array:22 [ "pii" => "S2173510724000703" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2023.11.006" "estado" => "S200" "fechaPublicacion" => "2024-06-09" "aid" => "1557" "copyright" => "SERAM" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0033833824000067" "issn" => "00338338" "doi" => "10.1016/j.rx.2023.11.010" "estado" => "S200" "fechaPublicacion" => "2024-03-23" "aid" => "1557" "copyright" => "SERAM" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ACTUALIZACIÓN</span>" "titulo" => "Revisión radiológica de la secreción mamaria en el varón" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A radiological review of male nipple discharge" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figura 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 667 "Ancho" => 1255 "Tamanyo" => 93925 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hombre de 21 años acude por presentar un nódulo retroareolar de larga evolución y secreción blanquecina de la mama derecha. Ecográficamente, se observan ectasias ductales retroareolar derechas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Azcona Sáenz, C.V. Martinez Stocker, E.N. Arenas Rivera, S. Marsico, E. Arizaga Batiz, R. Alcantara Souza" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Azcona Sáenz" ] 1 => array:2 [ "nombre" => "C.V." "apellidos" => "Martinez Stocker" ] 2 => array:2 [ "nombre" => "E.N." "apellidos" => "Arenas Rivera" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Marsico" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Arizaga Batiz" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Alcantara Souza" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510724000703" "doi" => "10.1016/j.rxeng.2023.11.006" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000703?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833824000067?idApp=UINPBA00004N" "url" => "/00338338/unassign/S0033833824000067/v1_202403230726/es/main.assets" ] ] "itemAnterior" => array:17 [ "pii" => "S2173510712001073" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2011.07.002" "estado" => "S200" "fechaPublicacion" => "2013-05-08" "aid" => "474" "copyright" => "SERAM" "documento" => "simple-article" "subdocumento" => "ret" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 166 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 70 "PDF" => 83 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "WITHDRAWN: Intraabdominal fat necrosis" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.J. Aguilar-García, P. Alcaide-León, B. Vargas-Serrano" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Aguilar-García" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Alcaide-León" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Vargas-Serrano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833811002578" "doi" => "10.1016/j.rx.2011.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833811002578?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510712001073?idApp=UINPBA00004N" "url" => "/21735107/unassign/S2173510712001073/v4_201502270129/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Update in Radiology</span>" "titulo" => "A radiological review of male nipple discharge" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Azcona Sáenz, C.V. Martinez Stocker, E.N. Arenas Rivera, S. Marsico, E. Arizaga Batiz, R. Alcantara Souza" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Azcona Sáenz" "email" => array:1 [ 0 => "javier.azcona.saenz@psmar.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C.V." "apellidos" => "Martinez Stocker" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E.N." "apellidos" => "Arenas Rivera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Marsico" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Arizaga Batiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Alcantara Souza" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital del Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Pompeu Fabra, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Revisión radiológica de la secreción mamaria en el varón" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 1298 "Ancho" => 2925 "Tamanyo" => 285268 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">70 year-old male presented with a right retroareolar mass and unilateral sanguineous nipple discharge. On the low energy images (A, C), at the right external periareolar region, 3 adjacent dense rounded masses with circumscribed margins are observed. On the recombined images (B, D), they show heterogeneous mass enhancement. Central areas without enhancement relate to the cystic components of the lesions. Sonographically (E), they correspond to solid-cystic nodules with peripheral Doppler vascularization (F). 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy confirmed invasive papillary carcinoma.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Nipple discharge is an uncommon complaint in men,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> not well-documented in the literature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> However, due to its strong association with underlying malignancy,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> it should always be radiologically further evaluated. Approximately 14% of male patients with breast cancer experience nipple discharge, typically serosanguineous in nature.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In male patients, sanguineous nipple discharge is associated with carcinoma in 50%–75% of cases, which is three times higher than the risk found in women.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Awareness of this clinical symptom by clinicians, patients, and radiologists may aid in the early detection of cancer, leading to improved survival rates.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although a high proportion of male patients presenting with nipple discharge have underlying malignancy such as invasive ductal carcinoma, ductal carcinoma in situ, papillary carcinoma or Paget disease, approximately 43% have a benign cause for their nipple discharge.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Some of these benign causes include gynecomastia, mammary duct ectasia, papillomas, abscesses, and fibrocystic changes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this article is to review some of the most common benign and malignant causes of male nipple discharge registered at our center.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Normal male breast</span><p id="par0020" class="elsevierStylePara elsevierViewall">Male breast is a rudimentary structure that consists of adipose tissue, a few subareolar ductlike structures a small nipple-areolar complex and a prominent pectoralis muscle.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In contrast to the female breast, ductal system is involuted due to increase in testosterone levels, terminal ductal-lobular unit is rare due to the lack of progesterone, stromal system is smaller in size, pectoralis muscles are more prominent and cooper ligaments are absent.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Mammographically, the male breast appears as homogenously radiolucent fat tissue with a prominent pectoralis muscle.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Sonographically, it appears as isoechoic fat lobules.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> MRI of male breast has limited use.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Workup of male nipple discharge</span><p id="par0035" class="elsevierStylePara elsevierViewall">The low positive and negative predictive value of physical breast examination suggests that male patients with nipple discharge should undergo a radiological examination.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Conventional techniques (mammography and ultrasound) are useful in the first evaluation of nipple discharge with a higher predictive negative value than physical examination.