A breast mass in a 56-year-old man

Abstract

A 56-year-old man living in Toronto, Ontario, presented to his family physician after finding a lump in his right breast on self-inspection. He described a onemonth history of pressure and tenderness at the site of the mass. No other lumps were detected, and there was no history of fever, sweats, weight loss or previous trauma to the breast. He had a history of obstructive sleep apnea, took no medications and did not use recreational or injection drugs. The patient had no relevant family history and no contacts with people who were ill. His history of travel was limited to his cottage in central Ontario.On examination, a 3-cm mass that extended medially was palpable in the retroareolar area of the patient's right breast. The mass was rubbery, nontender and did not appear to be tethered to the overlying skin, which was intact. No axillary lymph adenopathy was detected. The left breast and the remainder of the general examination were normal. What is the most common cause of a breast mass in a man?a. Gynecomastia b. Breast carcinoma c. Benign fibrocystic changes d. Inflammatory/infectious diseases of the breast e. Lymphoma Gynecomastia is the most common cause of combined unilateral and bilateral breast mass(es) in men (Box 1).1-4 Clinically, gynecomastia usually presents as a concentric retroareolar rubbery mass. 4 This patient's mass was atypical of gynecomastia as it extended medially in an asymmetric fashion. Given the possibility of a malignant cause, the patient was referred for further evaluation to a rapid diagnostic clinic for breast cancer.At the clinic, the patient received a mammogram, ultrasonography and a core biopsy of the mass. Mammography showed a well-defined 2.5-cm mass located within the right breast (Figure 1). No calcifications were present. Ultrasonography confirmed these findings and did not detect any substantial regional lymphadenopathy. A core biopsy and tissue staining suggested a fungal cause (Figure 2 and Appendix 1, available at www.cmaj .ca /lookup /suppl /doi :10 .1503 /cmaj .110953/-/DC1.), but no specimen was sent for culture. Based on the results of the biopsy, the patient was referred to an outpatient clinic for infectious diseases for further evaluation and management of the condition. What is your call?A breast mass in a 56-year-old man

Cutaneous Blastomycosis Mimicking Breast Malignancy

“…Blastomycosis mimics several diseases and can be easily misdiagnosed as neoplasia, pyogenic gangrenosum, nocardiosis, mycobacterial infection, immunologic skin disorders, and other mycoses [4]. In the spectrum of the presentation of blastomycosis, breast involvement is uncommon, as noted in the literature [5][6][7][8][9].…”