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Breast Imaging

E2360. What Lurks Beneath: Mammographically Occult Male Breast Lesions in the Setting of Gynecomastia

Magee A,  Sheth D. University of Chicago, Chicago, IL

Address correspondence to A. Magee (andrealmagee@gmail.com)

Background Information: The majority of male breast problems are benign, with gynecomastia as the most common cause of a palpable mass, breast enlargement, or pain. Per the American College of Radiology Appropriateness Criteria, traditional workup for a patient varies depending on the presence or absence of an indeterminate palpable mass. If present, recommended workup includes a diagnostic mammogram and ultrasound. If absent, a thorough clinical history and physical examination regarding the patient’s symptoms may be all that is conducted. This case-based educational exhibit demonstrates rare cases where malignant lesions are identified in the setting of a benign diagnosis as gynecomastia. These cases highlight the importance of incorporating clinical history and physical examination into the diagnostic imaging workup of a man in order to make the correct diagnosis. After reviewing this exhibit, viewers will hopefully agree that gynecomastia, while benign itself, may conceal a wide variety of breast lesions.

Educational Goals/Teaching Points: Although some available literature on the subject suggests that no further imaging evaluation is indicated following a mammogram showing gynecomastia, we present examples of pathology-proven, mammographically occult breast lesions in the setting of gynecomastia, which were identified using additional imaging techniques. Our purpose is to raise awareness of the utility of additional imaging modalities, such as ultrasound and MRI, in evaluating men with breast-related concerns who are found to have gynecomastia by mammogram.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The cases presented in this educational exhibit will include mammogram, ultrasound, and MRI examples of breast lesions that were ultimately identified in men who were given an initial mammogram report notable only for gynecomastia.

Conclusion: Although gynecomastia is considered to be a benign lesion, it may conceal additional breast lesions, and should be regarded with high clinical suspicion. These cases highlight the importance of incorporating clinical history and physical examination into the diagnostic imaging workup of a man in order to make the correct diagnosis.