DOI: 10.1148/rg.264055116
Imaging Characteristics of Malignant Lesions of the Male Breast1
Lina Chen, MD2,
Prem K. Chantra, MD2,
Linda H. Larsen, MD,
Premsri Barton, MD,
Montanan Rohitopakarn, MD,
Elise Q. Zhu, MD and
Lawrence W. Bassett, MD
1 From the Department of Radiology, University of California, 200 UCLA Medical Plaza, Room 165-47, Los Angeles, CA 90095-6952 (L.C., P.K.C., L.W.B.); the Department of Radiology, West Los Angeles Veterans Administration Healthcare System, Los Angeles, Calif (P.K.C.); the Department of Radiology, University of Southern California Medical Center, Los Angeles, Calif (L.H.L., E.Q.Z.); and the Department of Radiology, Washington University Medical Center, Seattle, Wash (P.B., M.R.). Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received May 12, 2005; revision requested July 8 and received August 22; accepted August 29. All authors have no financial relationships to disclose.
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Figure 1a. Normal male breast. (a) Mediolateral oblique mammogram shows the normal male breast, which consists predominantly of subcutaneous fat. Note the lack of the Cooper ligament. (b) Ultrasonographic (US) image obtained with the expanded field of view panoramic technique shows the anatomy of the normal male breast, which consists of the skin and subcutaneous fat. The pectoralis fascia (PF), pectoralis muscle (PM), ribs, and intercostal muscles (ICM) are also shown.
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Figure 1b. Normal male breast. (a) Mediolateral oblique mammogram shows the normal male breast, which consists predominantly of subcutaneous fat. Note the lack of the Cooper ligament. (b) Ultrasonographic (US) image obtained with the expanded field of view panoramic technique shows the anatomy of the normal male breast, which consists of the skin and subcutaneous fat. The pectoralis fascia (PF), pectoralis muscle (PM), ribs, and intercostal muscles (ICM) are also shown.
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Figure 2a. Invasive ductal carcinoma in a 52-year-old man with a palpable mass. (a) Mediolateral oblique mammogram shows an eccentrically located, irregular, indistinct, dense mass (M) deep in the palpated region with overlying skin thickening (S). The entire lesion could not be imaged with mammography because of its peripheral and deep location. (b) Transverse US image of the palpated region shows the nonparallel, hypoechoic, microlobulated mass with surrounding echogenic breast tissue. The overlying skin thickening is also seen.
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Figure 2b. Invasive ductal carcinoma in a 52-year-old man with a palpable mass. (a) Mediolateral oblique mammogram shows an eccentrically located, irregular, indistinct, dense mass (M) deep in the palpated region with overlying skin thickening (S). The entire lesion could not be imaged with mammography because of its peripheral and deep location. (b) Transverse US image of the palpated region shows the nonparallel, hypoechoic, microlobulated mass with surrounding echogenic breast tissue. The overlying skin thickening is also seen.
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Figure 3a. Invasive ductal carcinoma in a 77-year-old man with a 3-month history of a tender subareolar mass. (a) Coned-down craniocaudal mammogram shows a small, irregular, retroareolar density with nipple retraction and skin thickening. (b) Transverse US image of the nipple region shows the irregular, nonparallel, hypoechoic mass with angular margins and an isoechoic halo (*). The overlying low echogenicity corresponds to the nipple retraction and skin thickening seen on the mammogram.
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Figure 3b. Invasive ductal carcinoma in a 77-year-old man with a 3-month history of a tender subareolar mass. (a) Coned-down craniocaudal mammogram shows a small, irregular, retroareolar density with nipple retraction and skin thickening. (b) Transverse US image of the nipple region shows the irregular, nonparallel, hypoechoic mass with angular margins and an isoechoic halo (*). The overlying low echogenicity corresponds to the nipple retraction and skin thickening seen on the mammogram.
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Figure 4a. Invasive ductal carcinoma with ipsilateral axillary lymph node metastasis in a 66-year-old man with a 6-month history of a right breast lump. (a) Mediolateral oblique mammogram of the right breast shows a round, microlobulated, high-density mass in the retroareolar region with increased trabeculation of the entire breast. (b) Transverse US image of the right breast shows the round, microlobulated, hypoechoic, complex mass with posterior acoustic enhancement.
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Figure 4b. Invasive ductal carcinoma with ipsilateral axillary lymph node metastasis in a 66-year-old man with a 6-month history of a right breast lump. (a) Mediolateral oblique mammogram of the right breast shows a round, microlobulated, high-density mass in the retroareolar region with increased trabeculation of the entire breast. (b) Transverse US image of the right breast shows the round, microlobulated, hypoechoic, complex mass with posterior acoustic enhancement.
