Radiological evaluation of the male breast – signs of male breast cancer

Abstract

An increasing number of male patients presents at the outpatient clinic with with breast disorders such as palpable retroareolar tumors, nipple discharge, inflammation or ekzema of the nipple-areola complex. Although male breast cancer in Austria is still a rare event (for 2001–2003 48 male breast cancers versus 4858 in women were diagnosed) these patients necessitate clinical and radiological evaluation to distinguish between benigne and maligne lesions. The knowledge about the physiological effects of estrogens and testosterone as well as the knowledge about the mechanism for development of cancer is a precondition to work. The most common breast alteration is the gynecomastia. Physiological hormonal inbalance and many various disorders, supplements, medications and drugs can cause a benign proliferation of subareolar ductal and periductal stromal tissues. The major problem is to different the benign mass versus carcinomas. Besides clinical examination the radiological evaluation includes mammography, sonography, 3D ultrasound and in a few cases MRI. The radiological criteria for malignancy are the same as for the female, however male breast cancer more often reveals solid lesions and calcifications are rare. BI-RADS 4 lesions should be further evaluated using an ultrasound guided biopsy or open surgery with frozen section. The different radiological presentation of male breast cancer and gynecomastia is discussed and cases are presented.