Alone among Women

Clark Winterbottom (55) was persuaded to go to the breast clinic by his wife. He had felt a lump behind his right nipple a few weeks ago. To top it off, the whole thing now started to be painful. He sits in the waiting room and leafs through a fashion magazine uneasily. During her clinical examination of his breasts, Hannah palpates a lump in the retromamillary region on both sides. The ultrasound examination confirms the presence of glandular tissue. Hannah knows that there are only two major differential diagnoses for a man with a lump in the breast: a gynecomastia caused by a variety of factors (Fig. 12.27)—as is fortunately true in Mr. Winterbottom's case—and a breast carcinoma, which is very rare in men (Fig. 12.28). If there is the slightest doubt as to the benign character of the tumor, all of the glandular tissue is removed, which is in the interest of most patients anyway.

I The Case of Clark Winterbottom a a

Clinical Gynnacomastia

Fig. 12.27 The MR image after contrast administration displays the strong enhancement of the proliferative glandular parenchyma on both sides, but more on the right than on the left. The pattern fits well with a gynecomastia. The indication for surgery depends to a great extent on patient preference and on the underlying cause of the gynecomastia, which may be reversible and can sometimes be treated medically.

Fig. 12.27 The MR image after contrast administration displays the strong enhancement of the proliferative glandular parenchyma on both sides, but more on the right than on the left. The pattern fits well with a gynecomastia. The indication for surgery depends to a great extent on patient preference and on the underlying cause of the gynecomastia, which may be reversible and can sometimes be treated medically.

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