際際滷

際際滷Share a Scribd company logo

Mammography

L
Louie Robertson

Male breast cancer and gynecomastia are uncommon but important conditions to evaluate in men. Male breast cancer makes up about 1% of all breast cancers and usually presents as a hard, fixed, painless mass in the breast. Gynecomastia is a benign condition characterized by enlargement of breast tissue and can be caused by increased estrogen or decreased testosterone. Mammography is useful for evaluating suspicious breast lesions in men, with cancer appearing as spiculated or ill-defined masses and gynecomastia appearing as nodular or dendritic densities. Biopsy is needed to confirm a diagnosis of breast cancer in men.

1 of 45
Download to read offline
THE MALE BREAST: Breast tumor and Gynecomastia
Introduction to male breast tumor.. Male breast carcinoma is a rare disease < 1% of all malignancies in men 1% of all breast cancers
Introduction to male breast tumor: BREAST TUMOR IN MALES Testicular tumor such as leydig cell tumors or sertoli cell tumor such as (peutz Jeghers syndrome) or human chorionic gonadotropin (Hcg) secreting choriocarcinoma may result in gynecomastia. Other tumors such adrenocortical tumors,pituitary gland tumors (such as, prolactinoma) or broncchogenic carcinoma, can produce hormones that alter male female hormone balance and cause gynecomastia.
Introduction to male breast tumor: Clinically suspicious lesions Imaging evaluation Mammography In patients with questionable findings at mammography and for lesions that are difficult to image with mammography The relationship of the mass to the nipple should be carefully assessed an eccentric location is highly suspicious for cancer.
The breast tissues of both sexes are identical at birth Estrogen stimulates breast tissue Androgen antagonizes these effects At puberty in boys - increase in estrogen,testosterone Transient proliferation of the ducts and stroma Followed by involution and ultimate atrophy of the ducts. Breast Development
Normal Male Breast Characterized: Subcutaneous fat Remnant of subareolar ductal tissue Lobular development - which requires both estrogen and progesterone, is usually not observed in men
Normal Male Breast Anatomy of the normal male breast- consists of the skin and subcutaneous fat. The pectoralis fascia (PF), pectoralis muscle (PM), ribs,and intercostal muscles (ICM)
Introduction The two most important disease of the male breast Gynecomastia Breast cancer/tumor The majority of lesions in male breasts are benign Other disease arise from the skin&subcutan. Fat necrosis Lipoma Epidermal inclusion cyst
Imaging of the Male Breast Mammography - to diagnose gynecomastia and breast carcinoma Diagnostic mammography biopsy Standard mammographic views - Magnification and spot compression views suspicious findings on mammography effective for evaluating male patient as it is for female
Male Breast Tumor Male breast tumor - uncommon less than 1% of all malignancies in men only 1% of all breast cancers The mean age of diagnosis is 67 years Less than 6% of cases occur in males under the age of 40 years.
Male Breast Tumor.. Clinical manifestation (S/S) hard , fixed , painless mass Bloody nipple discharge common Secondary signs occur earlier in male patients because of smaller breast size. nipple retraction, skin ulceration, thickening, increased breast trabeculation Palpable axillary lymph nodes are present in about 50% of cases
Male Breast tumor Histologic subtype : Invasive ductul carcinoma- most common 85% Male breast contains only ducts Invasive lobular rare No lobules formation in male breast
Male Breast Tumor : Treatment Same as for women Surgery Axillary node dissection Chemotherapy Radiation therapy
Surgery of Left 京姻艶温壊岳
Male Breast Cancer- Mammographic Appearance Location - Subareolar position , eccentric to the nipple Margins well-defined, ill-defined, spiculated Shape round, oval, irregular , lobulated Calcification few , coarser Secondary signs skin thickening, nipple retraction , axillary lymphadenopathy
Invasive Duct Carcinoma
GYNECOMASTIA IN MALES:
Defination Of Gynecomastia Gynecomastia is enlargement of the gland tissue of the male breast . During infancy , puberty ,and in middle aged to older men gynecomastia can be common
Gynecomastia Gynecomastia is the most common benign condition of the male breast It is enlargement of the male breast due to benign ductal and stromal proliferation. Causes breast enlargement /subareolar mass with/without associated breast pain It can be unilateral, bilateral symmetric, or bilateral asymmetric.
