4. Breast p141-142 (Male Breast)

Question 1

Male breast - basics (3)

Answer 1

Male breast cancer is rare, but often advanced and invasive at the time of diagnosis.
Male breast does NOT have the elongated and branching ducts, or proliferated lobules that women have.
Therefore men do not get lobule associated pathology, lobular carcinoma, fibroadenoma or cysts

Question 2

Gynaecomastia (9)

Answer 2

Non-neoplastic enlargement of the epithelial and stromal elements in a man’s breast.
Occurs physiologically in adolescents, affecting 50%, and men over 65.
Considered pathological if aged 13-65, associated with:
- Spironolactone
- Marijuana
- Alcoholic cirrhosis
- Testicular cancer
3 main patterns, nodular is most common.
Flame shaped, behind the nipple, asymmetric, can be painful.
Not being gynaecomastia suggested by not being behind the nipple, eccentric location and calcification

Question 3

Patterns of gynaecomastia (3)

Answer 3

Nodular
Dendritic
Diffuse glandular

Question 4

Nodular gynaecomastia (3)

Answer 4

• Commonest
• Flame shaped, centred behind the nipple, radiating posterior as it blends into fat.
• Breast is often tender, lasts less than a year

Question 5

Dentritic gynaecomastia (3)

Answer 5

Resembles a branching tree
Usually chronic fibrotic pattern.
Usually not tender

Question 6

Diffuse glandular (2)

Answer 6

Mammogram looks like woman’s breast (diffuse increase in density).
Seen in men receiving oestrogen treatment

Question 7

Pseudogynaecomastia (2)

Answer 7

Increase in fat tissue of the breast, not glandular tissue
No discrete palpable findings, mount of tissue is not concentric to the nipple

Question 8

Lipoma

Answer 8

Second commonest palpable mass in a man

Question 9

Male breast cancer (9)

Answer 9

Rare, especially in younger men (average age 70).
1 in 4 have BRCA mutation, 2 is more common.
Other risk factors
- Klinefelter
- Cirrhosis
- Chronic alcoholism
Classically eccentric but near the nipple.
Almost always IDC-NOS type.
DCIS can occur, rare in isolation.
Mammography/US: looks like breast cancer. That said, nodular gynaecomastia can look sus on US.

Question 10

Suspicious features for male breast cancer (5)

Answer 10

Eccentric to nipple.
Unilateral.
Abnormal lymph nodes
Calcifications
Looks like breast cancer

Question 11

Calcifications in male breasts (2)

Answer 11

Micro-calcifications alone are uncommon.
If seen, tend to be less numerous, coarser and associated with mass (25% of male breast cancers have calcifications).

Question 12

Screening for male breast cancer (2)

Answer 12

Controversial, but only Klinefelters patients approach the level of risk to make screening worthwhile.
Males with gynaecomastia from gender reassignment, on hormone therapy, are not high risk enough for screening mammograms.