Immunohistochemical staining of tumor cells showed strongly positive nuclear staining for estrogen and progesterone receptors (Figure 3) and negative staining for HER-2neu protein over-expression. Histological examination of the left axillary nodes showed that three of the seven lymph nodes dissected from the axilla were harboring deposits of metastatic ductal carcinoma. The other four lymph nodes showed findings consistent with dermatopathic lymphadenopathy.

The patient's course a few months after the operation remained uneventful. Patient one month back at age of 80 years; two years after being diagnosed and treated was admitted with diagnosis of mild dehydration due to poor feeding and managed supportively and discharged home. During his hospitalization metastasis work up included Chest-x ray, ultrasound of liver, liver function tests, CBC and calcium were negative.

Discussion
There is no comprehensive data on male breast cancer in Saudi Arabia or in the Middle East, however, the American Cancer Society estimates that in the year 2001, 1500 new cases of male invasive breast cancer will be diagnosed in the USA. Breast cancer is 100 times more common in women than in men. It accounts for < 1% of male cancers. It usually occurs in men of advanced age and is often detected at a more advanced state.

Genetics, exposure to radiation, endocrine problems and history of benign breast lesions are common risk factors in both men and women. Specifically to men, however, risks also include old age, high socio-economic status, exposure to female hormone (patients with prostatic cancers on Estrogen treatment), and patients with reduced testicular function (Kleinfelter's Syndrome, mumps orchitis, and undescended testicles).

Patients with hyperprolactinemia and/or gynecomastia have also been associated with male breast cancer, though to lesser extent.

A painless lump beneath the areola, usually discovered by the patient himself, is the most common presenting symptom in patients with male breast cancer. Cancer size is usually less than 3 cm in diameter and usually associated with nipple retraction, discharge, and fixation of breast tissue to skin and muscles. Breast pain occurs less frequently, and approximately 50% of men with breast cancer have palpable axillary lymph nodes.

Mammography detects 80-90% of patients with breast cancer who present with suspicious masses. Mammographic characteristics of male breast cancer are sub-areola and eccentric to the nipple. According to Appelbaum et al, "Margins of the lesions are well defined, calcifications are rarer and coarser than those occurring in female breast cancer"6. Fine needle aspiration and surgical biopsy in high-risk patients will confirm the diagnosis and provides an indication about potential response to hormonal treatment. Though male breast cancer represents only 1% of all breast cancers, 80-90% of cancers are infiltrating (invasive) ductal carcinoma, mostly because of delayed diagnosis. This type of cancer breaks through the duct wall and invades surrounding fatty tissues. The early stage of the disease is ductal carcinoma in situ; cancer is confined and limited to ducts. Paget's disease of the nipple, lobular carcinoma and sarcoma are far less common in male breast cancers compared to female.