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DOI:10.2214/AJR.05.10781
AJR 2005; 185:S211-S213
© American Roentgen Ray Society

Imaging of the Male Breast: Self-Assessment Module

Ann A. Shi1, Dianne Georgian-Smith1 and Felix S. Chew2

1 AVON Breast Comprehensive Center and Department of Radiology, Massachusetts General Hospital, WACC 219R, 15 Parkman St., Boston, MA 02114.
2 Department of Radiology, University of Washington, Seattle, WA 98105.

Received June 29, 2005; accepted after revision September 28, 2005.

 
Address correspondence to D. Georgian-Smith (dgeorgiansmith{at}partners.org).


Abstract
Top
 Abstract
INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
The educational objectives for this self-assessment module on male breast imaging are for the participant to exercise, self-assess, and improve his or her understanding of the evaluation and management of a breast mass presenting in a man; gain familiarity with the differential diagnosis of breast masses in men and how to evaluate such lesions by imaging; gain familiarity with the sonographic features of breast cancer in men; and gain familiarity with the imaging features of vascular tumors of the breast.


INTRODUCTION
Top
 Abstract
 INTRODUCTION
EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
This self-assessment module on male breast imaging has an educational component and a self-assessment component. The educational component consists of three required articles that the participant should read, and two additional articles that are recommended. The self-assessment component consists of six multiple-choice questions with solutions. All of these materials are available on the ARRS Web site (www.arrs.org). To claim CME and SAM credit, each participant must enter his or her responses to the questions online.


EDUCATIONAL OBJECTIVES
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
By completing this educational activity, the participant will:

  1. Exercise, self-assess, and improve his or her understanding of the evaluation and management of a breast mass presenting in a man.
  2. Gain familiarity with the differential diagnosis of breast masses in men and how to evaluate such lesions by imaging.
  3. Gain familiarity with the sonographic features of breast cancer in men.
  4. Gain familiarity with the imaging features of vascular tumors of the breast.


REQUIRED READING
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
(available online at www.arrs.org)

  1. Shi AA, Georgian-Smith D, Cornell LD, Rafferty EA, Staffa M, Hughes K, Kopans DB. Radiological reasoning: male breast mass with calcifications. AJR2005 ;185:S205 -S210. Included in this issue.[Abstract/Free Full Text]
  2. Glazebrook K, Morton M, Reynolds C. Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR 2005;184:331 -338[Free Full Text]
  3. Yang WT, Whitman GJ, Yuen E, Tse G, Stelling CB. Sonographic features of primary breast cancer in men. AJR 2001;176:413 -416[Abstract/Free Full Text]


RECOMMENDED READING
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
(available online at www.arrs.org)

  1. Dershaw DD, Borgen PI, Deutch BM, Liberman L. Mammographic findings in men with breast cancer. AJR1993 ;160:267 -270[Abstract/Free Full Text]
  2. Appelbaum AH, Evans GFFF, Levy KR, Amirkhan RH, Schumpert TD. Mammographic appearances of male breast disease. RadioGraphics1999 ;19:559 -568[Abstract/Free Full Text]


INSTRUCTIONS
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 

  1. Complete the required reading.
  2. Visit www.arrs.org selecting the Journals/Integrative Imaging link on the left-hand side of the home page.
  3. Using your member login, order the online SAM as directed.
  4. Complete the test by answering the questions online. The test questions and solutions are printed on pages S212-S213, but you must register and complete the test online to receive CME and SAM credit.


QUESTION 1

What is the most common cause of a male breast mass?

  1. Breast cancer.
  2. Hemangioma.
  3. Gynecomastia.
  4. Parasitic infections.
  5. Osteosarcoma.

QUESTION 2

Which one of the following statements is true of male breast cancer?

  1. It is usually bilateral.
  2. The typical age of diagnosis is younger than 50 years.
  3. The most common histology is invasive ductal carcinoma.
  4. It often presents as a painful mass.
  5. It has a worse prognosis than breast cancer in women.

QUESTION 3

Calcification is NOT a feature of which one of the following conditions in men?