Gynecomastia The hallmark of gynecomastia is its central symmetric location under the nipple Reversible in early stages if the cause is corrected Reversible phase progress to late periductal edema with irreversible stromal fibrosis
Causes of Gynecomastia Physiologic: Senescence Puberty Hormonal : Klinefelter syndrome Hypogonadism Systemic disease: Cirrhosis Chronic renal insufficiency Lavender oil & tea tree oil when used as skin care product Neoplasm: Adrenal carcinoma Pituitary adenoma Hepatocellular carcinoma Drug use: Cimetidine Marijuana & HEROIN Thiaside diuretics Omeprazole Tricyclic antidepresasants Spironolactone Diazepam{VALIUM} Anabolic steroids Exogenouis estrogen
Gynecomastia Associated with increased levels of estradiol and decreased levels of testosterone Endocrine and hormonal disorders Systemic disease Neoplasm Drugs : Spirolactone {aldactone} a diuretics that has anti androgenic activity For hypertension {captopril [capoten] ,enalapril [vasotec] Anti ulcerative drugs for example : Ranitidine[rantac or zantac] ,cimetidine [tagamet] and omeprazole [prilosec] Cardio problems: digitoxin Some antibiotics for example : isoniazid,ketoconazole [nizoral, extina , xolegel , kuric and metronidazole [ flagyl ]
TYPES Of Gynecomastia mammographic patterns -representing various degrees and stages of ductal and stromal proliferation Nodular gynecomastia Dendritic gynecomastia Diffuse glandular gynecomastia
Gynecomastia Nodular G.- most common 77% Pathology florid g. early phase patients with gynecomastia < 1year The majority of patients will present with nipple tenderness , palpable lump Mammography-nodular subareolar density The typical mammographic confirms the diagnosis and requires no further imaging work-up.
Mammography - Nodular G. Nodular subareolar density
Nodular Gynecomastia a subareolar fan- or disk-shaped hypoechoic nodule surrounded by normal fatty tissue The zone of transition may be poorly defined, with lobular margin Hypervascularity can be seen secondary to stromal proliferation In cases of equivocal clinical and mammographic findings follow-up evaluation
Chronic Dendritic Gynecomastia Chronic dendritic gynecomastia (quiescent phase) -20% Patients with gynecomastia > 1 year. Pathology fibrous g.- long standing gynecomastia Fibrosis becomes the dominant process and is irreversible. Mammography - dendritic subareolar density with posterior linear projections radiating into the surrounding tissue toward the uoq
Chronic Dendritic Gynecomastia a subareolar hypoechoicstar-shaped, fingerlike projections or spider legs benignity - directly from the undersurface of the nipple without causing any overlying skin thickening or nipple retraction.
Chronic Dendritic Gynecomastia U.S image subareolar hypoechoic nodule with star-shaped projections into the surrounding echogenic fibrous tissue
Chronic Dendritic Gynecomastia The clinical history, particularly the duration of symptoms, can also be helpful in making this diagnosis. patients may have an acute episode of gynecomastia in addition to chronic dendritic gynecomastia.Both phases can be seen at imaging simultaneously.
Diffuse Glandular Gynecomastia Diffuse glandular 3% Patients receiving exogenous estrogen Mammography- enlargement of the breast , similar to heterogeneously dense female breast. Irreversible stromal fibrosis and ductal epithelial atrophy develop, the breast enlargement may decrease but not completely resolve. both nodular and dendritic features are seen surrounded by diffuse hyperechoic fibrous breast tissue.
Diffuse Glandular Gynecomastia Enlargement of the breast and diffuse density with both dendritic and nodular features
Pseudogynecomastia Pseudogynecomastia a fatty proliferation of the breasts , without proliferation of glandular tissue. Difficult to distinguish from normal male breast on mammography Diagnosis requires clinical correlation with breast enlargement
Less Common Benign Conditions Lipoma - second most common benign lesion in the male breast Mammography typically shows a subtle encapsulated fatty mass in the palpated area demonstrates one or multiple parallel, homogeneous, and mildly hyperechoic masses under the skin capsule is sometimes seen
Lipoma Parallel, homogeneous, mildlyhyperechoic mass with a capsule (arrow) under the skin. Subtle encapsulated fatty mass (arrows) in the palpated region.
Epidermal Inclusion Cyst Epidermal inclusion cyst is the third most common benign lesion in the male breast Arise from obstructed or occluded hair follicles, at the sites of previous skin trauma such as a surgical wound or insect bites Composed of laminated keratin surrounded by stratified squamous epithelium
Epidermal Inclusion Cyst Hypoechoic lesion, which is contiguous to the epidermis (arrows) (the claw sign) with increased through transmission well defined, dense, oval mass contiguous to the skin in the palpated region.
