Symptomatic Male Patient Overview
HIDEInteractive Transcript
0:00
So the next group of patients that we
0:03
see are male patients, and there's an ACR
0:08
appropriateness criteria for the symptomatic
0:10
male breast, so good to take a look at.
0:15
And, um, in general, our protocol is that
0:18
if the patient is, um, under age 25, we'll
0:22
start with ultrasound, add a mammogram if
0:25
we need it, and then age 25 and up, we'll
0:28
start with a diagnostic bilateral mammogram,
0:31
um, and then ultrasound if it's needed.
0:36
There are lots of reasons for palpable
0:37
lumps in a male patient or for the
0:40
perception of breast enlargement.
0:42
One of them is gynecomastia, which is just
0:44
development of breast tissue in a male patient.
0:47
There's also pseudogynecomastia, where
0:49
it looks like there's enlargement of the
0:51
breast, but it's really just fatty tissue
0:54
rather than development of breast tissue.
0:57
We also see lipomas and fat lobules presenting
1:00
as palpable lumps, epidermal inclusion cysts,
1:05
lymph nodes, breast cancer, and lymphoma.
1:10
So gynecomastia is the most
1:11
common cause of a palpable mass.
1:13
Breast enlargement or pain in a male
1:15
patient can cause all of those things.
1:18
Um, there are many causes, and it's
1:20
considered physiologic in neonates,
1:23
adolescents, and with aging.
1:25
There's a long list of medications
1:28
that are associated with gynecomastia.
1:30
Some recreational drugs can also cause it, uh,
1:34
chronic liver disease and hormonal changes.
1:39
On mammography, there are three different
1:41
types of gynecomastia that we see.
1:44
Nodular, dendritic, and diffuse glandular.
1:47
Nodular looks like a subareolar nodule or mass.
1:51
Dendritic is usually subareolar and flame shaped.
1:56
And diffuse glandular looks like a
1:58
heterogeneously dense female breast.
2:01
On ultrasound, uh, gynecomastia will look like
2:04
hypoechoic tissue centered under the nipple
2:07
and then extending out into the surrounding
2:10
tissue, and it may be quite vascular.
2:14
Male breast cancer accounts for less
2:17
than 1 percent of all breast cancers.
2:19
Uh, they often occur at an
2:20
older age, maybe in 63 years.
2:24
They usually present as a painless palpable lump.
2:27
We may see skin or nipple retraction or nipple
2:29
discharge, and they can be, um, subareolar,
2:32
so directly under the nipple, or they
2:34
can be eccentric, so in another location.
2:39
On mammography, uh, male breast cancer
2:42
may look like a circumscribed or
2:43
irregular mass or an asymmetry, and
2:46
we may see associated calcifications.
2:48
On ultrasound, we'll often see a
2:51
hypoechoic mass with irregular margins.
2:54
Uh, sometimes it's a hypoechoic mass
2:55
with circumscribed margins, and sometimes
2:58
we'll see a complex cystic and solid mass.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
© 2024 Medality. All Rights Reserved.