Male Breast Disease Research Articles

Paget's disease of the male breast

Paget’s disease of the breast is a rare type of breast cancer presenting as an eczematous eruption over of nipple and/or areola. It accounts for 0.8% of all breast cancers. Of all malignant breast cancer, 1% occurs in male patients. The incidence of Paget's disease in male breast is extremely rare. Most of the cases have an underlying breast cancer. It has a different tumor biology that dictates a favorable clinical behavior and outcome. This unique entity therefore merits reporting.

Epidemiologic and Clinical Profiles of Breast Diseases in Niger.

This study aimed at characterizing epidemiologic and clinical profiles of breast diseases in Niger during the period of 2010-2013 at the National Hospital of Niamey. Medical records were abstracted for demographic, reproductive, clinical, and treatment information. A process map of patient navigation and barriers to seeking medical care was developed after interviewing 26 local health professionals who encounter and/or manage breast diseases. We identified 245 breast cancers and 122 other breast diseases. Mean age of breast cancer patients was 45.4 (±13.26 years) and that of breast diseases was 31(±12.5 years) with 1/3 of cancers under age 44. Infection-related diseases represented 24% of non-cancers. Male breast diseases represented 4.75% of diseases and 2.05% of cancers. Only 37.1% of cancers had histopathologic confirmation and 90% of cancer patients presented at advanced stages and mastectomy was performed for 66% of breast cancers. Patient and system barriers to care were common in diagnosing and treating breast diseases. Women in Niger have double burden of infectious breast diseases and emerging breast cancer. Younger age and late diagnosis are common features. Reducing barriers to access to care, down-staging of cancer, implementation of clinical guidelines for managing advanced cases are important needs for reducing breast cancer morbidity and mortality in Niger.

Role of liposuction combined with subcutaneous mastectomy in the surgical treatment of gynecomastia

Background: Gynecomastia is one of the common benign male breast diseases, surgical treatment of which remains a controversial issue. Here, we describe successful combined use of liposuction and subcutaneous mastectomy in the treatment of gynecomastia. Aim: To evaluate the effectiveness of the liposuction combined with subcutaneous mastectomy in the treatment of gynecomastia. Subjects and Methods: In this study, a total of 28 patients were included. All the patients had undergone detailed clinical evaluation and appropriate investigations. Information regarding age of onset, etiology, laterality, nipple discharge was collected from patient’s medical records. Twenty of 28 patients had unilateral gynecomastia whereas 8 patients had bilateral gynecomastia. Based on the clinical evaluation and investigations, secondary causes of gynecomastia were ruled out. Subcutaneous mastectomy using infraareolar skin incision combined with liposuction was performed on 26 patients. Two patients underwent only liposuction. Results: Twenty‑four patients (86%) were satisfied with the results of the operative intervention. In 24/28 patients (86%), the indication of surgery was cosmetic reasons and in 4/28 patients (14%), the indication was failure to treatment with danazol. Average age of the patients was 24 (6) years and most of the patients were between 20 and 30 years of their age. The postoperative complications include infection in two patients and contour deformity in two other patients. Conclusions: Liposuction combined with subcutaneous mastectomy is a reliable, versatile, less time consuming and valid procedure for the treatment of gynecomastia. This procedure provides satisfactory aesthetic results.

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

The majority of male breast diseases are benign. The most common is gynaecomastia. Although it is rare, the most critical diagnosis is a malignancy. Radiologists are generally less familiar with breast disease in males compared with females. This pictorial review will highlight the ultrasonographic, mammographic and pathological features of a spectrum of benign and malignant male breast diseases. This includes gynaecomastia, fat necrosis, lipoma, epidermoid cyst, subareolar abscess, chronic inflammation, melanoma and ductal carcinoma.

