Male Breast Carcinoma in an Elderly Patient: A Rare Presentation and the Importance of Individualized Management

Male breast carcinoma (MBC) is a rare malignancy and often presents at an advanced stage due to low awareness and social stigma. Management is largely extrapolated from female breast cancer and must be individualized, particularly in elderly patients. An 87-year-old male patient presented with a painless left breast lump since three months and an ulcer over the nipple for since one month. Examination revealed a firm retroareolar mass with a healed ulcer over the lower aspect of the nipple and no palpable axillary lymphadenopathy. Imaging suggested a suspicious lesion, and core needle biopsy confirmed invasive ductal carcinoma. Staging workup with fludeoxyglucose-18 (FDG) positron emission tomography-computed tomography (PET-CT) showed no distant metastasis. The patient underwent a modified radical mastectomy with axillary lymph node dissection. Histopathology revealed Grade II invasive ductal carcinoma with nodal involvement (pT4bN1a, Stage IIIB). Immunohistochemistry demonstrated estrogen and progesterone receptor positivity, human epidermal growth factor receptor 2 (HER2) negativity, and a low proliferative index, consistent with a luminal A subtype. Following multidisciplinary tumour board discussion, adjuvant chemotherapy was omitted, considering advanced age and performance status. The patient was treated with tamoxifen and adjuvant chest wall + axillary radiotherapy. At follow-up, he remains disease-free with a good quality of life. This case highlights the importance of early suspicion in male breast lesions and emphasizes individualized management integrating tumor biology, stage, and patient factors.