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Günhan-Bilgen et al. emphasized the importance of mammography and ultrasound in the evaluation of male breast conditions, along with physical examination.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There is no accepted consensus for diagnostic imaging algorithm of the male breast.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The ACR criteria suggest an age limit of 25 years old for first-line imaging modality. Below 25 years old, ultrasound is recommended as the first-line imaging, whereas after 25 years old, mammography is suggested.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Since its approval by the Food and Drug Administration (FDA) in 2011, CEM has emerged as a new functional technique.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Although not yet described in the literature we have found that the use of CEM could significantly impact the approach to male nipple discharge. CEM has shown a higher sensitivity and negative predictive value than mammography or ultrasound,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a> potentially reducing unnecessary biopsies.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Even though a clinical-radiological approach is fundamental in male nipple discharge, definitive diagnosis relies on pathological assessment either with nipple fluid cytology, fine needle aspiration cytology, or core biopsy of a mass.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, cytological examination is only useful when positive, and can have a false-negative rate for cancer of up to 50%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">At our institution, in cases of suspicious male nipple discharge and non-suspicious male nipple discharge with a pathological breast examination, the first-line imaging technique is CEM. In cases of non-suspicious male nipple discharge with a normal breast examination we follow the ACR criteria. Therefore, below 25 years old ultrasound is performed and above 25 years old mammography is the first-line imaging (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). When a doubtful finding is seen on mammography or ultrasound, CEM is considered as a problem-solving tool. In the absence of morphologically suspicious lesions or pathological enhancements on CEM, BIRADS 2 may be assessed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In the flowchart for women with pathologic nipple discharge, it is recommended to perform an MRI after negative results from diagnostic breast imaging (mammography and ultrasound).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In our opinion, CEM could be a valuable alternative for men.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Benign entities</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Gynecomastia</span><p id="par0065" class="elsevierStylePara elsevierViewall">Gynecomastia is the most common cause of a male breast lump<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and the most prevalent benign condition affecting the male breast.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> It involves the enlargement of the male breast due to benign stromal and glandular proliferation,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and is commonly observed during pubertal period or senescence.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinically, gynecomastia may be detected as a palpable, discrete area of subareolar tissue,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> which has generally persisted for months.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In some cases, it can be accompanied by nipple discharge.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Gynecomastia tends to be bilateral <a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and has a central symmetric location under the nipple.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The etiology of gynecomastia includes physiological, endocrinological, metabolic, neoplastic, and drug-induced factors.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Apart from gynecomastia related to Klinefelter’s syndrome,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> there is no association between gynecomastia and male breast cancer.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The differential diagnosis for gynecomastia includes pseudogynecomastia (breast enlargement caused by fatty tissue without glandular or stromal involvement) and malignancy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Mammography has proven to be an accurate method for distinguishing between benign gynecomastia and breast carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,13</span></a> In fact, a mammographic diagnosis of gynecomastia does not require tissue confirmation.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">There are three mammographic patterns of gynecomastia<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), which represent different degrees and stages of ductal and stromal proliferation.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Nodular form</span><p id="par0085" class="elsevierStylePara elsevierViewall">The nodular form is seen in patients with gynecomastia for less than 1 year.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> It is often referred as the early florid phase. Histologically, nodular gynecomastia is characterized by prominent ductal hyperplasia and cellular/proliferative stroma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is worth noting that nodular gynecomastia is reversible if the underlying cause(s) is eliminated.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Mammographically, it manifests as a nodular or fan-shaped subareolar opacity.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> On ultrasound, it appears as a disk-shaped, hypervascular, hypoechoic subareolar nodule surrounded by breast tissue <a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11</span></a> (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dendritic form</span><p id="par0090" class="elsevierStylePara elsevierViewall">The dendritic form is seen in patients with gynecomastia for longer than 1 year.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> It is often referred as the late quiescent phase. Histologically, it is characterized by minimal ductal hyperplasia and periductal stromal fibrosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In this form, fibrosis becomes the dominant process rendering the dendritic form of gynecomastia irreversible.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Mammographically, it presents as a flame-shaped subareolar opacity<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with posterior linear projections radiating into the surrounding tissue towards the upper-outer quadrant<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). On ultrasound, it presents as a subareolar serpiginous tissue with “star-shaped” borders and “spider leg” appearance.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In some cases, patients with gynecomastia may experience an acute episode in addition to the presence of chronic dendritic gynecomastia. As a result, both the acute and chronic phases can be observed simultaneously.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Diffuse form</span><p id="par0100" class="elsevierStylePara elsevierViewall">The diffuse form of gynecomastia has properties of both early and late phases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is commonly associated to high-dose estrogen therapy<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11</span></a> and is frequently observed in transgender individuals undergoing hormone treatment.