Differential Radiodiagnosis of Pseudogynecomastia, Gynecomastia and Breast Cancer in Men

Abstract

Background: With the growth in the equipment clinics with modern diagnostic equipment is increasing the detectability of male breast pathology. In this connection there is a need to determine X-ray characteristics of some forms of the male breast pathology especially breast cancer, because in Russia it stills a problem of detecting male breast cancer at early stages. Purpose: To determine the diagnostic capabilities of chest CT to detect various pathologies of the male breast and to identify the statistically significant radiological symptoms for the differential diagnosis of pseudogynecomastia, gynecomastia and breast cancer. Material and methods: 150 chest CT of men who were screened and treated for the various diseases in the Voronezh Regional Clinical Diagnostic Center and Kursk Regional Clinical Hospital in 2013–2015. X-ray examinations (13 chest CT, 4 PET-CT and 16 mammography) of 31 male patients with breast cancer who were surgically treated at the Voronezh Regional Oncology Hospital in 2010–2016 are presented. Results: The obtained data on the prevalence of pseudogynecomastia and gynecomastia in men who have no presenting complaints about changes in breast. Determined the forms of gynecomastia in this group of patients. Identified radiographic signs that allow a differential diagnosis between gynecomastia and breast cancer. Conclusions: 1. Gynecomastia is a common pathology of the male breast diagnosed by chest CT, and was diagnosed in 68.7 % of patients, who have no presenting complaints about changes in breast. In 96.1 % of cases, gynecomastia had a dendritic form. Diffuse glandular and nodular were rare forms of the disease and were respectively 2.9 % and 1 % of all cases of this disease. 2. Statistically significant signs of malignant character of breast masses in men were: a) the connection of the tumor with skin, areola or nipple in the form of «track» to them, thickening of the skin, «pulling» of the skin or nipple to neoplasm or their immediate invasion by tumor; b) tumor invasion into the pectoralis major muscle; c) presence of microcalcifications in neoplasm; d) presence of pathologically altered axillary lymph nodes. The determination of these radiological symptoms require immediate consultation of an oncologist. 3. Statistically significant signs of the benign character of breast masses in men were: a) bilateral lesion and the symmetry of the changes in the breasts; b) adipose tissue inclusions in breast masses. When detection gynecomastia it needs the consultation of urologist, endocrinologist, oncologist. 4. Awareness of physicians and radiologists on the possibility of developing breast cancer in men and the knowledge of the symptoms of this disease is crucial to detect male breast cancer at early stages and, as a consequence, more successful treatment and a favorable prognosis.