Rare axillary cancer of unknown primary originating from the breast of a 64-year-old male patient: A case report and literature review

Sep 22, 2026

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Cancers of unknown primary (CUPs) are a heterogeneous tumor group marked by difficult diagnosis, since the primitive tumor remains occult while metastases predominate. Occult male breast cancers are exceptionally rare within CUP. This case report presents a 64-year-old man with a CUP presumed to be of mammary origin and focuses on management. With only thirteen previously reported cases, the article reviews how different, non-uniform approaches influence treatment and patient prognosis due to the lack of specific guidelines.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Introduction

Diagnostic management of CUP

Case report

Presentation and initial findings

Imaging and work-up

ONCOLOGY LETTERS 27: 86, 2024 Rare axillary cancer of unknown primary originating from the breast of a 64‑year‑old male patient: A case report and literature review SIMONA PARISI 1 , CLAUDIO GAMBARDELLA 1 , ROBERTO RUGGIERO 1 , SALVATORE TOLONE 1 , FRANCESCO IOVINO2 , FRANCESCO SAVERIO LUCIDO 1 , FRANCESCA FISONE 1 , MARIACHIARA LANZA VOLPE 1 , GIOVANNI COZZOLINO 1 , FEDERICO MARIAMONGARDINI 1 , LUIGI BRUSCIANO 1 , RONCHI ANDREA3 and LUDOVICO DOCIMO 1 1Department of Advanced Science and Surgery, General, Mini‑Invasive, Oncological and Obesity Surgery Unit; 2Department of Translational Medical Science, School of Medicine, General, Mini‑Invasive, Oncological and Obesity Surgery Unit; 3Mental and Physical Health and Preventive Medicine Department, Pathology Unit, Luigi Vanvitelli University of Campania, I‑80138 Naples, Italy Received July 12, 2023; Accepted November 28, 2023 DOI: 10. 3892/ol.2024.14220 Abstract. Cancers of unknown primary (CUPs) are a heterogeneous group of tumors characterized by a difficult diagnosis. The primitive tumor remains unknown, whereas metastases are the most common manifestation. Occult male breast cancers are very rare types of CUPs. The present study describes the case of a 64‑year‑old man affected by a CUP of presumed mammary origin. The aim of the article and the present review was to focus on their management. To the best of our knowledge, only thirteen cases have been reported in the literature. Because no specific guidelines are available, various approaches have been applied, influencing the treatment and the prognosis of patients with CUP. Introduction The cancers of unknown primary (commonly named CUPs) are a heterogeneous group of tumors characterized by a difficult diagnosis, because the primary site remains occult after extensive work‑up (1) . The CUPs represent about 3‑5% of all cancer diagnosis and the most common manifestations are metastases in the lymph nodes, lung, liver, or bone (2) . In 75‑85% of the cases, the metastases are disseminated (3) . Considering its enigmatic features, it was discussed about the validity of CUP as a distinct cancer Correspondence to: Dr Simona Parisi, Department of Advanced Science and Surgery, General, Mini‑Invasive, Oncological and Obesity Surgery Unit, Luigi Vanvitelli University of Campania, 2 Piazza Miraglia, I‑80138 Naples, Italy E‑mail: simona.parisi‑[sp@libero.it](sp@libero.it) Key words: male breast cancer, occult male breast cancer, male breast cancer of unknown primary entity supporting the hypothesis that the diagnosis of CUP could be erroneous because the work‑up may be incomplete or the syndrome may be correlated to relapses of precedent cancers (4) . Therefore, International Guidelines tried to clarify the diagnostic management (5), highlighting the importance of patients' clinical and familiar history, and on risk factors such as cancer predisposition and occupational activity. A complete physical examination should be performed with accuracy for respiratory and abdominal systems which are the most common sites of primary cancers, according to the data reported in the follow‑up and autopsy of CUPs' patients, without neglecting the clinical presentation that could drive the primary tumor research (6). The initial diagnostic work‑up should include basic blood analyses and relevant tumor markers. A computerized tomography (CT) of chest, abdomen and pelvis is recommended by ESMO guidelines (7) and Positron emission tomography (PET) imaging is frequently additionally employed in CUP to identify unrecognized malignant lesions (8). Only after that an extensive work‑up has been performed without the detection of a primitive cancer, the possibility of CUP syndrome should be considered. The pathogenesis is controversial, but CUP condition may be created by an early metastatic dissemination, whereas the primary tumor has receded or is too small to be detected (9) . The CUPs of possible breast origin represent a complex to

FAQs

What characterizes cancers of unknown primary (CUPs)?

CUPs are heterogeneous tumors where the primitive (primary) site remains unknown after extensive work-up, while metastases are the most common manifestation.

Why is male occult breast cancer within CUP considered rare?

Male breast cancer is uncommon and CUPs of male breast origin are therefore rarely considered in diagnosis, with very few cases reported in the literature.

How is the initial diagnostic work-up for CUP typically performed?

It includes basic blood analyses and relevant tumor markers, followed by imaging such as CT of the chest, abdomen, and pelvis and, frequently, PET to search for otherwise unrecognized malignant lesions.

Sep 22, 2026

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