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Mammographically, the diffuse form presents as heterogeneously enlarged breast tissue, resembling a female breast appearance<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). It displays a diffuse density with both dendritic and nodular features.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> On ultrasound, nodular and dendritic features are seen surrounded by diffuse hyperechoic fibrous breast tissue.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Based on our experience with CEM, gynecomastia typically does not exhibit enhancement on the recombined images (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 4</a>). However, in some cases, a progressive mild enhancement pattern may be observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). CEM is particularly valuable in distinguishing the nodular form of gynecomastia from malignancy when there is clinical suspicion. If no enhancement is detected, biopsy can most likely be avoided.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Mammary duct ectasia</span><p id="par0110" class="elsevierStylePara elsevierViewall">Mammary duct ectasia is a benign condition characterized by the presence of dilated ducts, often occurring in the subareolar region.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> It is accompanied by periductal fibrosis and inflammation.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> Within the dilated ducts, debris and secretions can accumulate, and may calcify.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The exact cause of mammary duct ectasia remains uncertain,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and its association with smoking remains controversial.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Mammary duct ectasia is rare in men.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">On physical examination, common findings of mammary duct ectasia include nipple discharge, a subareolar tender breast mass, and nipple retraction.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,15</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Common mammographic findings are subareolar ductal dilatation with intraductal calcified secretions, and coexistent mass-like opacities in subareolar location.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The most commonly reported US findings of mammary duct ectasia include dilated ducts and tubular anechoic lesions that may contain echogenic debris within the subareolar region<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Abscess</span><p id="par0125" class="elsevierStylePara elsevierViewall">A breast abscess is defined as an inflammatory mass that drains purulent material spontaneously or on incision. The most common cause of a breast abscess is mastitis, which is less often reported in men compared to women.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Other potential causes include surgery, diabetes, rheumatoid arthritis, among others. <span class="elsevierStyleItalic">Staphylococcus aureus</span> and <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> are the most commonly identified causative organisms.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Subareolar abscess, also known as, “Zuska’s disease,” is considered a specific type of abscess in subareolar location caused by aseptic inflammation due to squamous metaplasia secondary to obstruction of lactiferous ducts.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The clinical presentation of a breast abscess includes pain, warmth, redness, induration, palpable mass, and nipple discharge.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Treatment options involve antibiotic therapy and percutaneous ultrasound-guided drainage.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Adequate follow-up is essential to ensure complete resolution.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Although extremely rare, it is important to consider the possibility of malignancy presenting as an abscess.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Ultrasound is considered the most useful imaging modality for evaluating breast abscesses. It is valuable to monitor progress, response to therapy and to ensure resolution. Sonographically, it normally presents as a “heterogenous, irregular, hypoechoic mass” (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>) or as a “fluid collection with internal echoes, and irregular walls.” The surrounding tissues may exhibit increased vascularity with sparse to absent internal flow.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Thickening of skin due to inflammation, and fistulous tract formation may also be present.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Mammography is difficult to perform due to pain with breast compression.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, when feasible, mammographic findings of a breast abscess may include skin thickening, distortion, an ill-defined subareolar mass, and trabecular thickening.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Malignant entities</span><p id="par0140" class="elsevierStylePara elsevierViewall">Male breast cancer is relatively rare, accounting for approximately 0.5%–1% of all reported breast cancers and less than 0.1% of male cancer deaths.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The overall prognosis for men is less favorable than for women, primarily due to delayed detection. The most common clinical presentation is a centrally located, firm, painless mass. Other clinical presentations include nipple retraction and nipple discharge.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Various risk factors have been described, with the most prevalent being increasing age, often attributed to testicular malfunction and elevated estrogen levels. Other risk factors include a family history of breast cancer, mutations in breast cancer genes (BRCA2<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>BRCA1), Cowden and Klinefelter syndromes (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>), alcohol consumption, liver disease,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> hyperestrogenism, and a history of chest irradiation.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ductal carcinoma in situ</span><p id="par0145" class="elsevierStylePara elsevierViewall">Ductal carcinoma of the male is rare and is usually associated with invasive carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a> Ductal carcinoma in situ (DCIS) of the male breast represents less than 0.1% of all cancers in men.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> When the in situ component is present in pure form, the histological grade is normally low to intermediate.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The most common histological subtype of DCIS in males is papillary carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The most common presenting sign is a slowly growing subareolar mass.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> It may be accompanied by breast pain, nipple discharge, or nipple retraction.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Nipple discharge on its own is an uncommon form of presentation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In males with gynecomastia, detecting DCIS on mammography can be challenging.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Microcalcifications are seen less likely in male breast cancers, possibly due to the involuted ductal structure.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> When present, these calcifications often have a benign or nonspecific appearance <a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>). Additionally, if invasive carcinoma is present, parenchymal opacity or distortion may be seen.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> DCIS normally presents a non-mass enhancement on the recombined images of CEM (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>).