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<p>A 43&#xa0;year old male presented with a left sided breast lump and progressive right hip pain over four months. Initial symptoms began with a persistent dry cough and severe right hip pain, followed by hemoptysis, and subsequently the breast lump appeared. Initial clinical suspicion centered on primary male breast carcinoma. However, further imaging revealed widespread FDG avid metastatic disease involving the left anterior chest wall, right pulmonary hilum, mediastinal lymph nodes, proximal femur, liver, and brain. Core needle biopsy from the breast mass and the external report of an open biopsy of the right femur (performed at an outside facility) revealed metastatic poorly differentiated adenocarcinoma. Immunohistochemical staining was positive for thyroid transcription factor-1 (TTF-1) and negative for GATA3, consistent with a primary pulmonary origin. This case underscores the importance of maintaining a broad differential diagnosis when evaluating male breast lumps and highlights the critical role of tissue diagnosis and immunohistochemistry in distinguishing primary breast malignancies from metastatic lesions. Fine needle aspiration cytology alone may miss the diagnosis, while core needle biopsy or excisional tissue is more definitive. Early recognition of non mammary primaries presenting as breast masses can prevent unnecessary surgical intervention and guide appropriate systemic therapy. Notably, the patient, who arrived wheelchair bound due to severe pain and loss of mobility, became ambulatory and independent within two days after orthopedic surgical intervention. Given the presence of brain metastasis, palliative whole brain radiotherapy was performed prior to the femur surgery. Molecular analysis detected a CD74-ROS1 gene fusion, expanding treatment options to include targeted therapies such as entrectinib, crizotinib, repotrectinib, and lorlatinib.</p>

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Unusual Presentation of Lung Adenocarcinoma as Male Breast Lump and Pathological Femoral Fracture: A Surgeon’s Perspective

  • 期刊论文

  • 发表日期：

    2025年11月11日

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  • Rajshekhar C. Jaka,
  • Aishwarya Madasamy Swaminathan,
  • Lavina Loungani

摘要

A 43 year old male presented with a left sided breast lump and progressive right hip pain over four months. Initial symptoms began with a persistent dry cough and severe right hip pain, followed by hemoptysis, and subsequently the breast lump appeared. Initial clinical suspicion centered on primary male breast carcinoma. However, further imaging revealed widespread FDG avid metastatic disease involving the left anterior chest wall, right pulmonary hilum, mediastinal lymph nodes, proximal femur, liver, and brain. Core needle biopsy from the breast mass and the external report of an open biopsy of the right femur (performed at an outside facility) revealed metastatic poorly differentiated adenocarcinoma. Immunohistochemical staining was positive for thyroid transcription factor-1 (TTF-1) and negative for GATA3, consistent with a primary pulmonary origin. This case underscores the importance of maintaining a broad differential diagnosis when evaluating male breast lumps and highlights the critical role of tissue diagnosis and immunohistochemistry in distinguishing primary breast malignancies from metastatic lesions. Fine needle aspiration cytology alone may miss the diagnosis, while core needle biopsy or excisional tissue is more definitive. Early recognition of non mammary primaries presenting as breast masses can prevent unnecessary surgical intervention and guide appropriate systemic therapy. Notably, the patient, who arrived wheelchair bound due to severe pain and loss of mobility, became ambulatory and independent within two days after orthopedic surgical intervention. Given the presence of brain metastasis, palliative whole brain radiotherapy was performed prior to the femur surgery. Molecular analysis detected a CD74-ROS1 gene fusion, expanding treatment options to include targeted therapies such as entrectinib, crizotinib, repotrectinib, and lorlatinib.