Clinical and imaging features of male breast disease, with pathological correlation: A pictorial essay

Subareolar Breast Abscess in a Male: A Case Report

A subareolar breast abscess (SBA) is caused by the formation of an inflammatory abscess around the milk duct. SBAs usually occur in females, and reports of SBAs in males are very rare. This study reports the case of a 62-year-old male patient who presented with a subcutaneous nodule and diffuse erythema around the left nipple. Ultrasonography revealed a mixed lesion measuring 2.5 x 1.5 cm, mostly cystic. A computed tomography scan of the chest showed an irregular, nodular structure in the same area. Magnetic resonance imaging with contrast enhancement suggested an abscess. A needle biopsy was performed on the lesion, and results showed moderate inflammatory cell infiltration, including lymphocytes, plasma cells, neutrophils, and abscess formation, thus leading to the diagnosis of SBA. The patient did not strongly desire a surgical procedure. He was treated with the cephem antibiotic cefaclor and antipyretic analgesics. During the six-month healing period, cefaclor was administered for a total of six weeks. Once he improved, recurrence was observed two years after the onset of the disease; however, the symptoms improved with conservative treatment, such as warm compresses. Preventive measures should be considered as SBAs are prone to recurrence.

Differences in ultrasonographic features between males and females with breast cancer of the luminal A and luminal B molecular subtypes

AIM

To analyze the relationships between the ultrasonographic features and the molecular subtypes of breast cancer in men and women.

METHODS

Data were collected from 43 males and 80 females with breast cancer who were treated at our hospital. The following ultrasonographic characteristics of the tumors were evaluated: shape, orientation, margin, echo pattern, posterior features, calcifications, Color Doppler Flow Imaging, and Breast Imaging Reporting and Data System (BI-RADS) category.

RESULTS

On ultrasound, a nonparallel orientation, noncircumscribed margin, and attenuating posterior features were associated with luminal A lesions. A parallel orientation (P = 0.002), circumscribed margin (P = 0.04), no change in posterior features (P < 0.001), and the BI-RADS 4 category (P = 0.001) were significantly associated with luminal B lesions. In the group with luminal A lesions, male patients were older (P = 0.001) and a greater number of the tumors exhibited a regular shape (P = 0.009), circumscribed margin (P < 0.001), no change in posterior features (P < 0.001), and the BI-RADS 4 category (P < 0.001) than those in female patients. Male patients were older (P < 0.001) and a greater number showed a no change in posterior features (P < 0.001), spotty blood flow (P = 0.002), and the BI-RADS 4 category (P < 0.001) than female patients with masses of the luminal B subtype.

CONCLUSION

Obvious differences in the ultrasonographic and pathological features were noted between breast cancer in males and females, which provided the theoretical basis for the individualized treatment of breast cancer, particularly breast cancer in males.

Radiological and pathological correlation of a rare case of primary breast follicular lymphoma in a male patient, presenting as gynaecomastia

We present an exceptionally rare case of primary breast follicular lymphoma in a male patient, who presented to us with gynaecomastia for investigation. To our knowledge there have only been two other cases published in the literature to date. In Western Australia, there have been no cases in at least the past 10 years. This particular case highlights the importance of radiological and pathological correlation in making the diagnosis, particularly in the assessment of breast lumps in a male patient, where imaging and clinical findings alone could not make the diagnosis.

Characteristics and Management of Male Breast Parenchymal Cysts

OBJECTIVE

Parenchymal breast cysts are considered to be rare in men and are sparsely described in the literature. The purpose of this study was to review our institution's experience with male breast cysts in an effort to improve overall understanding and management of this rare entity.

METHODS

An institutional review board-exempt retrospective study was performed. Radiology reports for males who underwent mammogram and/or breast ultrasound at any of our institution's primary or satellite locations from January 1995 to January 2020 were screened to find males with breast cysts. If cysts were reported and images were available, case review was performed to confirm parenchymal breast cyst(s) and patient characteristics were collated.

RESULTS

Of 5425 male cases presenting for breast imaging, 19 (0.4%) cases of male breast cysts were confirmed, with a mean patient age of 41.6 years (range: 2-81 years). The most common indication leading to cyst discovery was a palpable lump, corresponding to the site of the cyst in 5 (26.3%) patients and near the site where cyst(s) were ultimately discovered in 7 (36.8%) patients. There were 8 (42.1%) instances of cysts without concurrent gynecomastia. Three (15.8%) men underwent needle sampling. There were no cases of atypia or malignancy on needle biopsy or on subsequent clinical follow-up, with median clinical follow-up of 70.3 months (range: 3.3-259.4 months).