Benign Conditions Associated with Gynecomastia Pseudoangiomatous stromal hyperplasia (PASH)- benign stromal tumor formed by myofibroblasts and with glandular hyperplasia Often incidentally seen in gynecomastia Mammography- non calcified breast mass, circumscribed or partially circumscribed solid circumscribed hyper echoic masses Recurrence is common after resection
PASH Dense circumscribed mass Solid hyperechoic mass with posterior acoustic shadowing
Intraductal Papilloma Intraductal papilloma - benign proliferation of intraductal mammary epithelium. Mammography - discrete dense mass against a background of subareolar changes consistent with gynecomastia multiple encentric, subareolar, elongated and welldefined hypoechoic masses, which have irregular shapes and are possibly confined to the lumina of markedly enlarged central ducts
Intraductal papilloma multiple eccentric, subareolar, elongated,well-defined, hypoechoic masses ;US image shows cystic areas, which may represent associated ductal ectasia. discrete dense mass against a background of subareolar density, which consistent with gynecomastia
DIAGNOSTIC EVALUATION COMPLETE ASSESSMENT OF MALE PATIENTS BREAST, COMPLETE BLOOD COUNT(CBC) MAMOGRAPHY, ULTRASOUND, FNAC [FINE NEEDLE ASPIRATION CYTOLOGY], LIVER FUNCTION TEST AND HORMONAL ASSESSMENT.
Conclusions The majority (99%) of male breast lesions are benign Mammography- for clinically suspicious lesions accurate for diagnosing gynecomastia useful for further characterization The relationship of the mass to the nipple should be carefully assessed Encentric location is highly suspicious for cancer the axillary region is helpful for staging In men - cystic lesions commonly malignant Cysts and complex masses should be worked up as potentially malignant lesions Suspicious lesion - biopsy - guidance is usually preferred
RISK FACTORS & COMPLICATIONS.. advanced age prior irradiction of the chest exogenous estrogen for prostate cancer treatment gender-reassignment procedures liver disease and other diseases associated with hyperestrogenism, androgen deficiency due to testicular dysfunction genetic and chromosomal conditions - Klinefelter syndrome.
MANAGEMENT MEDICAL MANAGEMENT : RADIOTHERAPHY, CHEMOTHERAPHY. SURGICAL MANAGEMENT: SURGERY OF THE CANCEROUS PART

More Related Content

Mammography

  • 1. THE MALE BREAST: Breast tumor and Gynecomastia
  • 2. Introduction to male breast tumor.. Male breast carcinoma is a rare disease < 1% of all malignancies in men 1% of all breast cancers
  • 3. Introduction to male breast tumor: BREAST TUMOR IN MALES Testicular tumor such as leydig cell tumors or sertoli cell tumor such as (peutz Jeghers syndrome) or human chorionic gonadotropin (Hcg) secreting choriocarcinoma may result in gynecomastia. Other tumors such adrenocortical tumors,pituitary gland tumors (such as, prolactinoma) or broncchogenic carcinoma, can produce hormones that alter male female hormone balance and cause gynecomastia.
  • 4. Introduction to male breast tumor: Clinically suspicious lesions Imaging evaluation Mammography In patients with questionable findings at mammography and for lesions that are difficult to image with mammography The relationship of the mass to the nipple should be carefully assessed an eccentric location is highly suspicious for cancer.
  • 5. The breast tissues of both sexes are identical at birth Estrogen stimulates breast tissue Androgen antagonizes these effects At puberty in boys - increase in estrogen,testosterone Transient proliferation of the ducts and stroma Followed by involution and ultimate atrophy of the ducts. Breast Development
  • 6. Normal Male Breast Characterized: Subcutaneous fat Remnant of subareolar ductal tissue Lobular development - which requires both estrogen and progesterone, is usually not observed in men
  • 7. Normal Male Breast Anatomy of the normal male breast- consists of the skin and subcutaneous fat. The pectoralis fascia (PF), pectoralis muscle (PM), ribs,and intercostal muscles (ICM)
  • 8. Introduction The two most important disease of the male breast Gynecomastia Breast cancer/tumor The majority of lesions in male breasts are benign Other disease arise from the skin&subcutan. Fat necrosis Lipoma Epidermal inclusion cyst
  • 9. Imaging of the Male Breast Mammography - to diagnose gynecomastia and breast carcinoma Diagnostic mammography biopsy Standard mammographic views - Magnification and spot compression views suspicious findings on mammography effective for evaluating male patient as it is for female
  • 10. Male Breast Tumor Male breast tumor - uncommon less than 1% of all malignancies in men only 1% of all breast cancers The mean age of diagnosis is 67 years Less than 6% of cases occur in males under the age of 40 years.