Male Breast Disease: Pictorial Review with Radiologic-Pathologic Correlation

The male breast is susceptible to many of the same pathologic processes as the female breast. Many of these conditions have mammographic, ultrasonographic (US), and magnetic resonance imaging findings that allow differentiation between clearly benign conditions and those that require biopsy. Gynecomastia is the most common abnormality of the male breast and has characteristic imaging features that usually allow differentiation from malignancy. Mammography is the initial imaging modality for a clinically suspicious mass. A palpable mass that is occult or incompletely imaged at mammography mandates targeted US. Suspicious or indeterminate masses require biopsy, which can usually be performed with US guidance. Approximately 0.7% of breast cancers occur in men. Men with breast cancer often present at a more advanced stage than do women owing to a delay in diagnosis. Benign breast neoplasms that may occur in men include angiolipoma, schwannoma, intraductal papilloma, and lipoma. Benign nonneoplastic entities that may occur in the male breast include intramammary lymph node, sebaceous cyst, diabetic mastopathy, hematoma, fat necrosis, subareolar abscess, breast augmentation, venous malformation, secondary syphilis, and nodular fasciitis. Familiarity with the salient features of the classic benign male breast conditions will allow accurate imaging interpretation and avoid unnecessary and often invasive treatment. © RSNA, 2013.

The diagnostic value of clinical examination and imaging used as part of an age-related protocol when diagnosing male breast disease: An audit of 1141 cases from a single centre

Triple assessment in men varies, possibly in response to currently published non-specific guidance. The study aims to assess the efficacy of triple assessment as part of an age related protocol currently used in the clinical setting.1141 referrals between 01.01.01 and 31.12.09 were evaluated. Patient age ranged from 29 to 89 years. Mammography (M) was performed in men ≥35years. Sensitivity for clinical examination (CE) was 64.0%, M 77.8%, US 92.0%. 25 cancers were diagnosed, 24 aged >40years, 1 aged 29. 2 presented with nipple discharge. The cancer <40years was diagnosed with CE and US, all others had suspicious CE and/or M necessitating US and biopsy.We suggest a protocol incorporating mammography in men ≥40years would capture all cancers. Combined specificities approaching 100% suggest men >40 years scored benign after CE and M warrant no further assessment. Bloody nipple discharge is a suspicious sign and the reassurance of non-bloody discharge should be treated with caution.

From the Radiologic Pathology Archives: Diseases of the Male Breast: Radiologic-Pathologic Correlation

Male breast disease includes a variety of benign and malignant conditions, many of which are hormonally influenced. Gynecomastia and skin lesions account for the majority of conditions in symptomatic men with a palpable abnormality, and these conditions should be accurately recognized. Imaging patterns of gynecomastia include nodular, dendritic, and diffuse patterns. Histopathologically, the nodular and dendritic patterns correlate with the florid and quiescent (fibrotic) phases of gynecomastia, respectively. The diffuse pattern may have features of both phases and is associated with exposure to exogenous estrogen. Benign-appearing palpable masses in male patients should be approached cautiously, given the overlapping morphologic features of benign and malignant tumors. In addition to gynecomastia, other benign male breast tumors include lipoma, pseudoangiomatous stromal hyperplasia, granular cell tumor, fibromatosis, myofibroblastoma, schwannoma, and hemangioma. Male breast cancer accounts for 1% of all breast carcinomas. Invasive ductal carcinoma accounts for the majority of cases in adult males and typically appears as a subareolar mass without calcifications that is eccentric to the nipple. Other epithelial and mesenchymal tumors that may occur, albeit not as commonly as in women, include papillary carcinoma, invasive lobular carcinoma, adenoid cystic carcinoma, liposarcoma, dermatofibrosarcoma, pleomorphic hyalinizing angiectatic tumor, basal cell carcinoma of the nipple, hematopoietic malignancies, and secondary tumors. Knowledge of the natural history, clinical characteristics, and imaging features of tumors that occur in the male breast will help narrow the radiologic differential diagnosis and optimize treatment.

The male mammary gland: A target for the xenoestrogen bisphenol A

Males of some strains of mice retain their mammary epithelium even in the absence of nipples. Here, we have characterized the mammary gland in male CD-1 mice both in whole mounts and histological sections. We also examined the effects of bisphenol A (BPA), an estrogen mimic that alters development of the female mouse mammary gland. BPA was administered at a range of environmentally relevant doses (0.25–250μg/kg/day) to pregnant and lactating mice and then the mammary glands of male offspring were examined at several periods in adulthood. We observed age- and dose-specific effects on mammary gland morphology, indicating that perinatal BPA exposures alter the male mammary gland in adulthood. These results may provide insight into gynecomastia, the most common male breast disease in humans, where proliferation of the mammary epithelium leads to breast enlargement.

