Simultaneous breast cancer and hepatocellular carcinoma in a male patient with alcoholic liver cirrhosis and a normal serum alpha-fetoprotein level

Abstract

Male breast cancer is rare, accounting for about 1% of all breast cancers. Hepatocellular carcinoma (HCC) is associated with liver cirrhosis in 70%–80% of cases; serum alpha-fetoprotein level is normal in less than half of HCC cases. We describe an 80-year-old male patient who experienced nausea and abdominal pain after food intake. On physical examination, a large, protruding, lobulated, and hard mass with skin discoloration was observed in the area of left breast. The serum alpha-fetoprotein level was normal. Ultrasonography (US) of the abdomen showed findings compatible with cholelithiasis, acute cholecystitis, liver cirrhosis, and a mixed-echoic tumor in segment 6 (S6) of the liver. Contrast-enhanced computed tomography (CT) with arterial and portal venous phases demonstrated the typical findings of cholelithiasis and acute cholecystitis; it also revealed a nodular liver surface, and a hypervascular liver tumor with an early washout pattern. Therefore, liver cirrhosis and HCC in S6 of the liver were suspected. A huge, irregular, lobulated mass with interior septation, solid and fluid components, and an enhanced solid component was also found in the subareolar region of the left breast. US-guided biopsy of the liver tumor was performed and a diagnosis of HCC was established. Laparoscopic cholecystectomy and an excision of the left breast mass were performed. The breast mass was pathologically confirmed to be infiltrating ductal carcinoma not otherwise specified and with predominantly cystic degeneration. The patient received chemotherapy with tamoxifen for the breast cancer, and transarterial chemoembolization for the HCC. Concomitant breast cancer and HCC in a male patient were rarely reported in the literature. Herein, we have discussed the possible relationship of these two disease entities.

Keywords

• Simultaneous breast cancer and hepatocellular carcinoma
• Male
• Alcoholic liver cirrhosis
• Normal alpha fetoprotein