Male breast disease: review of radiologic and clinical
findings
Poster No.:
C-1599
Congress:
ECR 2015
Type:
Educational Exhibit
Authors:
P. Rudenko, G. MONTOLIU, R. M. Viguer Benavent, M. Á.
Sánchez Fuster, R. Llorens, M. A. Jarre Mendoza, Y. Ochoa;
Valencia/ES
Keywords:
Cancer, Education, Biopsy, Ultrasound, MR, Mammography,
Oncology, Breast
DOI:
10.1594/ecr2015/C-1599
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Page 1 of 35
Learning objectives
-Review clinical and radiographic features of the most common benign and malignant
lesions of the male breast.
-Discuss the key radiologic signs of gynecomastia and its differentiation from breast
cancer.
-Recognize lesions that require biopsy.
Background
Male breast disease includes a wide spectrum of different conditions, most of them
benign (gynecomastia or cutaneous lesions), but there is significant overlap in imaging
and clinical presentation with malignancies, though radiologist should be familiar with the
most common lesions and be able identify the next step in diagnostic workup.
Over the last twenty years the percentage of men presenting with breast complaints has
increased almost three times from 0,8 to 2,4 % (1). Symptomatic men frequently refer a
palpable mass, breast enlargement and tenderness.
Gynecomastia is the most common finding in a man with palpable tender subareolar
mass.
Other benign breast conditions like myofibroblastoma, lipoma, inflammatory and
posttraumatic breast lesions are also found with relative frequency in a male population.
Male breast cancer accounts for 1% of all breast cancers, being an invasive ductal
carcinoma (IDC) not otherwise specified a most common type.
Malignancies other than cancer are very uncommon and include metastasis, liposarcoma
and lymphoma.
Normal anatomy
The male breast extends from the second to the sixth rib and normally is composed of
skin, subcutaneous fat, few ducts and some stroma elements Fig. 1 on page 4 .
Page 2 of 35
Approximately half of the male population over 44 years presents palpable breast tissue
(2).
Fig. 1: Normal male breast anatomy. A. Mediolateal oblique (MLO) mammogram
shows a normal male breast which consists predominantly of subcutaneous fat. There
is no glandular tissue. B. Ultrasound image (US) represents normal male breast
anatomy. Pectoralis fascia (PF), pectoralis muscle (PM).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Copper ligaments are absent in male breast. Breast lobular development, which is
stimulated by estrogen and progesterone, is extremely rare in men, therefore breast
conditions referred to lobular proliferation such as fibroadenoma, phyllodes tumor, lobular
carcinoma, carcinosarcoma should not be diagnosed by radiologist in a male breast (3).
Imaging Protocols
There is no standardized protocol for imaging workup in the male breast. Usually
mammography is a first step in imaging a man with a palpable mass. In our institution we
routinely perform mediolateral oblique views of both breast, that can be completed with
craniocaudal and pectoralis displaced views in those patients who have well-developed
pectoral muscle.
Page 3 of 35
After mammography we almost always perform ultrasound, to evaluate the
mammographic abnormality.
MRI is generally not indicated in the workup for male breast disease, but can b# used for
example in assessment for chest wall invasion in breast cancer.
CT is not a method of choice in breast-imaging, but sometimes performed for other
condition, it results to be a first imaging modality where a breast abnormality is detected.
Images for this section:
Fig. 1: Normal male breast anatomy. A. Mediolateal oblique (MLO) mammogram shows
a normal male breast which consists predominantly of subcutaneous fat. There is no
glandular tissue. B. Ultrasound image (US) represents normal male breast anatomy.
Pectoralis fascia (PF), pectoralis muscle (PM).
Page 4 of 35
Findings and procedure details
Gynecomastia
Gynecomastia is the most common disease of a male breast. Clinically it presents with as
a soft palpable subareolar mass, which can be tender at the examination. Gynecomastia
is caused by benign proliferation of the ductal and stromal tissue in response to hormone
(estrogen) stimulation. In males, estrogenic effects are physiologically increased in
neonates, adolescents and elderly (4). Some other endocrine disorders, systemic
diseases and certain drugs may also cause gynecomastia. See Table 1 below.
