User login
Recurrence of Adult Cerebellar Medulloblastoma With Bone Marrow Metastasis: A Case Report and Review of the Literature
INTRODUCTION
Medulloblastoma (MB) is rarely seen in adulthood. Treatment guidelines are derived from studies of the pediatric population, results favoring the Packer regimen (cisplatin plus cyclophosphamide or lomustine plus vincristine). MB rarely has extraneural metastases, especially the bone marrow.
CASE PRESENTATION
A 32-year-old female with a past medical history of cerebellar MB confirmed on surgical pathology status post resection, weekly radiation and vincristine treatment presented to us in clinic to re-establish care. She was lost to follow-up 9 months after initial diagnosis and wished to continue treatment. She was started on Lomustine, Cisplatin and Vincristine after discussion with our colleagues at MSKCC, where she had received her initial treatment. After cycle three, she developed intractable bone pain and pancytopenia. Bone marrow biopsy revealed metastasis of Sonic Hedgehog Desmoplastic/nodular variant MB. PET and CT imaging confirmed metastatic disease in the bone marrow and repeat MRI brain showed abnormal nodular enhancement. CSF analysis to assess for spinal metastasis was negative. The patient was started on Temozolomide, Irinotecan and Bevacizumab with significant improvement in bone pain and radiological improvement noted on PET and CT scans. After cycle six, the patient had increased bone pain and repeat FDG-PET showed increased uptake, however, she continued to receive treatment and her pain has improved off narcotics.
DISCUSSION
We highlight a case of adult MB in the bone marrow responsive to temozolomide, irinotecan and bevacizumab. We conducted a literature search using PubMed, Medline and Web of Science between 1990 to 2022. In 2021, COG Phase 2 screening trial showed bevacizumab, temozolamide/irinotecan therapy significantly reduced the risk of death with recurrent MBs, two studies included patients up to 21 and 23 years of age. Other modalities showing some response include Vincristine plus cyclophosphamide as well as high dose carboplatin, thiotepa and etoposide alongside autologous SCT. Vismodegib has also shown varied response of 15 months in two adults with extraneural MB metastasis. Given the unique entity of adult MB and extraneural metastasis, limitations include small sample and lack of generalizability.
CONCLUSIONS
Extraneural metastasis of MB yields a poor prognosis. Future considerations include randomized trials to establish efficacy of Temozolomide, Irinotecan plus Bevacizumab in this population.
INTRODUCTION
Medulloblastoma (MB) is rarely seen in adulthood. Treatment guidelines are derived from studies of the pediatric population, results favoring the Packer regimen (cisplatin plus cyclophosphamide or lomustine plus vincristine). MB rarely has extraneural metastases, especially the bone marrow.
CASE PRESENTATION
A 32-year-old female with a past medical history of cerebellar MB confirmed on surgical pathology status post resection, weekly radiation and vincristine treatment presented to us in clinic to re-establish care. She was lost to follow-up 9 months after initial diagnosis and wished to continue treatment. She was started on Lomustine, Cisplatin and Vincristine after discussion with our colleagues at MSKCC, where she had received her initial treatment. After cycle three, she developed intractable bone pain and pancytopenia. Bone marrow biopsy revealed metastasis of Sonic Hedgehog Desmoplastic/nodular variant MB. PET and CT imaging confirmed metastatic disease in the bone marrow and repeat MRI brain showed abnormal nodular enhancement. CSF analysis to assess for spinal metastasis was negative. The patient was started on Temozolomide, Irinotecan and Bevacizumab with significant improvement in bone pain and radiological improvement noted on PET and CT scans. After cycle six, the patient had increased bone pain and repeat FDG-PET showed increased uptake, however, she continued to receive treatment and her pain has improved off narcotics.
DISCUSSION
We highlight a case of adult MB in the bone marrow responsive to temozolomide, irinotecan and bevacizumab. We conducted a literature search using PubMed, Medline and Web of Science between 1990 to 2022. In 2021, COG Phase 2 screening trial showed bevacizumab, temozolamide/irinotecan therapy significantly reduced the risk of death with recurrent MBs, two studies included patients up to 21 and 23 years of age. Other modalities showing some response include Vincristine plus cyclophosphamide as well as high dose carboplatin, thiotepa and etoposide alongside autologous SCT. Vismodegib has also shown varied response of 15 months in two adults with extraneural MB metastasis. Given the unique entity of adult MB and extraneural metastasis, limitations include small sample and lack of generalizability.
