Occult Male Breast Cancer Presenting as Axillary Lymphadenopathy: A Rare Case Report

Occult Male Breast Cancer Presenting as Axillary Lymphadenopathy: A Rare Case Report | 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 Occult Male Breast Cancer Presenting as Axillary Lymphadenopathy: A Rare Case Report Mohtashim Idrees Akhtar, Dr. Jasmine Tabassum, Dr. Naushaba Tazeen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8393546/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Male breast cancer (MBC) is a rare condition within the broader spectrum of breast cancer. It is most commonly diagnosed in men between the ages of 60 and 70, with an average age of 67 at diagnosis [ 1 ] . MBC accounts for less than 1% of all breast cancer cases, with incidence varying across ethnic groups. Rates are highest among non-Hispanic Black men (1.89 per 100,000) [ 3 ] . Elevated incidence in South and Central Africa may be linked to hyperestrogenism from liver infections [ 4 ] . Genetic predispositions, especially BRCA2 mutations, significantly increase the risk of MBC greater than BRCA1 mutations. The most frequent histological type is infiltrating ductal carcinoma, while invasive lobular carcinoma is exceptionally uncommon. MBC tumours are typically hormone receptor positive [5]. Key risk factors for MBC include older age, Black ethnicity, genetic mutations, family history, liver cirrhosis, and testicular disorders. Most patients present with painless breast lumps, and about 50% have lymph node involvement at diagnosis [ 1 ] . Case presentation A 61-year-old male presented with a 6-year history of progressive, non-tender swelling in the left axilla, with no associated systemic symptoms. Clinical examination revealed matted, erythematous lymph nodes, prompting FNAC and subsequent excision biopsy. Cytology demonstrated markedly atypical tumour cells with high N:C ratio and significant pleomorphism. Histopathology of the lymph node confirmed effaced architecture with malignant cells arranged in sheets, cords, and globular patterns, along with capsular invasion. Immunohistochemistry showed CK7 and GATA3 positivity and strong HER2 (3+) expression, while ER, PR, mammaglobin, and CK20 were negative—findings consistent with metastatic HER2-positive primary breast carcinoma. PET imaging revealed metabolically active axillary and deep pectoral nodes. The patient received neoadjuvant chemotherapy with docetaxel, carboplatin, trastuzumab, and filgrastim, followed by modified radical mastectomy. While the breast parenchyma showed complete pathological response, residual nodal disease persisted. Conclusion This case highlights the diagnostic challenge of male breast cancer (MBC), particularly when presenting solely as axillary lymphadenopathy. Immunohistochemistry and PET imaging played essential roles in establishing diagnosis and staging. Timely neoadjuvant chemotherapy and surgery achieved primary tumour clearance, underscoring the importance of early suspicion, comprehensive evaluation, and guideline-based management of HER2-positive MBC. Male breast cancer BRCA2 mutation Infiltrating ductal carcinoma Hormone receptor positive Hyperestrogenism Lymph node involvement Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background Male breast cancer (MBC) is rare, comprising less than 1% of breast cancer diagnoses, yet its incidence is gradually rising. It predominantly affects older men and shares features with postmenopausal breast cancer [ 6 ] . In high-risk groups, lifetime risk may reach 15%. Key factors include ageing, hormonal imbalances, radiation exposure, family history, and BRCA2 mutations—the strongest genetic risk [ 7 ] . A major concerns include late-stage diagnosis due to a lack of awareness and insufficient understanding of risk factors, and affected men face an increased likelihood of developing a second primary malignancy. Case report History: This case involves a 61-year-old male patient who presented with a 6-year history of swelling in the left axillary region. The swelling occurred without any trauma or any accompanying symptoms like decreased appetite, significant weight loss, episodes of elevated evening temperature, and a lack of pain. It is pertinent to note that the patient was diagnosed with diabetes mellitus a decade ago and had a long-standing history of smoking and tobacco chewing, both of which he ceased 25 years ago. Clinical Examination: On physical examination, matted lymph nodes were observed, exhibiting signs of erythema and localised warmth, indicative of potential inflammatory or neoplastic processes. First, a fine needle aspiration cytology was performed, followed by an excision biopsy of the affected lymph node, both of which confirmed the presence of a neoplasm. Fine needle aspiration cytology: Fine Needle Aspiration Cytology (FNAC) revealed increased cellularity with atypical tumor cells arranged in sheets and clusters (Fig. 1 .1). At higher magnification, pronounced overcrowding and cells exhibited a high nuclear-to-cytoplasmic (N: C) ratio with significant pleomorphism (Fig. 1 .2), suggesting malignancy and necessitating further histopathological and immunohistochemical evaluation. Figure 1.1 : FNAC of the lymph node under 10x showing increased cellularity with atypical tumour cells arranged in sheets and clusters. Figure 1.2 : FNAC of the lymph node under 40x showing overcrowding, overlapping of cells along with increased N:C ratio, and significant pleomorphism. Gross examination of lymph node biopsy: A fibrofatty mass measuring 4 cm x 3 cm x 2 cm was received in formal saline. Examination of the cut section revealed multiple lymph nodes within the mass (Fig. 2). The largest measured 1.5 cm, the smallest measured 0.5 cm. Five distinct lymph nodes were identified during the examination. Histopathological Examination of Lymph Node Biopsy: Microscopic analysis revealed the histology of the lymph node with effaced architecture. Malignant cells were arranged in sheets, cords, and globular formations, exhibiting nuclear pleomorphism, high nuclear-to-cytoplasmic ratio, hyperchromatic nuclei, prominent nucleoli, irregular borders, and eosinophilic cytoplasm. Capsular invasion indicated aggressive tumor behaviour. Figure 3.1 and 3.2: H and E staining of the lymph node under 10x(a) and 40x(b) showing a capsule with thin cortical tissues, adipose and vascular structures, cells arranged in sheets cords and globular formations exhibiting high N:C ratio, hyperchromatic nuclei, prominent nucleoli, irregular borders, and eosinophilic cytoplasm. Capsular invasion is also present. Immunohistochemistry of Lymph Node Biopsy Immunohistochemistry revealed CK7 and GATA3 positivity, supporting a primary breast malignancy with axillary metastases. The tumor was ER-negative, PR-negative, and showed strong HER2 (3+) overexpression. The Ki-67 proliferation index was 28%, indicating moderate cellular proliferation. Figure 4.1 Figure 5.4 figure 5.1 : ER negative. Figure 5.2 : PR Negative. Figure 5.3 : Mammoglobin negative. Figure 5.4: CK 20 negative. Imaging : Figures 6.1 and 6.2 show the presence of metabolically active lymph nodes and subcutaneous fat stranding in the left axillary region and the deep pectoral node. Treatment and Management: The patient underwent four cycles of neoadjuvant chemotherapy, consisting of docetaxel (90 mg), carboplatin (500 mg), and trastuzumab (390 mg) per cycle. Filgrastim (300 mcg) was also administered to support neutrophil recovery and mitigate chemotherapy-induced neutropenia. Gross Examination of Modified Radical Mastectomy Specimen: The specimen included a left mastectomy (16 × 11 × 4 cm), an axillary tail segment (7 × 5 × 3 cm), and an overlying skin flap (12 × 6 cm). The nipple and areola were unremarkable. No visible lesion was observed within the breast parenchyma. Histopathological Examination No viable tumour was identified in the breast parenchyma, indicating a complete pathological response at the primary site. However, viable tumour cells were present within the lymph nodes, suggesting residual nodal disease in this known case of breast carcinoma following neoadjuvant chemotherapy (NACT). Figure 7.1 shows viable tumour tissue present in the lymph nodes after NACT. Imaging FDG PET was performed which revealed significant decrease in size, number and complete metabolic resolution of left level I axillary lymph nodes, complete resolution of left deep pectoral nodes and complete resolution of low grade FDG avid ill defined far stranding in the left breast. No abnormal FDG uptake/lesion is noted in the bilateral breast, bilateral supraclavicular and internal mammary regions. Overall, this clinical presentation, coupled with the investigative findings, underscores a serious metastatic process that requires timely and effective medical intervention, particularly considering the underlying history of diabetes mellitus and former tobacco use. Discussion Male breast cancer risk factors are less understood due to its rarity. Conditions like Klinefelter’s syndrome, acromegaly, and neurofibromatosis may contribute [ 14 ] . In regions like Central and Eastern Africa, hyperestrogenism from endemic liver infections has been linked to higher MBC rates [ 15 ] . Additionally, breast cancer has been observed in male-to-female trans individuals undergoing high-dose estrogen therapy [ 16 ] . Men often present with advanced-stage breast cancer due to delayed medical attention. Studies report that 50–67% of cases are diagnosed at late stages [ 17 , 18 , 19 ] . Contributing factors include lack of awareness, healthcare access barriers, fear of diagnosis, reliance on traditional medicine, low education levels, poverty, and general ignorance about the disease [ 20 – 25 ] . In this case, the patient did not seek medical care due to a lack of awareness about breast cancer in males. The most prevalent psychiatric co-morbidities in breast cancer patients are anxiety and depression [ 26 , 27 ] . These patients can encounter anxiety and/or depression at any point during their illness. 35% of Women with breast cancer experienced anxiety [ 28 ] . The diagnostic workup for male breast cancer includes mammography and ultrasonography of the axilla and breast [ 29 ] . Invasive ductal carcinoma is the most common subtype, often invading the pectoralis major due to limited breast tissue [ 30 ] . Standard treatment involves mastectomy with radiotherapy for complete tumour resection [ 31 ] . Systemic therapy for male breast cancer depends on hormone receptor and HER2 status, with about 56% of cases showing HER2 overexpression. [ 32 ] . Following the diagnosis, the patient underwent 4 cycles of neoadjuvant chemotherapy (docetaxel, carboplatin, trastuzumab, and filgrastim) followed by a modified radical mastectomy. This multimodal approach aims to reduce recurrence, target residual disease, and improve survival outcomes. Current clinical guidelines recommend neoadjuvant chemotherapy with trastuzumab (Herceptin) for HER2-positive breast cancer, as it is associated with up to a 40% increase in the rate of pathological complete response [ 33 ] and long-term survival benefit [ 34 ] . This case underscores the importance of early diagnostic evaluation, including tissue biopsy supplemented with IHC and FDG-PET, to guide optimal treatment planning in MBC. This case emphasizes the rarity and clinical significance of MBC, highlighting the need for early detection and thorough diagnostic evaluation. The patient’s delayed presentation and advanced-stage disease emphasise the importance of heightened awareness and improved screening. Histopathological findings confirmed an aggressive primary breast malignancy with axillary metastasis. The treatment—neoadjuvant chemotherapy with docetaxel, carboplatin, and trastuzumab followed by modified radical mastectomy—aligns with best practices for HER2-positive MBC, aiming to reduce recurrence and improve survival. However, challenges persist, including delayed diagnosis due to lack of awareness and the psychological impact on patients. Clinicians must maintain a high index of suspicion for MBC, particularly in cases of axillary lymphadenopathy. Promoting education and early intervention can lead to better outcomes and survival rates. Declarations Ethics approval and consent to participate: The patient's data was kept anonymous, so the need for ethics approval and consent was waived Consent for publication: Consent was taken Availability of data: The data is stored in the HMIS of the institution, so it cannot be accessed publicly, but can be provided upon request to the corresponding author Competing interests: The authors have no competing interests Funding: No funding was done Contributions: MIA and JT participated in data collection, analysis, literature review, and manuscript drafting. NT conducted data analysis and contributed to manuscript drafting. IAA provided final supervision, critical review, and approved the final version. References https://www.nationalbreastcancer.org Zheng G, Leone JP. Male Breast Cancer: An Updated Review of Epidemiology, Clinicopathology, and Treatment. J Oncol. 2022;2022:1734049. 10.1155/2022/1734049 . PMID: 35656339; PMCID: PMC9155932. Centers for Disease Control and Prevention. Male Breast Cancer Incidence and Mortality, United States—2013–2017 No 19. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020. Agrawal A, Ayantunde AA, Rampaul R, Robertson JF. Male breast cancer: a review of clinical management. Breast Cancer Res Treat. 2007;103(1):11–21. 10.1007/s10549-006-9356-z . Epub 2006 Oct 11. PMID: 17033919. Ionescu S, Nicolescu AC, Marincas M, Madge OL, Simion L. An Update on the General Features of Breast Cancer in Male Patients-A Literature Review. Diagnostics (Basel). 2022;12(7):1554. 10.3390/diagnostics12071554 . PMID: 35885460; PMCID: PMC9323942. Garreffa E, Arora D. Breast cancer in the elderly, in men and during pregnancy. Surg (Oxford). 2024;42(12):918–25. https://doi.org/10.1016/j.mpsur.2024.09.004 . Abdelwahab Yousef AJ. Male Breast Cancer: Epidemiology and Risk Factors. Semin Oncol. 2017;44(4):267–72. 10.1053/j.seminoncol.2017.11.002 . Epub 2017 Nov 9. PMID: 29526255. Sheikh A, Hussain SA, Ghori Q, Naeem N, Fazil A, Giri S, Sathian B, Mainali P, Al Tamimi DM. The spectrum of genetic mutations in breast cancer. Asian Pac J Cancer Prev. 2015;16(6):2177-85. 10.7314/apjcp.2015.16.6.2177 . PMID: 25824734. Stang A, Thomssen C. Decline in breast cancer incidence in the United States: What about male breast cancer? Breast Cancer Res Treat. 2008;112:595–96. American Cancer Society. Breast Cancer Facts & Figs. 2017–2018. Atlanta: American Cancer Society, Inc. 2017. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf Korde LA, Zujewski JA, Kamin L, et al. Multidisciplinary meeting on male breast cancer: Summary and research recommendations. J Clin Oncol. 2010;28:2114–22. PDQ Adult Treatment Editorial Board. Male Breast Cancer Treatment (PDQ®): Health Professional Version. 2002 (online). Available at: https://www.ncbi.nlm.nih.gov/books/NBK65792/ Giordano SH, Cohen DS, Buzdar AU, et al. Breast carcinoma in men: A pop ulation-based study. Cancer. 2004;101:51–7. Xu R, Li J, Zhang Y, et al. Male occult breast cancer with axillary lymph node metastasis as the first manifestation: A case report and literature review. Med (Baltim). 2017;96:e9312. Rudlowski C. Male breast cancer. Breast Care (Basel). 