</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">The findings on ultrasound for DCIS in males are non-specific and not well-documented in the literature. However, coexistent invasive ductal carcinoma foci may be visualized as a mass or distortion.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Invasive ductal carcinoma</span><p id="par0165" class="elsevierStylePara elsevierViewall">Invasive ductal carcinoma (IDC) of no special type is the most common type of male breast carcinoma, accounting for approximately 85% of cases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,21</span></a> Unlike in women, the male breast rarely develops terminal ductal-lobular units,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,20</span></a> making lobular carcinoma very uncommon.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The nipple tends to be affected earlier in men, due to the development of the tumor below the nipple, where rudimentary breast ducts are located.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Nevertheless, eccentric location can occur and is highly suspicious for cancer.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Bilateral carcinoma is less frequent in men (1,9%) compared to women (4,3%).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">It typically presents as a hard, painless, palpable mass that may be accompanied by secondary features such as nipple retraction, skin thickening, palpable axillary lymphadenopathies<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and nipple discharge.</p><p id="par0175" class="elsevierStylePara elsevierViewall">A common mammographic presentation of IDC of the male is as high-density irregular mass with well-defined contours and spiculated, lobulated, or microlobulated margins <a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11</span></a> (<a class="elsevierStyleCrossRefs" href="#fig0050">Figs. 10 and 11</a>). The incidence of calcifications is lower than in female breast cancer.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11</span></a> Bilateral mammography is recommended in case of malignity suspicion since the risk factors that predisposed the emergence of the disease in one breast have acted similarly in the contralateral breast.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,22,23</span></a> It normally presents a mass enhancement on the recombined images of CEM (<a class="elsevierStyleCrossRefs" href="#fig0050">Figs. 10 and 11</a>).</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Male breast cancers have similar ultrasound features as in women.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a> They most commonly present as non-parallel, discrete, hypoechoic masses with irregular margins and variable vascularity that may be accompanied by secondary features.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11</span></a> US of the axillary region should be a routine part of evaluation because up to 50% of males with breast cancer present with axillary lymphadenopathies.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11</span></a> (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a>).</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Papillary carcinoma</span><p id="par0185" class="elsevierStylePara elsevierViewall">Papillary carcinoma is the second most frequent histological subtype of male breast cancer.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> It accounts for approximately 4% of breast carcinomas in men.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> In terms of gender distribution, papillary carcinomas are more common in men compared to women, with a ratio of 2–1.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Papillary carcinoma represents 5% of breast carcinomas in men vs 1%–2% of breast carcinomas in women.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Cysts in the male breast must be considered suspicious for malignancy<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and intracystic papillary carcinoma should be taken into account.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Papillary carcinoma in men is more common than benign intraductal papilloma.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Therefore, complete surgical excision and histopathologic evaluation of the lesion are required.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Most male papillary carcinomas are intracystic and noninvasive.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Clinically, most reported male patients with papillary carcinoma present with a breast mass or swelling, sometimes accompanied by nipple discharge.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">On mammography, papillary carcinoma typically presents as a circumscribed round/oval mass<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> (<a class="elsevierStyleCrossRefs" href="#fig0060">Figs. 12 and 13</a>). The presence of focal poorly defined borders may indicate the presence of an invasive component.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although rare, satellite nodules and microcalcifications can also be observed<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,25</span></a> (<a class="elsevierStyleCrossRef" href="#fig0065">Fig. 13</a>). On the recombined images of CEM, papillary carcinoma may present as a mass with rim enhancement of the cyst walls, septa, and mural nodules (<a class="elsevierStyleCrossRef" href="#fig0060">Fig. 12</a>).</p><elsevierMultimedia ident="fig0060"></elsevierMultimedia><elsevierMultimedia ident="fig0065"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">Sonographically, it appears as a solid mass or a complex cystic mass with thick walls containing both solid and cystic components <a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,26</span></a> (<a class="elsevierStyleCrossRefs" href="#fig0060">Figs. 12 and 13</a>). Additionally, a hypoechoic nodule may be seen along the wall of the cyst <a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> (<a class="elsevierStyleCrossRefs" href="#fig0060">Figs. 12 and 13</a>).</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Mucinous carcinoma</span><p id="par0205" class="elsevierStylePara elsevierViewall">Invasive mucinous carcinoma is a specific histological variant of breast carcinoma characterized by the presence of extracellular mucin surrounding neoplastic cells.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Invasive mucinous carcinoma represents 1% of male breast cancers.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Mucinous carcinoma is histopathologically subclassified into pure and mixed types depending on the mucinous content of the carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,27</span></a> The pure form is defined as a lesion with a mucinous carcinoma component of over 90% of the tumor, while the mixed type is defined as having mucinous and conventional invasive ductal carcinoma components.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It is well-established that pure mucinous carcinoma is generally associated with low rates of recurrence and excellent survival outcomes.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Pure mucinous carcinoma is characterized by a higher volume of mucin, slower growht rate, a more benign clinical course and less frequent axillary node involvement.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Physical examination is typically non-specific, a palpable hard subareolar mass may be seen.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our case, the patient presented with a doubtful serous nipple discharge. To our knowledge, this is the first case in the literature in which a mucinous carcinoma presented with nipple discharge.