77-year-old man with painful palpable lump in right subareolar breast
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So our next patient is a 77-year-old
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man with a painful palpable
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lump in the right subareolar breast.
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For this patient, we did
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bilateral mammograms, CC (Craniocaudal), and MLO (Mediolateral Oblique).
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We marked the area of palpable concern on
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the right breast with a triangle, and we
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can just zoom in and take a look at that.
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It looks like he has some breast
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tissue here behind the nipple.
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And we'll look at it with
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tomosynthesis images as well.
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So breast tissue extending
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backward from the nipple.
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This would be more of that dendritic appearance.
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And then we had the CC view as
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well with tomosynthesis images.
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It just looks like breast tissue.
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So of course we always do both sides.
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So we had the left CC view really
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just fatty tissue behind the nipple.
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That looks fine.
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You know, there's often a little
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bit of tissue on the opposite side.
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So that looks okay.
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And then we get to the left MLO view and
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all of a sudden we have something else.
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So there's a dense mass
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overlying the pectoralis muscle.
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In the left breast, completely unexpected
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and not the area of interest to the patient.
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We looked through this with the tomosynthesis
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imaging, and you can see that there's a pretty
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dense mass there overlying the pectoralis muscle.
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So we went ahead and did an ultrasound, and
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this is that mass overlying the pectoralis
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muscle in the left lateral breast.
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So a 2.
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5-centimeter mass.
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With a lot of internal vascularity.
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And, you know, we weren't too worried about
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the gynecomastia on the right, but now
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we're more worried about this mass that was
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incidentally discovered in the left breast.
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So this was recommended for ultrasound
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guided biopsy, and that was performed,
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and this was a B-cell lymphoma.
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The patient did not carry a diagnosis of
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lymphoma; this was a new diagnosis, uh, focal
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lymphoma in the left breast in a male patient.
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So not all gynecomastia is just gynecomastia,
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and it's always good to look at both sides.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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