Management challenges of a male breast cancer in a resource-constrained setting: a case report
Edwin Liwa, Glory Makupa, Godwin Nnko, Subira Matiku, Hyasinta Jaka, Alex MremiBackground:
Male breast cancer is rare and often diagnosed late because awareness and male-specific screening are limited. In resource-constrained settings, delayed tissue diagnosis and restricted access to staging and receptor-directed treatment may further compromise outcomes.
Case presentation:
A 43-year-old man had a right breast mass for 5 years and had initially used herbal remedies. A peripheral non-oncologic excision was performed without histopathological examination; the mass rapidly recurred and ulcerated. Biopsy showed grade 2 invasive carcinoma of no special type with skin involvement. Tumor cells expressed estrogen receptor (40%), progesterone receptor (40%), and human epidermal growth factor receptor 2 (HER2) (strong, complete staining in >90% of cells). A fixed ipsilateral supraclavicular node, bilateral pulmonary nodules on chest radiography, and a right pleural effusion supported a clinical diagnosis of cT4b cN3c cM1 (stage IV) disease, although computed tomography and metastatic-site biopsy were unaffordable. Because of the rapidly progressive, bulky, and fungating disease, the multidisciplinary team selected initial palliative cytoreduction. Four cycles of doxorubicin and cyclophosphamide produced marked clinical tumor reduction and wound healing. Planned taxane- and HER2-directed therapies, and radiological reassessment, were not completed because of cost, availability, and follow-up barriers.
Conclusion:
This case demonstrates how the failure to submit excised tissue for histology and the inability to access staging and biomarker-directed treatment can compound delays. Earlier biopsy must be linked to affordable endocrine therapy and, where feasible, HER2-directed treatment.