Thread by @DrJordanaP

1/For this tweetorial in our #breastradpath series w @LizaMQuintana we're going to focus on #malebreastcancer for male breast cancer awareness week. An important topic that doesn't get enough attention! #BCAM @MBCC_MHBT @BreastCancerMen @BreastCancerNow @BreastImaging @Breast360

2/But before we can talk about the male breast, we first need to review the female breast. The female breast is made of skin, breast fat, ducts, and lobules. The breast sits on the pectoralis major muscle of the chest wall

3/The female breast is like a tree in springtime. A group of buds on a tree are like breast lobules (one bud is called an acinus). The tree branches are like breast ducts. Can you see the similarities between the sakura cherry tree and the specimen of breast tissue below???

4/When women lactate (produce milk), the milk forms in the lobules, travels down the ducts, and out the nipple

5/Unlike female breasts, male breasts do not have lobules. So they don't develop abnormalities that typically start in lobules. Without lobules, they can't produce milk

6/Here is an example of normal male breast tissue when looking under the microscope. There is mostly breast fat and a few ducts. But no lobules.

7/Common non-cancerous entities that form in men are: gynecomastia, angiolipoma, schwannoma, papilloma, lipoma, fat necrosis, and sebaceous cysts.

#Gynecomastia is pretty common. Men may present to their doctor with breast enlargement, nipple sensitivity, or breast lumps.

8/There are 3 types of #gynecomastia: nodular, dendritic, & diffuse glandular. Nodular happens early & is reversible (circle). Dendritic happens after1yr & has a flame shaped appearance on MG (arrows). Diffuse glandular is seen in pts taking high-dose estrogen (freeform circle)

9/This is what gynecomastia looks like under the microscope. There are more ducts and stroma (pink areas around the duct). The ducts have a specific look where the epithelial cells form tufts as part of a process called micropapillary pattern usual ductal hyperplasia

10/Gynecomastia can be caused by: certain meds (reflux reducers, steroids, antidepressents, heart medications), some medical conditions (liver cirrhosis, tumors, kidney disease), drugs (marijuana). And sometimes it just happens and we can't figure out why!

11/Treatment for gynecomastia varies from stopping any medications that might be causing it, to surgery to remove the excess breast tissue. Definitely worth talking to your MD to figure out next steps!

More info can be found here:
pubs.rsna.org/doi/pdf/10.114…

12/Next topic is #malebreastcancer. It can also present with a breast lump (like gynecomastia) but there are other warning signs. 40% of male breast cancers present late stage bc men may delay care even if they have a symptom. Bottom Line: Get checked if you notice a change!

13/This was a 57 yo man who presented with a left breast lump (not near nipple) which corresponded to a focal asymmetry in the upper outer left breast (arrow). This shouldn't be there! US showed a subtle mass. Notice the dendritic gynecomastia on the right (circle).

14/The left breast mass was biopsied. Path showed ductal carcinoma in situ (DCIS). This means that the cancer hasn't spread outside the duct. Studies suggest most male breast cancer are ER/PR+ HER2- ductal carcinoma. @DrLindaMoy @NYUImaging

pubs.rsna.org/doi/pdf/10.114…

15/The purple areas on the slide are DCIS. This DCIS had a papillary & cribriform pattern. Papillary refers to the vessels supplying the area (aka fibrovascular cores, star) and cribriform refers to the round spaces with atypical epithelial cells polarized around them (arrow)

16/Most importantly, men should do breast self-exams to make sure there are no changes to their chest wall that could be cancer! Some really great organizations put together a pamphlet on how to do this.

17/ Key take home points: Any man can get cancer but there are certain people that are at increased risk. Know your breasts! Go see your doctor if you notice any LUMPS, SKIN CHANGES, or NIPPLE DISCHARGE

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