Mass in Male (Gynecomastia, Cancer)

Gynecomastia is a benign condition manifesting as enlarged breasts in men and boys. This increased breast tissue is caused by excess fibroglandular deposits and is caused by hormonal imbalances, commonly due to estrogen excess or from various drugs, such as spironolactone, ketoconazole, cimetidine, ranitidine, and specific HIV therapies. Patients generally present with bilateral subareolar enlarged breasts (however, unilateral gynecomastia also occurs), which commonly exhibit tenderness on palpation, swelling, palpable lumps, or nipple discharge. This chapter reviews the important imaging protocols, pitfalls, differential diagnoses, radiology–pathology correlation, and management recommendations for gynecomastia and cancer of the male breast. Topics discussed include gynecomastia, breast cancer, pseudogynecomastia, hypogonadism, and lymphangioma.

Duct Ectasia

10.1093/med/9780190270261.003.0043 ◽

2018 ◽

Author(s):

Nicole S. Winkler

Keyword(s):

Lymph Nodes ◽

Chronic Inflammation ◽

Clinical Features ◽

Nipple Discharge ◽

Screening Mammography ◽

Differential Diagnoses ◽

Sonographic Evaluation ◽

Imaging Protocols ◽

Duct ectasia is a term used to describe benign dilation of fluid-filled mammary ducts. Duct ectasia is characterized by tubular fluid-filled structures >2 mm in diameter that are commonly bilateral and subareolar in location. Ductal dilation is due to weakened wall elasticity that occurs with age. The ducts fill with secretions that may result in intermittent nipple discharge or chronic inflammation. When duct ectasia involves multiple ducts bilaterally, it can be dismissed on screening mammography; however, a solitary dilated duct should be further evaluated, given the potential for associated non-calcified DCIS. This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for duct ectasia. Topics discussed include solitary dilated duct, nipple discharge, and sonographic evaluation of ducts.

Coarse Heterogeneous Calcifications

10.1093/med/9780190270261.003.0038 ◽

2018 ◽

Author(s):

Cheryce Poon Fischer

Keyword(s):

Breast Cancer ◽

Clinical Features ◽

Differential Diagnoses ◽

Intermediate Risk ◽

Imaging Protocols ◽

Prior Surgery ◽

Coarse heterogeneous calcifications are irregular calcifications that are between 0.5 mm and 1 mm in size. They are usually in a group and are smaller in size than dystrophic calcifications. Although they are of intermediate risk for breast cancer (most commonly, DCIS), they are also associated with benign entities, such as hyalinized/degenerating fibroadenoma, areas of fibrosis, papilloma, and evolving dystrophic calcifications from prior surgery or trauma. Generally, numerous bilateral groups of coarse heterogeneous calcifications may be considered benign. However, baseline magnification views may be helpful to confirm the morphology of the calcifications and to exclude more suspicious pleomorphic morphology. Coarse heterogeneous calcifications in a linear or segmental distribution are suspicious. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for coarse heterogeneous calcifications.

Intracystic/Intraductal Mass

10.1093/med/9780190270261.003.0046 ◽

2018 ◽

Author(s):

Nicole S. Winkler

Keyword(s):

Lymph Nodes ◽

Papillary Carcinoma ◽

Clinical Features ◽

Nipple Discharge ◽

Differential Diagnoses ◽

Imaging Findings ◽

Solid Mass ◽

Common Cause ◽

Imaging Protocols ◽

This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for intracystic and intraductal masses. The differential diagnoses of intraductal and intracystic masses are similar, with papilloma the most common cause for both. Therefore, we review descriptive terms for both together, with similar implications and management recommendations. Intracystic masses have a higher association with malignancy than intraductal masses, due in part to overlap of imaging appearances of intracystic mass and complex cystic and solid mass. Topics discussed include intraductal and intracystic masses, evaluation of ducts, papilloma, papillary carcinoma and nipple discharge.

Granulomatous Mastitis: A Rare Cause of Male Breast Lump

Case Reports in Oncology ◽

10.1159/000448990 ◽

2016 ◽

Vol 9 (2) ◽

pp. 516-519 ◽

Cited By ~ 12

Author(s):

Abdel Rahman A. Al Manasra ◽

Mohammad F. Al-Hurani

Keyword(s):

Breast Tissue ◽

Nipple Discharge ◽

Surgical Excision ◽

Male Breast ◽

Granulomatous Mastitis ◽

Idiopathic Granulomatous Mastitis ◽

Radiologic Findings ◽

Female Breast ◽

The Right ◽

Histopathologic Findings

Background: Mastitis is a common benign disorder of the female breast. It is frequently associated with tenderness, swelling and nipple discharge. We are describing an extremely rare case of an idiopathic granulomatous mastitis in the male breast. Only 1 previous case was reported. Case Report: A 29-year-old male patient presented with a hard, painless lump in the right breast of 2 weeks duration. The patient underwent surgical excision with margin. The histopathologic findings were consistent with granulomatous mastitis. The case was reported as idiopathic granulomatous mastitis after exclusion of all known causes of the disease. Conclusion: Granulomatous mastitis is rare in females and extremely rare in male breast tissue. Since this disease mimics breast cancer in its clinical picture and radiologic findings are usually not conclusive, surgical excision is recommended in all cases.