Table 1.
From reference (5).
Physiologic causes:
Neonatal period
Puberty
Elderly patients
Hormonal:
Kleinfelter syndrome
Hypogonadism
Systemic disoders:
Cirrhosis
Chronic renal insufficiency and dialysis
Hyperthyroidism
Neoplasic:
Adrenal cortical carcinoma
Page 5 of 35
Testicular tumors
Hepatocellular carcinoma
Pituitary adenoma
Drug use:
Anabolic steroids
Exogenous estrogen
Marijuana
Thiazide diuretics
Cimetidine
Tricyclis antidepressants
Estrogen therapy
Spironolactone
Digitalis
Omeprazol
Idiopathic
Gynecomastia by definition is 2 cm or more of subareolar glandular tissue, it can
be unilateral, bilateral, symmetric or asymmetric. The hallmark of gynecomastia is it
symmetric location under the nipple, usually with ill-defined borders because it lacks
capsule and spreads into the surrounding fat tissue (5).
Three main mammographic patterns have been described: nodular, dendritic, and
diffuse, each of them representing different stages of stromal and ductal proliferation.
-Nodular glandular pattern represents an early florid phase, with symptoms duration less
than one year (6). At mammography it appears as fan or wedge shaped subareolar
density. And on ultrasound we can notice a hypoechoic nodular lesion that can be
hypervascular due to proliferation of stroma Fig. 2 on page 21
Page 6 of 35
Fig. 2: Nodular pattern of gynecomastia in 60-year-old male who presents tender
movile left retroareolar mass. A. Left MLO mammogram shows unilateral round shape
subareolar glandular tissue. B. US shows a retroareolar disk shape area with indistinct
borders that corrsponds to glandular tissue (yellow arrows).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
-Dendritic pattern is seen in the fibrotic or quiescent phase; usually 1 year after the
symptoms had started. Both at ultrasound and mammography this pattern classically
manifests as "flame shaped" subareolar density with finger-like projections into breast
tissue (3) Fig. 3 on page 21 .
Page 7 of 35
Fig. 3: Dendritic pattern of gynecomastia in 58-year-old-male with unilateral, painful,
movile mass. A. Retroareolar soft tissue density lesion is seen in a left breast (circle)
as an incidental finding on CT image performed for another reason. B. Left MLO
mammography shows subareolar density with prominent extensions into the fat. C.
US image shows a classic hypoechoic finger-like projections (arrows) spreading into
surrounding fat. D. Decrease of retroareolar tissue after Tamoxifen treatment.
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
-Diffuse pattern is usually seen in a man with very high estrogen levels and combines
findings of dentdritic and nodular gynecomastia and resembles female breasts Fig. 4 on
page 22 . and Fig. 5 on page 23
Page 8 of 35
Fig. 4: Bilateral gynecomastia with diffuse pattern in patient with pituitary
microadenoma. It looks like female breast, seen even on chest X-ray (blue arrows
in A and B). C. Mammogram confirms the presence of bilateral glandular diffuse
tissue. D.T1 weighted post contrast MRI image reveals small less enhancing pituatary
microadenoma (yellow arrow).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Page 9 of 35
Fig. 5: Diffuse pattern in another patient with cirrhosis and treatment with
Spironolactone. (A). Bilateral gynecomastia on CT image. (B). MLO mammogram
shows bilateral glandular tissue corresponding to diffuse gynecomastia.
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Page 10 of 35
The main differential diagnosis for gynecomastia includes breast carcinoma (that will
be discussed later) and pseudogynecomastia (4). Pseudogynecomastia consists of
excessive fat deposition in breast area, usually in obese patients and doesn't demonstrate
palpable glandular tissue Fig. 6 on page 24 .
Fig. 6: Pseudogynecomastia in obese patient with breast enlargement. A.Bilateral
excessive fat deposition in the breast area, some small amount of glandular tissue.B
and C.US image of right and left breasts confirms that there is neither mass nor
retroareolar glandular tissue.
