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JAMA Clinical Challenge
August 29, 2019

Breast Mass in an African American Man

Author Affiliations
  • 1Section of General Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
  • 2Division of Hematology, Oncology, and Cell Therapy, Department of Medicine, Rush University Medical Center, Chicago, Illinois
JAMA. Published online August 29, 2019. doi:10.1001/jama.2019.12698

A 43-year-old African American man presented with a nontender, self-palpated mass in his left breast. He had hypertension, diabetes, hyperlipidemia, and obesity and was a current smoker. His medications included carvedilol, furosemide, lisinopril, metformin, and aspirin but no testosterone or herbal supplements. Family history was significant for a sister with brain cancer, diagnosed in her 40s. On physical examination, his vital signs were within normal limits; his body mass index, calculated as weight in kilograms divided by height in meters squared, was 53. His left nipple was retracted. At the 2-o’clock position of the left breast, 3 cm from the nipple, there was a 3.5 × 3.0–cm firm mass. The right breast was normal without masses, and there was no palpable axillary lymphadenopathy. He underwent a bilateral diagnostic mammogram, which showed a partially obscured mass in the left upper outer quadrant with linear extension to the nipple (Figure, left panel). Targeted ultrasound showed a 2.0 × 1.6 × 1.6–cm irregular hypoechoic mass (Figure, right panel).