Male inflammatory breast cancer.

A case of a 48-year-old male with an inflammatory breast cancer is used to illustrate this uncommon malignancy. The physical examination of thickening and erythema made the clinical diagnosis. Mammographic findings of increased density in the right breast with coarsened stroma and an underlying mass confirmed the clinical findings. The sonographic evaluation revealed a 2-cm ill-defined hypoechoic mass. The pathologic examination of the mastectomy specimen showed an infiltrating duct cell carcinoma with lobular features. Male breast cancer afflicts 1500 men each year. Clinically it must be differentiated from gynecomastia, a much more common and benign condition.

MR imaging in the management before surgery of lobular carcinoma of the breast: correlation with pathology.

OBJECTIVE: Our objective was to investigate the use of MR imaging in preoperative staging and characterization of lobular carcinoma. MATERIALS AND METHODS: MR imaging studies and mammographic studies in 20 patients with infiltrating lobular carcinoma were evaluated and correlated with pathology findings on serially sectioned tissue. The MR images and mammograms were reviewed retrospectively by three independent examiners unaware of the clinical, imaging, and pathology findings. RESULTS: The extent of disease found pathologically correlated with that predicted by MR imaging studies in 85% of patients, compared with a 32% correlation (p < .0001) with mammographic studies. Interobserver agreement on lesion morphology and extent of disease was higher for MR imaging (91% and 100%, respectively) than for mammography (64% and 91%, respectively). The retrospective MR readings did not differ from the prospective reports. No false-positive lymphadenopathy was interpreted on MR imaging. Lymph nodes having metastatic lobular carcinoma on the pathology examination were missed on MR imaging in four patients. CONCLUSION: MR imaging is significantly more accurate than mammography in determining the extent of disease and characterizing the morphology of infiltrating lobular carcinoma. MR imaging may play a role in preoperative planning, especially when breast conservation is being considered.

Three-dimensional RODEO breast MR imaging of lesions containing ductal carcinoma in situ.

PURPOSE: To assess whether rotating delivery of excitation off resonance (RODEO) breast magnetic resonance (MR) imaging can help detect ductal carcinoma in situ (DCIS) lesions, determine tumor extent, and differentiate pure DCIS from DCIS with an invasive component. MATERIALS AND METHODS: Twenty-two patients with DCIS lesions were evaluated with three-dimensional RODEO MR imaging. Nineteen patients had available mammograms for review. RESULTS: MR imaging enabled detection of all 22 cases of DCIS, DCIS with microinvasion, or invasive ductal carcinoma with extensive intraductal component. A clumped enhancement pattern was seen on MR images in all cases of pure DCIS. Spiculated enhancement was seen in four of six (67%) patients who had DCIS with microinvasion and in nine of 11 (82%) who had invasive ductal carcinoma with extensive intraductal component. RODEO MR imaging enabled accurate determination of tumor extent in 21 of 22 (95%) patients. Mammography depicted 18 of 19 DCIS lesions. No mammographic feature helped differentiate pure DCIS from DCIS with microinvasion. Mammography enabled accurate determination of tumor extent in 14 of 19 (74%) patients. CONCLUSION: Three-dimensional RODEO MR imaging can be an adjunct to mammography because of its ability to enable better determination of tumor extent and differentiation of pure DCIS from DCIS with an invasive component.