A case of subareolar abscess in the male breast: Usefulness of magnetic resonance imaging scan for diagnosis

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review ABSTRACTIntroduction: Subareolar abscess in the male breast is extremely rare. The main concern with this condition is performing the differential diagnosis, since clinically it often resembles breast cancer. Case Report: A 30-year-old Japanese male presented with pain and swelling of the left breast. Physical examination revealed a 3.0x3.0 cm palpable lump with redness of the skin in the left subareolar region. Magnetic resonance imaging (MRI) scan showed a ring-enhancing mass without wash out with central necrosis below the left nipple, suggesting subareolar abscess. A core needle biopsy was performed, and histological findings revealed granulation tissue with the infiltration of numerous neutrophils, a finding that was compatible with subareolar abscess. Conclusion: Male subareolar abscess is quite a rare disease, however, awareness of how to perform differential diagnosis of subareolar abscess and the use of MRI scan may help in making a definitive diagnosis of subareolar abscess in the male breast and might aid in the proper management of the condition.

Male breast abscess: A rare entity

“…While breast abscesses most commonly affect females [16] , there are few cases recorded in the literature of male breast abscesses. Nine male breast abscess cases were encountered in our literature review with ages ranging from 24 to 80 years old [4 , 7 , [9] , [10] , [11] , [12] , [13] , [14] ]. In Saudi Arabia, only 1 published case of a male with SBA was reported by Alqahtani et al.…”

“…In any male presenting with a breast lesion, it is critical to rule-out more serious pathology and differentiate the benign cases from malignant ones such as breast cancer [5] . The triple assessment starts with a clinical assessment, followed by radiology (X-ray, mammography, and US), and lastly a FNAC and culture [5] , [6] , [7] . A case was found by Gochhait et al.…”

“…On US, features of a breast abscess may mimic that of malignancy [17] . Documented breast abscesses have been described as a heterogeneous lesion with one or multiple hypoechogenic areas and a posterior echo enhancement [7 , 10 , 13] . Collections were also described to have irregular borders with a hyperechoic rim and no to mild increase in Doppler blood flow [4 , 10 , 13] .…”

“…Collections were also described to have irregular borders with a hyperechoic rim and no to mild increase in Doppler blood flow [4 , 10 , 13] . Because US findings in addition to FNA were sufficient to make a diagnosis of breast abscess, mammography was not ordered in many documented cases [4 , 7 , 9 , 10 , 11 , 13 , 14] . On mammogram, nonpuerperal breast abscesses usually show localized skin thickening [2 , 12] , roughly 20% of mammograms appear normal [2] , and the least common finding is a mass [2 , 17] , which is shown in our patient's mammogram.…”

“…The typical method for diagnosing SBA involves a triple assessment. This begins with a clinical evaluation, then proceeds with radiological examinations including X-ray, mammography, and ultrasound (US), and lastly involves fine needle aspiration cytology (FNAC) to confirm the abscess [5] , [6] , [7] . The majority of reported male breast abscesses have either aerobic or tubercular origins [1] , and the causal organisms can include methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive S aureus (MSSA), coagulase-negative Staphylococcus (CONS), Streptococcus and Proteus [5] .…”