Random Synchronous Malignancy in Male Breast: A Case Report
This 58-year-old male Indian male presented with an indurated lesion of size 2×2 cm in the posterior 1/3rd of right side of tongue, not crossing midline with normal tongue movements. Biopsy confirmed a poorly differentiated squamous cell carcinoma of base of tongue (). Subsequently he underwent a contrast enhanced whole body 18F-FDG PET/CT (head to mid thigh) on our General Electric Discovery PET 8 slice CT scanner. Standardized uptake value (SUVmax) of the lesions were calculated for body weight and expressed in gram per milliliter (g/mL). Apart from the known base of tongue lesion ( and ) in the right posterior 1/3rd (SUVmax, 8.2), a right level II cervical lymph nodal metastases (SUVmax, 5.3). Incidental FDG avid enhancing subcutaneous soft tissue lesion with spiculated margins of size 15×14 mm, in retro areolar region of right breast was noted (SUVmax, 2.1) ( and ). On subsequent physical examination, a right breast lump of size 2×2 cm at 9 o'clock position with surrounding periareolar nodularity was noted with no palpable axillary lymph nodes. Left breast and axilla were normal. Excision biopsy revealed an invasive ductal carcinoma, not otherwise specified, modified Bloom Richardson grade 1 (tubule 2, atypia 1, mitosis 1), tumor size of 1.5×1.3×1 cm. Immunohistochemistry revealed estrogen and progesterone receptor positive (). He underwent a right modified radical mastectomy. Histopathology showed no residual tumor while one lymph node was positive for metastases. After percutaneous endoscopic gastrostomy tube placement, concurrent chemoradiation for poorly differentiated squamous cell carcinoma of base of tongue (T1N1M0) was started. Patient received intensity modulated radiation therapy with 69 Gy to the tumor in 30 fractions, 60 Gy to level II-IV lymphnodes and 54 Gy to low anterior neck and weekly chemotherapy with Cisplatin 50 mg. Patient tolerated the concurrent chemoradiation well. On follow-up after 1 month of completion of concurrent chemoradiation, there was no visible base of tongue growth on endoscopy or on palpapation. Subsequently, patient received six cycles of adriamycin, cyclophosphamide, and 5-flurouracil for carcinoma breast (pT1cN1M0). Patient was subsequently on tamoxifen. Apart from a positive family history, patient does not have any known risk factors like alcoholism, liver cirrhosis, etc. One of his brother is known to have breast carcinoma. Genetic mutation testing was not done as this is locally not available to us in our hospital and outsourced testing for the same was not insisted upon taking in consideration the poor financial status of the patient.