2008;3:183–89. Maglione KD, Margolies L, Jaffer S, et al. Breast cancer in male-to-female transsexuals: Use of breast imaging for detection. Am J Roentgenol. 2014;203:W735–40. Al-Kahiry W, Omer HH, Saeed NM, Hamid GA. Late presentation of breast cancer in Aden, Yemen. Gulf J Oncolog. 2011;9:7–11. Clegg-Lamptey J, Hodasi W. A study of breast cancer in Korle Bu Teaching Hospital: Assessing the impact of health education. Ghana Med J. 2007;41:72–7. Bourhafour M, Belbaraka R, Souadka A, et al. Male breast cancer: A report of 127 cases at a Moroccan institution. BMC Res Notes. 2011;4:219. Espina C, McKenzie F, Dos-Santos-Silva I. Delayed presentation and diagno sis of breast cancer in African women: a systematic review. Ann Epidemiol. 2017;27:659–e717. Benbakhta B, Tazi M, Benjaafar N, et al. Determinants of patient and health system delays for women with breast cancer in Morocco, 2013. Rev Epidemiol Sante Publique. 2015;63:191–201. Clegg-Lamptey J, Dakubo J, Attobra YN. Why do breast cancer patients report late or abscond during treatment in Ghana? A pilot study. Ghana Med J. 2009;43:127–31. Ahmed AA. Clinicopathological profile of female Sudanese patients with locally advanced breast cancer. Breast Dis. 2014;34:131–34. Aloulou S, El Mahfoudi A, El Omrani A, Khouchani M. [Factors related to late diagnosis of breast cancer: Experience of CHU Mohammed VI Marrakech]. Pan Afr Med J. 2015;21:162. [in French]. Pace LE, Mpunga T, Hategekimana V, et al. Delays in breast cancer pre sentation and diagnosis at two rural cancer referral centers in Rwanda. Oncologist. 2015;20:780–88. Baumeister H, Kriston L, Bengel J, Härter M. High agreement of self-report and physician-diagnosed somatic conditions yields limited bias in exam ining mental-physical comorbidity. J Clin Epidemiol. 2010;63:558–65. Härter M, Reuter K, Aschenbrenner A, et al. Psychiatric disorders and asso ciated factors in cancer: Results of an interview study with patients in in patient, rehabilitation and outpatient treatment. Eur J Cancer. 2001;37:1385–93. Dastan NB, Buzlu S. Depression and anxiety levels in early stage Turkish breast cancer patients and related factors. Asian Pac J Cancer Prev. 2011;12:137–41. Gradishar W, Salerno KE. NCCN guidelines update: Breast cancer. J Natl Compr Canc Netw. 2016;14(5 Suppl):641–44. Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006;367:595–604. Patten DK, Sharifi LK, Fazel M. New approaches in the management of male breast cancer. Clin Breast Cancer. 2013;13:309–14. Avisar E, McParland E, Dicostanzo D, Axelrod D. Prognostic factors in node negative male breast cancer. Clin Breast Cancer. 2006;7:331–35. Buzdar AU, Ibrahim NK, Francis D, et al. Significantly higher pathologic com plete remission rate after neoadjuvant therapy with trastuzumab, paclitax el, and epirubicin chemotherapy: Results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 2005;23:3676–85. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26:778–85. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 Jan, 2026 Reviews received at journal 10 Jan, 2026 Reviewers agreed at journal 09 Jan, 2026 Reviews received at journal 08 Jan, 2026 Reviewers agreed at journal 08 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor assigned by journal 23 Dec, 2025 Submission checks completed at journal 23 Dec, 2025 First submitted to journal 18 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8393546","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":571707175,"identity":"49410558-4a2d-4bdd-b1b0-29635398de05","order_by":0,"name":"Mohtashim Idrees Akhtar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYFACHhBxAEgyNkiAmPwgIqEArxbGBhQtkg0gLQaEtYCZYC0GYDYeLbrtvccf/PhzR0a3gbnxdkWFjb3x+dWJHx4YMMjzix3AqsXszLnExt62ZzxmBxibLc+cSUvcduPtZgmgwwxnzk7AruVGjmEDb8NhkJY2yca2wwlmN85uAGlJMLiNW0vjnz8wLf/+2xvPOLv5ByEtzTxsMC0NBxg38Pduw2/LmTOGs2XbgFoOA/3ScCw5ccYN3m0WCQYSuP1yvMfg45s/h+3Njrc/vNlQY2fP3392880fFTby/NLYtSAAM4whAVYpQUA5CuA/QIrqUTAKRsEoGAEAAOB3aFSPBvILAAAAAElFTkSuQmCC","orcid":"","institution":"Deccan College of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mohtashim","middleName":"Idrees","lastName":"Akhtar","suffix":""},{"id":571707176,"identity":"153f6113-c9f4-4d82-980b-738914b74723","order_by":1,"name":"Dr. Jasmine Tabassum","email":"","orcid":"","institution":"Deccan College of Medical Sciences","correspondingAuthor":false,"prefix":"Dr.","firstName":"Jasmine","middleName":"","lastName":"Tabassum","suffix":""},{"id":571707177,"identity":"1a86ac7c-e0b8-4466-9722-bfc7074dcd4a","order_by":2,"name":"Dr. Naushaba Tazeen","email":"","orcid":"","institution":"Deccan College of Medical Sciences","correspondingAuthor":false,"prefix":"Dr.","firstName":"Naushaba","middleName":"","lastName":"Tazeen","suffix":""},{"id":571707178,"identity":"9641034f-fd9c-42b0-960b-8596804205b7","order_by":3,"name":"Dr. Idrees Akhtar Afroze","email":"","orcid":"","institution":"Deccan College of Medical Sciences","correspondingAuthor":false,"prefix":"Dr.","firstName":"Idrees","middleName":"Akhtar","lastName":"Afroze","suffix":""}],"badges":[],"createdAt":"2025-12-18 09:24:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8393546/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8393546/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100013041,"identity":"b1eecf18-811b-4d54-b7e1-71256a8ebe8a","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4585648,"visible":true,"origin":"","legend":"","description":"","filename":"cabreastmale.docx","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/621ec2461c5ee4d2ecd87bb6.docx"},{"id":100013029,"identity":"8cb71c94-01c3-43a1-b636-4ab15b40ce19","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6940,"visible":true,"origin":"","legend":"","description":"","filename":"a9a62162c22343afbc193db86d8257d6.json","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/f28ab9ca6f5e024e0efcc841.json"},{"id":100362236,"identity":"c8af0334-aa98-4ae9-9a8e-8624d97dd394","added_by":"auto","created_at":"2026-01-16 07:46:24","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70054,"visible":true,"origin":"","legend":"","description":"","filename":"a9a62162c22343afbc193db86d8257d61enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/123477026d6ded59015175bb.xml"},{"id":100362211,"identity":"4f96d7a0-4d8b-47e6-ae09-bd5adf41b635","added_by":"auto","created_at":"2026-01-16 07:46:21","extension":"jpeg","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83295,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/7ec4b79f5561a777447d111b.jpeg"},{"id":100361669,"identity":"8c217b4b-c7bc-41ef-ae0a-175b02546996","added_by":"auto","created_at":"2026-01-16 07:45:29","extension":"jpeg","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":599405,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage10.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/cbed480b2cd1e681e30aedda.jpeg"},{"id":100361354,"identity":"af78ead8-91d6-4c10-9bab-76b699a2cd25","added_by":"auto","created_at":"2026-01-16 07:45:00","extension":"png","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":872496,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/0df33e272c2b43235d705b2d.png"},{"id":100362119,"identity":"5298248d-1550-439e-9e98-fd9aa078decb","added_by":"auto","created_at":"2026-01-16 07:46:12","extension":"jpeg","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":48386,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage12.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/5832f78978ed6b6ea3adf3b6.jpeg"},{"id":100362188,"identity":"edb54a0e-fc76-444b-bbf7-a02951cb9eb3","added_by":"auto","created_at":"2026-01-16 07:46:17","extension":"jpeg","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":318726,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage13.