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Mammographically, pure mucinous carcinoma normally presents as a round, microlobulated, and well-circumscribed lesion <a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a> (<a class="elsevierStyleCrossRef" href="#fig0070">Fig. 14</a>). An indistinct margin favors the diagnosis of mixed mucinous carcinoma.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> On the recombined images of CEM it normally presents as a mass enhancement.</p><elsevierMultimedia ident="fig0070"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">Sonographically, pure mucinous carcinoma often has well-defined margins. The tumor tends to appear isoechogenic relative to the fat surrounding the breast tissue (<a class="elsevierStyleCrossRef" href="#fig0070">Fig. 14</a>). In contrast, hypoechoic masses with an irregular shape are more suggestive of mixed mucinous carcinomas.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">According to some authors, the presence of a homogenous mass with both cystic and solid components, vascularity, and peripheral enhancement should raise a strong suspicion of pure mucinous carcinoma.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Peripheral enhancement is likely a result of the high water content and the transmission of the ultrasound beam through the mucin.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Therefore, it is more frequently observed in cases of pure mucinous carcinoma.</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0235" class="elsevierStylePara elsevierViewall">Nipple discharge can be caused by both benign and malignant processes. The presence of nipple discharge in a male may herald an underlying malignancy, the detection of which in its early stages, may confer a survival benefit with improved outcomes to the patient.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, the low suspicion of breast cancer, both among patients and doctors, has often resulted in delayed diagnoses.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Besides physical breast examination, all male patients with nipple discharge should undergo a radiological examination.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Conventional techniques (mammography and ultrasound) are useful in the first evaluation of nipple discharge. CEM has shown the highest negative predictive value<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> of all tecnhiques potentially reducing unnecessary biopsies.</p><p id="par0245" class="elsevierStylePara elsevierViewall">Although further studies are needed, we believe that CEM could be potentially used in the setting of male nipple discharge as a problem-solving tool especially in cases of nodular gynecomastia, as a screening for the contralateral breast in patients with newly diagnosed primary breast cancer instead of digital mammography of digital breast tomosynthesis, and in cases of suspicious nipple discharge without a correlate in conventional techniques.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0250" class="elsevierStylePara elsevierViewall">1. Responsible for study integrity: J.A.S.</p><p id="par0255" class="elsevierStylePara elsevierViewall">2 Study conception: J.A.S.</p><p id="par0260" class="elsevierStylePara elsevierViewall">3. Study design: J.A.S.</p><p id="par0265" class="elsevierStylePara elsevierViewall">4. Data acquisition: J.A.S., C.V.M.S., E.N.A.R., E.A.B., and R.A.S.</p><p id="par0270" class="elsevierStylePara elsevierViewall">5. Data analysis and interpretation: J.A.S.</p><p id="par0275" class="elsevierStylePara elsevierViewall">6. Statistical processing: J.A.S.</p><p id="par0280" class="elsevierStylePara elsevierViewall">7. Literature search: J.A.S., S.M., and R.A.S.</p><p id="par0285" class="elsevierStylePara elsevierViewall">8. Drafting of the manuscript: J.A.S., S.M., and R.A.S.</p><p id="par0290" class="elsevierStylePara elsevierViewall">9. Critical review of the manuscript with intellectually significant contributions: J.A.S., S.M., and R.A.S.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0295" class="elsevierStylePara elsevierViewall">This work has not received any type of funding.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0300" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres2161763" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1834076" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2161762" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1834075" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Normal male breast" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Workup of male nipple discharge" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Benign entities" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0025" "titulo" => "Gynecomastia" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Nodular form" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Dendritic form" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Diffuse form" ] ] ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Mammary duct ectasia" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Abscess" ] ] ] 8 => array:3 [ "identificador" => "sec0055" "titulo" => "Malignant entities" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Ductal carcinoma in situ" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Invasive ductal carcinoma" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Papillary carcinoma" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Mucinous carcinoma" ] ] ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0085" "titulo" => "Authorship" ] 11 => array:2 [ "identificador" => "sec0090" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0095" "titulo" => "Conflict of interests" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-07-30" "fechaAceptado" => "2023-11-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1834076" "palabras" => array:5 [ 0 => "Nipple discharge" 1 => "Male" 2 => "Breast neoplasms" 3 => "Mammography" 4 => "Ultrasonography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1834075" "palabras" => array:5 [ 0 => "Secreción mamaria" 1 => "Hombre" 2 => "Cáncer de mama" 3 => "Mamografía" 4 => "Ecografía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Male nipple discharge is uncommon and highly associated with malignancy. However, it can also be due to benign processes. In addition to physical examination, all patients should undergo a radiological examination with mammography and/or ultrasound. Furthermore, we propose the use of contrast-enhanced mammography (CEM) in cases of suspicious nipple discharge due to the high negative predictive value of this technique, potentially reducing the number of unnecessary biopsies. The aim of this article is to review the imaging findings of the most common causes of male nipple discharge, both benign and malignant. Additionally, we would like to share our experience with the use of CEM in studying this condition.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">La secreción mamaria en el varón es infrecuente y se encuentra altamente asociada a malignidad. Sin embargo, también puede ser debida a procesos benignos. Además de la exploración física, todos los pacientes se deben realizar un examen radiológico con mamografía y/o ecografía. Además, nosotros proponemos el uso de la mamografía con contraste en los casos de secreción mamaria sospechosa dado el alto valor predictivo negativo de esta técnica, lo que permite reducir el número de biopsias innecesarias. El objetivo de este artículo es realizar una revisión de los hallazgos por imagen de las causas más frecuentes de secreción mamaria en el varón tanto benignas como malignas. Asimismo, nos gustaría compartir nuestra experiencia con el uso de la mamografía con contraste en el estudio de esta patología.