A compendium of male breast imaging: The road less traveled

Figure 1 Diagrammatic representation of male vs female breast anatomy. NAC: Nipple areola complex.

Figure 2 Diagrammatic representation of various male breast lesions according to their location. 1: Epidermal inclusion cyst; 2: Sebaceous cyst with punctum; 3: Lipoma with capsule; 4: Hematoma; 5: Gynecomastia; 6: Carcinoma breast; 7: Mastitis with abscess and surrounding trabecular thickening; 8: Vascular malformation; 9: Lymphoma; 10: Axillary lymph nodes.

Figure 3  Pseudogynecomastia: Mediolateral oblique mammography view of a 17-year-old obese male showing a diffuse bilateral increase in fat density.

Figure 4 Nodular gynecomastia in a 62-year-old male with tender subareolar masses in bilateral breasts. A: Mediolateral oblique; B: Craniocaudal mammography views show oval equal density masses in the retroareolar locations of both breasts (white arrows); C-E: Ultrasound images [C, D (color Doppler) and E (panoramic views)] demonstrate an oval parallel indistinct hypoechoic area (denoted by asterisks) in the retroareolar location with no evident vascularity, which is consistent with gynecomastia.

Figure 5 Dendritic gynecomastia in a 69-year-old male with a tender soft mass in the left breast. A: Mediolateral oblique mammography view showing a triangular flame-shaped area of increased density in the retroareolar location of the left breast (encircled); B: Ultrasound image showing an irregular hypoechoic retroareolar lesion with dendritic projections inside the underlying glandular fat (small white arrows).

Figure 6 Diffuse gynecomastia in a 42-year-old male on estrogen therapy. A: Mediolateral oblique; B: Craniocaudal mammography images showing a diffuse increase in breast density, with the male breast resembling the female breast; C and D: Ultrasound images showing diffuse deposition of glandular tissue (white arrows).

Figure 7 Epidermal inclusion cyst breast in a 23-year-old male with a palpable nodule and a history of blunt trauma to the chest. A: Magnified mediolateral oblique mammography view of the right breast showing an oval circumscribed high-density mass just below the skin (white arrow) with few foci of dystrophic eccentric calcifications (small white arrow in A). B: Ultrasound; C: Color Doppler images showing an oval circumscribed hypoechoic mass in the subcutaneous plane, with a linear hypoechoic tract reaching the skin surface (arrow in B) and no internal vascularity (C).

Figure 8  Fat necrosis in a 23-year-old male who suffered trauma to the right breast by football shows an irregular hyperechoic area with indistinct margins (white arrows) containing few anechoic areas.

Figure 9 Mastitis with abscess in a 61-year-old diabetic male with a tender enlarged breast. A: Ultrasound; B and C: Color Doppler images showing an irregular cystic collection with internal debris and peripheral vascularity. The surrounding fat appeared echogenic, suggesting inflammatory changes.

Figure 10  Infective collection from a 23-year-old male with a history of high-grade fever after trauma to the left breast. A: Mediolateral oblique; B: Craniocaudal mammography views showing no obvious abnormality; C: Ultrasound; D: Color Doppler images revealing a well-defined anechoic collection with peripheral internal vascularity.

Figure 11  Pilomatricoma in a 33-year-old male with a palpable left breast mass. A: Mediolateral oblique and B: Craniocaudal mammography images showing a large irregular high-density mass with circumscribed margins and coarse calcifications in the retroareolar location; C: Ultrasound; D: Color Doppler images showing an irregular lesion with extensive posterior acoustic shadowing and some internal vascularity; E and F: Histopathology images (hematoxylin and eosin, × 40) showing a circumscribed lobulated mass in subcutaneous tissue and islands of basaloid cells exhibiting abrupt keratinization without an intervening granular layer along with shadow cells and central calcification.

Figure 12  Venolymphatic malformation. A: Mediolateral oblique mammogram with an axillary view shows multiple well-defined, lobulated densities in the axilla (arrow), some containing coarse calcifications; B: Grayscale ultrasound reveals multiple anechoic and hypoechoic compressible tubular channels in the subcutaneous plane with echogenic phleboliths (arrow), which is consistent with dilated venous and lymphatic components; C: Color Doppler ultrasound demonstrates slow flow within some of the vascular channels; D: Coronal T2-weighted fat-saturated magnetic resonance image (MRI) shows hyperintense lobulated masses (arrows) in the axilla; E: Postcontrast axial T1-weighted fat-suppressed MRI shows enhancement of the lesion (thin arrows), with nonenhancing phleboliths, which is consistent with a benign low-flow vascular malformation.

Figure 13  Lipoma in a 34-year-old male with a palpable mass in the axilla. A: Ultrasound; B: Elastography images showing a circumscribed oval homogenous isoechoic mass (white arrow), which appeared soft on elastography.