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
The treatment of gynecomastia consists in assessment of underlying medical condition.
Discontinuation of offending drug or medication typically results in regression of
gynecomastia . Antagonist of estrogen receptors (tamoxifen), androgens and aromatase
inhibitors may be used. Subcutaneous mastectomy is indicated in cases that are
refractory to medical treatment (7).
Page 11 of 35
Male breast cancer
The overall incidence of male breast cancer is around 1% of all breast cancers and is on
the rise. (8). The main risk factors include chronic expose to estrogen, cirrhosis, testicular
injury, Klinefelter syndrome (50-fold increased risk) , BRCA 1 and BRCA 2 mutations,
chest wall irradiation (8-11).
The entire spectrum of histological variants of breast cancer has been seen in male
population.
The majority of breast cancers in men are infiltrating ductal carcinomas with incidence
ranging from 64-93% (8). Papillary carcinoma is a second in frequency, seen in 3-5 %
of male breast cancers and occurring twice as often in men than in women (12). As we
have mentioned above the lobular system is not developed in men that is why lobular
carcinoma is exceptional and is usually associated with estrogen exposure.
Also ductal carcinoma in situ is rare because there is no screening program for men, so
usually they present at a later stage with palpable mass found at the examination.
Breast cancer manifests clinically as hard, fixed, painless mass. Nipple involvement
manifesting as retraction, nipple discharge, ulceration or eczema is seen in 40-50% of
patients (8).
It has been reported that axillary lymph node involvement is very common and clinically
suspicious adenopathy has been seen in approximately half of the patients (13).
Mammography is usually a first image modality to be performed, in almost all cases
followed by ultrasound (US). Breast cancer typically is positioned subareolar but
eccentric to the nipple (in contrast to gynecomastia, which is normally central to
the nipple) and occasionally in peripheral location. At mammography most invasive
carcinomas appear as high density retroareolar lesions Fig. 7 on page 25 and can
present spiculated, lobulated and microlobulated margins Fig. 8 on page 26 (5).
Calcifications are rare, but when they occur they are coarser than in women (4).
Secondary features such as nipple retraction, skin thickening, and increased
trabeculation are worrisome findings (6).
Ultrasound features of male breast cancer are similar to those seen in females. Usually
it presents with solid, nonparallel, hypoicoic, subareolar mass, with spiculated and
microlubulated margins, normally eccentric to the nipple Fig. 7 on page 25 (6).
Posterior acoustic features are not helpful for distinguishing benign versus malignant
lesions, in a study realized by Chen et al. it was shown that half of the patients does not
have any posterior sonographic feature (6).
Page 12 of 35
US evaluation of axillary lymph nodes should be routinely performed in patients with
suspicious for breast cancer lesions Fig. 7 on page 25 . Abnormal enlarged lymph
nodes with an absent fatty hilum and asymmetric cortical thicknesses are suspicious for
regional metastatic disease.
Fig. 7: Infiltrating ductal carcinoma not otherwise specified in 59 year-old man.
A.Left MLO mammogram shows a dense, spiculated, subareolar mass (thin yellow
arrow) with associated skin thickening and nipple retraction (big arrows). Right MLO
mammogram shows dendritic gynecomastia. B.US image of enlarged axillary lymph
node with an absent fatty hilum, US features indicating tumoral adenopathy. C. Solid,
nonparallel, hypoicoic, subareolar mass, with ill-defined borders.
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Page 13 of 35
MRI is rarely performed in male breast cancer. It can be used in cases where initial
imaging is equivocal, for example in small tumors when there is a difficulty in location of
the lesion due to its size and similar texture to surrounding breast tissue in ultrasound
exam, or if the lesion is associated with gynecomastia. MRI can also improve evaluation
of chest-wall invasion (14).
The features of male breast cancer are similar to those seen in female: spiculated mass,
with washout kinetics enhancement and lymphadenopathy Fig. 8 on page 26 .