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/baef5a6665b4248e1acc5832.jpeg"},{"id":100013075,"identity":"9a593f15-a599-4817-9069-31df383c9df8","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"jpeg","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":388672,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage14.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/67c574160ec4afc084bbcffa.jpeg"},{"id":100362332,"identity":"3cc743f4-7b08-4dce-bebe-2602addb475c","added_by":"auto","created_at":"2026-01-16 07:46:34","extension":"jpeg","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":672399,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage15.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/cbb6636f7f035639583d4448.jpeg"},{"id":100361746,"identity":"cc5d8c08-822b-48dd-a9f1-72600b8d5502","added_by":"auto","created_at":"2026-01-16 07:45:40","extension":"jpeg","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12551,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage16.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/7356413636811daa658380a9.jpeg"},{"id":100013043,"identity":"34fc616a-7044-4e7c-a179-02c730f71a9a","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"jpeg","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":47363,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/d83228903986d06226ef79e7.jpeg"},{"id":100013045,"identity":"9c04aac9-a040-461a-b2f7-9a984d950712","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"jpeg","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":363747,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/bffefcfdced107b58fb4b69f.jpeg"},{"id":100013060,"identity":"43cc0262-aefc-4dc2-9821-c8fe263e01dc","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"jpeg","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":125322,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/3d2f14702f4db43984e2cab2.jpeg"},{"id":100013076,"identity":"6f2b02f1-c510-4197-847a-b1bdd1861798","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"jpeg","order_by":26,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":151931,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/caaa2fec98c33dc63f8ac612.jpeg"},{"id":100013069,"identity":"cec5c7c2-3fa1-45bd-ad9a-ad975e898670","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"jpeg","order_by":27,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":374535,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/d6c19406b4f25da4c2377b19.jpeg"},{"id":100013073,"identity":"ef80f858-a4ca-44fc-96bf-48cbd6110119","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"jpeg","order_by":28,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":281962,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/221fb037e304ea6afb543ae0.jpeg"},{"id":100362337,"identity":"ae6bc1fb-60a5-408c-aee4-7e8ff3ca189c","added_by":"auto","created_at":"2026-01-16 07:46:34","extension":"jpeg","order_by":29,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1023301,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/9d908d54909b6383d0109d48.jpeg"},{"id":100013067,"identity":"889b7439-e6d1-4c08-9b40-73ad07feb67f","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"jpeg","order_by":30,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":746942,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage9.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/7fe6f6b30749b52713ced989.jpeg"},{"id":100361521,"identity":"e78cbf17-0b1e-483a-9ac8-f4a6ee08baa4","added_by":"auto","created_at":"2026-01-16 07:45:15","extension":"png","order_by":31,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":82453,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/8d5f68c1dca61c709417c225.png"},{"id":100013059,"identity":"b7cd429c-9fc1-4b77-89e4-e1f52e67d41e","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"png","order_by":32,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":302336,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/98d6b41241817de4163aa41c.png"},{"id":100013066,"identity":"4693faa6-f130-4c9f-9a7f-5514e18da59b","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":33,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114776,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/a2e96ba68cd193c1d15d6369.png"},{"id":100013061,"identity":"a76012e6-dbce-4823-b447-f47dc6ddfd67","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"png","order_by":34,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":55778,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage12.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/639d2f4b7fdae17986af19e2.png"},{"id":100013078,"identity":"598f62c3-44aa-4d9d-b57e-0cb767e7e3af","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":35,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58321,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage13.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/1dddbaa6a2133a4464131d2d.png"},{"id":100362153,"identity":"6d30a6da-9733-4645-85ff-a111a687dafc","added_by":"auto","created_at":"2026-01-16 07:46:14","extension":"png","order_by":36,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":233633,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage14.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/e0cc3be981116e1e6ddd7413.png"},{"id":100013063,"identity":"dd52469a-6fb1-40b2-8bcf-a7ddac808997","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":37,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122852,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage15.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/ba91cd7d963c2573dcc477c7.png"},{"id":100013077,"identity":"72346b13-10fb-44db-bbba-89f3b1b5e3da","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":38,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3298,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage16.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/b92c24c1981f2e4fc3edba73.png"},{"id":100361779,"identity":"1f967f25-bbbc-4f43-85a9-409f8fcb72bf","added_by":"auto","created_at":"2026-01-16 07:45:43","extension":"png","order_by":39,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":45472,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/0d4f00d615c80bff8f74bdf4.png"},{"id":100013064,"identity":"47020181-b429-4351-a4fa-ed8b6bfe0f75","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":40,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":139889,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/643f2239301c4743ba393977.png"},{"id":100361741,"identity":"a980a09b-04bb-4f5c-a46a-c72b8e70f0eb","added_by":"auto","created_at":"2026-01-16 07:45:40","extension":"png","order_by":41,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124979,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/c84bd13737c136df512ca797.png"},{"id":100361183,"identity":"9cfc69f0-a4b7-4aa4-b214-e9b970862d05","added_by":"auto","created_at":"2026-01-16 07:44:36","extension":"png","order_by":42,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":217791,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/7528b293f6bc085a6c2d8126.png"},{"id":100013074,"identity":"1a29103f-342a-456e-8721-b78403d138e2","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":43,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":235988,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/da42b08857135ac482a902d0.png"},{"id":100013068,"identity":"d56fe18e-7d8b-4a34-a414-00f06efac702","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":44,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":177307,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/b4aed3d011bb7a27d42f9987.png"},{"id":100013070,"identity":"69e9e94b-ed1d-4bbd-82a8-f57073776c5f","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"png","order_by":45,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":435382,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/055bd8bb37a90ec1fcd1d957.png"},{"id":100360889,"identity":"63b36ccf-e834-4964-94cc-0181d27b37a7","added_by":"auto","created_at":"2026-01-16 