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Breast Imaging

E2736. Men Are From Mars: Spectrum of Disease of the Male Breast

Clark E,  McElligott S,  Gupta E. Northwell Health, Manhasset, NY

Address correspondence to E. Clark (eclark12@nshs.edu)

Background Information: The purpose of our exhibit is to review diseases of the male breast with emphasis on differences between male and female breast lesions (what can and cannot be seen in the male breast) based on cases seen at our institution. The male breast is anatomically and physiologically different than the female breast. Consequently, there is a characteristic spectrum of benign and malignant conditions that we see. Understanding the anatomy of the male breast is essential to forming an accurate differential diagnosis and critical in providing optimal care to male patients. We will review the specific imaging features, management and treatment of malignant breast lesions in men, and how to distinguish them from benign mimics of breast cancer in men.

Educational Goals/Teaching Points: Our goal is to explain why we see different types of lesions in the male breast and which features are highly concerning when seen in a man. The key teaching points are as follows. A cystic lesion in a man is suspicious for malignancy. Benign fibrocystic changes, which are common in women, normally do not occur in men. Calcifications are rare in the male breast and when seen are suggestive of malignancy. Male breast masses that are eccentric to the nipple, even circumscribed masses, are highly suspicious for malignancy. Ultrasound (US) of the axillary region is helpful for staging and should be routinely performed when evaluating a suspicious breast lesion because 50% of men have axillary lymph node metastasis at initial evaluation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The normal male breast is composed primarily of subcutaneous fat and a small amount of ductal tissue remnant in the subareolar region. Typically, the male breast does not undergo lobular development, and Cooper ligaments are absent. This anatomy determines the types and location of lesions that we see in the male breast. Malignant conditions that we will present include male breast invasive ductal carcinoma, invasive papillary carcinoma, breast lymphoma, and basal cell carcinoma of the breast. We will also present cases of common benign findings in the male breast and benign mimics including gynecomastia, gynecomastia with calcified axillary lymphadenopathy, mastitis, lipoma, epidermal inclusion cyst, fat necrosis, hematoma, and myofibroblastoma.

Conclusion: It is very important for radiologists to distinguish between benign and suspicious male breast lesions on imaging because of implications on the patient with respect to the need for biopsy and further work up. 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. Given the low incidence of male breast cancer, all imaging of the male breast is diagnostic, unlike in female patients. Palpable breast abnormalities in an adult male (age = 25) should be worked up with bilateral mammography and targeted US. The radiologist should be able to recognize the imaging signs that point to malignancy in male breast lesions including eccentric location, cystic components, and calcifications.