Non-Mass Enhancement on MRI

10.1093/med/9780190270261.003.0031 ◽

2018 ◽

Author(s):

Diana L. Lam ◽

Habib Rahbar

Keyword(s):

Breast Cancer ◽

Clinical Features ◽

Morphological Features ◽

Post Contrast ◽

Imaging Protocols ◽

Background Parenchymal Enhancement ◽

Normal Background ◽

Mass Enhancement ◽

Parenchymal Enhancement

Breast cancer presents on MRI as an enhancing finding on post-contrast T1-weighted images that is distinct from normal background parenchymal enhancement (BPE), and these enhancing lesions can be further described as a focus, mass, or non-mass enhancement (NME). Each enhancing lesion, with the exception of a focus, can be described further with specific morphological features that are defined by the ACR BI-RADS Atlas. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations of a focus of enhancement and non-mass enhancement on MRI. Topics discussed include distinguishing a focus from normal BPE, benign versus suspicious features of a focus, NME characterization, and kinetic enhancement curves.

Enhancing Mass on MRI

10.1093/med/9780190270261.003.0032 ◽

2018 ◽

Author(s):

John R. Scheel ◽

Diana L. Lam

Keyword(s):

Clinical Features ◽

Irregular Shape ◽

Differential Diagnoses ◽

Imaging Protocols ◽

Enhancement Curve ◽

Rim Enhancement ◽

Space Occupying Lesion

The ACR BI-RADS Atlas defines a “mass” on MRI as a space-occupying lesion with convex borders. Masses are characterized by their morphology and their internal enhancement characteristics. Mass morphology descriptor categories include shape (oval, round, irregular), margins (circumscribed, irregular, spiculated), and internal enhancement (homogeneous, heterogeneous, rim enhancement, dark internal septations). Suspicious morphology descriptors of MRI masses include irregular shape, irregular or spiculated margins, and heterogeneous internal enhancement. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for an enhancing mass on MRI. Topics discussed include characteristics of benign and malignant masses, classic benign masses, and enhancement curve assessment.

Multiple Circumscribed Masses

10.1093/med/9780190270261.003.0019 ◽

2018 ◽

Author(s):

Erin L. Prince ◽

Heidi R. Umphrey

Keyword(s):

Lymph Nodes ◽

Clinical Features ◽

Clinical Information ◽

Differential Diagnoses ◽

Surrounding Tissue ◽

Imaging Protocols ◽

Screening Mammograms ◽

A circumscribed mass is a mass with margins demonstrating a sharp demarcation between the lesion and surrounding tissue. On mammography, at least 75% of the margin must be well defined in order for the mass to qualify as circumscribed. Multiple circumscribed masses may be seen unilaterally or bilaterally and can be seen on up to 1.7% of screening mammograms. After mammography, these masses may need to be further evaluated with ultrasound and correlated with clinical information. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for multiple circumscribed masses. Topics discussed include cysts, fibroadenomas, oil cysts, metastases, lymph nodes, and neurofibromas.

Amorphous/Indistinct Calcifications (Regional/Diffuse)

10.1093/med/9780190270261.003.0040 ◽

2018 ◽

Author(s):

Lilian Wang

Keyword(s):

Breast Cancer ◽

Differential Diagnosis ◽

Morphological Classification ◽

Imaging Protocols ◽

Fibrocystic Change ◽

Perimenopausal Women ◽

Risk Of Malignancy ◽

Sclerosing Adenosis ◽

Diffuse Distribution

Amorphous calcifications are calcifications that are sufficiently small and/or hazy that a more specific morphological classification cannot be made. Historically, such calcifications were referred to as “indistinct” calcifications. The likelihood of malignancy and the management of amorphous calcifications largely depend on their distribution. The majority of amorphous calcifications are benign, most often due to fibrocystic change (60%). Sclerosing adenosis commonly occurs in perimenopausal women and is associated with a 1.5–2.1x relative risk for development of breast cancer. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis, and management recommendations for amorphous/indistinct calcifications in a regional or diffuse distribution. Topics discussed include influence of distribution on risk of malignancy and pathological entities, including sclerosing adenosis.

Mass with Indistinct Margins

10.1093/med/9780190270261.003.0024 ◽

2018 ◽

Author(s):

Lonie R. Salkowski

Keyword(s):

Clinical Features ◽

Differential Diagnoses ◽

Imaging Protocols ◽

Entire Margin

Masses described as having indistinct margins lack a clear demarcation of a portion or the entire margin from the surrounding tissues. The indistinctness of the margin raises the possibility of infiltration; therefore, this descriptor implies suspicion for malignancy. “Indistinct” differs from “obscured.” A mass with obscured margins insinuates that the surrounding tissues masks or covers the presence of the lesion. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for masses with indistinct margins. Topics discussed include differentiation of the mass with indistinct margins from an obscured mass and focal asymmetry, and how the presence of adjacent features can increase the suspicion of the mass with indistinct margins.

Nipple Discharge

10.1093/med/9780190270261.003.0044 ◽

2018 ◽

Author(s):

Nicole S. Winkler

Keyword(s):

Lymph Nodes ◽

Clinical Features ◽

Nipple Discharge ◽

Fluid Secretion ◽

Clinical Implications ◽

Imaging Findings ◽

Fluid Content ◽

Sonographic Evaluation ◽

Imaging Protocols ◽

Nipple discharge refers to expressible or spontaneous drainage of fluid from one or more duct orifices of the nipple. Discharge indicates excess fluid secretion into one or more ducts that will drain through an unobstructed duct orifice onto the nipple skin. The fluid content and appearance are important as they have clinical implications. Nipple discharge that is clear or bloody, unilateral (typically uniductal) and spontaneous (fluid discharges without breast or nipple compression) is considered suspicious for malignancy, though most cases are due to benign papillomas. This chapter, appearing in the section on nipple, skin and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple discharge. Topics discussed include clinical evaluation of nipple discharge, sonographic evaluation of ducts and nipple, ductography, intraductal mass, and papilloma.