Roentgenographic demonstration of calcification in carcinoma of the male breast. A case report.

Abstract

Many papers have appeared in recent years emphasizing the value of mammography. Although most of the data concerned lesions in the female, occasional reports have discussed mammography in suspected tumors of the male breast (1, 5). We have not been able to find any mention in the literature of calcification as a diagnostic feature in malignant tumors of the male breast. To our knowledge, the present case represents the first published example of the preoperative roentgen recognition of this characteristic calcification in a male breast carcinoma. Case Report O. S., a 73-year-old white male, was referred to the Cincinnati General Hospital, Cincinnati, Ohio, on Feb. 19, 1965, with a history of hoarseness and progressive soreness of the mouth for one month. The patient had previously been seen at this hospital in 1947 with a diagnosis of Korsakoff's psychosis. Physical examination revealed an ulcerating lesion involving the right tonsillar area and adjacent soft palate. The cervical lymph nodes were not enlarged. A hard nodular mass measuring 5 × 4 × 4 cm was discovered in the subareolar area of the left breast, attached to the overlying skin but freely movable on the chest wall. No axillary nodes could be palpated. On specific questioning, the patient acknowledged that the breast had been enlarging for the past six months. There had been no antecedent chest wall trauma. Biopsy of the oropharyngeal lesion on Feb. 23 revealed squamous-cell carcinoma. In addition, there was both histologic and radiographic evidence of tumor extension into the right maxillary antrum. Mammography (Fig. 1) demonstrated enlargement and almost total replacement of the left breast by an irregularly outlined mass. The lesion contained numerous punctate calcifications centrally and several somewhat larger spiculated calcifications in the peripheral areas. These findings were considered diagnostic of carcinoma. A simple mastectomy and left axillary node biopsy were performed on March 15. Microscopic sections revealed an infiltrating ductal type of carcinoma. Necrosis with associated calcification was evident in the center of many of the tumor nodules. The axillary node was not involved by tumor. The pathologist emphasized the distinct dissimilarity of the histological appearances of the breast and the oropharyngeal neoplasms. Cobalt-60 teletherapy was instituted to the oropharyngeal lesion. Discussion Carcinoma of the male breast is uncommon, less than 1 per cent of all primary breast cancers occurring in the male (8, 16). In certain tropical regions, however, the incidence of breast cancer in males is reported to be ten times this figure, constituting about 10 per cent of all breast carcinomas (14). It is also of interest that the incidence of breast cancer in men with Klinefelter's syndrome approximates that of the general female population (8).