Male breast cancer
Painless unilateral breast lump. Surgeon thinks it is likely unilateral gynaecomastia on palpation.
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Well-defined ovoid mass without blood flow a little above the right nipple. Left breast is normal. Biopsy shows invasive ductal carcinoma with focal lymphovascular invasion. Immunocytochemistry = > 90% + oestrogen receptor, > 90% + progestrone receptor, HER2 negative.
Male breast cancer is rare (1% of breast cancers) but has a poorer prognosis compared with women. In most cases unilateral breast lumps in men are benign ie unilateral gynaecomastia thus on ultrasound the characteristics must be carefully scrutinized to differentiate carcinoma.
Ultrasound appearances of ductal carcinoma are similar to those seen in women but in men particularly one should look for a hypoechoic solid mass (usually without shadowing or posterior acoustic enhancement) often without bloodflow as in this case.