</p></span>" ] ] "multimedia" => array:15 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1384 "Ancho" => 2508 "Tamanyo" => 177007 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">First-line imaging technique employed in the initial evaluation of male nipple discharge at our institution. CEM: contrast-enhanced mammography; US: ultrasound; DM: digital mammography; DBT: digital breast tomosynthesis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1076 "Ancho" => 2341 "Tamanyo" => 179299 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">60 year-old men with personal history of lung cancer presented with a left retroareolar lump and clear ipsilateral nipple discharge. On the low energy images (A, C), a nodular left subareolar opacity is seen. On the recombined images (B, D), it shows no enhancement. Sonographically (E), it corresponds to a hypoechoic subareolar nodule surrounded by breast tissue. Asymmetrical gynecomastia is also evident on CT images (F). Findings are suggestive of nodular pattern gynecomastia.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1141 "Ancho" => 2091 "Tamanyo" => 151432 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">60 year-old male, HIV positive, presented with a right retroareolar mass and clear nipple discharge. No lymphadenopathies on physical exam. On the low energy right CC image (B), a nodular subareolar image can be seen. On the recombined images (A, C), a progressive mass enhancement is depicted. Note the increased in conspicuity at the last performed view (R-ML). On ultrasound (D), a hypoechoic subareolar nodule surrounded by breast tissue is shown. A 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy confirmed the diagnosis of nodular gynecomastia.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1697 "Ancho" => 2925 "Tamanyo" => 270272 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">64-year-old male diagnosed with Multiple Endocrine Neoplasia type 1 (MEN1) who underwent surgery in his childhood for prolactinoma. Breast examination showed bilateral subareolar tissue. On the low energy images (A, C, E, G), a flame-shaped subareolar opacity is seen. On the recombined images (B, D, F, H), it exhibits no enhancement. The ultrasound of the right retroareolar region (I) shows a hypoecoic area with “star-shaped” borders.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1596 "Ancho" => 2508 "Tamanyo" => 217953 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">52 year-old male presented with increased density and mastalgia of the right breast, as well as clear nipple discharge. On DBT (A–D) bilateral asymmetrical gynecomastia can be seen. On the right breast (A, C) the fibroglandular tissue simulates a dense female breast (diffuse gynecomastia) while on the left breast (B, D) only sparse fibroglandular tissue, mainly at the subaeolar region, is seen.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 667 "Ancho" => 1255 "Tamanyo" => 94010 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">21-year-old man presented with a long time retroaerolar lump and whitish right nipple discharge on physical exam. On ultrasound, right subareolar mammary duct ectasia is seen.</p>" ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 818 "Ancho" => 1255 "Tamanyo" => 100998 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">53-year-old male with a history of subcutaneous right mastectomy due to abscessed gynecomastia in 2020, presented with pain, erythema and purulent discharge after the intervention. The ultrasound exam shows findings suggestive of cellulitis with a retroareolar fluid collection with irregular walls (abscess) on the right mastectomy bed. A fistulous tract in the external periareolar area was also seen during the breast scan (not shown on the image).</p>" ] ] 7 => array:8 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1216 "Ancho" => 2508 "Tamanyo" => 229519 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">56-year-old male diagnosed with Klinefelter’s syndrome presented with long standing pain in the left breast and sudden ipsilateral sanguineous nipple discharge. On Digital Mammography (A–D), a focal asymmetry with fine pleomorphic grouped calcifications is seen at the left internal retroareolar region (B, D). On ultrasound (E), an area of duct ectasia with a solid mass and associated calcifications (white arrow) is shown. 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy proved DCIS. Histology after mastectomy confirmed pure DCIS with no invasive component.</p>" ] ] 8 => array:8 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1369 "Ancho" => 2925 "Tamanyo" => 351141 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">47-year-old male presented with left breast growth for 5 months and unilateral clear discharge. On the low energy images (A, C), a focal asymmetry of the entire upper-external quadrant of the left breast with associated diffuse calcifications are seen. On the recombined images (B, D), a segmental non-mass enhancement is observed. Sonographically (E), the lesion corresponds to a heterogeneous mass. 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy proved DCIS (F). Histology after mastectomy confirmed pure DCIS with no invasive component.</p>" ] ] 9 => array:8 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 1527 "Ancho" => 2925 "Tamanyo" => 284176 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">71 year-old man with right nipple retraction, pain and sanguineous uniorificial discharge. On the low energy images (A, C), a right retroaerolar irregular mass with not-circumscribed margins that affects the nipple-areolar complex is seen. On the recombined images (B, D), it shows as a heterogeneous mass-like enhancement. Sonographically (E), it corresponds to a heterogeneous solid lesion with irregular shape and not-circumbscribed margins that invades the nipple-areolar complex. 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy demonstrated IDC.</p>" ] ] 10 => array:8 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 1361 "Ancho" => 2925 "Tamanyo" => 267848 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">70 year-old man presented with a long standing retroareolar palpable mass. On breast exam sanguineous nipple discharge and right axillary lymphadenopathies were also noted. On the low energy images (A, C), a dense irregular right retroareolar mass with not-circumscribed margins and infiltration of the nipple-areolar complex is seen. On the low energy images (B, D), it presents as a heterogeneous mass enhacement. Sonographically (E), it corresponds to a solid irregular heterogeneous lesion. Two BEDI-6 (replacement of the fatty hilum) adenopathies are seen at Berg’s level 1 of the right axilla (F). 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy proved IDC. Fine needle aspiration of both adenopathies was positive for malignancy.</p>" ] ] 11 => array:8 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 1298 "Ancho" => 2925 "Tamanyo" => 285268 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">70 year-old male presented with a right retroareolar mass and unilateral sanguineous nipple discharge. On the low energy images (A, C), at the right external periareolar region, 3 adjacent dense rounded masses with circumscribed margins are observed. On the recombined images (B, D), they show heterogeneous mass enhancement. Central areas without enhancement relate to the cystic components of the lesions. Sonographically (E), they correspond to solid-cystic nodules with peripheral Doppler vascularization (F). 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy confirmed invasive papillary carcinoma.</p>" ] ] 12 => array:8 [ "identificador" => "fig0065" "etiqueta" => "Figure 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 1671 "Ancho" => 2925 "Tamanyo" => 302126 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">79-year-old male presented with a right retroareolar lump and right unilateral uniorificial bleeding (9 o’clock) to breast examination. On digital mammography (A–D), a right retroareolar dense mass with an oval shape and not-circumbscribed margins is seen (A, C). Note the presence of coarse heterogeneous calcifications within the mass. On ultrasound (E), the lesion corresponds to a solid-cystic mass, with areas of increased Doppler signal (F). 