07:44:06","extension":"png","order_by":46,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":242986,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/601a651e23f3db430306b2a3.png"},{"id":100013082,"identity":"9104d85b-7b6f-4e04-b1dd-db67a80bd30b","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"xml","order_by":47,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67842,"visible":true,"origin":"","legend":"","description":"","filename":"a9a62162c22343afbc193db86d8257d61structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/4945f11aaa48c4c778aabeaf.xml"},{"id":100013080,"identity":"61885b9b-0788-497f-b1cd-624b95a9f87e","added_by":"auto","created_at":"2026-01-12 06:18:12","extension":"html","order_by":48,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":82087,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/56d2bab447ba02d9938b58d7.html"},{"id":100362193,"identity":"5a1b4fd0-d1b3-4874-8610-d0be85bb67a0","added_by":"auto","created_at":"2026-01-16 07:46:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":178973,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 1.1: FNAC of the lymph node under 10x showing increased cellularity with atypical tumour cells arranged in sheets and clusters. Figure 1.2: FNAC of the lymph node under 40x showing overcrowding, overlapping of cells along with increased N:C ratio, and significant pleomorphism.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/8233c86293af8e3f547a102e.jpg"},{"id":100362097,"identity":"a6baa64a-e0af-44c0-9219-c428f9a57428","added_by":"auto","created_at":"2026-01-16 07:46:11","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":87283,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2: fibrofatty mass measuring 4 x 3 x 2 cm.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/753943f022905261a879e4a1.jpg"},{"id":100362038,"identity":"3f2b4a17-e9f0-4cba-bccb-1f4ec0d58dbf","added_by":"auto","created_at":"2026-01-16 07:46:06","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":398212,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3.1 and 3.2: H and E staining of the lymph node under 10x(a) and 40x(b) showing a capsule with thin cortical tissues, adipose and vascular structures, cells arranged in sheets cords and globular formations exhibiting high N:C ratio, hyperchromatic nuclei, prominent nucleoli, irregular borders, and eosinophilic cytoplasm. Capsular invasion is also present.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/68237c54a0fa93184d8d9942.jpg"},{"id":100361759,"identity":"75648fb0-95a6-4343-991e-ce71b7ab26fd","added_by":"auto","created_at":"2026-01-16 07:45:41","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":343672,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 4.1: HER 2 positive. Figure 4.2: Ki-67 - 28%. Figure 4.3: GATA3 positive. Figure 4.4: CK7 positive.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/94683b374f303f01e6812f4e.jpg"},{"id":100013035,"identity":"f8af3b9f-2f78-4845-8836-fe67f9b3993f","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":235221,"visible":true,"origin":"","legend":"\u003cp\u003efigure 5.1: ER negative. Figure 5.2: PR Negative. Figure 5.3: Mammoglobin negative. Figure 5.4: CK 20 negative.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/da15bae259f3687aeb2c03c2.jpg"},{"id":100013036,"identity":"eaca6d96-d9dc-474b-bc71-2583e354bbb4","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":124001,"visible":true,"origin":"","legend":"\u003cp\u003eFigures 6.1 and 6.2 show the presence of metabolically active lymph nodes and subcutaneous fat stranding in the left axillary region and the deep pectoral node.\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/5559adcde9914ba5a928e3e4.jpg"},{"id":100013032,"identity":"16a9f7c8-0d29-4670-9489-ff6b6896d4f4","added_by":"auto","created_at":"2026-01-12 06:18:11","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":114048,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 7.1 shows viable tumour tissue present in the lymph nodes after NACT.\u003c/p\u003e","description":"","filename":"7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/737a7f8dfca491dac523659d.jpg"},{"id":100380975,"identity":"a5afd0b3-17d2-4f08-922b-0ba23832ea46","added_by":"auto","created_at":"2026-01-16 10:36:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1914470,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8393546/v1/8a91fb64-1f62-49f9-88d5-5f870b59b507.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Occult Male Breast Cancer Presenting as Axillary Lymphadenopathy: A Rare Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eMale breast cancer (MBC) is rare, comprising less than 1% of breast cancer diagnoses, yet its incidence is gradually rising. It predominantly affects older men and shares features with postmenopausal breast cancer \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. In high-risk groups, lifetime risk may reach 15%. Key factors include ageing, hormonal imbalances, radiation exposure, family history, and BRCA2 mutations\u0026mdash;the strongest genetic risk \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA major concerns include late-stage diagnosis due to a lack of awareness and insufficient understanding of risk factors, and affected men face an increased likelihood of developing a second primary malignancy.\u003c/p\u003e"},{"header":"Case report","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eHistory:\u003c/h2\u003e \u003cp\u003eThis case involves a 61-year-old male patient who presented with a 6-year history of swelling in the left axillary region. The swelling occurred without any trauma or any accompanying symptoms like decreased appetite, significant weight loss, episodes of elevated evening temperature, and a lack of pain. It is pertinent to note that the patient was diagnosed with diabetes mellitus a decade ago and had a long-standing history of smoking and tobacco chewing, both of which he ceased 25 years ago.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Examination:\u003c/h3\u003e\n\u003cp\u003eOn physical examination, matted lymph nodes were observed, exhibiting signs of erythema and localised warmth, indicative of potential inflammatory or neoplastic processes. First, a fine needle aspiration cytology was performed, followed by an excision biopsy of the affected lymph node, both of which confirmed the presence of a neoplasm.\u003c/p\u003e\n\u003ch3\u003eFine needle aspiration cytology:\u003c/h3\u003e\n\u003cp\u003eFine Needle Aspiration Cytology (FNAC) revealed increased cellularity with atypical tumor cells arranged in sheets and clusters (Fig.\u0026nbsp;1 .1). At higher magnification, pronounced overcrowding and cells exhibited a high nuclear-to-cytoplasmic (N: C) ratio with significant pleomorphism (Fig.\u0026nbsp;1 .2), suggesting malignancy and necessitating further histopathological and immunohistochemical evaluation.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1.1\u003c/span\u003e: FNAC of the lymph node under 10x showing increased cellularity with atypical tumour cells arranged in sheets and clusters. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1.2\u003c/span\u003e: FNAC of the lymph node under 40x showing overcrowding, overlapping of cells along with increased N:C ratio, and significant pleomorphism.