IS Case 379: Lipoma of the male breast

Daniel O'Connor, MD

2009 URMC Imaging Sciences
Publication Date: 2010-03-02

History

Patient is a 61-year-old male with a palpable lump in his right breast. No other significant medical or family history, including ovarian or breast cancer in first degree relatives.

Findings

Bilateral diagnostic mammography and subsequent right breast ultrasonography were performed. Mammogram demonstrated fatty appearance of the breast tissue bilaterally without evidence of masses, calcifications, or architectural changes suggestive of malignancy. Right breast ultrasound in the region of the palpable mass demonstrated a superficial well-circumscribed mass hyperechoic to the surrounding fatty tissue without acoustic shadowing or increased through transmission, typical of lipoma. No additional imaging was suggested.

Diagnosis

Lipoma of the male breast

Discussion

Palpable abnormalities in the male breast are not uncommon, and are usually attributable to gynecomastia resulting from endocrine, metabolic, iatrogenic (i.e. drug-induced), or idiopathic etiologies. Primary tumors of the male breast are less common, representing less than 1% of all breast cancers in the US and less than 1% of male cancers. Male breast cancers are typically diagnosed at a later age than in women (7th decade), are usually more advanced, and are typically in the subareolar or upper outer quadrant of the breast. Imaging, diagnosis, and management are identical as in women with the same stage of disease.

This patient presented with a palpable, painless lump with no mammographic abnormalities. Targeted ultrasound demonstrated features characteristic of a lipoma, with iso- to hyperechoic appearance of well-circumscribed oval or round mass without increased through-transmission or acoustic shadowing. Mammography depict a thin rim of fibrous tissue defining the region of a palpable lump, but patients (such as this gentleman) often have no associated mammographic abnormality. This is a benign lesion and requires no additional imaging or histopathological confirmation.

References

1. Ikeda DM. Breast Imaging: The Requisites. Elsevier-Mosby, Philadelphia, PA. 2004.