CONCLUSIONS
Extraneural metastasis of MB yields a poor prognosis. Future considerations include randomized trials to establish efficacy of Temozolomide, Irinotecan plus Bevacizumab in this population.
INTRODUCTION
Medulloblastoma (MB) is rarely seen in adulthood. Treatment guidelines are derived from studies of the pediatric population, results favoring the Packer regimen (cisplatin plus cyclophosphamide or lomustine plus vincristine). MB rarely has extraneural metastases, especially the bone marrow.
CASE PRESENTATION
A 32-year-old female with a past medical history of cerebellar MB confirmed on surgical pathology status post resection, weekly radiation and vincristine treatment presented to us in clinic to re-establish care. She was lost to follow-up 9 months after initial diagnosis and wished to continue treatment. She was started on Lomustine, Cisplatin and Vincristine after discussion with our colleagues at MSKCC, where she had received her initial treatment. After cycle three, she developed intractable bone pain and pancytopenia. Bone marrow biopsy revealed metastasis of Sonic Hedgehog Desmoplastic/nodular variant MB. PET and CT imaging confirmed metastatic disease in the bone marrow and repeat MRI brain showed abnormal nodular enhancement. CSF analysis to assess for spinal metastasis was negative. The patient was started on Temozolomide, Irinotecan and Bevacizumab with significant improvement in bone pain and radiological improvement noted on PET and CT scans. After cycle six, the patient had increased bone pain and repeat FDG-PET showed increased uptake, however, she continued to receive treatment and her pain has improved off narcotics.
DISCUSSION
We highlight a case of adult MB in the bone marrow responsive to temozolomide, irinotecan and bevacizumab. We conducted a literature search using PubMed, Medline and Web of Science between 1990 to 2022. In 2021, COG Phase 2 screening trial showed bevacizumab, temozolamide/irinotecan therapy significantly reduced the risk of death with recurrent MBs, two studies included patients up to 21 and 23 years of age. Other modalities showing some response include Vincristine plus cyclophosphamide as well as high dose carboplatin, thiotepa and etoposide alongside autologous SCT. Vismodegib has also shown varied response of 15 months in two adults with extraneural MB metastasis. Given the unique entity of adult MB and extraneural metastasis, limitations include small sample and lack of generalizability.
CONCLUSIONS
Extraneural metastasis of MB yields a poor prognosis. Future considerations include randomized trials to establish efficacy of Temozolomide, Irinotecan plus Bevacizumab in this population.
A Multi-Disciplinary Approach to Increasing Germline Genetic Testing for Prostate Cancer
PURPOSE
This quality improvement project aims to enhance the rate of germline genetic testing for prostate cancer at the Stratton VA Medical Center, improving risk reduction strategies and therapeutic options for patients.
BACKGROUND
Prostate cancer is prevalent at the Stratton VA Medical Center, yet the rate of genetic evaluation for prostate cancer remains suboptimal. National guidelines recommend genetic counseling and testing in specific patient populations. To address this gap, an interdisciplinary working group conducted gap analysis and root cause analysis, identifying four significant barriers.
METHODS
The working group comprised medical oncologists, urologists, primary care physicians, genetics counselors, data experts, and a LEAN coach. Interventions included implementing a prostate cancer pathway to educate staff on genetic testing indications and integrating genetic testing screening into clinic visits. After the interventions were implemented in January 2022, patient charts were reviewed for all genetic referrals and new prostate cancer diagnoses from January to December 2022.
DATA ANALYSIS
Descriptive analysis was conducted on referral rates, evaluation visit completion rates, and genetic testing outcomes among prostate cancer patients.
RESULTS
During the study period, 59 prostate cancer patients were referred for genetic evaluation. Notably, this was a large increase from no genetic referrals for prostate cancer in the previous year. Among them, 43 completed the evaluation visit, and 34 underwent genetic testing. Noteworthy findings were observed in 5 patients, including 3 variants of unknown significance and 2 pathogenic germline variants: HOXB13 and BRCA2 mutations.
IMPLICATIONS
This project highlights the power of a collaborative, multidisciplinary approach to overcome barriers and enhance the quality of care for prostate cancer patients. The team’s use of gap analysis and root cause analysis successfully identified barriers and proposed solutions, leading to increased referrals and the identification of significant genetic findings. Continued efforts to improve access to germline genetic testing are crucial for enhanced patient care and improved outcomes.
