Endgames Case Report

Evaluation of breast masses in male patients

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1579 (Published 14 April 2010) Cite this as: BMJ 2010;340:c1579
  1. Debra Meerkotter, consultant radiologist,
  2. Andrew Patrick, consultant ophthalmologist
  1. 1Regional Imaging Tasmania, St Vincent’s Hospital, Launceston, 7250, Tasmania, Australia
  1. Correspondence to: D Meerkotter deband67{at}gmail.com

    An 81 year old man presented to a breast clinic after being referred by his general practitioner. He had swelling of the breast, which was becoming increasingly tender. He first noticed swelling on the right side about three months before presentation, but both sides were now affected. The breast changes had been slowly progressive over this time. His medical history included hypertension (treated over a long period with an angiotensin converting enzyme inhibitor) and a diagnosis of atrial flutter four to five months before presentation. He was taking digoxin for the atrial flutter. There was no history of breast or ovarian cancer on the maternal or paternal side of the family.

    The patient was mobile and of average build. On inspection, he had bilateral fairly symmetrical breast enlargement. On supine examination, palpation revealed bilateral rubbery subareolar masses. The palpable change was centrally located and about 35 mm in diameter. The overlying skin and underlying structures were not fixed to the mass. We detected no axillary lymph adenopathy or changes to the skin or nipples. No nipple discharge was present. An examination of the abdomen, testes, and scrotal contents was normal.

    Questions

    • 1 How should a male patient with breast swelling be assessed?

    • 2 What are the indications for further investigations?

    • 3 If further investigations are indicated what would they be?

    • 4 What is the most likely diagnosis in this patient?

    • 5 How should this patient be managed?

    Answers

    1 How should a male patient with breast swelling be assessed?

    Short answer

    Take a detailed history, including age, medical history, details of breast changes, use of medications and illicit drugs, and oestrogen exposure. Ask about changes in sexual functioning and symptoms of oestrogen excess or androgen deficiency, such as decreased libido, overall decreased strength, infertility, sexual dysfunction, and impotence. Carry out a general examination, including the breasts and genitalia, and assess the degree of virilisation.

    Long answer

    The …

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