Findings
A circumscribed high density lesion ( size 4.5x5.5x6cm) is noted in the upper outer quadrant extending to the retroareolar region . On tomosynthesis, irregular margins were seen. There are fine pleomorphic microcalcifications in the lesion. The lesion is abutting the overlying skin. The skin is thickened and the nipple is retracted. The left axilla shows 2-3 lymph nodes with thickened cortex. On USG the mass was iso to hypechoic with irregular circumscribed margins with increased vascularity.There are mixed posterior features. Microcalcifications were seen in the upper outer region of the mass. BIRADS 5 was assigned for the lesion and USG guided biopsy was recommended. USG guided FNAC from the left axillary node showed only reactive lymphoid hyperplasia. USG guided core biopsy showed Invasive breast cancer NST, Nottingham Grade II. Immunohistochemistry report is awaited.
Answer
Sinister, BIRADS 5
Discussion
Although Male breast comprises only 1% of male cancers, male breast cancer is increasing. It is often neglected as clinicians and patients are more aware of female breast cancer. The patients present late especially in our set up. Radiologists and clinicians should be aware of this entity. All patients presenting with breast complaints should undergo triple assessment (clinical examination, imaging and histopathology) Gynaecomastia may coexist with breast cancer as is seen in this case, so mammograms should be carefully evaluated even after finding gynaecomastia
Reference
1. Khan NAJ, Tirona M. An updated review of epidemiology, risk factors, and management of male breast cancer. Med Oncol. 2021 Mar 15;38(4):39. doi: 10.1007/s12032-021-01486-x. PMID: 33721121 2.Yuan WH, Li AF, Chou YH, Hsu HC, Chen YY. Clinical and ultrasonographic features of male breast tumors: A retrospective analysis. PLoS One. 2018 Mar 20;13(3):e0194651. doi: 10.1371/journal.pone.0194651. PMID: 29558507; PMCID: PMC5860767.