PURPOSE
This quality improvement project aims to enhance the rate of germline genetic testing for prostate cancer at the Stratton VA Medical Center, improving risk reduction strategies and therapeutic options for patients.
BACKGROUND
Prostate cancer is prevalent at the Stratton VA Medical Center, yet the rate of genetic evaluation for prostate cancer remains suboptimal. National guidelines recommend genetic counseling and testing in specific patient populations. To address this gap, an interdisciplinary working group conducted gap analysis and root cause analysis, identifying four significant barriers.
METHODS
The working group comprised medical oncologists, urologists, primary care physicians, genetics counselors, data experts, and a LEAN coach. Interventions included implementing a prostate cancer pathway to educate staff on genetic testing indications and integrating genetic testing screening into clinic visits. After the interventions were implemented in January 2022, patient charts were reviewed for all genetic referrals and new prostate cancer diagnoses from January to December 2022.
DATA ANALYSIS
Descriptive analysis was conducted on referral rates, evaluation visit completion rates, and genetic testing outcomes among prostate cancer patients.
RESULTS
During the study period, 59 prostate cancer patients were referred for genetic evaluation. Notably, this was a large increase from no genetic referrals for prostate cancer in the previous year. Among them, 43 completed the evaluation visit, and 34 underwent genetic testing. Noteworthy findings were observed in 5 patients, including 3 variants of unknown significance and 2 pathogenic germline variants: HOXB13 and BRCA2 mutations.
IMPLICATIONS
This project highlights the power of a collaborative, multidisciplinary approach to overcome barriers and enhance the quality of care for prostate cancer patients. The team’s use of gap analysis and root cause analysis successfully identified barriers and proposed solutions, leading to increased referrals and the identification of significant genetic findings. Continued efforts to improve access to germline genetic testing are crucial for enhanced patient care and improved outcomes.
PURPOSE
This quality improvement project aims to enhance the rate of germline genetic testing for prostate cancer at the Stratton VA Medical Center, improving risk reduction strategies and therapeutic options for patients.
BACKGROUND
Prostate cancer is prevalent at the Stratton VA Medical Center, yet the rate of genetic evaluation for prostate cancer remains suboptimal. National guidelines recommend genetic counseling and testing in specific patient populations. To address this gap, an interdisciplinary working group conducted gap analysis and root cause analysis, identifying four significant barriers.
METHODS
The working group comprised medical oncologists, urologists, primary care physicians, genetics counselors, data experts, and a LEAN coach. Interventions included implementing a prostate cancer pathway to educate staff on genetic testing indications and integrating genetic testing screening into clinic visits. After the interventions were implemented in January 2022, patient charts were reviewed for all genetic referrals and new prostate cancer diagnoses from January to December 2022.
DATA ANALYSIS
Descriptive analysis was conducted on referral rates, evaluation visit completion rates, and genetic testing outcomes among prostate cancer patients.
RESULTS
During the study period, 59 prostate cancer patients were referred for genetic evaluation. Notably, this was a large increase from no genetic referrals for prostate cancer in the previous year. Among them, 43 completed the evaluation visit, and 34 underwent genetic testing. Noteworthy findings were observed in 5 patients, including 3 variants of unknown significance and 2 pathogenic germline variants: HOXB13 and BRCA2 mutations.
IMPLICATIONS
This project highlights the power of a collaborative, multidisciplinary approach to overcome barriers and enhance the quality of care for prostate cancer patients. The team’s use of gap analysis and root cause analysis successfully identified barriers and proposed solutions, leading to increased referrals and the identification of significant genetic findings. Continued efforts to improve access to germline genetic testing are crucial for enhanced patient care and improved outcomes.
Evaluating Progression Free Survival Among Veteran Population With Stage IV Non-Small Cell Immunotherapy vs Chemo- Immunotherapy
Background
Use of immune checkpoint inhibitors against advanced stage NSCLC has been associated with significant reduction in overall disease morbidity and mortality. However, despite the significant survival benefit, tumors invariably relapse. It is important to understand the pattern of progression and the progression free survival (PFS) to better predict disease outcomes and modify treatment approach.
