Dendritic gynecomastia

Case contributed by Dr Hala Maher

Presentation

Left UOQ para-areolar recently discovered swelling not associated with pain or skin inflammation. No history of trauma.

Patient Data

Age: 75 years
Gender: Male

Left 2 o'clock hypoechoic irregular outlines solid mass located about 1 cm from the nipple showing peripheral speculations.

It measures 9 x 15 mm and it shows internal vascularity by color Doppler.

It's almost superficially located about 4 mm from the skin surface and about 10 mm distance from the pectoralis muscle; no signs of deep invasion on US bases.

The retro-areolar region is normal.

Enlarged left axillary lymph node (not shown) with prominent cortex reach up to 2.2 mm, yet still keeps its fatty hilum.

Ultrasound-guided biopsy was performed (the last two images).

Case Discussion

Gynecomastia is one of the most common male breast lesions and in particular solid masses.

It's mainly composed of a benign proliferation of ducts and stroma.

In our case, we will focus on the dendritic type which is almost related to reduced androgen secretion in elderly males.

The dendritic type is the chronic and irreversible type and sometimes we misdiagnose it as a neoplastic lesion or at least raise its BI-RDS category to be 4c due to its branches that extend to the peripheral adipose tissue.

When do we need to biopsy a male breast lesion?

First, if it has an eccentric location.

Second, according to the morphological features of ultrasound and mammography if possible as it is not that easy to be able to differentiate between speculations and finger-like projection of the dendritic type.

However, if we have found any suspicious solid mass in a male breast we have to biopsy it as male neoplastic lesions are almost aggressive and easily infiltrate the chest wall.

Regarding our case, it has been given BI-RADS 4c and US-guided true cut biopsy was done.

It is proved by histopathology to be benign breast tissue consistent with gynecomastiod hyperplasia, B2. No dysplasia/evidence of malignancy.

B2: Benign lesion

RC Path Category: Reporting system of UK National Health Service Screening Program

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