CONCLUSION

Male breast parenchymal cysts are rare, but their prevalence is likely underestimated. If detected incidentally or upon targeted evaluation, biopsy may be averted if classic benign cyst features are identified.

Benign Breast Cyst in a Young Male

Simple benign breast cysts are commonly diagnosed in female breasts and may present as palpable masses. However, they are extremely uncommon in the male breast and are rarely reported in the literature. Here, we report a case of a simple benign cyst of the breast in a relatively healthy 37-year-old man. The patient initially presented with a palpable 2-3 mm tender left breast lump. Further evaluation with mammography and ultrasound revealed a mass most consistent with a simple benign cyst. However, considering the rarity of breast cysts in males, the lesion was biopsied to rule out malignancy. Pathology results from ultrasound-guided core needle biopsy demonstrated fibro-adipose tissue with a benign cyst lined by foamy cells with apocrine features, consistent with a diagnosis of a benign epithelial cyst and concordant with the radiological findings. To our knowledge, this is the youngest case of a benign breast cyst in a male that has been reported in the literature. In this case report, we discuss the typical features and presentation of breast cysts in males, associated imaging findings on mammography and ultrasound, and the necessity for pathological confirmation with biopsy in this population.

Breast panniculitis with liquefactive fat necrosis: A case report

Panniculitis is a group of heterogeneous disorders characterized by inflammation of the subcutaneous adipose tissue. Panniculitis of breast tissue as the initial manifestation has rarely been reported and is often misdiagnosed. Breast panniculitis may cause substantial morbidity and early diagnosis and treatment are important for the prognosis of the disease. The present study has reported a case of panniculitis with inflammation of the mammary glands as the initial presentation and provided a detailed description of ultrasonography, X-ray, computed tomography, magnetic resonance imaging and other imaging features of breast panniculitis. The treatment and follow-up were also described. Following treatment with systemic corticosteroids combined with methotrexate and thalidomide for 2 months, the breast appeared to be normal without scar formation. The present case report provides a good reference for the future diagnosis and treatment of breast panniculitis.

Clinical and ultrasonographic features of male breast tumors: A retrospective analysis

Objective

The purpose of this study was to determine clinical and ultrasonographic characteristics of male breast tumors.

Methods

The medical records of male patients with breast lesions were retrieved from an electronic medical record database and a pathology database and retrospectively reviewed. A total of 112 men (125 breast masses) with preoperative breast ultrasonography (US) were included (median age, 59.50 years; age range, 15–96 years). Data extracted included patient age, if the lesions were bilateral, palpable, and tender, and the presence of nipple discharge. Breast lesion features on static US images were reviewed by three experienced radiologists without knowledge of physical examination or pathology results, original breast US image interpretations, or surgical outcomes. The US features were documented according to the BI-RADS (Breast Imaging-Reporting and Data System) US lexicons. A forth radiologist compiled the data for analysis.

Results

Of the 125 breast masses, palpable tender lumps and bilateral synchronous masses were more likely to be benign than malignant (both, 100% vs 0%, P < 0.05). Advanced age and bloody discharge from nipples were common in malignant lesions (P <0.05). A mass eccentric to a nipple, irregular shape, the presence of an echogenic halo, predominantly internal vascularity, and rich color flow signal on color Doppler ultrasound were significantly related to malignancy (all, P < 0.05). An echogenic halo and the presence of rich color flow signal were independent predictors of malignancy.

Conclusion

Specific clinical and US characteristics of male breast tumors may help guide treatment, and determine if surgery or conservative treatment is preferable.

The Characteristics and Short-Term Surgical Outcomes of Adolescent Gynecomastia

BACKGROUND

Most adolescent gynecomastia is resolved spontaneously in 3 years. But, persistent gynecomastia could have a negative influence on psychoemotional development on adolescence. The purpose of this study is to report the characteristics of adolescent gynecomastia patients who received the surgeries, and discuss the short-term surgical outcomes.

METHODS

Of the 1454 patients who underwent gynecomastia surgery at Damsoyu hospital from January 2014 to May 2016, 71 were adolescents. Subcutaneous mastectomy with liposuction was performed for adolescent patients who had gynecomastia for more than 3 years and showed psychosocial distress. Demographic and outcome variables were retrospectively analyzed.