Fig. 8: Another case of invasive ductal carcinoma in 78-year-old patient with
palpable mass in a left breast. A.Left MLO mammogram dense mass with partially illdefined lobulated margins (yellow arrowheads) B. US confirms the presence of solid
hypoechoic , poorly vascularised mass ( asterisk) C.Post contrast T1 weighted MR
image shows a small spiculated mass with rim enhancement (thin arrow).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Gynecomastia versus carcinoma
Page 14 of 35
As stated above gynecomastia and breast carcinoma are two most common lesions in
male population. Usually they can be differentiated on basis of clinical and radiological
examination, but some features can ovelap, both gynecomastia and carcinoma mostly
occur in eldery patients, both can be soft, mobile, subareolar and unilateral, that is why
biopsy sometimes is needed to differentiate them.
In the Table 2 clinical and imaging features are presented helpful in differential diagnosis
of gynecomastia and breast cancer.
Table 2. Differential diagnosis of gynecomastia and breast cancer. From reference
(3)
Features
Gynecomastia
Breast carcinoma
Age
Peripubertal and more than > 60 years
50 years
Clinical appearance
Soft, tender, mobile mass
Soft or hard, usually no
tender, mobile or fixed
mass. Nipple discharge is
sometimes present
Relation with nipple
Subarealolar central
Subareolar eccentric
Laterality
Uni or bilateral
Normally unilateral
Mammographic
appearance
Fan shaped, "flame-like" or Dense mass, sometimes
nodular appearance
lobulated margin
Secondary findings
Usually none
US appearance
Hypoechoic irregular mas Most
commonly
solid
with
extensions
into hypoechoic,
subareolar
the surrounding fat. No mass,
with
spiculated
adenopathy.
or microlubulated margins.
Enlarged axillary lymph
nodes.
Nipple retraction, skin
thickening, calcifications,
axillary adenopathy
Breast malignancies different to breast cancer
Other breast malignancies include lymphoma, liposarcoma and metastaisis from other
non breast primary tumors.
Page 15 of 35
The metastasis to the breast are very rare, the most common primary malignancies that
can present breast metastasis are prostate cancer, non-Hodgkin lymphoma, sarcomas,
melanoma and lung carcinoima Fig. 9 on page 27 , Fig. 10 on page 28 .
Fig. 9: Breast metastasis in 67-year old man with antecedent of liposarcoma, who
presents a lump in a left breast. A.Left MLO shows round dense left breast mass
(arrows), minimal bilateral gynecomastia is present as well. B. Ultrasound reveals
heterogeneous round, well delimitated mass, adjacent to pectoralis muscle(PM).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Page 16 of 35
Fig. 10: Same patient as in 9, presents with a lump in a left breast (curved arrows in
A, 3D CT reconstruction). Total body CT was performed as a control for metastatic
disease. B. Round lesion is seen in a left breast adjacent to the left pectoral muscle
(yellow arrowhead) with a loss of fat plane, indicating possible muscle infiltration. C
and D. Liver, pelvic, subcutaneous metastasis (thin arrows) and local recurrence of
liposarcoma in a right lower extremity (thin arrows).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Myofibroblastoma
Myofibroblastoma is a rare, benign stromal tumor (1), being the only breast lesion
more common in man than in woman. It usually presents as a firm, painless, mobile
mass. Mammographic features usually consist in round, well defined mass that lacks of
calcifications Fig. 11 on page 29 (4) . At ultrasound it presents like solid, hypoechoic
Page 17 of 35
mass, that resembles a fibroadenoma in female breast (remember that fibroadenomas
do not occur in a male breast!). The treatment usually consists of surgical excision.
Fig. 11: Myofibroblastoma in 68 year-old male. A. Right mediolateral oblique (MLO)
mammogram shows a round, partially circumscribed, eccentric to the nipple lesion
(arrows). B and C. US image presents hypoechoic lobulated lesion, with well defined
borders, with some internal flow in Doppler examination (B).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Fat necrosis
Fat necrosis may result from accidental trauma, but most cases are seen after surgery
or radiation therapy. At mammography it can present as lipid cysts, coarse calcifications,
focal asymmetries, microcalcifications, or spiculated masses (15).
