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Case of the Month

September 2007

Patient Data: Male 74 years

Clinical Info: Palpable non painful mass


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The palpable mass is inhomogeneous and is mainly well defined with some peripheral irregularity


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The mass is connected to the nipple


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Color doppler shows only vascularity in part of the lesion


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Color doppler image of the same lesion with peripheral vascularity and connection to the nipple.


365.swf Cineloop of the lesion shows only flow in part of the lesion


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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 palpable anymore. However after aspiration of the hemorrhagic fluid a small irregular mass lesion remained.


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Image of the ill defined mass lesion. We decided to do a core biopsy of the mass lesion.


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Image of the mass lesion with the biopsy needle in front of the lesion.


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Image of the mass lesion with the biopsy needle passing through the lesion.

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.

For more male breast carcinomas see

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.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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