Introduction Cervical lymphadenopathy can be caused by numerous diseases, although a common entity, etiological diagnosis can be challenging.

Material and Methods A 51-year-old male patient presented in our emergency department with painless bilateral cervical lymphadenopathy for one month. The neck ultrasound revealed enlarged, morphologically suspicious lymph nodes. After consultation with our oncology department, given the clinical suspicion of lymphoma, a CT neck, chest, abdomen and a diagnostic lymph node extirpation were performed within a week.

Results The first pathology report revealed a necrotic lymph node metastasis of a carcinoma but was overall inconclusive. Suspecting a carcinoma of unknown primary (CUP) we performed a panendoscopy, a coloscopy, a urologic consultation and tumor marker tests within blood serum. The histological specimen was sent to a reference pathology center for further examination. The immunohistochemistry revealed a strong HER2 expression suggesting a carcinoma of glandular origin.

A subsequent gynaecological consultation revealed an adipomastia unremarkable on inspection, palpation identified a less than one-centimetre node in the right inframammary fold. Although the mammography was rated as BI-RADS 1 a biopsy of the palpatory finding revealed a hormone receptor-negative ductal invasive carcinoma of the right breast. A primary chemotherapy was initiated.

Discussion Cervical lymphadenopathy may result diverse etiologies. Male breast cancer is a rare entity and the clinical presentation is primarily in the form of a breast lump, ENT doctors see themselves rarely confronted with this entity. To our knowledge, this is the first report of cervical lymphadenopathy as first manifestation of male breast cancer.

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