Page 18 of 35
If minimal fibrosis occurs, the mass appears as a radiolucent lesion Fig. 12 on page
30 or as an oil cyst (16). Calcifications are very common, and usually are round,
smooth and curvilinear (15). At ultrasound examination fat necrosis have a great variety
of appearance, reflecting and amount of fibrosis.
Bilgen et al. in a retrospective study of 126 cases of fat necrosis, found a wide distribution
of sonographic presentations, being an increased echogenicity of the subcutaneous
tissues, with or without small cysts a most common feature (26.9% ), also they found
anechoic masses with posterior acoustic enhancement (in 16.6% of cases); anechoic
masses with posterior acoustic shadowing (in 15.8% of cases); solid-appearing masses
(in 14.2% of cases); cystic masses with internal echoes (in 11.1% of cases); and cystic
masses with mural nodules (in 3.9% of cases) (17).
Fig. 12: Fat necrosis in 59-year old patient who presented a palpable mass in a right
beast. A Right MLO reveals a retroareolar focal partially well-circumscribed radiolucent
lesion (white box). B Magnified view shows a thin capsule. C Gray-scale sonogram
shows hyperechoic lesion consistent with fat necrosis (yellow arrowheads).
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Subareolar abscess
Page 19 of 35
Subareolar abscess is a localized infection associated with ductal ectasia, chronic
inflammation and obstruction (18). Patients usually present with painful subareolar mass,
nipple swelling and nipple discharge. At mammography it commonly presents as ill
defined mass, with sorounding trabecular thickening (3). At ultrasound image it normally
appears as complex, hypoechoic, solid-cystic mass with posterior acoustic enhancement
Fig. 13 on page 31 . In Doppler examination the vascularity is absent, however some
abscess may present some internal flow, making it more suspicious for malignancy and
further biopsy is needed to complete the study (3).
Fig. 13: Subareolar abscess mimicking malignancy in 53 year-old man with painful
left breast mass and skin swelling. A Bilateral gynecomastia is present. Left MLO view
demonstrates dense irregular subareolar mass (thin arrow in A). B US image shows
heterogeneous mass with irregular margins and posterior acoustic enhancement
(arrowheads), findings that are suspicious for malignancy. During biopsy purulent
dense material was obtained. Excision demonstrated retroareolar abscess.
References: Hospital Universitario y Politécnico La Fe - Valencia/ES
Page 20 of 35
Images for this section:
Fig. 2: Nodular pattern of gynecomastia in 60-year-old male who presents tender
movile left retroareolar mass. A. Left MLO mammogram shows unilateral round shape
subareolar glandular tissue. B. US shows a retroareolar disk shape area with indistinct
borders that corrsponds to glandular tissue (yellow arrows).
Page 21 of 35
Fig. 3: Dendritic pattern of gynecomastia in 58-year-old-male with unilateral, painful,
movile mass. A. Retroareolar soft tissue density lesion is seen in a left breast (circle) as an
incidental finding on CT image performed for another reason. B. Left MLO mammography
shows subareolar density with prominent extensions into the fat. C. US image shows
a classic hypoechoic finger-like projections (arrows) spreading into surrounding fat. D.
Decrease of retroareolar tissue after Tamoxifen treatment.
Page 22 of 35
Fig. 4: Bilateral gynecomastia with diffuse pattern in patient with pituitary microadenoma.
It looks like female breast, seen even on chest X-ray (blue arrows in A and B). C.
Mammogram confirms the presence of bilateral glandular diffuse tissue. D.T1 weighted
post contrast MRI image reveals small less enhancing pituatary microadenoma (yellow
arrow).
Page 23 of 35
Fig. 5: Diffuse pattern in another patient with cirrhosis and treatment with Spironolactone.
(A). Bilateral gynecomastia on CT image. (B). MLO mammogram shows bilateral
glandular tissue corresponding to diffuse gynecomastia.
