Findings
Mammogram of left breast showed a round equal density mass with circumscribed margins eccentric to the nipple measuring approximately 4.3x4.2cm . Suspicious coarse heterogenous and pleomorphic calcifications were noted within the mass. No spiculation / architectural distortion noted. Right breast showed diffuse glandular type of gynecomastia. CEDM showed mild background parenchyma enhancement in both breasts . Mass in the left breast showed irregular nodular enhancement with peripheral rim enhancement. No suspicious enhancement noted in the right breast. Ultrasound demonstrated a circumscribed complex solid cyst mass measuring 4.0 x 3.3 x 4.1cm in the left breast. Color Doppler US showed significant internal vascularity within the solid papillary component. Significant posterior acoustic enhancement noted .No suspicious axillary lymph nodes were identified. Based on Mammogram , CEDM and ultrasound the mass was classified as BI-RADS 4C. USG guided biopsy was performed from left breast BI-RADS 4C lesion with HPE of intra-cystic papillary carcinoma. Then the patient underwent left mastectomy with axillary sentinel lymph node biopsy later. No positive axillary lymph nodes were detected.
Answer
Infiltrating ductal carcinoma, NOS
Discussion
Male breast carcinoma is an extremely rare entity constituting only 0.6% of all breast cancers. Intra-cystic papillary breast carcinoma is a rare form of non-invasive carcinoma in men with an excellent prognosis accounting for less than 5-7.5% of all breast carcinoma in males. Intra-cytic breast carcinoma has excellent prognosis due to localized , non-invasive nature of the cancer with papillary proliferation arising within or on the wall of large cystic lesion. The diagnosis of this carcinoma is often delayed due to benign appearance presenting as cystic lesion on physical examination and radiological imaging. Radiological studies like USG play an important role in diagnosis by identifying the solid component within the cystic lesion . CEDM can be a breakthrough in diagnosing such lesions by identifying the internal enhancing solid component.
Reference
1. Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, et al. Imaging Characteristics of Malignant Lesions of the Male Breast. RadioGraphics. 2006 Jul;26(4):993–1006. 2. Luo H, Meng K, He J, Hu Z, Yang O, Lan T, et al. Intracystic papillary carcinoma of the breast in males: Three case reports. Medicine. 2020 Jun 19;99(25):e20278. 3. Sahin C, Ucpinar BA, Mut DT, Yilmaz O, Ucak R, Kaya C, et al. Male Breast Cancer with Radiological and Histopathological Findings. Sisli Etfal Hastan Tip Bul. 2020;54(3):375–9.
