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Case of the Month

November 2011

Patient Data: 65 year old male

Clinical Info: Palpable mass behind the nipple


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The mass is hypoechoic ill defined with irregular contours and has punctate microcalcifications


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Another image of the irregular mass with microcalcifications


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The mass is vascularized


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With elastography the mass is stiffer (dark blue) than the surrounding tissues


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Cranio caudal view of the mass with mammography


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Medio latero oblique view of the mass with mammography


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Hypoechoic lymph node in the axilla


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Transverse image of the same lymph node The mass was biopsied under ultrasound guidance and a fine needle aspiration was performed of the axillary lymph node. It proved to be an infiltrating ductal carcinoma with an axillary lymph node metastasis


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A similar looking lesion was found in a 53 year old male with a paiful retroareolar mass


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Another image of the irregular hypoechoic mass


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There is also an abnormal axillary lymph node


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Another image of the axilla with 2 lymph nodes. Again in this case the mass and an axillary lymph node were biopsied but both proved to be benign. The pathologist only found chronic inflammatory changes without any signs of malignancy


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The above presented lesions must be diffentiated from this very common cause of a palpaple mass in a male caused by a benign gynaecomastia


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Gynaecomastia

The most common palpable mass in the breast of a male patient is gynaecomastia. Although breast carcinomas in males are not very common they must be differentiated from gynaecomastia. The features of breast carcinomas in males are similar to breast carcinomas in females. Sometimes a mass proves to be something completely else like inflammatory changes. In doubt always perform a biopsy

For more examples of gynaecomastia and malignant breast tumors in males see

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

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