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September 2007

Inhomogeneous mass behind the nipple
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Clinical information

Palpable non painful mass

Ultrasound Images & Clips

Male 74 years, Palpable non painful mass

The palpable mass is inhomogeneous and is mainly well defined with some peripheral irregularity
The palpable mass is inhomogeneous and is mainly well defined with some peripheral irregularity
The mass is connected to the nipple
The mass is connected to the nipple
Color doppler shows only vascularity in part of the lesion
Color doppler shows only vascularity in part of the lesion
Color doppler image of the same lesion with peripheral vascularity and connection to the nipple.
Color doppler image of the same lesion with peripheral vascularity and connection to the nipple.
Cineloop of the lesion shows only flow in part of the lesion
Mammography of the lesion shows a mainly well defined lesion with a slightly lobulated irregular anterior aspect. We decided to do an ultrasound guided puncture. The lesion proved to be mainly cystic with hemorrhagic fluid. After aspiration no mass was
Mammography of the lesion shows a mainly well defined lesion with a slightly lobulated irregular anterior aspect. We decided to do an ultrasound guided puncture. The lesion proved to be mainly cystic with hemorrhagic fluid. After aspiration no mass was
Image of the ill defined mass lesion. We decided to do a core biopsy of the mass lesion.
Image of the ill defined mass lesion. We decided to do a core biopsy of the mass lesion.
Image of the mass lesion with the biopsy needle in front of the lesion.
Image of the mass lesion with the biopsy needle in front of the lesion.
Image of the mass lesion with the biopsy needle passing through the lesion.
Image of the mass lesion with the biopsy needle passing through the lesion.

Conclusion

The pathologist could not find any malignant cells in the hemorrhagic fluid. The core biopsy however showed the lesion to be an infiltrating ductal carcinoma. Had a blind puncture been performed without ultrasound the conclusion could have been that the lesion was benign.

Most breast cancers in male patients are solid lesions. However malignant cystic lesions exist and core biopsy is the method of choice to confirm malignancy.

Conclusion Mainly cystic ductal carcinoma of the breast in a male.

References            
Yang WT, Whitman GJ, Yuen EH, Tse GM, Stelling CB. Sonographic features of primary breast cancer in men.AJR Am J Roentgenol. 2001 Feb;176(2):413-6.

Tochika N, Takano A, Yoshimoto T, Tanaka J, Sugimoto T, Kobayashi M, Matsuura K, Araki K, Ogawa Y, Moriki T. Intracystic carcinoma of the male breast: report of a case.
Surg Today. 2001;31(9):806-9.

Details

  • Sex: Male
  • Age: 74

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photo Taco Geertsma
Author

Dr. Taco Geertsma

Retired Radiologist, Gelderse Vallei Hospital

Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.

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