0:01

All right. This is a different patient. This was

0:04

an 80 year old male represented with a right breast, Mass.

0:07

and

0:08

his left breast is all

0:11

you know, he's got bilateral. So what causes this

0:14

appearance?

0:20

I'm gonna come out see a breast cancer both or neither.

0:26

Oops, I'm sorry. That was yeah. So so

0:29

it actually they're correct

0:32

answer is actually see so one person got it. Right and I want

0:35

I'm showing you this because I think this is a great place of

0:38

on the left. Sorry on the

0:42

left. He's got gynego massia. He's got that flame

0:45

shapes retro or density, but on the right, he's

0:48

got a true math where you know, there are real borders. You

0:51

can it's not a symmetry.

0:54

It's more of a mass. So when it's a mass you definitely want to

0:57

do an ultrasound so I you know, we'll talk a little bit more about gynecomastia and

1:00

ultrasound but this is

1:03

actually both because the right side is breast cancer and the left

1:06

side is kind of a mess. Yeah. So I'm Gonna Save the

1:09

question just for sake of time but you're by

1:12

red. I mean this is not going to go math. Yeah. I

1:15

mean it could be but you definitely would like to buy it see it. So in

1:18

this case you really want to give it a four kind of a nasty.

1:21

It does not look this math like it can and like the nodular phase,

1:24

but you

1:26

Really want to confirm this with the biopsy. This was a case of

1:29

male breast cancer.

1:30

So this would be a birads four or five.

1:34

So like I said, this is kind of a messiah. This

1:37

is a birets too. This is bilateral. It's

1:40

right breast cancer and left breast gynecomastia. This

1:43

is definitely a four or five

1:46

so

1:50

In terms of Imaging for for males,

1:53

you always want to start if

1:56

they're over age 25 you want to start with

1:59

a Mamo? A mammo is

2:02

usually the most Diagnostic Imaging modality for

2:05

gynecomastia ultrasound can be really confusing. So

2:08

I don't always do an ultrasound. I do an ultrasound if

2:11

it's not a hundred percent gynecomastia on

2:14

mammogram, but the ultrasound picture might be more confusing. So,

2:17

you know in that second case

2:20

where it was breast cancer, you definitely want to do an ultrasound because it certainly

2:23

does not look like an eagle Mass yet. But if it's gynecomastia on

2:26

mammogram stop don't do anything else. It's by Reds

2:29

to next case nothing else to do.

2:32

The difference is between gynecomastia. Gynecomastia is

2:35

usually bilateral but asymmetric, so there's usually one side

2:38

that's worse than the other usually see sub-areolar flame

2:41

shaped densities. Like I said, the mammo is

2:44

usually diagnostic ultrasound can often be confusing and as

2:48

opposed to breast cancer. So breast cancer is usually unilateral. You're

2:51

gonna see a math with true borders ultrasound

2:54

is necessary. If the mammo is

2:57

not diagnostic, which it should not be in breast cancer cases.

3:00

It's because it's not gynecomastia.

3:04

Um causes of gynecomastia. So most commonly, it's

3:07

just idiopathic. We always like to make jokes about

3:10

you know, drugs cause it like marijuana prostate cancer

3:13

meds anything that really messes with your estrogen estrogen

3:16

and testosterone levels will cause

3:19

there to be a that can

3:23

cause extra estrogen can cause gynecomastia so

3:26

liver disease testicular adrenal disease

3:29

and also male breast cancer causes can

3:32

cause gynecomastia on the other side because of the hormone.

3:36

So male breast cancer accounts for one person of

3:39

all breast cancers most are going to be invasive ductal men

3:42

don't have lobuil so they don't get invasive labular

3:45

cancer. They also don't get benign masses

3:48

like cyst or Fiber adenomas if you see something and it's not

3:51

going to go messy. You're probably gonna buy it yet unless it's clearly like an

3:54

instrument lymph node or something like that and male tend

3:57

to have a worse prognosis and certainly when a male

4:00

gets breast cancer. Their whole family is going to be genetic tested because it's unusual.

4:03

I've always seen a few cases.