RESULTS

The mean age was 17.5 ± 0.77 years old. All gynecomastia cases were bilateral. Simon's grade IIa (35 patients, 49.3%) was the most common, and grade III was not observed. Fifty-one patients (71.8%) were classified as having a glandular-type breast component. Fourteen patients (19.7%) had complications, but only 3 cases (4.2%) required revision. Most of the patients (70 patients, 98.6%) were satisfied with the esthetic results, and the average 5-point Likert score was 4.85 ± 0.40. Recurrence was not observed. As the Simon's grade increased from I to IIA, a higher BMI, larger amounts of breast tissue, and longer operation times were observed.

CONCLUSIONS

Gynecomastia that did not regress spontaneously was mostly the glandular type, so not only liposuction but also surgical removal of glandular tissue is necessary. Surgical treatment, selectively performed in patients who have had gynecomastia for 3 years, and have experienced psychosocial distress, could be an acceptable treatment for adolescent gynecomastia.

LEVEL OF EVIDENCE IV

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Radiologic presentation of a myofibroblastoma of the adult male breast

We present the case of a 50-year-old male with bilateral gynecomastia who was incidentally found to have 0.8-cm subareolar mass on computed tomography. Mammographic and sonographic characteristics of the lesion are described as well as a brief historical review of myofibroblastoma, a rare mesenchymal tumor.

Male Breast: Clinical and Imaging Evaluations of Benign and Malignant Entities with Histologic Correlation

Breast cancer is an uncommon disease in men. As a result, the diagnosis may not initially be considered. Understanding the common benign and malignant entities affecting the male breast is critical for timely and accurate diagnosis in the primary care setting. Most patients present with a palpable breast mass or pain. The usual etiology is gynecomastia, the most common breast condition in males, but breast cancer must always be excluded through careful imaging evaluation when physical examination findings are suspicious or inconclusive. Imaging of the male breast generally relies on mammography and ultrasound, with mammography employed as the initial imaging modality of choice and ultrasound when a mass is detected or suspected. Here we describe the normal male breast anatomy and present an evaluation algorithm for the male patient with breast signs or symptoms. The most common benign and malignant entities are described.

Mammography Findings of Male Breast Diseases

Over the past 2 decades, the percentage of men presenting with breast complaints has increased from 0.8% to 2.4%, and men now account for 1% of all breast cancer cases. The most common male breast mass is gynecomastia, followed by lipoma and epidermal inclusion cysts. Because there is a paucity of parenchyma as compared with the female breast, the malignancy rapidly progresses to the next stage, with the appearance of secondary signs like nipple retraction, fixation to deeper tissues, skin ulceration or adenopathy. Diagnostic evaluation is needed only when the palpable mass is unilateral, hard, fixed, peripheral to the nipple, or associated with nipple discharge, skin changes, or lymphadenopathy. Male breast cancer usually occurs in a subareolar location or is positioned eccentric to the nipple; occasionally, it occurs in a peripheral position. Secondary signs like skin thickening, nipple retraction, and axillary lymphadenopathy may be seen. Microcalcifications can occur. Mammography can accurately distinguish between malignant and benign male breast disease. Radiologists are generally less familiar with breast disease in males compared with females. In this article, we discuss the clinical, and mammographic features of a variety of benign and malignant diseases that can occur in the male breast.

Isolated panniculitis with vasculitis of the male breast suspicious for malignancy on CT and ultrasound: a case report and literature review

Introduction

We report a case of a 54-year-old male patient with a hard, painful nodule within his right breast which was misdiagnosed preoperatively as breast cancer.

Case description

Preoperative work-up included physical examination, non-contrast chest computed tomography (CT), sonography, and sono-guided breast biopsy. Isolated breast panniculitis with vasculitis (BPWV), a rare disease, was diagnosed by histopathologic examination of tissue obtained from excisional biopsy.

Discussion and Evaluation

Subcutaneous panniculitis with or without vasculitis, a condition of nonsuppurative inflammatory process involving the subcutaneous fat layer of skin, is related to different causes. A palpable benign male breast lesion resembling a malignancy includes gynecomastia, panniculitis with or without vasculitis, fat necrosis, ruptured epidermal cyst, pseudoangiomatous stromal hyperplasia, subareolar abscess, intraductal papilloma, hematoma, and atypical fibroadenoma. To make an accurate preoperative diagnosis of a male breast mass, a physician has to carefully analyze various imaging findings. The cases of BPWV may present as an isolated breast lesion or as a component of a systemic disease. The diagnosis of the reported patient was compatible with an isolated BPWV because panniculitis and/or vasculitis were not present at other sites or organs at the time of diagnosis or during follow-up.

Conclusions

Excisional biopsy and clinical data can provide the correct diagnosis and determined the appropriate treatment strategy of a male BPWV.