Imaging Spectrums of the Male Breast Diseases: A Pictorial Essay

Imaging Spectrums of the Male Breast Diseases: A Pictorial Essay

Mammography and ultrasound in the evaluation of male breast disease

To assess clinical variables that may be useful in differentiating gynaecomastia from carcinoma and to analyse the contribution of mammography and ultrasound to the evaluation of male breast disease. All men who underwent mammography and/or ultrasound between 1993 and 2006 in our hospital were retrospectively evaluated. Clinical characteristics in patients with gynaecomastia and those with carcinoma were compared. Radiological findings were classified according to the BI-RADS (Breast Imaging Reporting and Data System) criteria. The diagnostic performance of physical examination, mammography and ultrasound was determined and compared. A total of 628 patients with 518 mammograms and 423 ultrasounds were reviewed. The final diagnoses were: 19 carcinomas, 526 gynaecomastias, 84 other benign conditions and 25 normal. There were statistically significant differences in age, bilateral involvement, clinical presentation and physical examination between patients with carcinoma and those with gynaecomastia. The diagnostic performance of physical examination was lower than that of mammography and ultrasound (p < 0.05 for specificity). Mammography was the most sensitive (94.7%) and ultrasound the most specific (95.3%) for detection of malignancy (p > 0.05). We propose an algorithm for the use of mammography and ultrasound in men. Mammography and ultrasound, with a negative predictive value close to 100%, make it possible to avoid very many unnecessary surgical procedures in men.

Imaging Characteristics of Male Breast Disease

The purpose of the study was to describe the imaging findings of male breast disease. One hundred and sixty-four male patients, who underwent mammography and ultrasonography (US) between January 1999 and December 2008, were retrospectively evaluated. Seventy-five patients (46%) underwent biopsy, and 89 patients (54%) were diagnosed radiologically. The radiologic and pathologic diagnoses in 164 cases of this series were 13 cancers (8%), including one ipsilateral and one contralateral breast cancers, 147 cases of gynecomastia (90%), one fibroadenoma (0.6%), two cases of fibrocystic disease of the breast (1.2%), and one epidermoid inclusion cyst (0.6%). Three mammographic patterns were adequate to describe all 147 cases of gynecomastia in our series: 53 patients (36%) had nodular gynecomastia, 46 patients (31%) had dendritic gynecomastia, and 48 patients (33%) had diffuse gynecomastia. Gynecomastia was unilateral in 65% of cases (n=95), and bilateral in 35% of cases (n=52). On physical examination, two of the malignant lesions had no clinic features of malignancy (15%). On mammography, 11 of 13 malignant masses were demonstrated (85%). A mass with microcalcifications was seen on mammograms in one case (9%). The contours of the masses were irregular in nine cases (82%), well-circumscribed in two cases (18%). The location of the masses was retroareolar in seven cases (64%) and eccentric to the nipple in four cases (36%). The size of the masses varied between 0.5 cm and 5 cm (mean 2.4 cm). Nipple retraction was evident in five cases (45%), and skin thickening in four cases (36%). All of the malignant masses were demonstrated on ultrasound; however, one of them was seen retrospectively after mammography. All of the masses were hypoechoic and solid, the contours were well-defined and smooth in two masses (15%), and irregular in 11 masses (85%), and five masses (39%) had posterior prominent shadowing. Axillary lymphadenopathia was detected in two cases (15%). One patient had a previous contralateral breast cancer, and one had an ipsilateral. On mammography, breast cancer characteristically exhibits an irregular subareolar mass, nipple retraction, and skin ulceration or thickening, but sometimes breast cancer has a well-circumscribed contour and punctuated microcalcifications. Ultrasonography is essential and useful for further characterization and helpful for demonstrating lymphadenopathies of the axillary region.

