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Radiological Reasoning: Male Breast Mass with Calcifications

Ann A. Shi1, Dianne Georgian-Smith1, Lynn D. Cornell2, Elizabeth A. Rafferty1, Mary Staffa1, Kevin Hughes3 and Daniel B. Kopans1

1 AVON Breast Comprehensive Center and Department of Radiology, Massachusetts General Hospital, WACC 219R, 15 Parkman St., Boston, MA 02114.
2 Department of Pathology, Massachusetts General Hospital, Boston, MA.
3 Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA.



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  		Fig. 1A —30-year-old Brazilian man with mass in left breast. Craniocaudal view (A) and mediolateral oblique view (B) mammograms of both breasts show left breast (left half of images) is extremely dense and nodular with punctate and curvilinear calcifications. Right breast (right half of images) is normal.

 


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  		Fig. 1B —30-year-old Brazilian man with mass in left breast. Craniocaudal view (A) and mediolateral oblique view (B) mammograms of both breasts show left breast (left half of images) is extremely dense and nodular with punctate and curvilinear calcifications. Right breast (right half of images) is normal.

 


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  		Fig. 2 —Sonogram of 30-year-old Brazilian man with mass in left breast shows mixed echogenic mass with echogenic foci (arrows) that represent phleboliths.

 


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  		Fig. 3A —Axial MR images of both breasts in 30-year-old Brazilian man with mass in left breast show abnormal mass on left. T1-weighted spin-echo image with fat suppression shows mass is isointense to muscle.

 


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  		Fig. 3B —Axial MR images of both breasts in 30-year-old Brazilian man with mass in left breast show abnormal mass on left. T2-weighted spin-echo image shows mass is hyperintense and contains low-intensity internal septa.

 


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  		Fig. 3C —Axial MR images of both breasts in 30-year-old Brazilian man with mass in left breast show abnormal mass on left. Gadolinium-enhanced gradient-echo T1-weighted subtraction image with fat suppression shows mass markedly enhances, with multiple vessels infiltrating pectoralis muscle. These vessels were confirmed at surgery.

 


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  		Fig. 4A —30-year-old Brazilian man with mass in left breast. Photographs show surgical specimen, a hemangioma, at gross examination. Scale: centimeters. External view shows lobular surface.

 


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  		Fig. 4B —30-year-old Brazilian man with mass in left breast. Photographs show surgical specimen, a hemangioma, at gross examination. Scale: centimeters. Internal view on sectioning shows gray to white indurated areas and tan to yellow fibroadipose tissue.

 


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  		Fig. 5A —Photomicrographs of hemangioma, mass removed from left breast of 30-year-old Brazilian man. (H and E) Image (x100) shows lobulated groups of large, anastomosing vessels with RBCs and hemosiderin deposition.

 


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  		Fig. 5B —Photomicrographs of hemangioma, mass removed from left breast of 30-year-old Brazilian man. (H and E) Image (x20) shows calcifications (arrow) within blood vessels corresponding to mammographic phleboliths visible in Figures 1A, and 1B.

 

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