Encapsulated Papillary Carcinoma in A Man with Gynecomastia: Ultrasonography, Mammography and Magnetic Resonance Imaging Features with Pathologic Correlation

Abstract

Male breast cancer is an uncommon disease that constitutes 1% of all breast cancers and encapsulated papillary carcinoma (EPC) is a rare subtype of malignant male diseases. Gynecomastia is the most common disease of the male breast. We report a 63-year-old male patient with EPC accompanied by gynecomastia that was diagnosed and treated at our breast center. Mammography showed an oval-shaped dense mass with circumscribed margins on the ground of nodular gynecomastia. On ultrasonographic exam, we saw a well-circumscribed complex mass with a solid component which was vascular on Doppler ultrasonography. Magnetic resonance imaging revealed a complex cystic mass containing solid components. Dynamic images showed enhancement of the cystic mass wall and mural components. Tumor stage was evaluated as T2N0. The lesion's histologic examination and immunohistochemical analysis by showing no myoepithelial layer revealed an encapsulated papillary carcinoma. To our knowledge, this is the first case report which describes MR imaging findings of male breast encapsulated papillary cancer.

A case report of a mammary myofibroblastoma in a male and literature review of radiologic and pathologic features of breast myofibroblastoma

“…Although magnetic resonance imaging (MRI) is not routinely used in diagnosis of a breast mass, there are some reports of the features of myofibrobalastoma in MRI. The review of the MRI findings revealed the myofibroblastoma as a tumor with a hyperintense signal in T2‐weighted images surrounded by a hypointense capsule or nonenhancing internal septation in postcontrast imaging . In addition to the mentioned MRI characteristics, ADC has been reported as a useful MRI finding in distinguishing myofibroblastoma form malignant masses.…”

“…Since low values of ADC are detected in malignant lesions, high ADC values in myofibroblastoma may be helpful in differentiation of myofibroblastoma from malignant lesions . However, Yilmaz et al did not find the ADC value as a helpful index in differentiating myofibroblastoma from breast cancer …”

“…The ultrasonographic findings of myofibroblastoma are similar to those of fibroadenoma in women and angiolipoma, fat necrosis, and pseudoangiomatous stromal hyperplasia in men, considering myofibroblastoma as a differential diagnosis of a mass with benign sonographic features. 11,12 Moreover, the mammographic characteristics of myofibroblastoma are nonspecific findings, including a heterogeneous mass with a well-defined border and no evidences of microcalcification. 13 Although magnetic resonance imaging (MRI) is not routinely used in diagnosis of a breast mass, there are some reports of the features of myofibrobalastoma in MRI.…”

“…The review of the MRI findings revealed the myofibroblastoma as a tumor with a hyperintense signal in T2-weighted images surrounded by a hypointense capsule or nonenhancing internal septation in postcontrast imaging. 12,14,15 In addition to the mentioned MRI characteristics, ADC has been reported as a useful MRI finding in distinguishing myofibroblastoma form malignant masses. Since low values of ADC are detected in malignant lesions, high ADC values in myofibroblastoma may be helpful in differentiation of myofibroblastoma from malignant lesions.…”

“…16 However, Yilmaz et al did not find the ADC value as a helpful index in differentiating myofibroblastoma from breast cancer. 12 In addition to the mentioned diagnostic imaging methods, breast myofibroblastoma has been reported as an incidental finding in computed tomography (CT). It was described as a low or mixed low and high density mass on CT. [17][18][19] Although CT is not used as a diagnostic workup of mammary myofibroblastoma, it can be performed to exclude involvement of proximal structures.…”