Most men with breast symptoms can be diagnosed on the basis of clinical findings without imaging [1,2]. Gynecomastia is the most common cause of a palpable mass, breast enlargement, or pain [1-3]. Gynecomastia is bilateral in approximately half of patients. On physical examination, gynecomastia often presents as a soft, rubbery, or firm mobile mass directly under the nipple [3,4]. In addition, gynecomastia is more likely to be painful than cancer [3], especially gynecomastia that has been present for <6 months [3,4]. Mammography In men with clinical findings consistent with gynecomastia or pseudogynecomastia, mammography is not routinely indicated. When performed, 3 patterns of gynecomastia have been described on mammography: (1) nodular (subareolar nodule), (2) dendritic (subareolar flame-shaped tissue), and (3) diffuse glandular (much like a heterogeneously dense female breast) [11]. When pseudogynecomastia is identified as the sole imaging finding, aH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. bAlpert Medical School of Brown University, Providence, Rhode Island. cPanel Vice- Chair, NYU Clinical Cancer Center, New York, New York. dRoper St. Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons. eNorthwestern University Feinberg School of Medicine, Chicago, Illinois; American College of Physicians. fDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. gNew York University School of Medicine, New York, New York. hEmory University Hospital, Atlanta, Georgia. iThe University of Texas MD Anderson Cancer Center, Houston, Texas. jNew York University School of Medicine, New York, New York. kBeth Israel Deaconess Medical Center, Boston, Massachusetts. lBeth Israel Deaconess Medical Center, Boston, Massachusetts. mWomen and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists. nMecklenburg Radiology Associates, Charlotte, North Carolina.
Evaluation of the Symptomatic Male Breast. Most men with breast symptoms can be diagnosed on the basis of clinical findings without imaging [1,2]. Gynecomastia is the most common cause of a palpable mass, breast enlargement, or pain [1-3]. Gynecomastia is bilateral in approximately half of patients. On physical examination, gynecomastia often presents as a soft, rubbery, or firm mobile mass directly under the nipple [3,4]. In addition, gynecomastia is more likely to be painful than cancer [3], especially gynecomastia that has been present for <6 months [3,4]. Mammography In men with clinical findings consistent with gynecomastia or pseudogynecomastia, mammography is not routinely indicated. When performed, 3 patterns of gynecomastia have been described on mammography: (1) nodular (subareolar nodule), (2) dendritic (subareolar flame-shaped tissue), and (3) diffuse glandular (much like a heterogeneously dense female breast) [11]. When pseudogynecomastia is identified as the sole imaging finding, aH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. bAlpert Medical School of Brown University, Providence, Rhode Island. cPanel Vice- Chair, NYU Clinical Cancer Center, New York, New York. dRoper St. Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons. eNorthwestern University Feinberg School of Medicine, Chicago, Illinois; American College of Physicians. fDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. gNew York University School of Medicine, New York, New York. hEmory University Hospital, Atlanta, Georgia. iThe University of Texas MD Anderson Cancer Center, Houston, Texas. jNew York University School of Medicine, New York, New York. kBeth Israel Deaconess Medical Center, Boston, Massachusetts. lBeth Israel Deaconess Medical Center, Boston, Massachusetts. mWomen and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists. nMecklenburg Radiology Associates, Charlotte, North Carolina.