SHM Converge Scientific Abstract ePoster Gallery-Thrombocytopenia, Anemia, and B Symptoms as Initial Manifestations of Metastatic Breast Cancer in a Man

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This case describes a 43-year-old man with chronic hepatitis B who presented with back pain, weight loss, fevers, and fatigue. Exam showed diffuse cervical lymphadenopathy. Initial labs revealed severe anemia and thrombocytopenia, with rare circulating blasts on peripheral smear, raising concern for infection or hematologic malignancy. CT imaging showed hepatosplenomegaly and diffuse marrow heterogeneity but no discrete mass.<br /><br />Because the presentation suggested cancer of unknown primary (CUP), the team pursued a broad inpatient workup. Infectious testing was largely negative. Bone marrow biopsy revealed metastatic adenocarcinoma, and cervical lymph node biopsy confirmed ER/PR-negative, HER2-negative metastatic breast cancer. Tumor markers associated with breast cancer, including CA 15-3 and CA 27.29, were elevated. Additional studies for other possible primaries, including prostate, germ cell, liver, and salivary gland cancers, were unrevealing or nonspecific.<br /><br />The patient was treated with capecitabine rather than hormone therapy because of urgent cytoreduction needs from his cytopenias and only low-level ER positivity. After discharge, PET/CT demonstrated diffuse osseous metastases throughout the skeleton without an identifiable primary lesion. He was later readmitted with elevated liver enzymes, and liver biopsy showed diffuse tumor infiltration rather than hepatitis-related inflammation, prompting initiation of chemotherapy.<br /><br />The case highlights that metastatic solid tumors can rarely present as infiltrative marrow and liver disease without a visible primary tumor. In patients with cytopenias and B symptoms, especially when standard infectious workup is negative, clinicians should consider metastatic malignancy as well as hematologic disease.

Asset Subtitle

Andrew R. Lai

Meta Tag

Author List Andrew R. Lai, Jonathan Klein, Molly A. Kantor, Sam Brondfield, Yoo Jin (Eunice) Lee

Category Clinical Vignettes

Concept Advanced Solid Tumor

Concept Cancer of Unknown Primary

Concept Bone Marrow Involvement

Concept Biopsy

Concept Cytopenia

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Andrew R. Lai

Track Adult

Keywords

metastatic breast cancer

cancer of unknown primary

bone marrow biopsy

cervical lymphadenopathy

cytopenias

hepatosplenomegaly

diffuse osseous metastases

CA 15-3

CA 27.29

chronic hepatitis B

Advanced Solid Tumor

Cancer of Unknown Primary

Bone Marrow Involvement

Biopsy

Cytopenia