Unusual Male Breast Lesions

Abstract

Most of male breast masses are benign with gynecomastia being the most common entity encountered. Primary male breast cancer accounts for less than 1% of the total number of breast cancer. Male breast can be affected by a variety of conditions affecting the female breast with less frequency due to the lack of hormonal influence and consequent glandular sub-development. Imaging features of male breast masses are quite similar to the female breast. Therefore, using the knowledge of the female breast and applying it may help in the diagnosis and management of male breast abnormalities. In this article, we aim to review a variety of unusual male breast masses. We discuss the demographics of male breast tumors, describe the diagnostic algorithm for evaluating male breast masses, and review the imaging features of rare breast masses and mimickers of male breast cancer.

Keywords: Benign; Male breast; Malignant; Mammogram; Ultrasound.

Figure 1:

Classification of male breast masses according to mammographic appearance.

Figure 2:

Papilloma: 24-year-old presented with unilateral nipple discharge. (a) Ultrasound (US) showed intra-ductal hypoechoic mass with perilesional vascularity in color Doppler (asterisks). Core biopsy showed papilloma. 55-years-old (b-d); (b) Galactography shows intra-ductal persistent filling defect (asterisks); (c) US showed intra-ductal hypoechoic mass with intra-lesional vascularity in color Doppler (cross mark); (d) MRI shows wash out post-contrast administration (ellipsoids). Core biopsy showed papilloma.

Figure 3:

Cutaneous cyst: 26-year-old male presented with non-tender right breast lump. (a and b) Mammograms show isodense large cutaneous mass with no associated calcifications (asterisks). Clinical exam revealed suspicion of slow flow venous malformation.

Figure 4:

Pseudoangiomatous stromal hyperplasia (PASH): 40-year-old male with known pancreatic cancer, presented with bilateral breast masses (a and b); (a) mammogram shows bilateral oval circumscribed high-density masses in retro-areolar location (asterisks). No associated microcalcifications; (b) Color Doppler US show bilateral oval parallel oriented hypoechoic symmetrical masses with no posterior acoustic features and rim vascularity (cross marks). Core biopsy revealed PASH. (c) US color Doppler images of 13-year-old boy showing hypoechoic mass with no posterior acoustic features and internal vascularity (asterisks). Pathology revealed PASH.

Figure 5:

Hemangioma: 66-year-old male presented with palpable right breast abnormality. (a) Mammograms show deep micro-lobulated isodense mass with no calcification (asterisks); (b) US image shows indistinct heterogeneous mass with absent vascularity in color Doppler (cross mark); (c) Needle localization was performed. Biopsy showed hemangioma.

Figure 6:

Lipoma: 72-year-old male presented with palpable mass. (a) US shows a circumscribed parallel slightly hyperechoic mass with posterior acoustic enhancement and internal vascularity (asterisks); pathology revealed lipoma. Lipoma: 49-year-old male (b and c). (b) Mammogram shows a large retro-pectoralis muscle pure fat containing mass (arrows), note incidental bilateral dendritic gynecomastia (asterisks). (c) Contrast-enhanced CT scan show an encapsulated retro-pectoral fatty mass with no solid components or calcifications (cross mark). Liposarcoma: 77-year-old male (d-f). (d and e) Mammograms show a circumscribed isodense mass with soft tissue components and fat (asterisks), note the left dendritic gynecomastia (number signs). (f) US show a circumscribed oval hyperechoic mass with absent vascularity in color Doppler (asterisk). pathology showed liposarcoma.

Figure 7:

Pilomatricoma: 54-year-old male (a-d); (a) Mammogram shows circumscribed mass with associated amorphous microcalcifications (asterisk); (b) magnified mammographic view shows the microcalcifications better (asterisk); (c) US image show circumscribed parallel subcutaneous heterogeneous oval mass with no posterior acoustic feature and thin hypoechoic capsule (cross mark); (d) T2w MRI showing circumscribed superficial mass with heterogeneous high signal intensity (circle), pathology revealed Pilomatricoma.

Figure 8:

Angiolipoma: Male patient presented with palpable abnormality (a and b). (a) Mammogram corresponding to the palpable abnormality (BB marker), not incidental dendritic gynecomastia (asterisk). The palpable area shows breast fat with no masses. (b) US show circumscribed parallel slightly hyperechoic mass (cross mark). Pathology revealed angiolipoma. Angiomyxoma: 59-year-old male presented with firm right breast mass (c and d). (c) Mammogram shows an oval circumscribed high-density mass (asterisks). No associated microclassifications or skin thickening. (d) Color Doppler ultrasound show an oval parallel oriented hypoechoic mass with mild posterior acoustic enhancement and rim vascularity (cross mark). Core biopsy revealed angiomyxoma.

Figure 9:

Lymphoma: 44-year-old male patient presented with palpable breast masses (a-c). (a) Mammogram shows multiple high and equal density irregular, indistinct masses (ellipsoid). (b and c) Representative ultrasound images show oval indistinct predominantly hyperechoic masses with mild internal vascularity in color Doppler (asterisks). Core biopsy showed breast lymphoma.

Figure 10:

Metastasis (a-d): 66-year-old male patient with renal carcinoma (a and b). (a) Mammogram shows a round partially obscured isodense mass in retro-areolar location (ellipsoid). (b) US shows a circumscribed hypoechoic mass with internal and rim vascularity in color Doppler and no posterior acoustic features (asterisk). Pathology revealed renal cell carcinoma metastasis. 59-year-old male with nasopharyngeal carcinoma presented with breast masses (c and d). (c) Mammogram shows multiple obscured isodense masses (arrow). (d) US images show multiple irregular speculated and micro-lobulated hypoechoic masses with rim vascularity in color Doppler and no posterior acoustic features (asterisks). Pathology revealed nasopharyngeal carcinoma metastasis.

Figure 11:

Ductal carcinoma In Situ: 41 year-old male (a-c). (a) Mammogram showed an asymmetry in the lateral aspect of the breast (arrow). (b) US image showed mildly thickened retro-areolar duct (asterisk). (c) T1w MRI showed segmental homogenous non-mass enhancement (ellipsoid). Pathology revealed ductal carcinoma in situ.