Page 24 of 35
Fig. 6: Pseudogynecomastia in obese patient with breast enlargement. A.Bilateral
excessive fat deposition in the breast area, some small amount of glandular tissue.B and
C.US image of right and left breasts confirms that there is neither mass nor retroareolar
glandular tissue.
Page 25 of 35
Fig. 7: Infiltrating ductal carcinoma not otherwise specified in 59 year-old man. A.Left
MLO mammogram shows a dense, spiculated, subareolar mass (thin yellow arrow) with
associated skin thickening and nipple retraction (big arrows). Right MLO mammogram
shows dendritic gynecomastia. B.US image of enlarged axillary lymph node with an
absent fatty hilum, US features indicating tumoral adenopathy. C. Solid, nonparallel,
hypoicoic, subareolar mass, with ill-defined borders.
Page 26 of 35
Fig. 8: Another case of invasive ductal carcinoma in 78-year-old patient with palpable
mass in a left breast. A.Left MLO mammogram dense mass with partially ill-defined
lobulated margins (yellow arrowheads) B. US confirms the presence of solid hypoechoic ,
poorly vascularised mass ( asterisk) C.Post contrast T1 weighted MR image shows a
small spiculated mass with rim enhancement (thin arrow).
Page 27 of 35
Fig. 9: Breast metastasis in 67-year old man with antecedent of liposarcoma, who
presents a lump in a left breast. A.Left MLO shows round dense left breast mass (arrows),
minimal bilateral gynecomastia is present as well. B. Ultrasound reveals heterogeneous
round, well delimitated mass, adjacent to pectoralis muscle(PM).
Page 28 of 35
Fig. 10: Same patient as in 9, presents with a lump in a left breast (curved arrows in A,
3D CT reconstruction). Total body CT was performed as a control for metastatic disease.
B. Round lesion is seen in a left breast adjacent to the left pectoral muscle (yellow
arrowhead) with a loss of fat plane, indicating possible muscle infiltration. C and D. Liver,
pelvic, subcutaneous metastasis (thin arrows) and local recurrence of liposarcoma in a
right lower extremity (thin arrows).
Page 29 of 35
Fig. 11: Myofibroblastoma in 68 year-old male. A. Right mediolateral oblique (MLO)
mammogram shows a round, partially circumscribed, eccentric to the nipple lesion
(arrows). B and C. US image presents hypoechoic lobulated lesion, with well defined
borders, with some internal flow in Doppler examination (B).
Page 30 of 35
Fig. 12: Fat necrosis in 59-year old patient who presented a palpable mass in a right
beast. A Right MLO reveals a retroareolar focal partially well-circumscribed radiolucent
lesion (white box). B Magnified view shows a thin capsule. C Gray-scale sonogram shows
hyperechoic lesion consistent with fat necrosis (yellow arrowheads).
Page 31 of 35
Fig. 13: Subareolar abscess mimicking malignancy in 53 year-old man with painful
left breast mass and skin swelling. A Bilateral gynecomastia is present. Left MLO
view demonstrates dense irregular subareolar mass (thin arrow in A). B US image
shows heterogeneous mass with irregular margins and posterior acoustic enhancement
(arrowheads), findings that are suspicious for malignancy. During biopsy purulent dense
material was obtained. Excision demonstrated retroareolar abscess.
Page 32 of 35
Conclusion
In the setting of a palpable mass in a male patient, mammography is a first image modality
to apply, usually completed with ultrasound.
Gynecomastia and breast cancer are the most common lesions, normally they can
be differentiated on the basis of clinical and radiographic features. Gynecomastia consists
in retroaleolar tissue that is concentric to the nipple-areola complex and bilateral in half of
the cases, while breast carcinoma is typically located eccentric to the nipple and usually
is unilateral.
We have always keep in mind that some malignant lesions in men can have a benign
appearance, so a biopsy should be performed always when radiologist is not completely
sure that the lesion is benign.