Sonographic Appearances of Benign and Malignant Male Breast Disease With Mammographic and Pathologic Correlation

Imaging of the male breast is most often performed for the evaluation of a clinical abnormality such as breast enlargement or tenderness, a palpable mass, nipple skin changes, or nipple discharge. Most breast lesions encountered in men are benign. Malignant breast lesions are less frequent; breast cancer accounts for less than 1% of all male cancers in the United States. The initial imaging evaluation of a finding in the male breast is performed with mammography. Sonography is frequently used as an adjunct to mammography but is less often used as the primary imaging modality. The objective of this article is to provide readers with a thorough review of the sonographic appearances of benign and malignant male breast disease. We reviewed our institution's case database to identify male patients who underwent mammography, sonography, and subsequent biopsy of a breast lesion. These cases were collected and reviewed to select the best imaging examples. A spectrum of benign and malignant male breast disease is presented with corresponding sonographic, mammographic, and pathologic imaging. For each entity, the salient imaging findings and typical clinical presentation are discussed. Most studies in the literature have reported on the mammographic and sonographic imaging features of primary breast carcinoma in men. However, very little has been reported on the sonographic appearance of benign and malignant male breast conditions. Recognition and correct identification of pathologic male breast entities on sonography is essential to determine appropriate management recommendations and avoid unnecessary biopsies.

Conditions of the male breast: Gynaecomastia and male breast cancer (Review)

Breast disease most commonly affects females; however, a small percentage of men are also affected. Understandably given its low incidence, awareness of male breast disease is low, particularly among the general population. We searched the Medline database from 1950 onwards using the search terms male, breast, neoplasms and gynaecomastia, and reviewed the conditions associated with male breast disease, examining some of the risk factors and discussing how these conditions are diagnosed and treated, and finally putting forward some suggestions for their future management.

The Diagnostic Accuracy of Mammography and Ultrasound in the Evaluation of Male Breast Disease: A New Algorithm

Background: The purpose of this study was to define the diagnostic accuracy of mammography and ultrasound in the evaluation of male breast disease, and to suggest a diagnostic protocol for male breast disease. Material and Methods: We retrospectively reviewed clinical, radiographic, and pathologic records of 75 patients. Breast Imaging Reporting and Data System (BI-RADS) category 4–5 mammograms and ultrasonograms were suggested as suspicious for malignancy. Results: Of the 75 patients, 23 (31%) were considered to have suspicious lesions by mammography and/or ultrasonography. 13 of the patients were shown to have breast cancer. The remaining 52 (69%) were referred for biopsy by clinicians; all of the biopsy specimens were benign (gynecomastia). The accuracy data of mammography and ultrasonography are: sensitivity, 69 and 100%; specificity, 87 and 97%; positive predictive value, 53 and 87%; negative predictive value, 93 and 100%; and accuracy, 84 and 97%, respectively. Conclusion: We suggest a new diagnostic algorithm for the evaluation of male breast disease in which ultrasonography may be used to evaluate palpable abnormalities as the first diagnostic tool of choice. To use and to trust imaging would decrease the number of falsepositive biopsies that would be generated by physical examination alone.

1090: US Evaluation in Male Breast Disease

1090: US Evaluation in Male Breast Disease

Gynecomastia With Marked Cellular Atypia Associated With Chemotherapy A Diagnostic Pitfall in Fine-Needle Aspiration

c Gynecomastia is a common benign male breast disease, which may exhibit mild cellular atypia in cytology specimens. However, marked cytologic atypia can be seen in gynecomastia superimposed by chemotherapy. The case described in this report demonstrated severe cytologic atypia of gynecomastia mimicking carcinoma in a patient treated with chemotherapy for acute leukemia. A distinct cytologic feature helpful in avoiding the diagnostic error is described, namely, atypical cells admixed with bland ductal cells and appearing at a different plane. The importance of applying strict diagnostic criteria in breast cytology and clinical correlation is also emphasized. (Arch Pathol Lab Med. 2002;126:613‐614)

Comparative genomic hybridization analysis of benign and invasive male breast neoplasms

Comparative genomic hybridization (CGH) analysis was performed for the identification of chromosomal imbalances in two benign gynecomastias and one malignant breast carcinoma derived from patients with male breast disease and compared with cytogenetic analysis in two of the three cases. CGH analysis demonstrated overrepresentation of 8q in all three cases. One case of gynecomastia presented gain of 1p34.3∼pter, 11p14∼q12, and 17p11.2∼qter, and loss of 1q41∼qter and 4q33∼qter. The other gynecomastia presented del(1)(q41) as detected by both cytogenetic and CGH analysis. CGH analysis of the invasive ductal carcinoma confirmed a gain of 17p11.2∼qter previously detected by cytogenetic analysis. These regions showed some similarity in their pattern of imbalance to the chromosomal alterations described in female and male breast cancer.

