Male breast cancer masquerading as a chronic chest wall ulcer

Abstract

Male breast cancer is rare and may present with atypical local findings, resulting in delayed or incorrect initial diagnostic consideration. A large ulcerative lesion involving the male chest wall may mimic a primary cutaneous malignancy or chronic inflammatory/infective ulcer. A 49-year-old man presented with a large ulceroproliferative lesion involving the left anterior chest wall and nipple–areolar region. The lesion measured approximately 23×75×62 mm³ on imaging and was associated with left axillary lymphadenopathy. Ultrasonography demonstrated a heterogeneous hypoechoic vascular mass, while contrast-enhanced CT showed an ulcerated soft-tissue lesion involving the skin and abutting/involving the underlying pectoral musculature. Core biopsy showed poorly differentiated carcinoma. Immunohistochemistry demonstrated CK7 positivity, strong GATA3 positivity, diffuse strong estrogen receptor and progesterone receptor expression (Allred score 8/8 for both), and HER2 negativity, supporting mammary origin. The patient underwent wide local excision with left axillary lymph node dissection and reconstruction with a latissimus dorsi myocutaneous flap. Final pathology showed a 10×7×2 cm³ infiltrative invasive breast carcinoma involving skin and skeletal muscle, with lymphovascular and perineural invasion, clear margins, and metastases in 3 of 10 axillary lymph nodes with extranodal extension. Male breast carcinoma should be considered in the differential diagnosis of persistent or fungating ulcers involving the nipple–areolar or anterior chest wall region. Correlation of clinical findings, imaging, histopathology and immunohistochemistry is essential for establishing the primary site and guiding treatment.