Mammographic Appearances of Male Breast Disease1
Alan H. Appelbaum, MB, BCh,
Gregory F. F. Evans, MB, ChB,
Karen R. Levy, MD,
Robin H. Amirkhan, MD and
Terence D. Schumpert, MD
1 From the Departments of Radiology (A.H.A., G.F.F.E.) and Pathology (R.H.A.), Veterans Affairs Medical Center, 4500 S Lancaster Ave, Dallas, TX 75216 and the Departments of Radiology (A.H.A., G.F.F.E., K.R.L., T.D.S.) and Pathology (R.H.A.), University of Texas Southwestern Medical Center, Dallas. Recipient of a Certificate of Merit award for a scientific exhibit at the 1997 RSNA scientific assembly. Received April 30, 1998; revision requested May 27; final revision received November 5; accepted November 5. Address reprint requests to A.H.A.
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Figure 1a. Nodular gynecomastia. (a) Craniocaudal mammogram shows a subareolar density that appears wedge shaped. (b) On the mediolateral oblique view, the density appears more rounded. Note the gradual tapering of soft tissue into surrounding fat.
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Figure 1b. Nodular gynecomastia. (a) Craniocaudal mammogram shows a subareolar density that appears wedge shaped. (b) On the mediolateral oblique view, the density appears more rounded. Note the gradual tapering of soft tissue into surrounding fat.
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Figure 2. Florid (nodular) gynecomastia. Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a surgical biopsy specimen shows proliferation of irregularly branching ducts surrounded by loose, edematous, periductal stroma and residual adipose tissue.
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Figure 3. Florid (nodular) gynecomastia. Photomicrograph (original magnification, x400; Papanicolaou stain) of a fine-needle aspirate demonstrates clusters of bland, cohesive, ductal epithelial cells.
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Figure 4a. Dendritic gynecomastia. Mediolateral oblique (a) and craniocaudal (b) mammograms show stranded densities, which radiate from the nipple and are more prominent in the upper outer quadrant.
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Figure 4b. Dendritic gynecomastia. Mediolateral oblique (a) and craniocaudal (b) mammograms show stranded densities, which radiate from the nipple and are more prominent in the upper outer quadrant.
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Figure 5. Fibrous (dendritic) gynecomastia. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a surgical biopsy specimen reveals dense, sparsely cellular, fibrous stroma; no periductal edema; and minimal surrounding adipose tissue.
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Figure 6. Diffuse glandular gynecomastia. Mediolateral oblique mammogram of a male breast demonstrates an appearance that is very similar to that of a heterogeneously dense female breast.
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Figure 7a. Gynecomastia. (a) Craniocaudal mammogram shows minimal density radiating from the nipple. This finding was histologically proved to represent gynecomastia. (b) Magnified view demonstrates gradual feathering of soft tissue into fat.
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Figure 7b. Gynecomastia. (a) Craniocaudal mammogram shows minimal density radiating from the nipple. This finding was histologically proved to represent gynecomastia. (b) Magnified view demonstrates gradual feathering of soft tissue into fat.
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Figure 8. Figures 8–10. Infiltrating ductal carcinoma. (8) Craniocaudal mammogram shows a lobulated mass with a primarily well-defined margin and eccentrically located relative to the nipple. (9) Craniocaudal mammogram shows a retroareolar mass with ill-defined margins and nipple retraction. (10) Infiltrating ductal carcinoma with an in situ component. Craniocaudal mammogram reveals a lobulated mass with ill-defined margins and coarse calcifications. Nipple retraction is also seen.
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Figure 9. Figures 8–10. Infiltrating ductal carcinoma. (8) Craniocaudal mammogram shows a lobulated mass with a primarily well-defined margin and eccentrically located relative to the nipple. (9) Craniocaudal mammogram shows a retroareolar mass with ill-defined margins and nipple retraction. (10) Infiltrating ductal carcinoma with an in situ component. Craniocaudal mammogram reveals a lobulated mass with ill-defined margins and coarse calcifications. Nipple retraction is also seen.
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Figure 10. Figures 8–10. Infiltrating ductal carcinoma. (8) Craniocaudal mammogram shows a lobulated mass with a primarily well-defined margin and eccentrically located relative to the nipple. (9) Craniocaudal mammogram shows a retroareolar mass with ill-defined margins and nipple retraction. (10) Infiltrating ductal carcinoma with an in situ component. Craniocaudal mammogram reveals a lobulated mass with ill-defined margins and coarse calcifications. Nipple retraction is also seen.
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Figure 11. Infiltrating ductal carcinoma. Photomicrograph (original magnification, x200; hematoxylin-eosin stain) of a surgical biopsy specimen shows rounded and linear groups of infiltrating malignant cells with solid and glandular foci.
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Figure 12. Infiltrating ductal carcinoma. Photomicrograph (original magnification, x400; Papanicolaou stain) of a fine-needle aspirate demonstrates poorly cohesive groups of large, crowded, pleomorphic cells with increased nuclear-to-cytoplasmic ratios, irregular membranes, and macronucleoli.
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Figure 13. Figures 13, 14. Infiltrating ductal carcinoma. (13) Craniocaudal mammogram shows a small lobulated mass with well-defined borders and eccentrically located relative to the nipple. There is obvious nipple retraction. (14) Mediolateral oblique mammogram reveals a subareolar mass with ill-defined margins and overlying skin thickening.
