Gynecomastia
Updates to Article Attributes
Gynaecomastia refers to benign excess of the male breast tissue, that is usually reversible. It is not a risk factor per se for developing male breast cancer.
Epidemiology
While it can occur at any age, it tends to have greater prevalence in two groups : adolescent boys and older men (some publications describe a trimodal age distribution, occurring in neonatal, pubertal, and elderly males 8).
Clinical presenation
Palpation usually demonstrates a palpable, tender, firm, mobile, disc-like mound of tissue 8.
Pathology
In gynaecomastia, there is enlargement of the male breast due to benign ductal and stromal proliferation. A hallmark of gynecomastia is its central symmetric location under the nipple. Gynaecomastia in most cases tends to be unilateral and/or asymmetrical 3.
The imbalance between oestrogen action relative to androgen action at the breast tissue level appears to be a key aetiological factor in gynaecomastia 8.
Aetiology
The causes of gynaecomastia are many and include:
-
hormonal:
- neonatal: maternal oestrogens
- pubertal: high oestradiol levels
- elderly: decline in testosterone levels
- hypogonadism/androgen deficiency states:
- Klinefelter syndrome
- anorchism
- testicular failure, e.g. testicular cancer
-
drugs:
- diethylstilbestrol
- spironolactone
- thiazide diuretics
- digoxin
- anabolic steroids
- oestrogen treatment
- isoniazid
- ergotamine
- narcotics:
- marijuana
- heroin
- cimetidine
- nifedipine
- reserpine
- methyldopa
- theophylline
-
systemic disorders:
- advanced alcoholic cirrhosis
- chronic pulmonary disease, e.g. emphysema, tuberculosis
- haemodialysis in chronic renal failure
- hyperthyroidism
- malnutrition
-
tumours: particularly oestrogenic tumours
- adrenal carcinoma
- hepatoma
- lung cancer
- pituitary adenoma
- testicular cancer: including sex-cord stromal, and germ cell tumours 9
- idiopathic
Histology
There can be three forms of gynaecomastia histologically:
- florid
- intermediate
- fibrotic
Radiographic features
Mammography
May appear as an increased sub-areolar density, which may be flame-shaped.
Three mammographic patterns of gynecomastia have been described representing various degrees and stages of ductal and stromal proliferation. They are:
- nodular pattern
- dendritic pattern
- diffuse glandular pattern
Early nodular gynecomastia (florid phase) is seen in patients with gynecomastia for less than 1 year. At mammography, there is often a nodular subareolar density.
Chronic dendritic gynecomastia (quiescent phase) is seen in patients with gynecomastia for longer than 1 year. Fibrosis becomes the dominant process and is irreversible. Mammograms this phase typically show a dendritic subareolar density with posterior linear projections radiating into the surrounding tissue toward the upper-outer quadrant.
Diffuse glandular gynecomastia is commonly seen in patients receiving exogenous estrogenoestrogen. At mammography, there is enlargement of the breast and diffuse density with both dendritic and nodular features.
Breast ultrasound
Focal gynaecomastia can variably appear as a retroareolar, triangular, hypoechoic ( ~ 80% 2) mass.
In early nodular gynecomastia there can be subareolar fan or disc shaped hypoechoic nodule surrounded by normal fatty tissue.
In diffuse glandular gynecomastia both nodular and dendritic features are seen surrounded by diffuse hyperechoic fibrous breast tissue.
In chronic dendritic gynecomastia, there is a often a subareolar hypoechoic lesion with an anechoic star-shaped posterior border, which can be described as fingerlike projections or "spider legs" insinuating into the surrounding echogenic fibrous breast tissue.
See also
-</ul><p>Early nodular gynecomastia (florid phase) is seen in patients with gynecomastia for less than 1 year. At mammography, there is often a nodular subareolar density.</p><p>Chronic dendritic gynecomastia (quiescent phase) is seen in patients with gynecomastia for longer than 1 year. Fibrosis becomes the dominant process and is irreversible. Mammograms this phase typically show a dendritic subareolar density with posterior linear projections radiating into the surrounding tissue toward the upper-outer quadrant.</p><p>Diffuse glandular gynecomastia is commonly seen in patients receiving exogenous estrogen. At mammography, there is enlargement of the breast and diffuse density with both dendritic and nodular features.</p><h5>Breast ultrasound</h5><p>Focal gynaecomastia can variably appear as a retroareolar, triangular, hypoechoic ( ~ 80%<sup> 2</sup>) mass.</p><p>In early nodular gynecomastia there can be subareolar fan or disc shaped hypoechoic nodule surrounded by normal fatty tissue.</p><p>In diffuse glandular gynecomastia both nodular and dendritic features are seen surrounded by diffuse hyperechoic fibrous breast tissue.</p><p>In chronic dendritic gynecomastia, there is a often a subareolar hypoechoic lesion with an anechoic star-shaped posterior border, which can be described as fingerlike projections or "spider legs" insinuating into the surrounding echogenic fibrous breast tissue.</p><h4>See also</h4><ul>- +</ul><p>Early nodular gynecomastia (florid phase) is seen in patients with gynecomastia for less than 1 year. At mammography, there is often a nodular subareolar density.</p><p>Chronic dendritic gynecomastia (quiescent phase) is seen in patients with gynecomastia for longer than 1 year. Fibrosis becomes the dominant process and is irreversible. Mammograms this phase typically show a dendritic subareolar density with posterior linear projections radiating into the surrounding tissue toward the upper-outer quadrant.</p><p>Diffuse glandular gynecomastia is commonly seen in patients receiving exogenous oestrogen. At mammography, there is enlargement of the breast and diffuse density with both dendritic and nodular features.</p><h5>Breast ultrasound</h5><p>Focal gynaecomastia can variably appear as a retroareolar, triangular, hypoechoic ( ~ 80%<sup> 2</sup>) mass.</p><p>In early nodular gynecomastia there can be subareolar fan or disc shaped hypoechoic nodule surrounded by normal fatty tissue.</p><p>In diffuse glandular gynecomastia both nodular and dendritic features are seen surrounded by diffuse hyperechoic fibrous breast tissue.</p><p>In chronic dendritic gynecomastia, there is a often a subareolar hypoechoic lesion with an anechoic star-shaped posterior border, which can be described as fingerlike projections or "spider legs" insinuating into the surrounding echogenic fibrous breast tissue.</p><h4>See also</h4><ul>
References changed:
- 10. Dialani V, Baum J, Mehta TS. Sonographic features of gynecomastia. J Ultrasound Med. 2010;29 (4): 539-47. <a href="http://www.jultrasoundmed.org/content/29/4/539.full">J Ultrasound Med (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/20375373">Pubmed citation</a><span class="ref_v3"></span>
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