Gynecomstia and pseudogynecomastia can be diagnosed on the basis of image and
clinical work-up and normally do not require biopsy, as well as characteristically benign
lesions containing fat (lipomas) or typical lymph nodes. Lesions eccentric to the nipple
require biopsy (excluding normal lymph nodes and fat containing lesions).
Familiarity with radiologic and clinical features of most common male breast conditions
will allow accurate interpretation of findings and reduce unnecessary diagnostic and
treatment procedures.
Personal information
References
1. Iuanow E, Kettler M, Slanetz PJ. Spectrum of disease in the male breast. AJR Am J
Roentgenol 2011; 196(3):W247-W259.
2. Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation and
management. Mayo Clin Proc 2009; 84:1010-1015.
3. Cheri Nguyen, Mark D. Kettler, Michael E. Swirsky, MD Vivian I. Miller, Caleb Scott,
Rhett Krause, Jennifer A. Hadro. Male Breast Disease Pictorial Review with RadiologicPathologic Correlation. RadioGraphics 2013; 33:763-779.
Page 33 of 35
4. Grant E. Lattin, Robert A. Jesinger, Rubina Mattu, Leonard M. Glassman. Diseases of
the Male Breast: Radiologic-Pathologic Correlation RadioGraphics 2013; 33:461-489.
5. Appelbaum AH, Evans GF, Levy KR, Amirkhan RH, Schumpert TD. Mammographic
appearances of male breast disease. RadioGraphics 1999;19(3): 559-568.
6. Chen L, Chantra PK, Larsen LH, et al. Imaging characteristics of malignant lesions of
the male breast. RadioGraphics 2006;26(4):993-1006.
7. Braunstein GD. Clinical practice: gynecomastia. N Engl J Med 2007;357(12):1229-123.
8. Contractor KB, Kaur K, Rodrigues GS, Kulkarni DM, Singhal H. Male breast cancer: is
the scenario changing. World J Surg Oncol. Jun 16 2008;6:58.
9. Hultborn R, Hanson C, Kopf I, Verbiene I, Warnhammar E, Weimarck A.
Prevalence of Klinefelter's syndrome in male breast cancer patients. Anticancer Res.
1997;17:4293-297.
10. Sørensen HT, Friis S, Olsen JH, Thulstrup AM, Mellemkjaer L, Linet M, Trichopoulos
D, Vilstrup H, Olsen J. Risk of breast cancer in men with liver cirrhosis. Am J
Gastroenterol. 1998;93:231-233.
11. Haraldsson K, Loman L, Zhang Q, Johannsson O, Olsson H, Borg A. BRCA2 germline
mutations are frequent in male breast cancer patients without a family history of the
disease. Cancer Res. 1998;58:1367-1371.
12. Burga AM, Fadare O, Lininger RA, Tavassoli FA. Invasive carcinomas of the male
breast: a morphologic study of the distribution of histologic subtypes and metastatic
patterns in 778 cases. Virchows Arch 2006;449(5):507-512.
13. Giordano SH. A review of the diagnosis and management of male breast cancer.
Oncologist 2005;10 (7):471-479.
14. Shaw A, Smith B, Howlett D. Male breast carcinoma and the use of MRI. Radiology
Case Reports. (Online) 2011;6:455.
Page 34 of 35
3
15. Jorge L. Taboada, Tanya W. Stephens, Savitri Krishnamurthy, Kathleen R. Brandt
and Gary J. Whitman .The Many Faces of Fat Necrosis in the Breast.American Journal
of Roentgenology. 2009;192: 815-825.
16. Hogge JP, Robinson RE, Magnant CM, Zuurbier RA. The mammographic spectrum
of fat necrosis of the breast. RadioGraphics 1995; 15:1347-1356
17. Bilgen IG, Ustun EE, Memis A. Fat necrosis of the breast: clinical, mammographic,
and sonographic features. Eur J Radiol 2001; 39:92-99
18. Versluijs-Ossewaarde FN, Roumen RM, Goris RJ. Subareolar breast abscesses:
characteristics and results of surgical treatment. Breast J 2005;11(3): 179-182.
Page 35 of 35