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Figure 5a. Invasive ductal carcinoma with ipsilateral axillary lymph node metastases in a 49-year-old man with a palpable right breast mass. Physical examination demonstrated that the right breast was markedly larger than the left with induration, erythema, and nipple retraction. There were palpable nodes in the right axillary and supra-clavicular regions. (a) Mediolateral oblique mammogram of the right breast shows an irregular, retroareolar, high-density mass with increased trabeculation of the breast. (b) Craniocaudal mammogram of the right breast shows the high-density mass with microcalcification and overlying skin thickening. (c) Transverse US image of the palpated region shows the irregular hypoechoic mass with punctate calcifications and mild posterior acoustic enhancement. (d) US image of the right axilla shows an irregular hypoechoic mass, which represents an abnormal lymph node.
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Figure 5b. Invasive ductal carcinoma with ipsilateral axillary lymph node metastases in a 49-year-old man with a palpable right breast mass. Physical examination demonstrated that the right breast was markedly larger than the left with induration, erythema, and nipple retraction. There were palpable nodes in the right axillary and supra-clavicular regions. (a) Mediolateral oblique mammogram of the right breast shows an irregular, retroareolar, high-density mass with increased trabeculation of the breast. (b) Craniocaudal mammogram of the right breast shows the high-density mass with microcalcification and overlying skin thickening. (c) Transverse US image of the palpated region shows the irregular hypoechoic mass with punctate calcifications and mild posterior acoustic enhancement. (d) US image of the right axilla shows an irregular hypoechoic mass, which represents an abnormal lymph node.
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Figure 5c. Invasive ductal carcinoma with ipsilateral axillary lymph node metastases in a 49-year-old man with a palpable right breast mass. Physical examination demonstrated that the right breast was markedly larger than the left with induration, erythema, and nipple retraction. There were palpable nodes in the right axillary and supra-clavicular regions. (a) Mediolateral oblique mammogram of the right breast shows an irregular, retroareolar, high-density mass with increased trabeculation of the breast. (b) Craniocaudal mammogram of the right breast shows the high-density mass with microcalcification and overlying skin thickening. (c) Transverse US image of the palpated region shows the irregular hypoechoic mass with punctate calcifications and mild posterior acoustic enhancement. (d) US image of the right axilla shows an irregular hypoechoic mass, which represents an abnormal lymph node.
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Figure 5d. Invasive ductal carcinoma with ipsilateral axillary lymph node metastases in a 49-year-old man with a palpable right breast mass. Physical examination demonstrated that the right breast was markedly larger than the left with induration, erythema, and nipple retraction. There were palpable nodes in the right axillary and supra-clavicular regions. (a) Mediolateral oblique mammogram of the right breast shows an irregular, retroareolar, high-density mass with increased trabeculation of the breast. (b) Craniocaudal mammogram of the right breast shows the high-density mass with microcalcification and overlying skin thickening. (c) Transverse US image of the palpated region shows the irregular hypoechoic mass with punctate calcifications and mild posterior acoustic enhancement. (d) US image of the right axilla shows an irregular hypoechoic mass, which represents an abnormal lymph node.
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Figure 6a. Bilateral invasive ductal carcinoma with left axillary lymph node metastasis in a patient with a family history of breast cancer who presented with bilateral palpable breast lumps. (a) Craniocaudal mammograms show bilateral lobulated, high-density, retroareolar masses. (b, c) Longitudinal US images of the right (b) and left (c) breasts show the bilateral nonparallel lobulated masses, which are adjacent to but separate from the nipples. The masses are predominantly hypoechoic with mixed internal echogenicity.
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Figure 6b. Bilateral invasive ductal carcinoma with left axillary lymph node metastasis in a patient with a family history of breast cancer who presented with bilateral palpable breast lumps. (a) Craniocaudal mammograms show bilateral lobulated, high-density, retroareolar masses. (b, c) Longitudinal US images of the right (b) and left (c) breasts show the bilateral nonparallel lobulated masses, which are adjacent to but separate from the nipples. The masses are predominantly hypoechoic with mixed internal echogenicity.
