ABSTRACT
Introduction Male breast cancer is rare, accounting for about 1% of total breast cancer cases. In contrast to gynecomastia, which has a painful, soft, movable mass concentric to the nipple, the traditional presentation is a painless, hard, eccentric retro-areolar mass. However, when cancer occurs concurrently with significant gynecomastia, the mammographic pattern simulates female-type breast cancer, whereby there is a variable location and pattern of cancer. This study addresses the clinical and radiologic implications of this combination of gynecomastia and co-existing breast cancer. This combined presentation has not been highlighted thus far. Materials and method Following institutional approval, a retrospective study of male breast cancer was conducted over a 10-year period (2011-2021) in a single institution. Age, clinical presentation, risk factors, comorbidities, imaging results, and comprehensive pathology reports were all obtained from the picture archiving and communication system (PACS). Patients who did not have an initial imaging examination were eliminated from the study. Results There were 17 cases in all that were investigated. Nine of the men exhibited a classic presentation appearance, whereas eight had gynecomastia. The mean age was 58 years. The female-type presentation included multicentric cancers away from the nipple, diffuse parenchymal involvement, leukemia/lymphoma, and positive axillary lymphadenopathy without intramammary lesion, some of which had delayed investigation due to clinical suspicion of gynecomastia or breast swelling. All of the radiologic diagnoses were accurate. The pathology report in all except two cases was hormone receptor-positive and human epidermal growth factor receptor 2 (HER2) negative. Conclusion Female-type presentation of male breast cancer is highlighted to prevent false clinical impressions and delayed radiologic investigation and treatment. Mammography readily identifies such cancers and should be requested at the initial clinical presentation of males with significant gynecomastia or risk factor.
ABSTRACT
PURPOSE: Breast cancer affects a significant number of patients younger than 40 years in the Gulf and breast conservative treatment is highly preferred. Pathological complete response (pCR) following neoadjuvant chemotherapy is increasingly being observed with the new chemotherapy agents. Although MRI is more accurate in such evaluations, digital mammography and high-resolution ultrasound (US) which are less expensive may accurately predict pCR which is the focus of this study. METHODS: A 6-year retrospective study of 93 breast cancer cases who had neoadjuvant chemotherapy and had presurgical radiological localization was carried out. Forty-five had US localization while 48 underwent mammographic localization when US failed to define any residual mass. Radiologic complete response (rCR) was defined as absence of mass with only postbiopsy clip overlying normal breast parenchyma pattern in US and in mammography (clip sign). Mass or abnormal parenchymal pattern was considered as residual tumor. The pathology reports of pCR or not with background changes were recorded. RESULTS: Ultrasound localization correctly predicted 42 out of 43 pathologic masses with 98 % accuracy. Mammographic localization correctly predicted 40 out of 43 pCR with 93 % accuracy. The best responders were triple negative and HER2 positive hormone negative breast cancer. CONCLUSION: The study defines radiologic complete response (rCR) as absence of a mass with the postbiopsy tissue marker overlying a normal-looking breast parenchyma in both ultrasound and mammographic evaluation. A correlation of 93 % was found with pCR. The few false negative cases were associated with overlying dense breast and possibly post treatment reaction. Allocation of a BI-RADS category for rCR is suggested.
