Case Report, Clinic Oncol Case Rep Vol: 8 Issue: 1

Case Report: Bilateral DCIS in a Male Patient

Mitchell Sager^*, Madison Moran, Nafisa Kuwajerwala, Joseph Giannola

Department of General Surgery and Family Medicine, American University of the Caribbean Medicine, Michigan, USA

*Corresponding Author: Mitchell Sager
Department of General Surgery and Family Medicine, American University of the Caribbean Medicine, Michigan, USA
E-mail: mmsager1162@gmail.com

Received: June 04, 2025, Manuscript No. COCR-25-166693
Editor assigned: June 06, 2025, PreQC No. COCR-25-166693 (PQ)
Reviewed: June 20, 2025, QC No. COCR-25-166693
Revised: August 04, 2025, Manuscript No. COCR-25-166693 (R)
Published: August 11, 2025, DOI: 10.4173/cocr.8(1).370

Citation: Sager M. et al., (2025) Case Report: Bilateral DCIS in a Male Patient. Clin Oncol Case Rep 8:1.

Abstract

Keywords: Male breast cancer, Pancreatic cancers, Ductal carcinoma, BRCA 1, BRCA 2, Contralateral prophylactic bilateral mastectomy, Nipple discharge, Cribriform type, High mitosis grade

Keywords

Male breast cancer, Pancreatic cancers, Pancreatic cancers, Ductal carcinoma; BRCA 1, BRCA 2, contralateral prophylactic bilateral mastectomy, nipple discharge, cribriform type, high mitosis grade,

Introduction

Male Breast Cancer (MBC) is a rare disorder, with an approximate lifetime risk of 0.1% [1]. This risk increases to around 7-8% with BRCA2 mutations and 1% with BRCA1 mutations [1]. BRCA1 and BRCA2 (BRCA1/2) are tumor suppressor genes, best known for their involvement in DNA repair and maintenance. Mutations in these genes are known to increase risk in breast, ovarian, prostate, melanoma and pancreatic cancers [1]. Mutations in BRCA1/2 genes are inherited in an autosomal dominant fashion, leading to a significant increase in risk for the aforementioned forms of cancer.

MBC is often diagnosed within the sixth decade of life, which is almost 10 years later than the average female breast cancer counterparts [2]. The primary complaint is most often a solid, sub areolar mass with or without gynecomastia. Other symptoms can include nipple retraction and/or ulceration. Nipple discharge is only present in around 6% of the cases of MBC, with bloody and clear discharge being highly associated with underlying malignancy. The survival rate at 5 and 10 years overall in patients with MBC is about 60 and 40% respectively [3]. Prognostic factors include positive axillary lymph nodes and tumor size as well as age at time of diagnosis and presence of treatment-limiting comorbidities [3].

Treatment for MBC is primarily mastectomy, with or without radiotherapy, hormonal therapy and chemotherapy [4,5]. The use of Contralateral Prophylactic Mastectomy (CPM) is controversial as it is unclear whether the benefits of cancer-free survival outweigh its cost. At the present, the strongest indication for CPM is the presence of BRCA1/2 mutations [6]. One retrospective cohort study built a nomogram to estimate breast cancer specific death over several year parameters in male breast cancer patients who received a unilateral mastectomy or CPM [7]. This study revealed that administration of CPM was associated with an overall decrease in the risk of breast cancer specific death in patients with MBC [7].

This discusses the case of a 52-year-old male who presented with left sided nipple pain and bloody discharge. Upon further evaluation, he was diagnosed with Ductal Carcinoma In-situ (DCIS) in the left breast. Bilateral mastectomy with sentinel lymph node biopsy was performed and postoperative pathological reports found evidence of DCIS on the right side as well. This case aims to add to the literature with reference to the relatively rare diagnosis of MBC. Additionally, we hope to emphasize the need for early screening and diagnosis of patients with elevated risk of MBC.

Case Representation

A 52-year-old male presented to his primary care physician for one episode of bloody discharge in the left nipple. He had woken up the morning prior with symptoms of a dull pain in the left breast and noticed bloody discharge that increased in volume upon squeezing the nipple. Additionally, the patient noticed a hardening of breast tissue underneath the nipple. Upon further questioning, he endorsed a family history of BRCA positive breast and testicular cancer (Figure 1).