\u003c/p\u003e\n\u003ch3\u003eGross examination of lymph node biopsy:\u003c/h3\u003e\n\u003cp\u003eA fibrofatty mass measuring 4 cm x 3 cm x 2 cm was received in formal saline. Examination of the cut section revealed multiple lymph nodes within the mass (Fig.\u0026nbsp;2). The largest\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003emeasured 1.5 cm, the smallest measured 0.5 cm. Five distinct lymph nodes were identified during the examination.\u003c/p\u003e\n\u003ch3\u003eHistopathological Examination of Lymph Node Biopsy:\u003c/h3\u003e\n\u003cp\u003e Microscopic analysis revealed the histology of the lymph node with effaced architecture. Malignant cells were arranged in sheets, cords, and globular formations, exhibiting nuclear pleomorphism, high nuclear-to-cytoplasmic ratio, hyperchromatic nuclei, prominent nucleoli, irregular borders, and eosinophilic cytoplasm. Capsular invasion indicated aggressive tumor behaviour.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3.1\u003c/span\u003e and 3.2: H and E staining of the lymph node under 10x(a) and 40x(b) showing a capsule with thin cortical tissues, adipose and vascular structures, cells arranged in sheets cords and globular formations exhibiting high N:C ratio, hyperchromatic nuclei, prominent nucleoli, irregular borders, and eosinophilic cytoplasm. Capsular invasion is also present.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eImmunohistochemistry of Lymph Node Biopsy\u003c/h2\u003e \u003cp\u003e Immunohistochemistry revealed CK7 and GATA3 positivity, supporting a primary breast malignancy with axillary metastases. The tumor was ER-negative, PR-negative, and showed strong HER2 (3+) overexpression. The Ki-67 proliferation index was 28%, indicating moderate cellular proliferation.\u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e4.1\u003c/span\u003e\u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;5.4\u003c/p\u003e \u003cp\u003efigure \u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e5.1\u003c/span\u003e: ER negative. Figure\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e5.2\u003c/span\u003e: PR Negative. Figure\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e5.3\u003c/span\u003e: Mammoglobin negative. Figure\u0026nbsp;5.4: CK 20 negative.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eImaging\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eFigures \u003cspan refid=\"Fig13\" class=\"InternalRef\"\u003e6.1\u003c/span\u003e and 6.2 show the presence of metabolically active lymph nodes and subcutaneous fat stranding in the left axillary region and the deep pectoral node.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTreatment and Management:\u003c/h3\u003e\n\u003cp\u003eThe patient underwent four cycles of neoadjuvant chemotherapy, consisting of docetaxel (90 mg), carboplatin (500 mg), and trastuzumab (390 mg) per cycle. Filgrastim (300 mcg) was also administered to support neutrophil recovery and mitigate chemotherapy-induced neutropenia.\u003c/p\u003e \u003cp\u003eGross Examination of Modified Radical Mastectomy Specimen:\u003c/p\u003e \u003cp\u003eThe specimen included a left mastectomy (16 \u0026times; 11 \u0026times; 4 cm), an axillary tail segment (7 \u0026times; 5 \u0026times; 3 cm), and an overlying skin flap (12 \u0026times; 6 cm). The nipple and areola were unremarkable. No visible lesion was observed within the breast parenchyma.\u003c/p\u003e \u003cp\u003eHistopathological Examination\u003c/p\u003e \u003cp\u003e No viable tumour was identified in the breast parenchyma, indicating a complete pathological response at the primary site. However, viable tumour cells were present within the lymph nodes, suggesting residual nodal disease in this known case of breast carcinoma following neoadjuvant chemotherapy (NACT).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig14\" class=\"InternalRef\"\u003e7.1\u003c/span\u003e shows viable tumour tissue present in the lymph nodes after NACT.\u003c/p\u003e \u003cp\u003eImaging\u003c/p\u003e \u003cp\u003eFDG PET was performed which revealed significant decrease in size, number and complete metabolic resolution of left level I axillary lymph nodes, complete resolution of left deep pectoral nodes and complete resolution of low grade FDG avid ill defined far stranding in the left breast. No abnormal FDG uptake/lesion is noted in the bilateral breast, bilateral supraclavicular and internal mammary regions.\u003c/p\u003e \u003cp\u003eOverall, this clinical presentation, coupled with the investigative findings, underscores a serious metastatic process that requires timely and effective medical intervention, particularly considering the underlying history of diabetes mellitus and former tobacco use.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003c/p\u003e \u003cp\u003eMale breast cancer risk factors are less understood due to its rarity. Conditions like Klinefelter\u0026rsquo;s syndrome, acromegaly, and neurofibromatosis may contribute \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. In regions like Central and Eastern Africa, hyperestrogenism from endemic liver infections has been linked to higher MBC rates \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Additionally, breast cancer has been observed in male-to-female trans individuals undergoing high-dose estrogen therapy \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMen often present with advanced-stage breast cancer due to delayed medical attention. Studies report that 50\u0026ndash;67% of cases are diagnosed at late stages \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Contributing factors include lack of awareness, healthcare access barriers, fear of diagnosis, reliance on traditional medicine, low education levels, poverty, and general ignorance about the disease \u003csup\u003e[\u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. In this case, the patient did not seek medical care due to a lack of awareness about breast cancer in males.\u003c/p\u003e \u003cp\u003eThe most prevalent psychiatric co-morbidities in breast cancer patients are anxiety and depression \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. These patients can encounter anxiety and/or depression at any point during their illness. 35% of Women with breast cancer experienced anxiety \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe diagnostic workup for male breast cancer includes mammography and ultrasonography of the axilla and breast \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Invasive ductal carcinoma is the most common subtype, often invading the pectoralis major due to limited breast tissue \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Standard treatment involves mastectomy with radiotherapy for complete tumour resection \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSystemic therapy for male breast cancer depends on hormone receptor and HER2 status, with about 56% of cases showing HER2 overexpression. \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Following the diagnosis, the patient underwent 4 cycles of neoadjuvant chemotherapy (docetaxel, carboplatin, trastuzumab, and filgrastim) followed by a modified radical mastectomy. This multimodal approach aims to reduce recurrence, target residual disease, and improve survival outcomes.\u003c/p\u003e \u003cp\u003eCurrent clinical guidelines recommend neoadjuvant chemotherapy with trastuzumab (Herceptin) for HER2-positive breast cancer, as it is associated with up to a 40% increase in the rate of pathological complete response \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e and long-term survival benefit \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis case underscores the importance of early diagnostic evaluation, including tissue biopsy supplemented with IHC and FDG-PET, to guide optimal treatment planning in MBC.