Ductal Carcinoma In situ of the Male Breast

Abstract

Background: Ductal carcinoma in situ of the male breast is an unusual lesion and most often associated with invasive carcinoma. On rare occasions when the in situ component is present in pure form, histological grade is almost always low to intermediate. Imaging for these patients is difficult as gynecomastia is often present and can mask underlying calcifications or carcinoma. Case Report: We report a case of pure high-grade ductal carcinoma in situ of the male breast in a patient with clear nipple discharge. Breast mammography showed bilateral gynecomastia and benign calcifications. Subsequent breast ultrasound showed dilated ducts of the left breast, and a left breast ductogram showed filling defects suggestive of a papilloma. Excisional biopsy and subsequent mastectomy were consistent with high-grade ductal carcinoma in situ. Conclusion: Male breast cancer is uncommon and, although there is increasing awareness, it is less studied compared to female breast cancer. With a clinical history of nipple discharge of any kind, further evaluation with imaging should be considered. In males with gynecomastia, it is important to remember that ductal carcinoma in situ, even of high grade, is difficult to detect on mammography and may not be associated with suspicious calcifications.

Magnetic resonance imaging findings of high-grade ductal carcinoma in situ of the male breast: A case report

“…In the only pure high-grade DCIS case in current literature, the duration of symptoms is reported to be 6 months. 10 In our case, the duration of symptoms was 8 years. The most common sign at presentation is a retroareolar, firm, painless, palpable mass.…”

“…The most common sign at presentation is a retroareolar, firm, painless, palpable mass. 9 , 10 In 39% of DCIS cases, bloody nipple discharge is the leading symptom. 8 Additional signs may be breast pain, skin lesions or lymphadenopathy.…”

“… 17 In previous studies, as well as in our case, mammography and ultrasound are often equivocal in men. 10 If mammography and high-resolution ultrasound are unrevealing, central duct excision (CDE) can be considered the gold standard in the management of bloody nipple discharge. 18 Although there is still inadequate scientific evidence, most authors agree that MRI should be performed in all patients with bloody nipple discharge and negative conventional imaging.…”

Male Breast Cancer; A Review of Risk Factors and Clinical and Radiological Features

“…Most of DCIS are high grade form. Pure DCIS occurs in 7% to 11% of the cases, usually low to intermediate grades [13,14]. Other less common subtypes are inflammatory carcinoma and invasive papillary carcinoma, respectively [15].…”

Pure low-grade DCIS in a male patient: a case report

“…Male breast cancer is very rare and represents 1% of all cancers diagnosed in the USA [ 1 ]. Pure ductal carcinoma in situ (DCIS) in a male is even more rare and represents ~0.1% of all breast cancers [ 2 ]. Proposed risk factors for development of DCIS in men is the same as the risks factors for any male breast cancer and includes age, family history, exposure to radiation, conditions causing increased estrogen to androgen ratio (Klinefelter, obesity), and pathological gene mutations (CHEK2, BRCA2 > BRCA1) [ 3 ].…”