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
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
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
By completing this educational activity, the participant will:
- 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.
- Gain familiarity with the imaging features of vascular tumors of the
breast.
REQUIRED READING
(available online at
www.arrs.org)
-
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]
-
Glazebrook K, Morton M, Reynolds C. Vascular tumors of the
breast: mammographic, sonographic, and MRI appearances.
AJR 2005;184:331
-338[Free Full Text]
-
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
(available online at
www.arrs.org)
-
Dershaw DD, Borgen PI, Deutch BM, Liberman L. Mammographic
findings in men with breast cancer. AJR1993
;160:267
-270[Abstract/Free Full Text]
-
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
- Complete the required reading.
- Visit
www.arrs.org
selecting the Journals/Integrative Imaging link on the left-hand side of the
home page.
- Using your member login, order the online SAM as directed.
- 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?
- Breast cancer.
- Hemangioma.
- Gynecomastia.
- Parasitic infections.
- Osteosarcoma.
QUESTION 2
Which one of the following statements is true of male breast
cancer?
- It is usually bilateral.
- The typical age of diagnosis is younger than 50 years.
- The most common histology is invasive ductal carcinoma.
- It often presents as a painful mass.
- 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?
- Breast cancer.
- Posttraumatic change of the breast.
- Breast tuberculosis.
- Hemangioma.
- Gynecomastia.
|
Solution to Question 1
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
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?
- Hemangioma can be easily differentiated from angiosarcoma on MRI.
- Hemangiomas lack early contrast enhancement but often demonstrate delayed
enhancement.
- On sonography, a breast hemangioma is typically a hyperechoic mass with
well-defined borders.
- Fluid-fluid levels on MRI are features of hemangiomas.
- 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?
- Microlobulated margins.
- Hypoechoic, solid.
- Extensive central vascular flow.
- Uniform hyperechoic.
- Hypoechoic halo.
To complete the SAM and earn 2.0 CME credits, visit
www.arrs.org.
|
Solution to Question 3
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
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
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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Abstract
INTRODUCTION