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Figure 14. Figures 13, 14. Infiltrating ductal carcinoma. (13) Craniocaudal mammogram shows a small lobulated mass with well-defined borders and eccentrically located relative to the nipple. There is obvious nipple retraction. (14) Mediolateral oblique mammogram reveals a subareolar mass with ill-defined margins and overlying skin thickening.
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Figure 15a. Infiltrating ductal carcinoma. (a) Mediolateral oblique mammogram shows a mass (arrow), distant from the nipple and overlying the pectoralis muscle. A few pleomorphic microcalcifications are seen adjacent to the mass, which is partially obscured by gynecomastia. (b) Magnification compression view better demonstrates the mass and adjacent microcalcifications. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a resected specimen shows linear groups of carcinoma cells with glandular foci (left) infiltrating an area of fibrous gynecomastia (right).
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Figure 15b. Infiltrating ductal carcinoma. (a) Mediolateral oblique mammogram shows a mass (arrow), distant from the nipple and overlying the pectoralis muscle. A few pleomorphic microcalcifications are seen adjacent to the mass, which is partially obscured by gynecomastia. (b) Magnification compression view better demonstrates the mass and adjacent microcalcifications. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a resected specimen shows linear groups of carcinoma cells with glandular foci (left) infiltrating an area of fibrous gynecomastia (right).
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Figure 15c. Infiltrating ductal carcinoma. (a) Mediolateral oblique mammogram shows a mass (arrow), distant from the nipple and overlying the pectoralis muscle. A few pleomorphic microcalcifications are seen adjacent to the mass, which is partially obscured by gynecomastia. (b) Magnification compression view better demonstrates the mass and adjacent microcalcifications. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a resected specimen shows linear groups of carcinoma cells with glandular foci (left) infiltrating an area of fibrous gynecomastia (right).
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Figure 16. Bilateral infiltrating ductal carcinoma with an in situ component and gynecomastia. Craniocaudal mammograms demonstrate a nodule medial to the nipple (arrow) and retroareolar gynecomastia in the right breast as well as gynecomastia in the left breast. The gynecomastia in the left breast obscured a 1-cm invasive carcinoma.
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Figure 17a. Mediolateral oblique (a) and craniocaudal (b) mammograms show normal lucent fat with strands of ductal and connective tissue radiating from the nipple.
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Figure 17b. Mediolateral oblique (a) and craniocaudal (b) mammograms show normal lucent fat with strands of ductal and connective tissue radiating from the nipple.
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Figure 18. Figures 18, 19. Epidermal inclusion cyst. (18) Craniocaudal mammogram shows a dense, well-defined nodule distant from the nipple and gynecomastia. (19) Mediolateral oblique mammogram demonstrates two adjacent nodules and scattered calcifications. Margins of the inferiorly located nodule are obscured by stranded densities. The superiorly located nodule has primarily well-defined borders but is obscured along the inferior margin. Both nodules proved to be epidermal inclusion cysts. Obscuration of borders is presumed to be secondary to inflammation from rupture of the lower cyst.
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Figure 19. Figures 18, 19. Epidermal inclusion cyst. (18) Craniocaudal mammogram shows a dense, well-defined nodule distant from the nipple and gynecomastia. (19) Mediolateral oblique mammogram demonstrates two adjacent nodules and scattered calcifications. Margins of the inferiorly located nodule are obscured by stranded densities. The superiorly located nodule has primarily well-defined borders but is obscured along the inferior margin. Both nodules proved to be epidermal inclusion cysts. Obscuration of borders is presumed to be secondary to inflammation from rupture of the lower cyst.
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Figure 20. Epidermal inclusion cyst. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a resected specimen demonstrates a subcutaneous or intradermal cyst lined by true squamous epithelium and filled with horny, keratinaceous material.
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Figure 21. Subcutaneous leiomyoma. Craniocaudal mammogram shows an enlarged nipple, which proved to be a subcutaneous leiomyoma. Gynecomastia is evident.
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Figure 22. Subcutaneous leiomyoma. Photomicrograph (original magnification, x50; hematoxylin-eosin stain) of a resected specimen reveals a poorly demarcated mass composed of interlacing bundles of bland, benign smooth muscle fibers with varying amounts of intermingled collagen bundles.
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Figure 23. Figures 23, 24. Subareolar abscess. (23) Magnified craniocaudal view reveals a nodule with indistinct borders and punctate calcifications, located posterior to the nipple. (24) Mediolateral oblique mammogram shows stranded inflammatory changes that mimic gynecomastia. No mass is identifiable, but skin thickening is seen.
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Figure 24. Figures 23, 24. Subareolar abscess. (23) Magnified craniocaudal view reveals a nodule with indistinct borders and punctate calcifications, located posterior to the nipple. (24) Mediolateral oblique mammogram shows stranded inflammatory changes that mimic gynecomastia. No mass is identifiable, but skin thickening is seen.
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Figure 25. Intramammary lymph node. Mediolateral oblique mammogram shows a nodule with a lucent center and well-defined borders.
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Figure 26. Chronic inflammation. Mediolateral oblique mammogram demonstrates stranded densities radiating from the nipple that mimic gynecomastia. These findings actually represented chronic inflammation and fibrosis from a wound that would not heal.
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Copyright © 1999 by the Radiological Society of North America.