  • 11. Male Breast Tumor.. Clinical manifestation (S/S) hard , fixed , painless mass Bloody nipple discharge common Secondary signs occur earlier in male patients because of smaller breast size. nipple retraction, skin ulceration, thickening, increased breast trabeculation Palpable axillary lymph nodes are present in about 50% of cases
  • 12. Male Breast tumor Histologic subtype : Invasive ductul carcinoma- most common 85% Male breast contains only ducts Invasive lobular rare No lobules formation in male breast
  • 13. Male Breast Tumor : Treatment Same as for women Surgery Axillary node dissection Chemotherapy Radiation therapy
  • 14. Surgery of Left 京姻艶温壊岳
  • 15. Male Breast Cancer- Mammographic Appearance Location - Subareolar position , eccentric to the nipple Margins well-defined, ill-defined, spiculated Shape round, oval, irregular , lobulated Calcification few , coarser Secondary signs skin thickening, nipple retraction , axillary lymphadenopathy
  • 18. Defination Of Gynecomastia Gynecomastia is enlargement of the gland tissue of the male breast . During infancy , puberty ,and in middle aged to older men gynecomastia can be common
  • 19. Gynecomastia Gynecomastia is the most common benign condition of the male breast It is enlargement of the male breast due to benign ductal and stromal proliferation. Causes breast enlargement /subareolar mass with/without associated breast pain It can be unilateral, bilateral symmetric, or bilateral asymmetric.
  • 20. Gynecomastia The hallmark of gynecomastia is its central symmetric location under the nipple Reversible in early stages if the cause is corrected Reversible phase progress to late periductal edema with irreversible stromal fibrosis
  • 21. Causes of Gynecomastia Physiologic: Senescence Puberty Hormonal : Klinefelter syndrome Hypogonadism Systemic disease: Cirrhosis Chronic renal insufficiency Lavender oil & tea tree oil when used as skin care product Neoplasm: Adrenal carcinoma Pituitary adenoma Hepatocellular carcinoma Drug use: Cimetidine Marijuana & HEROIN Thiaside diuretics Omeprazole Tricyclic antidepresasants Spironolactone Diazepam{VALIUM} Anabolic steroids Exogenouis estrogen
  • 22. Gynecomastia Associated with increased levels of estradiol and decreased levels of testosterone Endocrine and hormonal disorders Systemic disease Neoplasm Drugs : Spirolactone {aldactone} a diuretics that has anti androgenic activity For hypertension {captopril [capoten] ,enalapril [vasotec] Anti ulcerative drugs for example : Ranitidine[rantac or zantac] ,cimetidine [tagamet] and omeprazole [prilosec] Cardio problems: digitoxin Some antibiotics for example : isoniazid,ketoconazole [nizoral, extina , xolegel , kuric and metronidazole [ flagyl ]
  • 23. TYPES Of Gynecomastia mammographic patterns -representing various degrees and stages of ductal and stromal proliferation Nodular gynecomastia Dendritic gynecomastia Diffuse glandular gynecomastia
  • 24. Gynecomastia Nodular G.- most common 77% Pathology florid g. early phase patients with gynecomastia < 1year The majority of patients will present with nipple tenderness , palpable lump Mammography-nodular subareolar density The typical mammographic confirms the diagnosis and requires no further imaging work-up.
  • 25. Mammography - Nodular G. Nodular subareolar density
  • 26. Nodular Gynecomastia a subareolar fan- or disk-shaped hypoechoic nodule surrounded by normal fatty tissue The zone of transition may be poorly defined, with lobular margin Hypervascularity can be seen secondary to stromal proliferation In cases of equivocal clinical and mammographic findings follow-up evaluation
  • 27. Chronic Dendritic Gynecomastia Chronic dendritic gynecomastia (quiescent phase) -20% Patients with gynecomastia > 1 year. Pathology fibrous g.- long standing gynecomastia Fibrosis becomes the dominant process and is irreversible. Mammography - dendritic subareolar density with posterior linear projections radiating into the surrounding tissue toward the uoq
  • 28. Chronic Dendritic Gynecomastia a subareolar hypoechoicstar-shaped, fingerlike projections or spider legs benignity - directly from the undersurface of the nipple without causing any overlying skin thickening or nipple retraction.