14<span class="elsevierStyleHsp" style=""></span>G core needle biopsy showed papillary carcinoma.</p>" ] ] 13 => array:8 [ "identificador" => "fig0070" "etiqueta" => "Figure 14" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr14.jpeg" "Alto" => 1256 "Ancho" => 2925 "Tamanyo" => 252743 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">78 year-old man presented with a long-term palpable lump, that he related to a trauma and sanguineous nipple discharge in the left breast. On the low energy images (B, D), at the left retroareolar region, a dense mass with rounded morphology and microlobulated margins is seen. On recombined images (B, D), it appears as a heterogeneous mass-like enhancement. Sonographically (E), it corresponds to an isoechogenic mass, with a rounded morphology and microlobulated margins with little Doppler vascularization.</p>" ] ] 14 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nodular form \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dendritic form \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diffuse form \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle">Chronology</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>1year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="middle">Both</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early (florid) phase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Late (quiescent) phase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Histology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prominent ductal hyperplasia<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>cellular/proliferative stroma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Minimal ductal hyperplasia<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>periductal stromal fibrosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversibility \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reversible (if underlying cause(s) is eliminated) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Irreversible \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Many</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High-dose estrogen therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mammography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nodular or fan-shaped subareolar opacity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Flame-shaped subareolar opacity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both female breast appearence \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recombined images (CEM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Most common: no enhancement. Sometimes a progressive mild enhancement pattern can be seen throughout the sequence of recombined views</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">US \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disk-shaped, hypervascular, hypoechoic subareolar nodule \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subareolar serpiginous tissue with “star-shaped” borders and “spider leg” appearance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3562286.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Gynecomatia patterns.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The significance of nipple discharge of the male breast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Morrogh" 1 => "T.A. King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4741.2009.00818.x" "Revista" => array:7 [ "tituloSerie" => "Breast J" "fecha" => "2009" "volumen" => "15" "numero" => "November" "paginaInicial" => "632" "paginaFinal" => "638" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19735390" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of mammography and breast ultrasound in male patients with nipple discharge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Muñoz Carrasco" 1 => "M. Álvarez Benito" 2 => "E. Rivin Del Campo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2012.10.019" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2013" "volumen" => "82" "paginaInicial" => "478" "paginaFinal" => "484" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23182522" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Male breast cancer presenting as nipple discharge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Farooq" 1 => "K. Horgan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Case Rep Surg" "fecha" => "2011" "volumen" => "2011" "paginaInicial" => "1" "paginaFinal" => "3" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging findings and classification of the common and uncommon male breast diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Ö Önder" 1 => "A. Azizova" 2 => "G. Durhan" 3 => "F.D. Elibol" 4 => "M.G. Akpınar" 5 => "F. Demirkazık" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13244-019-0834-3" "Revista" => array:5 [ "tituloSerie" => "Insights Imaging" "fecha" => "2020" "volumen" => "11" "paginaInicial" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32072386" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographic appearances of benign and malignant male breast disease with mammographic and pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Yitta" 1 => "C.I. Singer" 2 => "H.B. Toth" 3 => "C.L. Mercado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7863/jum.2010.29.6.931" "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "931" "paginaFinal" => "947" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20498468" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Male breast disease: clinical, mammographic, and ultrasonographic features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Günhan-Bilgen" 1 => "H. Bozkaya" 2 => "E.E. Üstün" 3 => "A. Memis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0720-048x(01)00483-1" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2002" "volumen" => "43" "paginaInicial" => "246" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12204407" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.H. Lee" 1 => "J. Phillips" 2 => "J.S. Sung" 3 => "J.M. Lewin" 4 => "M.S. Newell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2022" "paginaInicial" => "3" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-enhanced mammography: state of the art" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.S. Jochelson" 1 => "M.B.I. Lobbes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2021201948" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2021" "volumen" => "299" "paginaInicial" => "36" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33650905" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B.I. Lobbes" 1 => "U. Lalji" 2 => "J. Houwers" 3 => "E.C. Nijssen" 4 => "P.J. Nelemans" 5 => "L. van Roozendaal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-014-3154-5" "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "1668" "paginaFinal" => "1676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24696228" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nipple discharge the state of art" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Panzironi" 1 => "F. Pediconi" 2 => "F. Sardanelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BJR Open" "fecha" => "2018" "volumen" => "1" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging characteristics of malignant lesions of the male breast" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Chen" 1 => "P.K. Chantra" 2 => "L.H. Larsen" 3 => "P. Barton" 4 => "M. Rohitopakarn" 5 => "E.Q. Zhu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.264055116" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2006" "volumen" => "26" "paginaInicial" => "993" "paginaFinal" => "1006" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16844928" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seminar Male breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I.S. Fentiman" 1 => "A. Fourquet" 2 => "G.N. Hortobagyi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "The Lancet" "fecha" => "2006" "volumen" => "367" "paginaInicial" => "595" "paginaFinal" => "604" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The diagnostic accuracy of mammography in the evaluation of male breast disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.F.F. Evans" 1 => "T. Anthony" 2 => "A.H. Appelbaum" 3 => "T.D. Schumpert" 4 => "K.R. Levy" 5 => "R.H. Amirkhan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9610(00)00571-7" "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "2001" "volumen" => "181" "paginaInicial" => "96" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11425067" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound findings of mammary duct ectasia causing bloody nipple discharge in infancy and childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Moon" 1 => "H.S. Lim" 2 => "S.Y. Ki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jum.14970" "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2019" "volumen" => "38" "paginaInicial" => "2793" "paginaFinal" => "2798" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30768798" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mammary duct ectasia: an overview" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M.E.S. Rahal" 1 => "R. de Freitas-Júnior" 2 => "L. Carlos da Cunha" 3 => "M.A.R. Moreira" 4 => "V.D.L. Rosa" 5 => "D.M. Conde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4741.2011.01166.x" "Revista" => array:6 [ "tituloSerie" => "Breast J" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "694" "paginaFinal" => "695" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21999642" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.N. Sencha" 1 => "E.V. Evseeva" 2 => "I.A. Ozerskaya" 3 => "E.P. Fisenko" 4 => "Y.N. Patrunov" 5 => "M.S. Mogutov" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "A.N.Sencha" "titulo" => "Imaging of male breast cancer" "paginaInicial" => "118" "paginaFinal" => "119" "serieFecha" => "2015" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Male breast disease: pictorial review with radiologic-pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Nguyen" 1 => "M.D. Kettler" 2 => "M.E. Swirsky" 3 => "V.I. Miller" 4 => "C. Scott" 5 => "R. Krause" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.333125137" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2013" "volumen" => "33" "paginaInicial" => "763" "paginaFinal" => "779" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23674773" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Male breast cancer is rare: an initial presentation may be as an abscess" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.T. Ventham" 1 => "M.I. Hussien" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2010" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ductal carcinoma in situ of the male breast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Brents" 1 => "J. Hancock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000447768" "Revista" => array:6 [ "tituloSerie" => "Breast Care" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "288" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27721718" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ductal carcinoma in situ (DCIS) in the male breast a morphologic study of 84 cases of pure DCIS and 30 cases of DCIS associated with invasive carcinoma—a preliminary report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.P. Hittmair" 1 => "R.A. Lininger" 2 => "F.A. Tavassoli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/(sici)1097-0142(19981115)83:10<2139::aid-cncr12>3.0.co;2-f" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1998" "volumen" => "83" "paginaInicial" => "2139" "paginaFinal" => "2149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9827718" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mucinous carcinoma occurring in the male breast" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Ishida" 1 => "T. Umeda" 2 => "Y. Kawai" 3 => "T. Mori" 4 => "Y. Kubota" 5 => "H. Abe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/ol.2013.1730" "Revista" => array:6 [ "tituloSerie" => "Oncol Lett" "fecha" => "2014" "volumen" => "7" "paginaInicial" => "378" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24396451" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Male breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.O. Reis" 1 => "F. Gf Dias" 2 => "M.A. Castro" 3 => "U. Ferreira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "The Aging Male" "fecha" => "2011" "volumen" => "14" "paginaInicial" => "99" "paginaFinal" => "109" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of mammography in male patients with breast symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.L. Hines" 1 => "W.W. Tan" 2 => "M. Yasrebi" 3 => "E.R. DePeri" 4 => "E.A. Perez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/82.3.297" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2007" "volumen" => "82" "paginaInicial" => "297" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17352365" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cystic encapsulated papillary carcinoma in the male breast: an unusual feature with a diagnostic challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Li" 1 => "K. Saluja" 2 => "B. Mai" 3 => "M. Covinsky" 4 => "H. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/10668969211018754" "Revista" => array:6 [ "tituloSerie" => "Int J Surg Pathol" "fecha" => "2022" "volumen" => "30" "paginaInicial" => "63" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34304607" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "intracystic papillary carcinoma of the breast: mammographic, sonographic, and MR appearance with pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.H. Knelson" 1 => "S.J. el Yousef" 2 => "R.E.A. Goldberg" 3 => "W. Ballance" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00004728-198711000-00033" "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "1987" "volumen" => "11" "paginaInicial" => "1074" "paginaFinal" => "1076" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3316325" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographic features of primary breast cancer in men" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.T. Yang" 1 => "G.J. Whitman" 2 => "E.H.Y. Yuen" 3 => "G.M.K. Tse" 4 => "C.B. Stelling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2001" "volumen" => "176" "paginaInicial" => "413" "paginaFinal" => "416" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographic appearance of mucinous carcinoma of the breast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.W.M. Lam" 1 => "W.C.W. Chu" 2 => "G.M. Tse" 3 => "T.K. Ma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2004" "volumen" => "182" "paginaInicial" => "1069" "paginaFinal" => "1074" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pure mucinous carcinoma with axillary lymph node metastasis in a male breast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.M. Dragoumis" 1 => "A.S. Assimaki" 2 => "A.P. Tsiftsoglou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12282-009-0163-3" "Revista" => array:6 [ "tituloSerie" => "Breast Cancer" "fecha" => "2012" "volumen" => "19" "paginaInicial" => "365" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19756925" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/unassign/S2173510724000703/v1_202406091037/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735107/unassign/S2173510724000703/v1_202406091037/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000703?idApp=UINPBA00004N" ]
Journal Information
Share
Download PDF
More article options
Update in Radiology
Available online 9 June 2024
A radiological review of male nipple discharge
Revisión radiológica de la secreción mamaria en el varón