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Jung HK, Lim YJ. Sonographic Features of Palpable Breast and Axillary Lesions in Adult Male Patients: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:830-845. [PMID: 36238906 PMCID: PMC9514573 DOI: 10.3348/jksr.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 11/15/2022]
Abstract
The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast cancer, male breast cancer has a low incidence, and there is no established breast cancer screening program for male patients. Therefore, the diagnostic evaluation is usually performed in male patients with symptoms such as palpability or pain in the breasts. Furthermore, most adult male patients who visit breast clinics sometimes present with not only breast symptoms but also axillary symptoms, and both the breast and axilla are usually examined during breast ultrasonography in daily clinical practice. The purpose of this pictorial essay was to present the sonographic features of various palpable breast and axillary lesions in adult male patients.
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Patel K, Khan Z, Costumbrado J. To Drain or not to Drain? Point-of-care Ultrasound to Investigate an Axillary Mass: Case Report. Clin Pract Cases Emerg Med 2022. [DOI: 10.5811//cpcem.2022.2.53357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Point-of-care ultrasound (POCUS) has great sensitivity in the diagnosis of abscesses and swollen lymph nodes. Many studies outline the characteristics that distinguish abscesses from lymph nodes on POCUS.
Case Report: We present a case from the emergency department in which a patient presented with a potential abscess but was found to have a malignant lymph node on imaging.
Conclusion: Point-of-care ultrasound can be used to differentiate an abscess from a swollen lymph node. Abscesses are generally anechoic or hypoechoic with septae, sediment or gas contents, and they lack internal vascularity. Benign lymph nodes are echogenic with hypoechoic cortex with hilar vascularity.
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Affiliation(s)
- Kishan Patel
- University of California, Riverside School of Medicine, Riverside, California
| | - Zara Khan
- Riverside Community Hospital/University of California, Riverside, Department of Emergency Medicine, Riverside, California
| | - John Costumbrado
- Riverside Community Hospital/University of California, Riverside, Department of Emergency Medicine, Riverside, California
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Wang X, Fan L, Yan W, Zhang Q, Bao S, Wang Y, Bao X, Liu L. Axillary lymph node metastasis as the first manifestation of male occult breast cancer: A Case Report. Medicine (Baltimore) 2018; 97:e13706. [PMID: 30558087 PMCID: PMC6320098 DOI: 10.1097/md.0000000000013706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONAL Occult breast cancer (OBC) is an extremely rare breast cancer and is defined by the presence of axillary metastasis without a primary tumor in the breasts or any abnormality on radiologic examination. PATIENT CONCERNS This case report presents a 49-year-old man who was diagnosed with male OBC, which first manifested as an axillary lymph node metastasis followed by the emergence of infraclavicular lymph node metastasis. Neither the breast nor other organs had any abnormality. DIAGNOSIS The pathological examination revealed metastatic adenocarcinoma. Immunohistochemical (IHC) staining results were positive for estrogen receptor (ER), progesterone receptor (PR), and gross cystic disease fluid protein-15 (GCDFP-15); and negative for human epidermal receptor-2 (Her-2) 1+, cytokeratin (CK) 7, CK20, and thyroid transcription factor-1 (TTF-1). INTERVENTIONS The patient underwent left axillary lymph node dissection but not a mastectomy. After the operation, the patient subsequently underwent chemotherapy, radiotherapy, and endocrinotherapy. OUTCOMES Currently, he has been followed-up for >4 years without any signs of recurrence. LESSONS Careful physical and imaging examinations combined with pathological analysis are essential in the diagnosis of male OBC. Early surgery remains the primary treatment.
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Xu R, Li J, Zhang Y, Jing H, Zhu Y. Male occult breast cancer with axillary lymph node metastasis as the first manifestation: A case report and literature review. Medicine (Baltimore) 2017; 96:e9312. [PMID: 29390502 PMCID: PMC5758204 DOI: 10.1097/md.0000000000009312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
RATIONALE Occult breast cancer (OBC) is extremely rare in males with neither symptoms in the breast nor abnormalities upon imaging examination. PATIENT CONCERNS This current case report presents a young male patient who was diagnosed with male OBC first manifesting as axillary lymph node metastasis. The physical and imaging examination showed no primary lesions in either breasts or in other organs. DIAGNOSES The pathological results revealed infiltrating ductal carcinoma in the axillary lymph nodes. Immunohistochemical (IHC) staining was negative for estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK)20 and thyroid transcription factor-1 (TTF-1), positive for CK7, gross cystic disease fluid protein-15 (GCDFP-15), epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), and suspicious positive for human epidermal receptor-2 (Her-2). On basis of IHC markers, particularly such as CK7, CK20 and GCDFP-15, and eliminating other malignancies, male OBC was identified in spite of negativity for hormone receptors. INTERVENTIONS The patient underwent left axillary lymph node dissection (ALND) but not mastectomy. After the surgery, the patient subsequently underwent chemotherapy and radiotherapy. OUTCOMES The patient is currently being followed up without any signs of recurrence. LESSONS Carefully imaging examination and pathological analysis were particularly essential in the diagnosis of male OBC. The guidelines for managing male OBC default to those of female OBC and male breast cancer.
