Learning objectives
-Review clinical and radiographic features of the most common benign and malignant lesions of the male breast.
-Discuss the key radiologic signs of gynecomastia and its differentiation from breast cancer.
-Recognize lesions that require biopsy.
Background
Male breast diseaseincludes a wide spectrum of different conditions,
most of them benign (gynecomastia or cutaneous lesions),
but there is significant overlap in imaging and clinical presentation with malignancies,
though radiologist should be familiar with the most common lesions and be able identify the next step in diagnostic workup.
Over the last twenty years the percentage of men presenting with breast complaints has increased almost three times from 0,8 to 2,4 % (1). Symptomatic men frequently refer a palpable mass,
breast enlargement and tenderness.
Gynecomastia...
Findings and procedure details
Gynecomastia
Gynecomastia is the most common disease of a male breast.
Clinically it presents with as a soft palpable subareolar mass,
which can be tender at the examination.
Gynecomastia is caused by benign proliferation of the ductal and stromal tissue in response to hormone (estrogen) stimulation. In males,
estrogenic effects are physiologically increased in neonates,
adolescents and elderly (4).
Some other endocrine disorders,
systemic diseases and certain drugs may also cause gynecomastia. See Table 1 below.
Table 1.
From reference (5).
Physiologic causes:
Neonatal period...
Conclusion
In the setting of a palpable mass in a male patient,
mammography is a first image modality to apply,
usually completed with ultrasound.
Gynecomastia and breast cancer are the most common lesions,
normally they can be differentiated on the basis of clinical and radiographic features.
Gynecomastia consists in retroaleolar tissue that is concentric to the nipple-areola complex and bilateral in half of the cases,
while breast carcinoma is typically located eccentric to the nipple and usually is unilateral.
We have always keep in mind that...
References
1.
Iuanow E,
Kettler M,
Slanetz PJ.
Spectrum of disÂease in the male breast.
AJR Am J Roentgenol 2011; 196(3):W247–W259.
2.
Johnson RE,
Murad MH.
Gynecomastia: pathophysiology,
evaluation and management. Mayo Clin Proc 2009; 84:1010–1015.
3.
Cheri Nguyen,
Mark D.
Kettler,
Michael E.
Swirsky,
MD Vivian I.
Miller,
Caleb Scott,
Rhett Krause,
Jennifer A.
Hadro.
Male Breast Disease Pictorial Review with Radiologic-Pathologic Correlation. RadioGraphics 2013; 33:763–779.
4.
Grant E.
Lattin,
Robert A.
Jesinger,
Rubina Mattu,
Leonard M.
Glassman.
Diseases of the Male Breast: Radiologic-Pathologic Correlation...