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Saturday, October 5, 2013

Diseases of the Male Breast : Radiologic-Pathologic Correlation

From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (G.E.L., R.A.J.); American Institute for Radiologic Pathology, Silver Spring, Md (G.E.L., L.M.G.); Department of Radiology, David Grant USAF Medical Center, Travis AFB, Calif (R.A.J.); Department of Breast and Gynecologic Pathology, Joint Pathology Center, Silver Spring, Md (R.M.); and Washington Radiology Associates, Washington, DC (L.M.G.).

Abstract - Diseases of the Male Breast

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.

Footnotes

  • 1 Supported by the American Institute for Radiologic Pathology (AIRP), the Joint Pathology Center (JPC), and Uniformed Services University of the Health Sciences (USU).
  • Recipient of a Magna Cum Laude award for an education exhibit at the 2011 RSNA Annual Meeting.
  • For this journal-based SA-CME activity, the authors, editor, and reviewers have no relevant relationships to disclose.
  • The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as representing the views of the Departments of the Army, Navy, Air Force, or Defense.
  • Abbreviations:

    ACC =
    adenoid cystic carcinoma
    BCC =
    basal cell carcinoma
    GCT =
    granular cell tumor
    H-E =
    hematoxylin-eosin
    IDC =
    invasive ductal carcinoma
    ILC =
    invasive lobular carcinomar
    MLO =
    mediolateral oblique
    NOS =
    not otherwise specified
    PASH =
    pseudoangiomatous stromal hyperplasia
    PHAT =
    pleomorphic hyalinizing angiectatic tumor

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