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Figure 6c. Bilateral invasive ductal carcinoma with left axillary lymph node metastasis in a patient with a family history of breast cancer who presented with bilateral palpable breast lumps. (a) Craniocaudal mammograms show bilateral lobulated, high-density, retroareolar masses. (b, c) Longitudinal US images of the right (b) and left (c) breasts show the bilateral nonparallel lobulated masses, which are adjacent to but separate from the nipples. The masses are predominantly hypoechoic with mixed internal echogenicity.
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Figure 7a. Bilateral invasive ductal carcinoma with bilateral axillary lymph node metastases in a 48-year-old man with Klinefelter syndrome and a history of bilateral breast lumps for several months. (a) Mediolateral oblique mammograms show bilateral large, retroareolar, spiculated, high-density masses with skin thickening and nipple retraction. (b) Transverse US image of the nipple region of the right breast shows the hypoechoic and irregular retroareolar mass with spiculation and angular margins. There is mild posterior acoustic shadowing. (c) US image of the right axilla shows a hypoechoic lobulated mass, which represents metastatic cancer in a lymph node. Similar US findings were seen on images of the left breast and axilla.
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Figure 7b. Bilateral invasive ductal carcinoma with bilateral axillary lymph node metastases in a 48-year-old man with Klinefelter syndrome and a history of bilateral breast lumps for several months. (a) Mediolateral oblique mammograms show bilateral large, retroareolar, spiculated, high-density masses with skin thickening and nipple retraction. (b) Transverse US image of the nipple region of the right breast shows the hypoechoic and irregular retroareolar mass with spiculation and angular margins. There is mild posterior acoustic shadowing. (c) US image of the right axilla shows a hypoechoic lobulated mass, which represents metastatic cancer in a lymph node. Similar US findings were seen on images of the left breast and axilla.
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Figure 7c. Bilateral invasive ductal carcinoma with bilateral axillary lymph node metastases in a 48-year-old man with Klinefelter syndrome and a history of bilateral breast lumps for several months. (a) Mediolateral oblique mammograms show bilateral large, retroareolar, spiculated, high-density masses with skin thickening and nipple retraction. (b) Transverse US image of the nipple region of the right breast shows the hypoechoic and irregular retroareolar mass with spiculation and angular margins. There is mild posterior acoustic shadowing. (c) US image of the right axilla shows a hypoechoic lobulated mass, which represents metastatic cancer in a lymph node. Similar US findings were seen on images of the left breast and axilla.
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Figure 8a. Metastatic adenocarcinoma in an axillary lymph node with occult primary breast cancer in a 77-year-old man with a left axillary mass. Fine-needle aspiration of the axillary lymph node demonstrated an adenocarcinoma with mucin. Surgical biopsy of the breast tissue demonstrated no histopathologic abnormality. (a) Coned-down mediolateral oblique mammogram shows minimal glandular density in the subareolar area. (b) Transverse US image of the nipple region shows nipple shadowing. (c) US image of the left axilla shows a lobulated hypoechoic mass, which represents an enlarged lymph node.
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Figure 8b. Metastatic adenocarcinoma in an axillary lymph node with occult primary breast cancer in a 77-year-old man with a left axillary mass. Fine-needle aspiration of the axillary lymph node demonstrated an adenocarcinoma with mucin. Surgical biopsy of the breast tissue demonstrated no histopathologic abnormality. (a) Coned-down mediolateral oblique mammogram shows minimal glandular density in the subareolar area. (b) Transverse US image of the nipple region shows nipple shadowing. (c) US image of the left axilla shows a lobulated hypoechoic mass, which represents an enlarged lymph node.
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Figure 8c. Metastatic adenocarcinoma in an axillary lymph node with occult primary breast cancer in a 77-year-old man with a left axillary mass. Fine-needle aspiration of the axillary lymph node demonstrated an adenocarcinoma with mucin. Surgical biopsy of the breast tissue demonstrated no histopathologic abnormality. (a) Coned-down mediolateral oblique mammogram shows minimal glandular density in the subareolar area. (b) Transverse US image of the nipple region shows nipple shadowing. (c) US image of the left axilla shows a lobulated hypoechoic mass, which represents an enlarged lymph node.
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Figure 9a. Hodgkin lymphoma in a 58-year-old man with a new lump in the left axilla and hardening of the left breast associated with intermittent pain. (a, b) Bilateral mediolateral oblique mammograms (a) and coned-down views of the axilla (b) show no suspicious breast mass. However, there are multiple enlarged dense lymph nodes in the left axilla (b). (c) US image of the left axilla shows one of the large hypoechoic masses with loss of normal architecture.
