Zuska's disease in a male patient. The critical role of ultrasound imaging in diagnosis and management of this rare entity

Abstract

Zuska's disease is a pathologic entity characterized by the formation of subareolar breast abscess caused by the obstruction of lactiferous ducts. Although Zuska's disease is found relatively often in female patients, only 19 male cases have been reported. That makes Zuska's diagnosis challenging in males, leading to significant morbidity and high recurrence rates. Clinical evaluation and imaging techniques, especially ultrasound and mammography, are considered the cornerstones for the diagnosis of Zuska's disease, whereas fine-needle aspiration cytology is necessary in order to exclude malignancy. Multiple treatment approaches have been used including conservative antibiotic therapy, drainage of the abscess and surgical excision of the lactiferous ducts. We present the case of a 57 year old male who was diagnosed with Zuska's disease and treated via ultrasound-guided drainage of the abscess. Having a high level of suspicion, performing appropriate imaging tests and offering definite treatment, is the only way to decrease morbidity and recurrence.

Keywords: Abscess; Breast; Disease treatment; Fine needle aspiration cytology; Male; Ultrasonography.

Fig. 1

Left breast ultrasound. 2.4 × 2 cm subareoral hypoechogenic lesion with irregular borders, internal moving echoes and hyperechogenic rim. The green arrow is demonstrating the lesion.

Fig. 2

Left breast ultrasound. Diffuse periareolar subcutaneous edema. The green arrow is demonstrating the edema.

Fig. 3

Fine needle aspiration cytology. Inflammatory cells, some macrophages, and a multinucleated giant cell (Papanicolaou stain × 40).

Fig. 4

Nipple discharge cytology. Inflammatory cells, some macrophages, a multinucleated giant cell and a few nonatypical ductal cells (Papanicolaou stain × 40).