancer. 2023; 9(1): 91.\u003c/li\u003e\n\u003cli\u003eDogan I, Khanmammadov N, Ozkurt S, Aydiner A, Saip P. Outcomes of the patients with metastatic male breast cancer. Journal of Cancer Research and Therapeutics. 2023.\u003c/li\u003e\n\u003cli\u003eKhare VS, Huda F, Misra S, Amulya KR, Raj N, Karn S, Basu S. Male Breast Cancer: An Updated Review of Patient Characteristics, Genetics, and Outcome. International Journal of Breast Cancer. 2024.\u003c/li\u003e\n\u003cli\u003eDobre EG, Surcel M, Constantin C, Ilie MA, Caruntu A, Caruntu C, Neagu M. Skin cancer pathobiology at a glance: a focus on imaging techniques and their potential for improved diagnosis and surveillance in clinical cohorts. International Journal of Molecular Sciences. 2023; 24(2): 1079.\u003c/li\u003e\n\u003cli\u003eMannix J, Duke H, Almajnooni A, Ongkeko M. Imaging the Male Breast: Gynecomastia, Male Breast Cancer, and Beyond. Radio Graphics. 2024; 44(6): e230181.\u003c/li\u003e\n\u003cli\u003eWang F, Shu X, Meszoely I, Pal T, Mayer IA, Yu Z, Shu XO. Overall mortality after diagnosis of breast cancer in men vs women. JAMA oncology. 2019; 5(11): 1589-1596.\u003c/li\u003e\n\u003cli\u003eHuntley C, Torr B, Kavanaugh G, George A, Hanson H, Snape K, Turnbull, C. Breast cancer risk assessment for prescription of Menopausal Hormone Therapy in women who have a family history of breast cancer. British Journal of General Practice. 2024.\u003c/li\u003e\n\u003cli\u003eManoharan GV. Breast Carcinoma in a 62 year old male: A case report. International Archives of Integrated Medicine. 2020; 7(11).\u003c/li\u003e\n\u003cli\u003eCheng Y, Huang Z, Liao Q, Yu X, Jiang H, He Y, Liu L. Risk of second primary breast cancer among cancer survivors: Implications for prevention and screening practice. PLoS One. 2020; 15(6): e0232800.\u003c/li\u003e\n\u003cli\u003eAllen I, Hassan H, Joko-Fru WY, Huntley C, Loong L, Rahman T, Antoniou AC. Risks of second primary cancers among 584,965 female and male breast cancer survivors in England: a 25-year retrospective cohort study. The Lancet Regional Health\u0026ndash;Europe 2024.\u003c/li\u003e\n\u003cli\u003eGalati F, Rizzo V, Moffa G, Caramanico C, Kripa E, Cerbelli B, Pediconi F. Radiologic-pathologic correlation in breast cancer: do MRI biomarkers correlate with pathologic features and molecular subtypes?. European Radiology Experimental. 2022; 6(1): 39.\u003c/li\u003e\n\u003cli\u003eNa S, Kim M, Park Y, Kwon HJ, Shin HC, Kim EK, Park SY. Concordance of HER2 status between core needle biopsy and surgical resection specimens of breast cancer: an analysis focusing on the HER2-low status. Breast Cancer. 2024; 1-12.\u003c/li\u003e\n\u003cli\u003eClusan L, Ferri\u0026egrave;re F, Flouriot G, Pakdel FA. Basic review on estrogen receptor signaling pathways in breast cancer. International journal of molecular sciences. 2023; 24(7): 6834.\u003c/li\u003e\n\u003cli\u003eIonescu S, Nicolescu AC, Marincas M, Madge OL, Simion L. An Update on the General Features of Breast Cancer in Male Patients\u0026mdash;A Literature Review. Diagnostics. 2022; 12(7): 1554.\u003c/li\u003e\n\u003cli\u003eBergeron A, Bertaut A, Beltjens F, Charon-Barra C, Amet A, Jankowski C, Arnould L. Anticipating changes in the HER2 status of breast tumours with disease progression\u0026mdash;towards better treatment decisions in the new era of HER2-low breast cancers. British Journal of Cancer. 2023; 129(1): 122-134.\u003c/li\u003e\n\u003cli\u003eChen H, Gui X, Zhou Z, Su F, Gong C, Li S, Yao H. Distinct ER and PR expression patterns significantly affect the clinical outcomes of early HER2-positive breast cancer: A real-world analysis of 871 patients treated with neoadjuvant therapy. The Breast. 2024; 75: 103733.\u003c/li\u003e\n\u003cli\u003eChatterji S, Krzoska E, Thoroughgood CW, Saganty J, Liu P, Elsberger B, Speirs V. Defining genomic, transcriptomic, proteomic, epigenetic, and phenotypic biomarkers with prognostic capability in male breast cancer: a systematic review. The Lancet Oncology. 2023; 24(2): e74-e85.\u003c/li\u003e\n\u003cli\u003eSahin S I, Balci S, Guler G, Altundag K. Clinicopathological analysis of 38 male patients diagnosed with breast cancer. Breast Disease, 2024; 43(1): 1-8. \u003c/li\u003e\n\u003cli\u003eMadeira M, Mattar A, Passos RJB, Mora CD, Mamede LHBV, Kishino VH, Gebrim LH. A case report of male breast cancer in a very young patient: What is changing?. World journal of surgical oncology. 2011; 9: 1-5.