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis case emphasizes the rarity and clinical significance of MBC, highlighting the need for early detection and thorough diagnostic evaluation. The patient\u0026rsquo;s delayed presentation and advanced-stage disease emphasise the importance of heightened awareness and improved screening. Histopathological findings confirmed an aggressive primary breast malignancy with axillary metastasis.\u003c/p\u003e \u003cp\u003eThe treatment\u0026mdash;neoadjuvant chemotherapy with docetaxel, carboplatin, and trastuzumab followed by modified radical mastectomy\u0026mdash;aligns with best practices for HER2-positive MBC, aiming to reduce recurrence and improve survival. However, challenges persist, including delayed diagnosis due to lack of awareness and the psychological impact on patients.\u003c/p\u003e \u003cp\u003eClinicians must maintain a high index of suspicion for MBC, particularly in cases of axillary lymphadenopathy. Promoting education and early intervention can lead to better outcomes and survival rates.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe patient\u0026apos;s data was kept anonymous, so the need for ethics approval and consent was waived\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication:\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eConsent was taken\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The data is stored in the HMIS of the institution, so it cannot be accessed publicly, but can be provided upon request to the corresponding author\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was done\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eContributions:\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eMIA and JT participated in data collection, analysis, literature review, and manuscript drafting. NT conducted data analysis and contributed to manuscript drafting. IAA provided final supervision, critical review, and approved the final version.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nationalbreastcancer.org\u003c/span\u003e\u003cspan address=\"https://www.nationalbreastcancer.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng G, Leone JP. Male Breast Cancer: An Updated Review of Epidemiology, Clinicopathology, and Treatment. J Oncol. 2022;2022:1734049. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2022/1734049\u003c/span\u003e\u003cspan address=\"10.1155/2022/1734049\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35656339; PMCID: PMC9155932.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. Male Breast Cancer Incidence and Mortality, United States\u0026mdash;2013\u0026ndash;2017 No 19. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgrawal A, Ayantunde AA, Rampaul R, Robertson JF. Male breast cancer: a review of clinical management. Breast Cancer Res Treat. 2007;103(1):11\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10549-006-9356-z\u003c/span\u003e\u003cspan address=\"10.1007/s10549-006-9356-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2006 Oct 11. PMID: 17033919.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIonescu S, Nicolescu AC, Marincas M, Madge OL, Simion L. An Update on the General Features of Breast Cancer in Male Patients-A Literature Review. Diagnostics (Basel). 2022;12(7):1554. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/diagnostics12071554\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics12071554\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35885460; PMCID: PMC9323942.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarreffa E, Arora D. Breast cancer in the elderly, in men and during pregnancy. Surg (Oxford). 2024;42(12):918\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.mpsur.2024.09.004\u003c/span\u003e\u003cspan address=\"10.1016/j.mpsur.2024.09.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdelwahab Yousef AJ. Male Breast Cancer: Epidemiology and Risk Factors. Semin Oncol. 2017;44(4):267\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.seminoncol.2017.11.002\u003c/span\u003e\u003cspan address=\"10.1053/j.seminoncol.2017.11.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2017 Nov 9. PMID: 29526255.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheikh A, Hussain SA, Ghori Q, Naeem N, Fazil A, Giri S, Sathian B, Mainali P, Al Tamimi DM. The spectrum of genetic mutations in breast cancer. Asian Pac J Cancer Prev. 2015;16(6):2177-85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7314/apjcp.2015.16.6.2177\u003c/span\u003e\u003cspan address=\"10.7314/apjcp.2015.16.6.2177\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 25824734.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStang A, Thomssen C. Decline in breast cancer incidence in the United States: What about male breast cancer? Breast Cancer Res Treat. 2008;112:595\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Cancer Society. Breast Cancer Facts \u0026amp; Figs. 2017\u0026ndash;2018. Atlanta: American Cancer Society, Inc. 2017. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf\u003c/span\u003e\u003cspan address=\"https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorde LA, Zujewski JA, Kamin L, et al. Multidisciplinary meeting on male breast cancer: Summary and research recommendations. J Clin Oncol. 2010;28:2114\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePDQ Adult Treatment Editorial Board. Male Breast Cancer Treatment (PDQ\u0026reg;): Health Professional Version. 2002 (online). Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK65792/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK65792/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiordano SH, Cohen DS, Buzdar AU, et al. Breast carcinoma in men: A pop ulation-based study. Cancer. 2004;101:51\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu R, Li J, Zhang Y, et al. Male occult breast cancer with axillary lymph node metastasis as the first manifestation: A case report and literature review. Med (Baltim). 2017;96:e9312.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRudlowski C. Male breast cancer. Breast Care (Basel). 2008;3:183\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaglione KD, Margolies L, Jaffer S, et al. Breast cancer in male-to-female transsexuals: Use of breast imaging for detection. Am J Roentgenol. 2014;203:W735\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Kahiry W, Omer HH, Saeed NM, Hamid GA. Late presentation of breast cancer in Aden, Yemen. Gulf J Oncolog. 2011;9:7\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClegg-Lamptey J, Hodasi W. A study of breast cancer in Korle Bu Teaching Hospital: Assessing the impact of health education. Ghana Med J. 2007;41:72\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBourhafour M, Belbaraka R, Souadka A, et al. Male breast cancer: A report of 127 cases at a Moroccan institution. BMC Res Notes. 2011;4:219.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEspina C, McKenzie F, Dos-Santos-Silva I. Delayed presentation and diagno sis of breast cancer in African women: a systematic review. Ann Epidemiol. 2017;27:659\u0026ndash;e717.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenbakhta B, Tazi M, Benjaafar N, et al. Determinants of patient and health system delays for women with breast cancer in Morocco, 2013. Rev Epidemiol Sante Publique. 