0:00

So 45 year old male presenting with

0:03

alum. What's the first best imaging test

0:06

for a 45 year old male?

0:10

Start with an ultrasound mammogram MRI or

0:13

none of the above.

0:17

Men by definition are usually a diag.

0:21

Good. So most of you said mammogram and for

0:24

men actually 25 is the age

0:27

that cut off that you're going to go from ultrasound. I'm from start with

0:30

a mammo. So under 25, you're gonna start with an ultrasound

0:33

over 25. You're going to start with a mammogram.

0:36

And usually the mammogram is diagnostic.

0:39

When we're talking about gynecomastia, the

0:42

mammogram is usually diagnostic. We may not need an ultrasound.

0:45

In this case though. You can

0:48

see this palpable lump.

0:51

That's when you take a minute. Look at this image.

0:55

I'm sorry if it means to advance. So

0:58

the question to you is this classic

1:01

gynego? Massia or doesn't mean more more imaging?

1:05

things to yourself for a minute

1:10

So what's the next step? Is that a no further Imaging this

1:13

is gynecomastia, you need to do an ultrasound to confirm

1:16

gynecomastia or do an ultrasound because of findings

1:19

are currently suspicious for male breast cancer.

1:24

Good. Yeah, so, you know, this is suspicious. It's a mass gynecomastia

1:27

is not a method to not have convex borders.

1:30

It's flame shaped. It's right behind the nipple.

1:33

Does not cause nipple retraction like they

1:36

did in this case.

1:37

So yes, this is suspicious. Sorry go in

1:40

a minute.

1:43

Yeah, so suspicious for breast.

1:45

Cancer so you could see if you do an ultrasound

1:48

like if you were on the fence and you wanted to do an ultrasound or the

1:52

patient's doctor wanted it. You could see that this is not

1:55

a flame shaped retro or density. This isn't

1:58

a regular hypocalic mass. And the retailer region. He has another

2:01

lesion here to a clock you can see that these are separated by

2:04

two point three centimeters and he's got it a normal

2:07

lymph node.

2:09

So by Reds here, thank you

2:12

all know the answer by now.

2:17

Okay gonna give you a second. Yep. So this is

2:20

the Byron's four very good. You're getting the hang of it now.

2:24

Um, so just to kind of talk about male breast

2:27

cancer gynecomastia is usually bilateral could be

2:30

a it's usually asymmetric though, but it both sides are

2:33

usually affected one side more than the other. It's going to

2:36

be a sub-areolar flame shape density mammals, usually

2:39

diagnostic ultrasound can actually be pretty confusing.

2:42

So if it looks like gynecomastia on the mammogram, there

2:45

may not be a need to do an ultrasound. It's supposed

2:48

to breast cancer. It's going to be usually unilateral

2:51

though. The other side might have gynecomastia which

2:54

we see often. It's going to be a mass with

2:57

border. So if it's if it's if it looks like a mass it needs to

3:00

be by at seed, um, ultrasound necessary if in

3:03

mammo is not classic for a gynecomastia.

3:07

Um when you talk about gynecomastia, there's a few common causes.

3:10

It's usually there's no identifiable cause

3:13

idiopathic drugs commonly. We talk

3:16

about marijuana or digitalis prostate cancer

3:19

meds anything that that causes a patient have

3:22

increased estrogen like if they take if they

3:25

take estrogen for for gender

3:28

differences or

3:31

liver disease or if they have testicular adrenal tumor

3:34

also male breast cancer. Sometimes just

3:37

the hormone levels can cause gynecomastia in the

3:40

other breasts.

3:41

Nail breast cancer accounts for one percent of

3:44

all breast cancers. It's invasive Dussel men

3:47

don't have lobular. So they don't get invasive lobular. It's usually

3:50

a worse prognosis. They typically don't get benign masses

3:53

like fibrinomas or CIS. So unless it's

3:57

you know, and if there's a math it probably needs to

4:00

buy it be