  • 29. Chronic Dendritic Gynecomastia U.S image subareolar hypoechoic nodule with star-shaped projections into the surrounding echogenic fibrous tissue
  • 30. Chronic Dendritic Gynecomastia The clinical history, particularly the duration of symptoms, can also be helpful in making this diagnosis. patients may have an acute episode of gynecomastia in addition to chronic dendritic gynecomastia.Both phases can be seen at imaging simultaneously.
  • 31. Diffuse Glandular Gynecomastia Diffuse glandular 3% Patients receiving exogenous estrogen Mammography- enlargement of the breast , similar to heterogeneously dense female breast. Irreversible stromal fibrosis and ductal epithelial atrophy develop, the breast enlargement may decrease but not completely resolve. both nodular and dendritic features are seen surrounded by diffuse hyperechoic fibrous breast tissue.
  • 32. Diffuse Glandular Gynecomastia Enlargement of the breast and diffuse density with both dendritic and nodular features
  • 33. Pseudogynecomastia Pseudogynecomastia a fatty proliferation of the breasts , without proliferation of glandular tissue. Difficult to distinguish from normal male breast on mammography Diagnosis requires clinical correlation with breast enlargement
  • 34. Less Common Benign Conditions Lipoma - second most common benign lesion in the male breast Mammography typically shows a subtle encapsulated fatty mass in the palpated area demonstrates one or multiple parallel, homogeneous, and mildly hyperechoic masses under the skin capsule is sometimes seen
  • 35. Lipoma Parallel, homogeneous, mildlyhyperechoic mass with a capsule (arrow) under the skin. Subtle encapsulated fatty mass (arrows) in the palpated region.
  • 36. Epidermal Inclusion Cyst Epidermal inclusion cyst is the third most common benign lesion in the male breast Arise from obstructed or occluded hair follicles, at the sites of previous skin trauma such as a surgical wound or insect bites Composed of laminated keratin surrounded by stratified squamous epithelium
  • 37. Epidermal Inclusion Cyst Hypoechoic lesion, which is contiguous to the epidermis (arrows) (the claw sign) with increased through transmission well defined, dense, oval mass contiguous to the skin in the palpated region.
  • 38. Benign Conditions Associated with Gynecomastia Pseudoangiomatous stromal hyperplasia (PASH)- benign stromal tumor formed by myofibroblasts and with glandular hyperplasia Often incidentally seen in gynecomastia Mammography- non calcified breast mass, circumscribed or partially circumscribed solid circumscribed hyper echoic masses Recurrence is common after resection
  • 39. PASH Dense circumscribed mass Solid hyperechoic mass with posterior acoustic shadowing
  • 40. Intraductal Papilloma Intraductal papilloma - benign proliferation of intraductal mammary epithelium. Mammography - discrete dense mass against a background of subareolar changes consistent with gynecomastia multiple encentric, subareolar, elongated and welldefined hypoechoic masses, which have irregular shapes and are possibly confined to the lumina of markedly enlarged central ducts
  • 41. Intraductal papilloma multiple eccentric, subareolar, elongated,well-defined, hypoechoic masses ;US image shows cystic areas, which may represent associated ductal ectasia. discrete dense mass against a background of subareolar density, which consistent with gynecomastia
  • 42. DIAGNOSTIC EVALUATION COMPLETE ASSESSMENT OF MALE PATIENTS BREAST, COMPLETE BLOOD COUNT(CBC) MAMOGRAPHY, ULTRASOUND, FNAC [FINE NEEDLE ASPIRATION CYTOLOGY], LIVER FUNCTION TEST AND HORMONAL ASSESSMENT.
  • 43. Conclusions The majority (99%) of male breast lesions are benign Mammography- for clinically suspicious lesions accurate for diagnosing gynecomastia useful for further characterization The relationship of the mass to the nipple should be carefully assessed Encentric location is highly suspicious for cancer the axillary region is helpful for staging In men - cystic lesions commonly malignant Cysts and complex masses should be worked up as potentially malignant lesions Suspicious lesion - biopsy - guidance is usually preferred
  • 44. RISK FACTORS & COMPLICATIONS.. advanced age prior irradiction of the chest exogenous estrogen for prostate cancer treatment gender-reassignment procedures liver disease and other diseases associated with hyperestrogenism, androgen deficiency due to testicular dysfunction genetic and chromosomal conditions - Klinefelter syndrome.
  • 45. MANAGEMENT MEDICAL MANAGEMENT : RADIOTHERAPHY, CHEMOTHERAPHY. SURGICAL MANAGEMENT: SURGERY OF THE CANCEROUS PART