Methods
We performed a retrospective review of 74 veterans with new diagnosis of stage IV NSCLC who received 2 or more cycles of immunotherapy with/without concurrent chemotherapy between 2015-2021 at the Stratton VA Medical Center. IRB approval was obtained. Fisher exact probability test and Kaplan-Meier estimators were used to analyze data with level of significance P < .05.
Results
Out of 74 patients, 38 patients were identified who received immunotherapy alone (Group A; n = 23, 60.5%) vs chemo-immunotherapy (Group B; n = 15, 39.5%). Baseline characteristics of Group A revealed median age 70 (IQR, 65-78), adenocarcinoma (n = 10, 43.4%), squamous cell carcinoma (n = 12, 52.1%), PD-L1 > 50% expression (n = 21, 91.3%), molecular testing positive for EGFR in 1 patient, otherwise negative for ROS, ALK, EGFR and BRAF mutations in all patients. Similarly, in Group B, median age 66 (IQR, 63-72), adenocarcinoma (n = 6, 40%), squamous cell carcinoma (n = 8, 53.3%), PD-L1 > 50% expression (n = 3, 20%), no mutations noted on molecular testing. Out of 38 patients, disease progression was noted in 19 patients, 10 in Group A (progression at initial site and new site n = 5, 50%) vs 9 in Group B (progression at initial site and new site, n = 6, 66.7%). Most common sites of progression included local and distant lymph nodes, brain, bone, and liver. Using the Kaplan-Meier analysis, median progression free survival (PFS) from start of immunotherapy till evidence of progression on imaging was 11 months in Group A and 7 months in Group B, P = .22. Our study recognized widespread metastases at the time of diagnosis (P = .03) as a possible factor affecting progression of diseases in Group A compared to Group B.
Conclusion
We conclude that although no statistically significant association was noted between the progression free survival between the two groups, the increased median PFS in immunotherapy only group is worth additional investigation. We recommend further large-scale studies to explore this association.
Background
Use of immune checkpoint inhibitors against advanced stage NSCLC has been associated with significant reduction in overall disease morbidity and mortality. However, despite the significant survival benefit, tumors invariably relapse. It is important to understand the pattern of progression and the progression free survival (PFS) to better predict disease outcomes and modify treatment approach.
Methods
We performed a retrospective review of 74 veterans with new diagnosis of stage IV NSCLC who received 2 or more cycles of immunotherapy with/without concurrent chemotherapy between 2015-2021 at the Stratton VA Medical Center. IRB approval was obtained. Fisher exact probability test and Kaplan-Meier estimators were used to analyze data with level of significance P < .05.
Results
Out of 74 patients, 38 patients were identified who received immunotherapy alone (Group A; n = 23, 60.5%) vs chemo-immunotherapy (Group B; n = 15, 39.5%). Baseline characteristics of Group A revealed median age 70 (IQR, 65-78), adenocarcinoma (n = 10, 43.4%), squamous cell carcinoma (n = 12, 52.1%), PD-L1 > 50% expression (n = 21, 91.3%), molecular testing positive for EGFR in 1 patient, otherwise negative for ROS, ALK, EGFR and BRAF mutations in all patients. Similarly, in Group B, median age 66 (IQR, 63-72), adenocarcinoma (n = 6, 40%), squamous cell carcinoma (n = 8, 53.3%), PD-L1 > 50% expression (n = 3, 20%), no mutations noted on molecular testing. Out of 38 patients, disease progression was noted in 19 patients, 10 in Group A (progression at initial site and new site n = 5, 50%) vs 9 in Group B (progression at initial site and new site, n = 6, 66.7%). Most common sites of progression included local and distant lymph nodes, brain, bone, and liver. Using the Kaplan-Meier analysis, median progression free survival (PFS) from start of immunotherapy till evidence of progression on imaging was 11 months in Group A and 7 months in Group B, P = .22. Our study recognized widespread metastases at the time of diagnosis (P = .03) as a possible factor affecting progression of diseases in Group A compared to Group B.
Conclusion
We conclude that although no statistically significant association was noted between the progression free survival between the two groups, the increased median PFS in immunotherapy only group is worth additional investigation. We recommend further large-scale studies to explore this association.
Background
Use of immune checkpoint inhibitors against advanced stage NSCLC has been associated with significant reduction in overall disease morbidity and mortality. However, despite the significant survival benefit, tumors invariably relapse. It is important to understand the pattern of progression and the progression free survival (PFS) to better predict disease outcomes and modify treatment approach.