  1. Breast cancer.
  2. Posttraumatic change of the breast.
  3. Breast tuberculosis.
  4. Hemangioma.
  5. Gynecomastia.

 


Solution to Question 1
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
Gynecomastia is the most common cause of a male breast mass. It frequently appears as a flame-shaped subareolar mass on mammography [1]. Option C is the best response. Breast cancer is uncommon in males, accounting for fewer than 1% of all cancers in men. Vascular tumors of the breast are very infrequent and even more rare in men. Parasitic infections of the breast, such as schistosomaisas, paragonimiasis, and myiasis are rare, even in endemic areas. Osteosarcoma of the breast is extremely rare in either sex.


Solution to Question 2
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
The majority of male breast cancers are invasive ductal cancer, with most remaining tumors being medullary and papillary tumors [2]. Option C is the best response. Male breast cancer is usually unilateral. Breast cancer in men is usually diagnosed at or around 60 years of age. Male breast cancer generally manifests as a hard, painless subareolar mass eccentric to the nipple, with occasional nipple discharge or ulceration. Breast cancer in men has the same prognosis as in women.


QUESTION 4

Which of the following statements regarding breast hemangiomas is true?

  1. Hemangioma can be easily differentiated from angiosarcoma on MRI.
  2. Hemangiomas lack early contrast enhancement but often demonstrate delayed enhancement.
  3. On sonography, a breast hemangioma is typically a hyperechoic mass with well-defined borders.
  4. Fluid-fluid levels on MRI are features of hemangiomas.
  5. Hemangiomas have low signal intensity on T2-weighted images.

QUESTION 5

In an adult male with a breast mass, which sonographic feature should lead to a biopsy?

  1. Microlobulated margins.
  2. Hypoechoic, solid.
  3. Extensive central vascular flow.
  4. Uniform hyperechoic.
  5. Hypoechoic halo.

To complete the SAM and earn 2.0 CME credits, visit www.arrs.org.

 


Solution to Question 3
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
Solution to Question 4
 Solution to Question 5
 
Calcification is not a feature of gynecomastia [1]. Option E is the best response. Calcification is reported in 13-30% of male breast cancers. Dystrophic calcium deposition occurs with fat necrosis or old hematoma; both conditions may be secondary to trauma. Common mammographic features of breast TB include mass lesions, duct ectasia, skin thickening, nipple retraction, and macrocalcifications. Hemangiomas contain calcifications secondary to phlebolith formation. Calcifications are often punctate, but can also appear coarse or bizarre.


Solution to Question 4
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
Solution to Question 5
 
Fluid-fluid levels on MRI can sometimes be seen in hemangiomas due to sedimentation of blood products [3]. Option D is the best response. On MRI, both hemangiomas and angiosarcomas demonstrate variable intensity on T1-weighted images, high intensity on T2-weighted images, and contrast enhancement. These imaging features make it difficult to distinguish them from one another. The definitive diagnosis requires pathologic examination. Hemangiomas commonly demonstrate early enhancement due to their highly vascular nature. Sonographic findings of a hemangioma are variable and nonspecific: it can have well-defined or ill-defined borders; it can be hypoechoic or hyperechoic with distal shadowing. Hemangiomas have high signal intensity on T2-weighted mages due to cavernous or cystic vascular spaces.


Solution to Question 5
Top
 Abstract
 INTRODUCTION
 EDUCATIONAL OBJECTIVES
 REQUIRED READING
 RECOMMENDED READING
 INSTRUCTIONS
 Solution to Question 1
 Solution to Question 2
 Solution to Question 3
 Solution to Question 4
 Solution to Question 5
 
In a study of eight men with primary breast cancer, four had heterogeneous hypoechoic solid lesions and four had complex cystic lesions [4]. Option B is the best response. The margins of the lesions were irregular in three patients, indistinct in three, microlobulated in one, and smooth in one patient. Posterior acoustic enhancement was present in three patients, mild shadowing was visible in three, and no posterior acoustic phenomena were visualized in the remaining two patients. Vascularity,as determined by the presence of color flow, was present in five; the flow was predominantly peripheral and scanty. A hypoechoic halo has not been described as a feature of any lesion on breast sonography. A hyperechoic halo can be a sonographic feature of breast cancer in females, but has not yet been described in breast cancer in males.


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This Article
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