Triple-negative locally advanced male breast cancer in a 93 years old man: case report

Male breast cancer (MBC) represents approximately 1% of all breast cancers and typically manifests in the seventh decade of life. While hormone receptor-positive disease is the predominant subtype, triple-negative phenotypes are rare. Consequently, evidence-based treatment strategies for nonagenarians remain extremely limited. A 93-year-old male presented with a one-year history of a progressive, ulcerated right-sided retroareolar mass associated with sanguineous nipple discharge. Imaging identified a highly suspicious lesion (BI-RADS 5) with ipsilateral axillary lymphadenopathy. Core needle biopsy confirmed invasive carcinoma of no special type (NST), Scarff–Bloom–Richardson grade III. Immunohistochemistry (IHC) demonstrated a triple-negative phenotype (ER–, PR–, HER2–) with a Ki-67 index of 70%. Systemic staging revealed no evidence of distant metastases (cT4bN2aM0, Stage IIIB, AJCC 8th edition). Geriatric assessment using the G8 (10/17) and CARG (10/19) scores indicated significant vulnerability and a high risk of chemotherapy-related toxicity. The patient subsequently underwent modified radical mastectomy with level I–II axillary dissection. Final pathology confirmed a 47-mm grade III tumor with lympho-vascular and peri-neural invasion and 8 positive lymph nodes (pT4b pN2a cM0). Postmastectomy radiotherapy was administered. At 6 months, the patient remained free of locoregional recurrence. Locally advanced, triple-negative MBC in a nonagenarian poses complex therapeutic challenges. This case demonstrates the importance of integrating geriatric assessment into oncologic decision-making and suggests that some carefully selected elderly patients may tolerate standard locoregional therapy, although further evidence is required to define optimal management in this demographic.