대한흉부영상의학회 Weekly Chest Cases

Case No : 493 Date 2007-04-09

Courtesy of Jeong Geun Yi, M.D. / Konkuk University, Department of Radiology, Korea
Age/Sex 70 / M
Chief Complaint1. Slowly growing skin nodule, left breast area (3 year ago) 2. Dyspnea (1 year ago)

Figure 1
Figure 2
Figure 3
Figure 4

Diagnosis With Brief Discussion

Diagnosis: Male breast cancer (invasive ductal carcinoma) and non small cell lung carcinoma (adenocarcinoma) in RLL developed in UIP patient.
Radiologic Findings: Fig 1. Chest PA shows bilateral reticular and cystic densities, dominantly lower lung zones and consolidation or mass, right lower lobe medial portion.
Fig 2. Contrast enhanced chest CT shows 2cm sized round soft tissue nodule with central low density on left anteriorchest wall or subareolar area of this male patient.
Fig 3. Thin section CT of lower lung zone shows cysticand honeycomb pattern, dominantly on subpleural, posterior portion suggestingusual interstitial pneumonitis and lobulating contoured solid mass, right lower lobe.
Brief Review: Male breast cancer accounts for 0.7% of total breast cancers. Over the past 25 years, the incidence of male breast cancer has risen 26%, from 0.86 to 1.08 per 100,000 population. The mean age of diagnosis is 67 years, and less than 6% of cases occur in males under the age of 40 years. At mammography, these are typically high-density irregular masses with well-defined contours. Margins are usually spiculated, lobulated, or microlobulated. Most are retroareolar since male breast cancers commonly arise from central ducts. They can be distinguished form benign gynecomastia by appearing as a discrete mass, commonly with secondary features. Eccentric location is not typical for benign gynecomastia and is suspicious for carcinoma (1).
The main CT criteria for the diagnosis of malignant breast lesions include irregular-bordered, high-density masses and spicules of dense tissue radiating from such masses into the adjacent mammary tissue. Other signs of malignancy are thickening of the overlying skin, the presence of significantly enlarged dense lymph nodes, invasion of the pectoralis muscle, and pleural effusion. The early, strong enhancement of malignant lesions using rapid bolus intravenous administration of 100 mL of iodine contrast agent for 25 seconds (4 mL/s) on CT has already been reported; however, microcalcifications are usually not recognized on CT (2).
Lung cancer developed mostly (65.6%) in the peripheral portion, where advanced fibrosis predominates. These findings suggest that the occurrence of lung cancer is related to diffuse fibrosis of the lung including IPF. In comparison with most carcinomas, which are in the upper lobe, carcinomas associated with IPF are located mainly in the lower lobe (65.6%, 21/32). Our results are well consistent with other previous studies (3).
References: 1. Lina Chen, Prem K. Chantra, Linda H. Larsen, et al. Imaging Characteristics of Malignant Lesions of the Male Breast. RadioGraphics. 2006;26:993-1006
2. Kim. SM, Park. JM. Computed Tomography of the Breast: Abnormal Findings with Mammographic and Sonographic Correlation. J Comput Assist Tomogr. 2003;27:761-770
3. Lee HJ, Im J-G, Ahn JM, et al. Lung cancer in patients with idiopathic pulmonary fibrosis: CT findings. J Comput Assist Tomogr. 1996;20:979-982
Keywords: Lung, Chest wall, Malignant tumor, IIP,

No. of Applicants : 53

▶ Correct Answer : 4/53, 7.5%

- Akdeniz University School of Medicine, Radiology Dept Antalya, Turkey Gokhan Arslan
- Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
- ANNEMASSE, Polyclinique de SAVOIE, France Gay-Depassier Philippe
- Department of radiology, Severance hospital, Korea Myoung Soo Lee

▶ Correct Answer as Differential Diagnosis : 1/53, 1.9%

- St. Mary's hospital, The Catholic University, Korea Soo Kyung Yoon

▶ Semi-Correct Answer : 37/53, 69.8%

- Depart of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Regional Imaging Riverina, Australia Rashid Hashmi
- Inha University Hospital, Korea Seung Woo Choi
- Marien Hospital, Hamm, Germany Davis Chiramel
- CHRU Lille hopital calmette, France Toledano Manuel
- National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
- Deptt. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Jikei University, Japan Shigeki Misumi
- KAUMS, Kashan, Iran Ebrahim razi
- Sctimst, Trivandrum, Kerala, India Santhosh Kannath
- Nirman Diagnostic Centre, Mumbai, India Padma Kannan
- Kazipet, Warangal, A.P., India Pavankumar Vodithala
- Hando general hospital, Korea Ha Young Kim
- Aditya imaging Centre, Sayajigunj, Gujarat, India Vivek Patel
- Nanavati Hospital, Mumbai, India Ajay Kumar
- Kaith
- Apollo Clinic, Kandivali (west), Mumbai, India Jeshil R. Shah
- Turkey Cetin Celenk
- Gyeongsang National University Hospital, Korea Seok-Hyun Kim
- E-Da hospital, Taiwan Yu-Feng Wei
- ASCS, Safwa, Saudi Arabia Kalari Adinarayana
- Osaka University, Japan Osamu Honda
- Lilavati hospital, Mumbai, Indai Anil P. Ramnani
- China Medical University Hospital, Taiwan Jun-Jun Yeh
- Ulsan University Hospital, Ulsan, Korea Jong-Chang Jang
- Hospital Sotiria, Athens, Greece Vasilios Tzilas
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Changi General Hospital, Singapore Angeline Poh
- Mackay Memorial Hospital, Tapei, Taiwan Chia-Fu Tsai
- Chung Moo Hospital, Korea Jong Hyeon Mo
- Kyunghee University Medical Center, Korea Su Youn Sim
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- Dongguk University International Hosipital, Korea Hee Seok Choi
- Yongdong Severance Hospital, Korea Chul Hwan Park
- IRSA, La Rochelle, France Denis Chabassiere
- Annecy Hospital, France Gilles Genin
- Doctors Hospital, Nassau, Bahamas N.B.S.Mani

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 493 Date 2007-04-09

Discussion

No. of Applicants : 53