Diagnostic mammogram revealed a mass with calcifications in the left breast central to the nipple in the retro areolar region. Ultrasound confirmed these results, revealing a 14 mm × 10 mm × 7 mm hypoechoic irregular mass of the left breast. This mass was categorized as BI-RADS 4 and ultrasound guided biopsy was scheduled for 4 days after. Surgical pathology revealed DCIS tisN0M0. Semi quantitative estrogen/progesterone receptor assay came back positive for estrogen and progesterone receptors. Due to the extensive family history of BRCA positive breast cancer, the patient was also referred to a geneticist and was found to be positive for a BRCA-2 mutation. Results were discussed with the patient and an appointment with breast surgeon was made. It was decided that the patient would undergo a bilateral mastectomy with sentinel lymph node biopsy [8].

On the day of the operation, the patient received a bilateral nerve block along the pectoral muscle with ropivacaine 0.5 30 ml per anesthesia for pain control. The surgical team dissected both breasts anterior to the superficial fascia and lifted them off the pectoralis major. The left axilla was entered at the lateral border of the pectoral major. A level I node with an ex vivo count of 108 was dissected and sent to pathology. No other lymph nodes were palpated or dissected. Two Jackson-Pratt drains were placed on each side of the patient’s chest for drainage. Samples were sent to pathology and the patient was discharged home later in the evening. The resulting pathology reports revealed the patient had bilateral DCIS, not just left sided cancer as previously believed. Specifically, it was found that he had left sided DCIS of the cribriform type with medium to high mitotic grade in addition to right sided DCIS, cribriform type, with a mitotic grade of low to intermediate grade. The sampled lymph node was negative and negative margins were present bilaterally [9].

Discussion

Breast cancer in women is one of the most prevalent malignancies, with the average woman having a lifetime risk of 12%. Conversely, MBC is a much rarer disorder, accounting for only 1.5% of all male malignancies. However, while MBC is far less common than female breast cancer, it is often associated with a worse prognosis due to delayed diagnosis. One case study found there was an approximate 15.7 month delay in the start of treatment in patients with MBC. This delay in medical attention often results in more advanced breast cancer at the time of diagnosis, with approximately 30% of the cases already being metastasized.

The largest risk factor for MBC is increasing age, likely due to testicular decline and the associated increase in levels of estrogen. Other risk factors include family history (positive in 15-20% of MBC patients) as well as mutations in BRCA genes, Klinefelter’s syndrome, alcohol consumption and liver disease [10].

As there are no specific guidelines for managing MBC, female guidelines are frequently used. Surgery is often performed, with the majority of patients undergoing a modified radical mastectomy with or without contralateral prophylactic mastectomy. Axial lymph nodes are usually dissected in conjunction. High percentages of MBC are hormone receptor-positive, making adjuvant chemotherapy and/or hormonal treatment another useful tool of treatment [11].

Most cases of MBC are discovered through self-palpation. And while it is not routinely recommended to conduct self-checks, due to the rarity of the disorder, this case demonstrates the possible benefits of early screening and diagnosis, especially in patients with strong risk factors.

This case was unique in that the patient presented with bloody discharge, a symptom that is very rare in cases of MBC. This symptom is often overlooked by male patients, despite the fact that they are highly associated with underlying malignancy. However, because the patient was acutely aware of his increased risk of MBC and reported the symptoms to his primary care provider soon after they occurred. As such, he was diagnosed at a much younger age and consequently his cancer being found in-situ rather than invasive. One literature review found that approximately 30%-50% of all male and female patients with DCIS develop invasive cancer in the following 10-20 years. As such, having awareness about the possible symptoms of MBC allowed for his cancer to be discovered at a much earlier stage. Not only did the prompt diagnosis and treatment of this patient minimize the chances of invasive cancer developing on the left side, but it also revealed concurrent cancer on the right side that was able to be treated [12].

Conclusion

This report provides diagnostic and therapeutic insight into MBC, demonstrating a unique case of unilateral DCIS, later found to be bilateral DCIS. Additionally, this discussion hopes to emphasize the need for increased awareness in both the public and healthcare professionals about prompt diagnosis and treatment of MBC, especially in patients that are at increased risk of developing the disease. Early recognition and treatment will allow for the best prognosis for these patients.