Veiled in Gynecomastia: A B3 breast lesion in a male patient with subsequent “upgrade” to invasive malignancy

B3 breast lesions are a heterogeneous group with uncertain malignant potential. While female-specific guidelines often recommend vacuum-assisted excision (VAE) followed by surveillance, these strategies are less applicable in male patients. This case report highlights a male patient initially diagnosed with a B3 lesion—specifically atypical intraductal epithelial proliferation (AIDEP)—that was later “upgraded” to invasive carcinoma and ductal carcinoma in situ (DCIS) following surgical excision. The case illustrates the limitations of current protocols when applied to men and supports considering surgical excision as a first-line management strategy in high-risk B3 lesions. It also highlights the potential diagnostic value of mammography in high-risk males, particularly when ultrasound findings are inconclusive. Overall, this report emphasizes the need for male-specific, evidence-based guidelines to ensure timely and accurate diagnosis and treatment of B3 breast lesions in men.