2015;63:191\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClegg-Lamptey J, Dakubo J, Attobra YN. Why do breast cancer patients report late or abscond during treatment in Ghana? A pilot study. Ghana Med J. 2009;43:127\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed AA. Clinicopathological profile of female Sudanese patients with locally advanced breast cancer. Breast Dis. 2014;34:131\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAloulou S, El Mahfoudi A, El Omrani A, Khouchani M. [Factors related to late diagnosis of breast cancer: Experience of CHU Mohammed VI Marrakech]. Pan Afr Med J. 2015;21:162. [in French].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePace LE, Mpunga T, Hategekimana V, et al. Delays in breast cancer pre sentation and diagnosis at two rural cancer referral centers in Rwanda. Oncologist. 2015;20:780\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaumeister H, Kriston L, Bengel J, H\u0026auml;rter M. High agreement of self-report and physician-diagnosed somatic conditions yields limited bias in exam ining mental-physical comorbidity. J Clin Epidemiol. 2010;63:558\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026auml;rter M, Reuter K, Aschenbrenner A, et al. Psychiatric disorders and asso ciated factors in cancer: Results of an interview study with patients in in patient, rehabilitation and outpatient treatment. Eur J Cancer. 2001;37:1385\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDastan NB, Buzlu S. Depression and anxiety levels in early stage Turkish breast cancer patients and related factors. Asian Pac J Cancer Prev. 2011;12:137\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGradishar W, Salerno KE. NCCN guidelines update: Breast cancer. J Natl Compr Canc Netw. 2016;14(5 Suppl):641\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006;367:595\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatten DK, Sharifi LK, Fazel M. New approaches in the management of male breast cancer. Clin Breast Cancer. 2013;13:309\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAvisar E, McParland E, Dicostanzo D, Axelrod D. Prognostic factors in node negative male breast cancer. Clin Breast Cancer. 2006;7:331\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuzdar AU, Ibrahim NK, Francis D, et al. Significantly higher pathologic com plete remission rate after neoadjuvant therapy with trastuzumab, paclitax el, and epirubicin chemotherapy: Results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 2005;23:3676\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26:778\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\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":false,"email":"[email protected]","identity":"surgical-and-experimental-pathology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"saep","sideBox":"Learn more about [Surgical and Experimental Pathology](http://surgexppathol.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/SAEP/default.aspx","title":"Surgical and Experimental Pathology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Male breast cancer, BRCA2 mutation, Infiltrating ductal carcinoma, Hormone receptor positive, Hyperestrogenism, Lymph node involvement","lastPublishedDoi":"10.21203/rs.3.rs-8393546/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8393546/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMale breast cancer (MBC) is a rare condition within the broader spectrum of breast cancer. It is most commonly diagnosed in men between the ages of 60 and 70, with an average age of 67 at diagnosis \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. MBC accounts for less than 1% of all breast cancer cases, with incidence varying across ethnic groups. Rates are highest among non-Hispanic Black men (1.89 per 100,000) \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Elevated incidence in South and Central Africa may be linked to hyperestrogenism from liver infections \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Genetic predispositions, especially BRCA2 mutations, significantly increase the risk of MBC greater than BRCA1 mutations. The most frequent histological type is infiltrating ductal carcinoma, while invasive lobular carcinoma is exceptionally uncommon. MBC tumours are typically hormone receptor positive [5]. Key risk factors for MBC include older age, Black ethnicity, genetic mutations, family history, liver cirrhosis, and testicular disorders. Most patients present with painless breast lumps, and about 50% have lymph node involvement at diagnosis \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCase presentation\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA 61-year-old male presented with a 6-year history of progressive, non-tender swelling in the left axilla, with no associated systemic symptoms. Clinical examination revealed matted, erythematous lymph nodes, prompting FNAC and subsequent excision biopsy. Cytology demonstrated markedly atypical tumour cells with high N:C ratio and significant pleomorphism. Histopathology of the lymph node confirmed effaced architecture with malignant cells arranged in sheets, cords, and globular patterns, along with capsular invasion. Immunohistochemistry showed CK7 and GATA3 positivity and strong HER2 (3+) expression, while ER, PR, mammaglobin, and CK20 were negative\u0026mdash;findings consistent with metastatic HER2-positive primary breast carcinoma. PET imaging revealed metabolically active axillary and deep pectoral nodes. The patient received neoadjuvant chemotherapy with docetaxel, carboplatin, trastuzumab, and filgrastim, followed by modified radical mastectomy. While the breast parenchyma showed complete pathological response, residual nodal disease persisted.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis case highlights the diagnostic challenge of male breast cancer (MBC), particularly when presenting solely as axillary lymphadenopathy. Immunohistochemistry and PET imaging played essential roles in establishing diagnosis and staging. Timely neoadjuvant chemotherapy and surgery achieved primary tumour clearance, underscoring the importance of early suspicion, comprehensive evaluation, and guideline-based management of HER2-positive MBC.\u003c/p\u003e","manuscriptTitle":"Occult Male Breast Cancer Presenting as Axillary Lymphadenopathy: A Rare Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 06:18:02","doi":"10.21203/rs.3.rs-8393546/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-12T12:18:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-10T06:52:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93520728818841292072186157578417482944","date":"2026-01-10T03:10:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-08T20:57:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18853857970583513957260171281829285593","date":"2026-01-08T20:35:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T13:07:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-24T01:35:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-24T01:35:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Surgical and Experimental Pathology","date":"2025-12-18T09:03:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":false,"email":"[email protected]","identity":"surgical-and-experimental-pathology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"saep","sideBox":"Learn more about [Surgical and Experimental Pathology](http://surgexppathol.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/SAEP/default.aspx","title":"Surgical and Experimental Pathology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e0a4e894-4a74-458f-8cdd-392167f4c0a4","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T14:12:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 06:18:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8393546","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8393546","identity":"rs-8393546","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}