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Figure 9b. Hodgkin lymphoma in a 58-year-old man with a new lump in the left axilla and hardening of the left breast associated with intermittent pain. (a, b) Bilateral mediolateral oblique mammograms (a) and coned-down views of the axilla (b) show no suspicious breast mass. However, there are multiple enlarged dense lymph nodes in the left axilla (b). (c) US image of the left axilla shows one of the large hypoechoic masses with loss of normal architecture.
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Figure 9c. Hodgkin lymphoma in a 58-year-old man with a new lump in the left axilla and hardening of the left breast associated with intermittent pain. (a, b) Bilateral mediolateral oblique mammograms (a) and coned-down views of the axilla (b) show no suspicious breast mass. However, there are multiple enlarged dense lymph nodes in the left axilla (b). (c) US image of the left axilla shows one of the large hypoechoic masses with loss of normal architecture.
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Figure 10a. Mantle cell lymphoma in a 51-year-old man with dyspnea due to pleural effusion. Bilateral breast masses were found at admission; CT showed mediastinal, retroperitoneal, and pelvic masses. (a) Mammograms show bilateral circumscribed, oval or lobular, high-density masses. (b) Longitudinal US image shows one of the hypoechoic, circumscribed, microlobulated masses.
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Figure 10b. Mantle cell lymphoma in a 51-year-old man with dyspnea due to pleural effusion. Bilateral breast masses were found at admission; CT showed mediastinal, retroperitoneal, and pelvic masses. (a) Mammograms show bilateral circumscribed, oval or lobular, high-density masses. (b) Longitudinal US image shows one of the hypoechoic, circumscribed, microlobulated masses.
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Figure 11a. Dermatofibro-sarcoma in a 49-year-old man who initially presented with a palpable small right breast mass and underwent right breast lumpectomy. He presented 3 years later with a new lump at the surgical site. (a) Mammogram (magnification view) from the initial presentation shows a small spiculated mass. (b) Transverse US image of the palpated region shows the hyperechoic mass with lobulated margins extending to the dermis. (c) Craniocaudal mammogram from the second presentation shows a spiculated mass in the same region. (d) Transverse US image of the palpated region shows the superficial lobulated mass with mixed internal echogenicity.
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Figure 11b. Dermatofibro-sarcoma in a 49-year-old man who initially presented with a palpable small right breast mass and underwent right breast lumpectomy. He presented 3 years later with a new lump at the surgical site. (a) Mammogram (magnification view) from the initial presentation shows a small spiculated mass. (b) Transverse US image of the palpated region shows the hyperechoic mass with lobulated margins extending to the dermis. (c) Craniocaudal mammogram from the second presentation shows a spiculated mass in the same region. (d) Transverse US image of the palpated region shows the superficial lobulated mass with mixed internal echogenicity.
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Figure 11c. Dermatofibro-sarcoma in a 49-year-old man who initially presented with a palpable small right breast mass and underwent right breast lumpectomy. He presented 3 years later with a new lump at the surgical site. (a) Mammogram (magnification view) from the initial presentation shows a small spiculated mass. (b) Transverse US image of the palpated region shows the hyperechoic mass with lobulated margins extending to the dermis. (c) Craniocaudal mammogram from the second presentation shows a spiculated mass in the same region. (d) Transverse US image of the palpated region shows the superficial lobulated mass with mixed internal echogenicity.
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Figure 11d. Dermatofibro-sarcoma in a 49-year-old man who initially presented with a palpable small right breast mass and underwent right breast lumpectomy. He presented 3 years later with a new lump at the surgical site. (a) Mammogram (magnification view) from the initial presentation shows a small spiculated mass. (b) Transverse US image of the palpated region shows the hyperechoic mass with lobulated margins extending to the dermis. (c) Craniocaudal mammogram from the second presentation shows a spiculated mass in the same region. (d) Transverse US image of the palpated region shows the superficial lobulated mass with mixed internal echogenicity.
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Figure 12a. Early nodular gynecomastia. (a) Craniocaudal mammogram shows a nodular subareolar density. (b) Transverse US image shows the subareolar, fan-shaped, hypoechoic nodule surrounded by echogenic normal fatty tissue. (c) Color Doppler image shows hyper-vascular flow within the mass.
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Figure 12b. Early nodular gynecomastia. (a) Craniocaudal mammogram shows a nodular subareolar density. (b) Transverse US image shows the subareolar, fan-shaped, hypoechoic nodule surrounded by echogenic normal fatty tissue. (c) Color Doppler image shows hyper-vascular flow within the mass.