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MESH Headings
- Adult
- Axilla/diagnostic imaging
- Axilla/pathology
- Breast Neoplasms, Male/diagnostic imaging
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Humans
- Lymph Node Excision
- Lymphatic Metastasis
- Male
- Neoplasms, Unknown Primary/diagnostic imaging
- Neoplasms, Unknown Primary/pathology
- Neoplasms, Unknown Primary/therapy
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Affiliation(s)
- Ruixin Xu
- Medicine and Life Sciences College of Shandong Academy of Medical Sciences, University of Jinan
- Department of Radiation Oncology
| | | | | | - Hongbiao Jing
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Youzhe Zhu
- Medicine and Life Sciences College of Shandong Academy of Medical Sciences, University of Jinan
- Department of Radiation Oncology
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Zhang L, Zhang C, Yang Z, He M, Zhang L, Ezzat S, Liang X. Male occult triple-negative breast cancer with dermatomyositis: a case report and review of the literature. Onco Targets Ther 2017; 10:5459-5462. [PMID: 29180879 PMCID: PMC5694202 DOI: 10.2147/ott.s151260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Occult breast cancer is defined by the presence of axillary metastases without an identifiable primary breast tumor. Here, we report a rare case of a male occult breast cancer with dermatomyositis. We performed a modified radical mastectomy consisting of whole breast mastectomy and axillary lymph node dissection. Immunohistochemistry and fluorescent in situ hybridization analyses demonstrated an adenocarcinoma likely of breast origin, which was an occult triple-negative breast cancer. Interestingly, the patient’s previously noted periorbital dermatomyositis resolved promptly following surgical excision.
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Affiliation(s)
- Le Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Chenghua Zhang
- Endoscopy Department, Jilin Cancer Hospital, Changchun, Jilin, China
| | - Zhaoying Yang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Miao He
- Department of Anesthesia, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lijuan Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Shereen Ezzat
- Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Xi Liang
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Lim HS, Kim SJ, Baek JM, Kim JW, Shin SS, Seon HJ, Heo SH. Sonographic Findings of Accessory Breast Tissue in Axilla and Related Diseases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1469-1478. [PMID: 28370098 DOI: 10.7863/ultra.16.06056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/23/2016] [Indexed: 06/07/2023]
Abstract
Accessory breast tissue results from failed regression of primitive mammary tissue and is most often located in the axilla. Accessory breast tissue itself is normal and should not be misdiagnosed as an abnormality. Both benign and malignant diseases that occur in the normal breast can also develop in accessory breast tissue in the axilla. In this pictorial essay, we show sonographic findings of normal accessory breast tissue in the axilla and various lesions that occur in accessory axillary breast tissue, along with other imaging findings and pathologic features.
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Affiliation(s)
- Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Shin Jung Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jang Mi Baek
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Jin Woong Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Seon
- Department of Radiology, Chosun University School of Medicine, Gwangju, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
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Accessory Axillary Breast Excision with Liposuction Using Minimal Incision: A Preliminary Report. Aesthetic Plast Surg 2017; 41:10-18. [PMID: 28032153 DOI: 10.1007/s00266-016-0729-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accessory breasts have received little attention in the surgical fields, although the condition is quite common in the female population, with 2-6% of women suffering from it. Its convexity and cyclic pain make women feel embarrassed and uncomfortable, so patients often desire surgical excision to improve their appearances and to remove the pain. METHODS A total of 967 patients who had been treated by an excision of accessory breast tissue with liposuction using minimal incision from September 2013 to Dec 2015 at the Damsoyu Hospital were analyzed for clinical factors retrospectively. RESULTS All 967 patients were female. There were 514 (53.2%) unmarried patients and 453 (46.8%) married patients. The major clinical manifestation was the problem in the appearance with cyclic pain in both unmarried and married groups (82.7 vs. 87.9%). Three types of accessory breasts were observed: 779 (80.6%) breast tissue only in axillae, 182 (18.8%) breast tissue with accessory nipple, and 6 (0.6%) breast tissue with accessory nipple-areolar complex. The mean operation time was 58 min. All cyclic axillar pain in our cases was resolved after the operation. Postoperative complications developed in 160 patients (16.55%). Among them, seroma after operation was the most common (11.27%). In our study, 95.65% of the patients were satisfied with the cosmetic outcomes. CONCLUSIONS The surgical excision of accessory breasts with liposuction through the minimal incision is a safe and effective method to make women feel comfortable in clinical manifestations and be satisfied with their cosmetic axillar line. