Male breast cancer

Case contributed by Dr. Chris O'Donnell

Presentation

Painless unilateral breast lump. Surgeon thinks it is likely unilateral gynecomastia on palpation.

Patient Data

Age: 70 years
Gender: Male
ultrasound

Well-defined ovoid mass without blood flow a little above the right nipple.  The left breast is normal. Core biopsy performed. 

Case Discussion

Biopsy shows invasive ductal carcinoma with focal lymphovascular invasion. Immunocytochemistry = > 90% + estrogen 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, i.e. unilateral gynecomastia 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 blood flow as in this case.

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