Methods
We performed a retrospective review of 74 veterans with new diagnosis of stage IV NSCLC who received 2 or more cycles of immunotherapy with/without concurrent chemotherapy between 2015-2021 at the Stratton VA Medical Center. IRB approval was obtained. Fisher exact probability test and Kaplan-Meier estimators were used to analyze data with level of significance P < .05.
Results
Out of 74 patients, 38 patients were identified who received immunotherapy alone (Group A; n = 23, 60.5%) vs chemo-immunotherapy (Group B; n = 15, 39.5%). Baseline characteristics of Group A revealed median age 70 (IQR, 65-78), adenocarcinoma (n = 10, 43.4%), squamous cell carcinoma (n = 12, 52.1%), PD-L1 > 50% expression (n = 21, 91.3%), molecular testing positive for EGFR in 1 patient, otherwise negative for ROS, ALK, EGFR and BRAF mutations in all patients. Similarly, in Group B, median age 66 (IQR, 63-72), adenocarcinoma (n = 6, 40%), squamous cell carcinoma (n = 8, 53.3%), PD-L1 > 50% expression (n = 3, 20%), no mutations noted on molecular testing. Out of 38 patients, disease progression was noted in 19 patients, 10 in Group A (progression at initial site and new site n = 5, 50%) vs 9 in Group B (progression at initial site and new site, n = 6, 66.7%). Most common sites of progression included local and distant lymph nodes, brain, bone, and liver. Using the Kaplan-Meier analysis, median progression free survival (PFS) from start of immunotherapy till evidence of progression on imaging was 11 months in Group A and 7 months in Group B, P = .22. Our study recognized widespread metastases at the time of diagnosis (P = .03) as a possible factor affecting progression of diseases in Group A compared to Group B.
Conclusion
We conclude that although no statistically significant association was noted between the progression free survival between the two groups, the increased median PFS in immunotherapy only group is worth additional investigation. We recommend further large-scale studies to explore this association.
A Rare Case of Triple Positive Inflammatory Breast Cancer in An Elderly Male
BACKGROUND: An 84-year-old male presented with a rapidly growing left breast mass associated with warmth, erythema, and serous discharge from left nipple for 2.5 months. Physical exam revealed ‘peau d’orange’ appearance of skin and a 3×7 cm, firm, irregular, fixed mass in left breast. Core needle biopsy of left breast revealed invasive ductal carcinoma and a computed tomography scan of chest showed multiple small pulmonary nodules. Patient was diagnosed with inflammatory breast carcinoma (Stage IV, cT4d cN1 cM1), ER/ PR positive, HER-2 positive. BRCA testing was negative. After a normal MUGA scan, patient was started on weekly paclitaxel and trastuzumab. After 4 cycles patient developed diarrhea and elected to stop paclitaxel. After 10 cycles of trastuzumab, patient developed signs of heart failure and a MUGA showed depressed left ventricular ejection fraction (LVEF). Trastuzumab was held and patient was started on tamoxifen. Patient had progression of primary mass into a fungating lesion and evidence of new pulmonary metastatic disease on tamoxifen. The primary lesion was treated with palliative radiation and after a subsequent MUGA scan showed normalization of LVEF; trastuzumab was resumed. Patient had stable disease on trastuzumab and continued to follow with oncology.
DISCUSSION: Male breast cancer is < 1% of all breast cancer but incidence is rising in the US. Risk factors include family history, BRCA2 > BRCA1, obesity, cirrhosis, and radiation exposure. Inflammatory breast cancer (IBC) is a rapidly progressive malignancy with a clinicopathological diagnosis. There are paucity of data of IBC in men due to rarity of the disease. Many patients initially are misdiagnosed with mastitis, unresponsive to antibiotics. At diagnosis, most patients have a higher age compared with females (by 5-10 years), and advanced stage, though have a similar prognosis by stage. Prognostic factors and treatment principles are same as females with multimodal approach of chemotherapy, radiation therapy, and hormone therapy.
CONCLUSIONS: IBC in men is very rare and awareness of its risk factors and presentation can lead to early diagnosis and better survival. Urgent referral to oncology is needed if index of suspicion is high. Further research is needed for defining best treatment modalities in elderly males.”