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Figure 12c. Early nodular gynecomastia. (a) Craniocaudal mammogram shows a nodular subareolar density. (b) Transverse US image shows the subareolar, fan-shaped, hypoechoic nodule surrounded by echogenic normal fatty tissue. (c) Color Doppler image shows hyper-vascular flow within the mass.
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Figure 13a. Chronic dendritic gynecomastia. (a) Craniocaudal mammogram shows a dendritic subareolar density with posterior linear projections radiating into the surrounding tissue. (b) Transverse US image shows the subareolar hypoechoic nodule with star-shaped projections into the surrounding echogenic fibrous tissue.
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Figure 13b. Chronic dendritic gynecomastia. (a) Craniocaudal mammogram shows a dendritic subareolar density with posterior linear projections radiating into the surrounding tissue. (b) Transverse US image shows the subareolar hypoechoic nodule with star-shaped projections into the surrounding echogenic fibrous tissue.
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Figure 14a. Diffuse gynecomastia. (a) Craniocaudal mammogram shows enlargement of the breast and diffuse density with both dendritic and nodular features. (b) Transverse US image shows the diffusely heterogeneous breast with both nodular and dendritic projections surrounded by diffuse hyperechoic fibrous tissue.
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Figure 14b. Diffuse gynecomastia. (a) Craniocaudal mammogram shows enlargement of the breast and diffuse density with both dendritic and nodular features. (b) Transverse US image shows the diffusely heterogeneous breast with both nodular and dendritic projections surrounded by diffuse hyperechoic fibrous tissue.
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Figure 15a. Lipoma. (a) Craniocaudal mammogram shows a subtle encapsulated fatty mass (arrows) in the palpated region. (b) Transverse US image shows the parallel, homogeneous, mildly hyperechoic mass with a capsule (arrow) under the skin.
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Figure 15b. Lipoma. (a) Craniocaudal mammogram shows a subtle encapsulated fatty mass (arrows) in the palpated region. (b) Transverse US image shows the parallel, homogeneous, mildly hyperechoic mass with a capsule (arrow) under the skin.
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Figure 16a. Epidermal inclusion cyst. (a) Mammogram (spot magnification view) shows a well-defined, dense, oval mass contiguous to the skin in the palpated region. (b) Transverse US image shows the hypoechoic lesion, which is contiguous to the epidermis (arrows) (the "claw sign") with increased through transmission.
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Figure 16b. Epidermal inclusion cyst. (a) Mammogram (spot magnification view) shows a well-defined, dense, oval mass contiguous to the skin in the palpated region. (b) Transverse US image shows the hypoechoic lesion, which is contiguous to the epidermis (arrows) (the "claw sign") with increased through transmission.
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Figure 17a. Pseudoangiomatous stromal hyperplasia. (a) Coned-down mammogram shows a dense circumscribed mass. (b) Transverse US image shows the solid hyperechoic mass with posterior acoustic shadowing.
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Figure 17b. Pseudoangiomatous stromal hyperplasia. (a) Coned-down mammogram shows a dense circumscribed mass. (b) Transverse US image shows the solid hyperechoic mass with posterior acoustic shadowing.
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Figure 18a. Intraductal papilloma. (a) Craniocaudal mammogram shows a discrete dense mass against a background of subareolar density, which is consistent with gynecomastia. (b) Transverse US image shows multiple eccentric, subareolar, elongated, well-defined, hypoechoic masses, which have irregular shapes and are possibly confined to the lumina of markedly enlarged central ducts. (c) Longitudinal US image shows cystic areas, which may represent associated ductal ectasia.
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Figure 18b. Intraductal papilloma. (a) Craniocaudal mammogram shows a discrete dense mass against a background of subareolar density, which is consistent with gynecomastia. (b) Transverse US image shows multiple eccentric, subareolar, elongated, well-defined, hypoechoic masses, which have irregular shapes and are possibly confined to the lumina of markedly enlarged central ducts. (c) Longitudinal US image shows cystic areas, which may represent associated ductal ectasia.
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Figure 18c. Intraductal papilloma. (a) Craniocaudal mammogram shows a discrete dense mass against a background of subareolar density, which is consistent with gynecomastia. (b) Transverse US image shows multiple eccentric, subareolar, elongated, well-defined, hypoechoic masses, which have irregular shapes and are possibly confined to the lumina of markedly enlarged central ducts. (c) Longitudinal US image shows cystic areas, which may represent associated ductal ectasia.
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Copyright © 2006 by the Radiological Society of North America.
