0:00

So the next group of patients that we

0:03

see are male patients, and there's an ACR

0:08

appropriateness criteria for the symptomatic

0:10

male breast, so good to take a look at.

0:15

And, um, in general, our protocol is that

0:18

if the patient is, um, under age 25, we'll

0:22

start with ultrasound, add a mammogram if

0:25

we need it, and then age 25 and up, we'll

0:28

start with a diagnostic bilateral mammogram,

0:31

um, and then ultrasound if it's needed.

0:36

There are lots of reasons for palpable

0:37

lumps in a male patient or for the

0:40

perception of breast enlargement.

0:42

One of them is gynecomastia, which is just

0:44

development of breast tissue in a male patient.

0:47

There's also pseudogynecomastia, where

0:49

it looks like there's enlargement of the

0:51

breast, but it's really just fatty tissue

0:54

rather than development of breast tissue.

0:57

We also see lipomas and fat lobules presenting

1:00

as palpable lumps, epidermal inclusion cysts,

1:05

lymph nodes, breast cancer, and lymphoma.

1:10

So gynecomastia is the most

1:11

common cause of a palpable mass.

1:13

Breast enlargement or pain in a male

1:15

patient can cause all of those things.

1:18

Um, there are many causes, and it's

1:20

considered physiologic in neonates,

1:23

adolescents, and with aging.

1:25

There's a long list of medications

1:28

that are associated with gynecomastia.

1:30

Some recreational drugs can also cause it, uh,

1:34

chronic liver disease and hormonal changes.

1:39

On mammography, there are three different

1:41

types of gynecomastia that we see.

1:44

Nodular, dendritic, and diffuse glandular.

1:47

Nodular looks like a subareolar nodule or mass.

1:51

Dendritic is usually subareolar and flame shaped.

1:56

And diffuse glandular looks like a

1:58

heterogeneously dense female breast.

2:01

On ultrasound, uh, gynecomastia will look like

2:04

hypoechoic tissue centered under the nipple

2:07

and then extending out into the surrounding

2:10

tissue, and it may be quite vascular.

2:14

Male breast cancer accounts for less

2:17

than 1 percent of all breast cancers.

2:19

Uh, they often occur at an

2:20

older age, maybe in 63 years.

2:24

They usually present as a painless palpable lump.

2:27

We may see skin or nipple retraction or nipple

2:29

discharge, and they can be, um, subareolar,

2:32

so directly under the nipple, or they

2:34

can be eccentric, so in another location.

2:39

On mammography, uh, male breast cancer

2:42

may look like a circumscribed or

2:43

irregular mass or an asymmetry, and

2:46

we may see associated calcifications.

2:48

On ultrasound, we'll often see a

2:51

hypoechoic mass with irregular margins.

2:54

Uh, sometimes it's a hypoechoic mass

2:55

with circumscribed margins, and sometimes

2:58

we'll see a complex cystic and solid mass.

Symptomatic Male Patient Overview

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Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

So the next group of patients that we

0:03

see are male patients, and there's an ACR

0:08

appropriateness criteria for the symptomatic

0:10

male breast, so good to take a look at.

0:15

And, um, in general, our protocol is that

0:18

if the patient is, um, under age 25, we'll

0:22

start with ultrasound, add a mammogram if

0:25

we need it, and then age 25 and up, we'll

0:28

start with a diagnostic bilateral mammogram,

0:31

um, and then ultrasound if it's needed.

0:36

There are lots of reasons for palpable

0:37

lumps in a male patient or for the

0:40

perception of breast enlargement.

0:42

One of them is gynecomastia, which is just

0:44

development of breast tissue in a male patient.

0:47

There's also pseudogynecomastia, where

0:49

it looks like there's enlargement of the

0:51

breast, but it's really just fatty tissue

0:54

rather than development of breast tissue.

0:57

We also see lipomas and fat lobules presenting

1:00

as palpable lumps, epidermal inclusion cysts,

1:05

lymph nodes, breast cancer, and lymphoma.

1:10

So gynecomastia is the most

1:11

common cause of a palpable mass.

1:13

Breast enlargement or pain in a male

1:15

patient can cause all of those things.

1:18

Um, there are many causes, and it's

1:20

considered physiologic in neonates,

1:23

adolescents, and with aging.

1:25

There's a long list of medications

1:28

that are associated with gynecomastia.

1:30

Some recreational drugs can also cause it, uh,

1:34

chronic liver disease and hormonal changes.

1:39

On mammography, there are three different

1:41

types of gynecomastia that we see.

1:44

Nodular, dendritic, and diffuse glandular.

1:47

Nodular looks like a subareolar nodule or mass.

1:51

Dendritic is usually subareolar and flame shaped.

1:56

And diffuse glandular looks like a

1:58

heterogeneously dense female breast.

2:01

On ultrasound, uh, gynecomastia will look like

2:04

hypoechoic tissue centered under the nipple

2:07

and then extending out into the surrounding

2:10

tissue, and it may be quite vascular.

2:14

Male breast cancer accounts for less

2:17

than 1 percent of all breast cancers.

2:19

Uh, they often occur at an

2:20

older age, maybe in 63 years.

2:24

They usually present as a painless palpable lump.

2:27

We may see skin or nipple retraction or nipple

2:29

discharge, and they can be, um, subareolar,

2:32

so directly under the nipple, or they

2:34

can be eccentric, so in another location.

2:39

On mammography, uh, male breast cancer

2:42

may look like a circumscribed or

2:43

irregular mass or an asymmetry, and

2:46

we may see associated calcifications.

2:48

On ultrasound, we'll often see a

2:51

hypoechoic mass with irregular margins.

2:54

Uh, sometimes it's a hypoechoic mass

2:55

with circumscribed margins, and sometimes

2:58

we'll see a complex cystic and solid mass.

Report

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Lesson

Sample Lesson

Lesson

Palpable Lumps

Lesson

Breast Pain

Lesson

Nipple Discharge

Lesson

Skin Changes/Inflammation

Lesson

Recall from Screening

Lesson

Surveillance After Breast Cancer Treatment

Lesson

Follow Up Probably Benign Findings - BI-RADS 3

Lesson

Follow up Benign Biopsy

Lesson

Pregnant and Lactating Women

Lesson

Male Patients

Symptomatic Male Patient Overview