Primary breast cancer in men: Clinical, imaging, and pathologic findings in 57 patients

OBJECTIVE. The purpose of our study was to describe the imaging findings in primary breast cancer in men. MATERIALS AND METHODS. Male patients from a single pathology database with the histologic diagnosis of breast cancer who had undergone preoperative mammography or sonography were included in this study. The mammograms and sonograms were retrospectively reviewed according to the American College of Radiology BI-RADS lexicon. Patients who did not have films available but had imaging reports available for review were also included. Sonograms of the regional nodal basins, including axillary, infraclavicular, internal mammary, and supraclavicular regions, were noted. Histopathology subtype of breast cancer and axillary nodal status were documented. RESULTS. A total of 57 patients with imaging and 187 patients without imaging were included. The median age was 62 years (range, 19-80 years). Forty-nine patients had undergone both mammography and sonography; six, mammography alone; and two, sonography alone. Ninety-five percent (54/57) of patients presented with a palpable mass and 4% (2/57) with nipple inversion. At mammography, 69% (38/55) of cancers showed a mass; 29% (16/55), mass with microcalcifications; and 2% (1/55), microcalcifications. Gynecomastia was noted in 22 (40%) of 55 patients. Mammographic features included an irregular mass with spiculated or indistinct margins. Calcifications were typically pleomorphic and segmental. Sonographic features were typically an irregular mass with microlobulated margins. Axillary nodal involvement was present in 47% of patients. Most cancers were ductal carcinoma, either invasive or in situ. CONCLUSION. Breast cancer in men characteristically presents as an irregular subareolar mass with spiculated or indistinct margins on mammography and can be associated with calcifications and gynecomastia. Sonography has a role in regional staging of lymph nodes.