leuprolide and Breast-Neoplasms--Male

Prostate adenocarcinoma can manifest as a fairly indolent tumor or as a very aggressive cancer with significant invasive and metastatic potential. Common metastatic sites include bone, liver, lymph nodes, and adrenal glands. Dermatologic manifestations are rare. We present a case of a man who presented with breast skin changes that mimicked inflammatory breast carcinoma with specialized testing ultimately giving a diagnosis of metastatic prostatic adenocarcinoma. A 78-year-old man presented with left breast redness and swelling. Examination revealed an erythematous rash with subcutaneous edema over the left hemithoracic area. A breast ultrasound showed no focal mass, and a breast core biopsy had no evidence of tumor. A skin biopsy showed metastatic carcinoma in dermal lymphatics, and the tumor was found to have no estrogen or progesterone receptors or HER2 expression. Computed tomography scans, positron emission tomography, and a nuclear bone scan revealed widespread skeletal metastases. The patient received a 3-month course of capecitabine and cyclophosphamide with no improvement in his skin lesions. Subsequent immunohistochemical staining on the tumor specimen was positive for prostate-specific antigen (PSA) and alpha-methyl-CoA-racemase, confirming a diagnosis of metastatic prostatic adenocarcinoma. He received leuprolide and bicalutamide and demonstrated significant improvement with near-complete resolution of his skin lesions and a decrease in his PSA level. Prostatic adenocarcinoma presenting initially as a breast malignancy is a rarely recognizable clinical event. Undoubtedly, increased awareness and recognition of the rare entity described herein will allow for the prompt initiation of specific therapies, which might be of benefit to many patients.

Topics: Adenocarcinoma; Aged; Anilides; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms, Male; Capecitabine; Carotid Stenosis; Coronary Artery Disease; Cyclophosphamide; Deoxycytidine; Diabetes Mellitus; Fluorouracil; Humans; Immunohistochemistry; Leuprolide; Male; Nitriles; Osteoarthritis; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Pulmonary Disease, Chronic Obstructive; Tomography, X-Ray Computed; Tosyl Compounds

Fibroepithelial lesions are uncommon in the male breast. Most published reports describe phyllodes tumors. Fibroadenomas are very common in female breasts, but are exceedingly rare in the male breast. Gynecomastia and/or lobular differentiation have been known to coexist in both types of fibroepithelial lesions in men. We report an exceptional case of recurrent, bilateral fibroadenomas in a man under treatment for prostatic carcinoma. Intracytoplasmic inclusion bodies in stromal cells identical to those seen in infantile digital fibromatosis were identified in one fibroadenoma. To the best of our knowledge, this is the first reported case of bilaterally occurring fibroadenomas in the male breast, one of which also contained digital fibroma-like inclusions, a second unreported phenomenon.

Topics: Aged; Breast Neoplasms, Male; Fibroadenoma; Fibroma; Humans; Inclusion Bodies; Leuprolide; Male; Prostatic Neoplasms

Topics: Adenocarcinoma; Aged, 80 and over; Breast Neoplasms, Male; Fertility Agents, Female; Genes, BRCA2; Humans; Leuprolide; Male; Mutation; Prostatic Neoplasms

Topics: Anastrozole; Androstadienes; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Aromatase Inhibitors; Bone Neoplasms; Breast Neoplasms, Male; Carcinoma, Ductal, Breast; Chemotherapy, Adjuvant; Humans; Letrozole; Leuprolide; Lung Neoplasms; Lymphatic Metastasis; Male; Mastectomy, Modified Radical; Middle Aged; Nitriles; Receptors, Estrogen; Receptors, Progesterone; Treatment Outcome; Triazoles