Background
Male breast disease can often be an overwhelming topic for breast imagers. Male patients are subject to many of the same benign and malignant processes we typically see in females when it comes to breast pathology. It is important for radiologists to have an in-depth knowledge of the how male patients may present, characteristic imaging features, as well as the appropriate workup and management for various male breast disease pathologies.
Educational Goals / Teaching Points
We have three learning objectives associated with our educational exhibit on male breast disease. The first learning objective is to review the appropriate steps to workup male breast disease. The second learning objective is to refamiliarize radiologists with types of male breast disease, including processes such as gynecomastia, pseudogynecomastia, pseudoangiomatous stromal hyperplasia (PASH), mammary myofibroblastoma, myofibroblastoma myxoid variant, hemangioma, schwannoma, lipoma, resolving hematoma, fat necrosis, plasmacytoma, fibromatosis, abscess, papilloma, invasive carcinomas, lymphoma, and metastatic disease. The third learning objective will be a brief review of relevant pathology, histology when appropriate, and treatment for each male breast disease etiology discussed.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Mammography is typically the initial imaging modality of choice when evaluating male breast disease. Ultrasound can also be utilized if there is a palpable abnormality, incompletely evaluated mass, or occult findings that have not been adequately assessed with mammography. Although MRI is typically not utilized as frequently for evaluation of male breast disease, it can be used for problem solving or staging of male breast carcinoma. As in females, any indeterminate or suspicious findings noted on imaging within the male breast need to be further evaluated with tissue sampling. A high level of suspicion is appropriate when evaluating male breast disease, especially if there is a clinical suspicion for breast cancer, as males typically present at a more advanced stage than their female counterparts.
Conclusion
Male breast disease can be an intimidating topic and a thorough understanding of the embryology, anatomy, and physiology of the male breast can aid our understanding of the various etiologies that make up male breast disease. Familiarity is imperative to accurately recognize and assess classic benign male breast diseases to prevent unnecessary imaging and further workup or invasive treatment for a benign process. Conversely, the radiologist’s recognition of any suspicious findings within the male breast is imperative to hasten a diagnosis and prevent further workup delay or treatment for a patient with malignant male breast disease.