Figure 14  Giant lipoma in a 52-year-old male with a palpable nontender mobile mass in the left breast. A: Mediolateral oblique; B: Craniocaudal mammography views showing a large, circumscribed round fat density mass in the left breast; C and D: Digital breast tomosynthesis slices demonstrating the lipoma capsule (denoted by vvv); E: Ultrasound; F: Elastography images showing a fat-containing isoechoic mass that appears soft on elastography.

Figure 15  Intrapectoral lipoma in a 45-year-old male with a palpable mass in the left breast. A: Mediolateral oblique; B: Craniocaudal mammography views showing a large, circumscribed fat density mass causing splaying of pectoralis muscle fibers in the left breast (arrows); C: Panoramic ultrasound image showing a circumscribed fat-containing echogenic mass in the intrapectoral location (arrow); D: Axial computed tomography image showing fat-containing mass splaying the pectoralis muscle (arrow); E-G: Magnetic resonance images (E: T1-weighted image; F: T2-weighted image; G: T1 fat-saturated image) demonstrating T1 and T2 hyperintense masses with suppression of fat saturation, suggestive of lipoma (arrows).

Figure 16  Myofibroblastoma in a 56-year-old male with a palpable mass in the right breast. A: Ultrasound image showing a round circumscribed heterogeneously hypoechoic mass; B: Axial; C: Sagittal noncontrast computed tomography sections demonstrating a well-defined hypoattenuating soft tissue density mass in the right breast (white arrows) with no calcifications or chest wall invasion.

Figure 17  Intraductal papilloma in a 46-year-old male with a palpable abnormality. A-C: Ultrasound; D: Color Doppler images showing a circumscribed, oval, slightly hypoechoic, solid mass within a dilated duct (white arrows) with internal vascularity.

Figure 18  Ductal carcinoma in situ in a 69-year-old male with a palpable lump in the left breast. A: Mediolateral oblique (MLO) view; B: Craniocaudal (CC) mammography view showing an irregular, high-density mass with indistinct margins in the retroareolar location with surrounding architectural distortion and nipple retraction; C and D: Contrast-enhanced mammography; C: MLO; D: CC views of recombined images showing heterogeneous postcontrast enhancement of the mass; E: Ultrasound-guided core needle biopsy image of the mass depicting the heteroechoic mass (needle denoted by vvvvv), with histopathology initially revealing ductal carcinoma in situ. Subsequent surgery, however, revealed invasive cancer.

Figure 19  Invasive breast cancer in a 74-year-old male with a hard lump in left breast. A: Mediolateral oblique (MLO) view; B: Craniocaudal (CC) view showing an irregular, high-density mass; C and D: Contrast-enhanced mammography; C: MLO and D: CC views of the recombined images showing heterogeneous enhancement; E: Ultrasound; F: Elastography images showing an irregular heteroechoic mass with microlobulated margins that appear hard on elastography; G-J: Magnetic resonance images showing an irregular mass; G: T1-weighted image showing a hypointense signal; H: T2-weighted image showing a heterogeneously hyperintense signal; I and J: DWI-ADC images showing central diffusion restriction; K: Postcontrast image showing heterogeneous septal enhancement; L: Histopathological examination image (hematoxylin–eosin, × 40) showing invasive breast cancer (no special type) composed of tumor cells arranged in clusters and tubules.

Figure 20  Invasive lobular carcinoma in a 65-year-old male with a hard retroareolar lump. A: Mediolateral oblique; B: Craniocaudal mammography views showing an irregular high-density mass with spiculated margins, few punctate calcific foci and surrounding architectural distortion. Nipple retraction and overlying skin thickening are also observed; C: Ultrasound; D: Elastography images show an irregular mass with angular margins, which appears hard on elastography; E: Histopathology (hematoxylin and eosin, × 40); F: E-cadherin images show medium to small dyscohesive cells that lack E-cadherin expression.

Figure 21  Papillary carcinoma in a 54-year-old male with a hard mass in left breast. A: Ultrasound; B: Color Doppler images showing an irregular solid-cystic mass with an eccentric solid component, with minimal peripheral vascularity.

Figure 22  Lymphoma in a 43-year-old male after 3 cycles of chemotherapy. A: Magnified mediolateral oblique view of the right breast showing a round high-density mass with partially indistinct margins and few punctate calcifications. B: Ultrasound image showing an oval hypoechoic parallel mass with circumscribed margins. C: Histopathology (hematoxylin and eosin, × 40). D: CD20 immunohistochemical staining revealed diffuse large B-cell lymphoma with sheets of atypical lymphoid cells that were positive for CD20.

Figure 23  Craniocaudal mammogram of a transfeminine (male to female) individual showing bilateral silicone implants with smooth margins and no signs of rupture.