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Singal R, Mehta SK, Bala J, Zaman M, Mittal A, Gupta G, Rudra S, Singal S. A Study of Evaluation and Management of Rare Congenital Breast Diseases. J Clin Diagn Res 2016; 10:PC18-PC24. [PMID: 27891392 DOI: 10.7860/jcdr/2016/21077.8648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/16/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Polymastia and polythelia may be asymptomatic or cause pain, restriction of arm movement, milk discharge, cosmetic problems or anxiety. Cosmesis is the main indication for surgical excision of accessory breasts in axilla. In addition it also confirms the diagnosis and allays the patient's fear of harbouring a malignancy. AIM To evaluate the presentation of symptoms, investigations required for diagnosis and the management to improve the treatment protocols in patients with breast diseases. MATERIALS AND METHODS This retrospective study on breast diseases presenting as supernumerary breasts and nipples was conducted in the Department of Surgery between January 2013 and January 2016 at MMIMS Research and hospital, Mullana, Ambala. Patients were evaluated for breast diseases, either benign or malignant in both genders. A total of 32 cases diagnosed as accessory breasts disease were retrieved from the hospital archive. The clinical and radiological evaluation was done in the form of ultrasound and mammography wherever necessary. Accessory breast tissues were excised under general anesthesia and histopathological examinations were done. RESULTS Out of 32 cases: 1(3.125%) male patient had unilateral and 1(3.125%) male had bilateral accessory nipple, 7 (21.87%) females had unilateral and 1(3.125%) had bilateral accessory nipple, 1 (3.125%) diagnosed as accessory axillary fibroadenoma in female, 16(50%) presented as unilateral and 5 (15.62%) had bilateral swelling in the axilla as accessory breast. Patients underwent surgical excision and in 8(25%) cases z- shaped incision was made in view of better cosmesis. Patients were followed up upto 6 months postoperatively. There were no residual swelling and movements of the arm over the shoulder joint were normal. In 3(9.37%) cases, wound dehiscence occurred; in 2 (6.25%) cases lymphoedema formation was seen. These were successfully managed conservatively. CONCLUSION As breast swellings either fibroadenoma or carcinoma are common entities to come across everywhere but accessory breasts are rarely encountered especially in rural areas because of less awareness. The study found that there was tendency to neglect the swelling as there were minimal symptoms present. We also came across a rare entity, accessory breast and accessory nipples. A clinician should not ignore such cases taking as simple swelling because of chances of discovering a malignancy can occur.
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Affiliation(s)
- Rikki Singal
- Professor, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Sudhir Kumar Mehta
- Associate Professor, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Jyoti Bala
- Professor, Department of Patholgy, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Muzzafar Zaman
- Assistant Professor, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Amit Mittal
- Professor and Head, Department of Radiodiagnosis and Imaging, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Guarav Gupta
- Head of the Department, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Samer Rudra
- Head of the Department, Department of Gynaecology and Obstrectics, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Samita Singal
- Assistant Professor, Department of Radiodiagnosis and Imaging, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
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How to approach breast lesions in children and adolescents. Eur J Radiol 2015; 84:1350-64. [DOI: 10.1016/j.ejrad.2015.04.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 04/10/2015] [Accepted: 04/11/2015] [Indexed: 12/25/2022]
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He M, Liu H, Jiang Y. A Case Report of Male Occult Breast Cancer First Manifesting as Axillary Lymph Node Metastasis With Part of Metastatic Mucinous Carcinoma. Medicine (Baltimore) 2015; 94:e1038. [PMID: 26107674 PMCID: PMC4504636 DOI: 10.1097/md.0000000000001038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Occult breast cancer (OBC) is a type of breast cancer without any symptoms in the breast (no primary cancer lesion is found in either breast on a physical examination or imaging examination such as ultrasound and mammography). The incidence of OBC is rare in females, whereas in males, there are few cases of breast cancer, and the rate of OBC is very low. This is the first time report a case of male OBC first manifested as axillary metastasis, of which the pathological results showed moderately differentiated adenocarcinoma with part of metastatic mucinous carcinoma.A 40-year-old male patient presenting palpable masses in his left axillary on physical and imaging examination revealed unremarkable despite of multiple swollen lymph nodes in the left axillary, and the resected sample showed metastatic adenocarcinoma with part of metastatic mucinous carcinoma. Based on immunohistochemical analysis, positive of estrogen receptor (ER), progesterone receptor (PR), and human epidermal receptor 2 (Her-2), it was identified as an OBC.This is the fourth case report of male OBC in the literature; 1 case was reported in China in 2008, and it was metastatic infiltrating ductal carcinoma, and 2 cases were reported in Korea in 2012, one of which was reported as metastatic carcinoma and the other was metastatic adenocarcinoma; however, our case was a moderately differentiated adenocarcinoma with part of mucinous carcinoma. Our case of male OBC could metastasize to supraclavicular region and lung in addition to axillary lymph nodes, and the prognosis was relatively poor compared to the 3 cases reported before.The aim of this case report is to introduce the imaging, pathological features, and management of a rare male OBC.
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Affiliation(s)
- Mengna He
- From the Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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