\u003c/li\u003e\n\u003cli\u003eSwerdlow AJ, Bruce C, Cooke R, Coulson P, Schoemaker MJ, Jones ME. Risk of breast cancer in men in relation to weight change: A national case‐control study in England and Wales. International Journal of Cancer. 2022; 150(11): 1804-1811.\u003c/li\u003e\n\u003cli\u003eSwerdlow AJ, Bruce C, Cooke R, Coulson P, Jones ME. Infertility and risk of breast cancer in men: a national case\u0026ndash;control study in England and Wales. Breast Cancer Research. 2022; 24(1): 29.\u003c/li\u003e\n\u003cli\u003eFentiman IS. Risk factors for male breast cancer. American Journal of Translational Research. 2023; 15(12): 6918.\u003c/li\u003e\n\u003cli\u003eMa X, Wu S, Zhang X, Chen N, Yang C, Yang C, Liu Y. Adjuvant chemotherapy and survival outcomes in older women with HR+/HER2\u0026minus; breast cancer: a propensity score-matched retrospective cohort study using the SEER database. BMJ open. 2024; 14(3): e078782.\u003c/li\u003e\n\u003cli\u003eHurvitz SA, McAndrew NP, Bardia A, Press MF, Pegram, M, Crown JP, Slamon DJ. A careful reassessment of anthracycline use in curable breast cancer. NPJ Breast Cancer. 2021; 7(1): 134.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, male, clinical features, mastectomy, histopathology, invasive ductal carcinoma","lastPublishedDoi":"10.21203/rs.3.rs-7099539/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7099539/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBreast cancer in a male is rare condition comprising less than 1% of all male cancers and breast cancers. Its incidence rate is less than 1 per 100,000 men, with a mean age of diagnosis at 67 years.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e\u003cp\u003eWe present a case of 55-year-old normotensive and normoglycemic man with a four-months history of mild pain and lump in the left breast. Physical examination revealed a hard lump with overlying skin changes suggestive of malignancy. Incisional biopsies confirmed invasive ductal carcinoma, grade II with ER-positive, PR-negative and HER2/neu-negative status. Imaging studies showed lobulated mass in the left breast with axillary lymphadenopathy, renal calculus and benign lytic lesions. Initial treatment included Adrim and Cyclomide injections whilst residual invasive carcinoma remained persistent after nine weeks during follow-up. Thus, the patient was treated with second-line neoadjuvant therapy including Tab Tamoxifen with subsequent investigations indicating stability. The patient was stable and follow-up was advised.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis case highlights the unique aspects and challenges of diagnosing and treating male breast cancer emphasizing the importance of early diagnosis, hormone receptor status for treatment planing and ongoing research to manage male breast cancer effectively.\u003c/p\u003e","manuscriptTitle":"Invasive Ductal Carcinoma of Breast in 55-Years Old Male: A Rare Case Report from Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 10:23:59","doi":"10.21203/rs.3.rs-7099539/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-29T12:26:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T10:22:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173931595513646907524276283877998966784","date":"2025-08-25T19:22:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-22T19:23:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44400547596352555176661961066567598188","date":"2025-08-22T17:46:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126398027973537935380980228620969810375","date":"2025-08-19T20:09:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T18:39:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T18:13:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304022546186461353776123074974956818075","date":"2025-08-17T17:45:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192765320220050625265655028734463127382","date":"2025-08-17T11:11:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-13T08:30:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-07T11:30:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-01T11:01:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Oncology","date":"2025-08-01T10:58:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e93fee6d-abe1-42c2-b0b3-7a1977f88d16","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T03:55:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-21 10:23:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7099539","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7099539","identity":"rs-7099539","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}