IS Case 184: Infiltrating ductal carcinoma in a male

Wade Hedegard, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-21

History

Patient is a 67-year-old male with 6 month history of a palpable left breast lump and nipple retraction not responding to antibiotic therapy.

Findings

Diagnostic mammogram demonstrated predominantly fatty replaced breast tissue. In the left retroareolar region, there was a high density lobulated oval mass with spiculated margins and contained a few microcalcifications. Ultrasound of the left breast showed a large irregular hypoechoic mass in the retroareolar region. The mass had a hyperechoic rim and contained a few calcifications. BIRADS 5 - highly suggestive of malignancy.

Diagnosis

Infiltrating ductal carcinoma in a male

Discussion

Male breast cancer is relatively rare, accounting for 1% of all breast cancers. Each year around 2,000 male patients are diagnosed with breast cancer in the U.S. Approximately 30% of males with breast cancer have a positive family history. Other predisposing factors for male breast cancer include Klinefelter's syndrome, exogenous hormone therapy, hyperestrogenism due to liver failure and history of radiation exposure. Over 93% of male breast cancers are ductal carcinoma. Papillary and lobular carcinomas are extremely rare. Commonly, the stage of breast cancer is more advanced in males due to delays in detection. The rarity of male breast cancer however, does not warrant screening mammography. Overall, five year survival is 30-80%. The differential diagnosis for a palpable breast lump in a male includes gynecomastia, abscess, fat necrosis, lipoma and breast cancer. Secondary signs of malignancy on clinical exam such as nipple retraction, skin thickening or axillary lymphadenopathy are more prevalent than in women due to smaller breast size. Any discrete breast mass on mammography or ultrasound in a male is suspicious and warrants biopsy.

References

  1. Roubidoux MA, Patterson SK. Breast Cancer, Male. eMedicine. Feb. 2, 2005. http://emedicine.medscape.com/article/345979-overview
  2. Chen L, Chantra PK, Larsen LH, et al. Imaging characteristics of malignant lesions of the male breast. Radiographics. 2006 Jul-Aug;26(4):993-1006. [PMID: 16844928]
  3. Appelbaum AH, Evans GF, Levy KR, Amirkhan RH, Schumpert TD. Mammographic appearances of male breast disease. Radiographics. 1999 May-Jun;19(3):559-68. [PMID: 10336188]

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