Breast Imaging Society, India

Contributed By:

Dr.D PORKODI
Kilpauk Medical College Kilpauk

Case History:

A 46 year old male patient presented with history of gradual onset bilateral painless lumps. As the lumps were painless he did not seek medical advice. One month back he noticed that the left breast lump is increasing and he started having pain in the left breast for which he consulted some local practioner and was given analgesics. However no documentation is available. As the pain persisted and redness developed, he presented to our breast clinic in AIIMS Rishikesh. There is no history of fever, diabetes mellitus, hypertension or tuberculosis. His family history was non- contributory. As per protocol, he underwent triple assessment.

Quiz Question:

Innocuous or Sinister! What do you think this is?

Answer

Sinister, BIRADS 5

Discussion

Although Male breast comprises only 1% of male cancers, male breast cancer is increasing. It is often neglected as clinicians and patients are more aware of female breast cancer. The patients present late especially in our set up. Radiologists and clinicians should be aware of this entity. All patients presenting with breast complaints should undergo triple assessment (clinical examination, imaging and histopathology) Gynaecomastia may coexist with breast cancer as is seen in this case, so mammograms should be carefully evaluated even after finding gynaecomastia

Findings

A circumscribed high density lesion ( size 4.5x5.5x6cm) is noted in the upper outer quadrant extending to the retroareolar region . On tomosynthesis, irregular margins were seen. There are fine pleomorphic microcalcifications in the lesion. The lesion is abutting the overlying skin. The skin is thickened and the nipple is retracted. The left axilla shows 2-3 lymph nodes with thickened cortex. On USG the mass was iso to hypechoic with irregular circumscribed margins with increased vascularity.There are mixed posterior features. Microcalcifications were seen in the upper outer region of the mass. BIRADS 5 was assigned for the lesion and USG guided biopsy was recommended. USG guided FNAC from the left axillary node showed only reactive lymphoid hyperplasia. USG guided core biopsy showed Invasive breast cancer NST, Nottingham Grade II. Immunohistochemistry report is awaited.

References

1. Khan NAJ, Tirona M. An updated review of epidemiology, risk factors, and management of male breast cancer. Med Oncol. 2021 Mar 15;38(4):39. doi: 10.1007/s12032-021-01486-x. PMID: 33721121 2.Yuan WH, Li AF, Chou YH, Hsu HC, Chen YY. Clinical and ultrasonographic features of male breast tumors: A retrospective analysis. PLoS One. 2018 Mar 20;13(3):e0194651. doi: 10.1371/journal.pone.0194651. PMID: 29558507; PMCID: PMC5860767.

December 2022