BACKGROUND: An 84-year-old male presented with a rapidly growing left breast mass associated with warmth, erythema, and serous discharge from left nipple for 2.5 months. Physical exam revealed ‘peau d’orange’ appearance of skin and a 3×7 cm, firm, irregular, fixed mass in left breast. Core needle biopsy of left breast revealed invasive ductal carcinoma and a computed tomography scan of chest showed multiple small pulmonary nodules. Patient was diagnosed with inflammatory breast carcinoma (Stage IV, cT4d cN1 cM1), ER/ PR positive, HER-2 positive. BRCA testing was negative. After a normal MUGA scan, patient was started on weekly paclitaxel and trastuzumab. After 4 cycles patient developed diarrhea and elected to stop paclitaxel. After 10 cycles of trastuzumab, patient developed signs of heart failure and a MUGA showed depressed left ventricular ejection fraction (LVEF). Trastuzumab was held and patient was started on tamoxifen. Patient had progression of primary mass into a fungating lesion and evidence of new pulmonary metastatic disease on tamoxifen. The primary lesion was treated with palliative radiation and after a subsequent MUGA scan showed normalization of LVEF; trastuzumab was resumed. Patient had stable disease on trastuzumab and continued to follow with oncology.
DISCUSSION: Male breast cancer is < 1% of all breast cancer but incidence is rising in the US. Risk factors include family history, BRCA2 > BRCA1, obesity, cirrhosis, and radiation exposure. Inflammatory breast cancer (IBC) is a rapidly progressive malignancy with a clinicopathological diagnosis. There are paucity of data of IBC in men due to rarity of the disease. Many patients initially are misdiagnosed with mastitis, unresponsive to antibiotics. At diagnosis, most patients have a higher age compared with females (by 5-10 years), and advanced stage, though have a similar prognosis by stage. Prognostic factors and treatment principles are same as females with multimodal approach of chemotherapy, radiation therapy, and hormone therapy.
CONCLUSIONS: IBC in men is very rare and awareness of its risk factors and presentation can lead to early diagnosis and better survival. Urgent referral to oncology is needed if index of suspicion is high. Further research is needed for defining best treatment modalities in elderly males.”
BACKGROUND: An 84-year-old male presented with a rapidly growing left breast mass associated with warmth, erythema, and serous discharge from left nipple for 2.5 months. Physical exam revealed ‘peau d’orange’ appearance of skin and a 3×7 cm, firm, irregular, fixed mass in left breast. Core needle biopsy of left breast revealed invasive ductal carcinoma and a computed tomography scan of chest showed multiple small pulmonary nodules. Patient was diagnosed with inflammatory breast carcinoma (Stage IV, cT4d cN1 cM1), ER/ PR positive, HER-2 positive. BRCA testing was negative. After a normal MUGA scan, patient was started on weekly paclitaxel and trastuzumab. After 4 cycles patient developed diarrhea and elected to stop paclitaxel. After 10 cycles of trastuzumab, patient developed signs of heart failure and a MUGA showed depressed left ventricular ejection fraction (LVEF). Trastuzumab was held and patient was started on tamoxifen. Patient had progression of primary mass into a fungating lesion and evidence of new pulmonary metastatic disease on tamoxifen. The primary lesion was treated with palliative radiation and after a subsequent MUGA scan showed normalization of LVEF; trastuzumab was resumed. Patient had stable disease on trastuzumab and continued to follow with oncology.
DISCUSSION: Male breast cancer is < 1% of all breast cancer but incidence is rising in the US. Risk factors include family history, BRCA2 > BRCA1, obesity, cirrhosis, and radiation exposure. Inflammatory breast cancer (IBC) is a rapidly progressive malignancy with a clinicopathological diagnosis. There are paucity of data of IBC in men due to rarity of the disease. Many patients initially are misdiagnosed with mastitis, unresponsive to antibiotics. At diagnosis, most patients have a higher age compared with females (by 5-10 years), and advanced stage, though have a similar prognosis by stage. Prognostic factors and treatment principles are same as females with multimodal approach of chemotherapy, radiation therapy, and hormone therapy.
CONCLUSIONS: IBC in men is very rare and awareness of its risk factors and presentation can lead to early diagnosis and better survival. Urgent referral to oncology is needed if index of suspicion is high. Further research is needed for defining best treatment modalities in elderly males.”