Symptomatic Male Patient Overview
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So the next group of patients that we
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see are male patients, and there's an ACR
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appropriateness criteria for the symptomatic
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male breast, so good to take a look at.
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And, um, in general, our protocol is that
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if the patient is, um, under age 25, we'll
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start with ultrasound, add a mammogram if
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we need it, and then age 25 and up, we'll
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start with a diagnostic bilateral mammogram,
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um, and then ultrasound if it's needed.
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There are lots of reasons for palpable
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lumps in a male patient or for the
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perception of breast enlargement.
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One of them is gynecomastia, which is just
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development of breast tissue in a male patient.
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There's also pseudogynecomastia, where
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it looks like there's enlargement of the
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breast, but it's really just fatty tissue
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rather than development of breast tissue.
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We also see lipomas and fat lobules presenting
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as palpable lumps, epidermal inclusion cysts,
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lymph nodes, breast cancer, and lymphoma.
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So gynecomastia is the most
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common cause of a palpable mass.
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Breast enlargement or pain in a male
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patient can cause all of those things.
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Um, there are many causes, and it's
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considered physiologic in neonates,
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adolescents, and with aging.
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There's a long list of medications
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that are associated with gynecomastia.
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Some recreational drugs can also cause it, uh,
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chronic liver disease and hormonal changes.
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On mammography, there are three different
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types of gynecomastia that we see.
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Nodular, dendritic, and diffuse glandular.
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Nodular looks like a subareolar nodule or mass.
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Dendritic is usually subareolar and flame shaped.
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And diffuse glandular looks like a
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heterogeneously dense female breast.
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On ultrasound, uh, gynecomastia will look like
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hypoechoic tissue centered under the nipple
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and then extending out into the surrounding
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tissue, and it may be quite vascular.
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Male breast cancer accounts for less
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than 1 percent of all breast cancers.
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Uh, they often occur at an
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older age, maybe in 63 years.
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They usually present as a painless palpable lump.
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We may see skin or nipple retraction or nipple
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discharge, and they can be, um, subareolar,
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so directly under the nipple, or they
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can be eccentric, so in another location.
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On mammography, uh, male breast cancer
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may look like a circumscribed or
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irregular mass or an asymmetry, and
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we may see associated calcifications.
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On ultrasound, we'll often see a
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hypoechoic mass with irregular margins.
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Uh, sometimes it's a hypoechoic mass
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with circumscribed margins, and sometimes
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we'll see a complex cystic and solid mass.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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