Male breast disease: clinical, mammographic, and ultrasonographic features

Purpose: To describe and quantitate the radiological (mammographic and ultrasonographic) characteristics of male breast disease and to report the clinical and pathological findings. Materials and methods: Two-hundred-thirty-six male patients with different male breast diseases, diagnosed at our institution between January 1990 and July 2001, were retrospectively evaluated. The history, physical examination, mammographic and ultrasonographic findings were analyzed. Results: The spectrum of the disease in 236 male patients were gynecomastia ( n=206), primary breast carcinoma ( n=14), fat necrosis ( n=5), lipoma ( n=3), subareolar abscess ( n=2), epidermal inclusion cyst ( n=1), sebaceous cyst ( n=1), hematoma ( n=1), myeloma ( n=1), and metastatic carcinoma ( n=2). The distribution of patterns of gynecomastia were; 34% ( n=71) nodular, 35% ( n=73) dendritic and 31% ( n=62) diffuse glandular. Gynecomastia was unilateral in 55% ( n=113) and bilateral in 45% ( n=93) of the patients. Male breast cancer presented as a mass without microcalcifications in 86% ( n=12) and with microcalcifications in 7% ( n=1) of patients. The mass was obscured by gynecomastia, partially in two, totally in one patient. The location of the mass was retroareolar in 46% ( n=6) and eccentric to the nipple in 54% ( n=7) of patients. On ultrasonography (US), the contours were well-circumscribed in 20% ( n=3) and irregular in 80% ( n=12) of the masses. Conclusion: Male breast has a wide spectrum of diseases, some of which have characteristic radiological appearances that can be correlated with their pathologic diagnosis. In the evaluation of the male breast, mammography and US are essential and should be performed along with physical examination.

The diagnostic accuracy of mammography in the evaluation of male breast disease

Background: The role of mammography in the evaluation of male patients presenting with breast disease is controversial. This controversy is a function of the lack of specific data concerning the diagnostic accuracy of mammography when used in this clinical setting. The purpose of this study was to define the diagnostic accuracy of mammography in the evaluation of male breast disease. Methods: One hundred and four prebiopsy mammograms from 100 patients with tissue diagnoses were read blindly by two independent radiologists, and placed into one of five predetermined categories: definitely malignant, possibly malignant, gynecomastia, benign mass, and normal. Radiologic/pathologic correlation was performed and the sensitivity (Sn), specificity (Sp), positive (Ppv) and negative predictive value (Npv), and accuracy (Ac) for each of the mammographic diagnostic category determined. Results: The pathologic diagnoses were 12 cancers, including 1 patient with bilateral breast cancer, 70 cases of gynecomastia, 16 benign masses, and 6 normals. The accuracy data for the mammographic diagnostic categories are as follows: malignant (combined definitely and possibly malignant), Sn 92%, Sp 90%, Ppv 55%, Npv 99%, Ac 90%; and overall benignity (combined gynecomastia, benign mass, and normal), Sn 90%, Sp 92%, Ppv 99%, Npv 55%, Ac 90%. Six cancers (50%) coexisted with gynecomastia. Conclusions: Mammography can accurately distinguish between malignant and benign male breast disease. Although not a replacement for clinical examination, its routine use could substantially reduce the need for biopsy in patients whose mammograms and clinical examination suggest benign disease.

Mammographic appearances of male breast disease.

Various male breast diseases have characteristic mammographic appearances that can be correlated with their pathologic diagnoses. Male breast cancer is usually subareolar and eccentric to the nipple. Margins of the lesions are more frequently well defined, and calcifications are rarer and coarser than those occurring in female breast cancer. Gynecomastia usually appears as a fan-shaped density emanating from the nipple, gradually blending into surrounding fat. It may have prominent extensions into surrounding fat and, in some cases, an appearance similar to that of a heterogeneously dense female breast. Although there are characteristic mammographic features that allow breast cancer in men to be recognized, there is substantial overlap between these features and the mammographic appearance of benign nodular lesions. The mammographic appearance of gynecomastia is not similar to that of male breast cancer, but in rare cases, it can mask malignancy. Gynecomastia can be mimicked by chronic inflammation. All mammographically lucent lesions of the male breast appear to be benign, similar to such lesions in the female breast.