Gynecomastia

Case contributed by Dr Ali Abougazia

Presentation

Left breast lump with occasional pain. Cannot remember the onset, duration, or any trauma.

Patient Data

Age: 55 years
Gender: Male
mammography
A left breast subareolar flame shaped lesion is noted.
No left breast macro- or micro-calcific foci.
Normal skin thickness and contour of left breast.Normal areola / nipple complex of left breast.
ultrasound
Left breast shows subareolar hypoechoic volcano-like mass lesion measuring 2.8 X 1.2 cm.
Normal right breast parenchyma with no evidences of solid or cystic masses.
Right axillary lymph nodes are noted retaining ovoid shape and fatty hila.
No enlarged right axillary lymph nodes.

Case Discussion

These findings are consistent with left breast gynecomastia.

Gynecomastia refers to enlargement of the male breast and is the most common male breast abnormality. It occurs most commonly in adolescent males and males older than 50 years. It has a variety of causes including drugs, functioning testicular tumors and liver cirrhosis. It is commonly unilateral or assymetrical bilateral in distribution.

In this case, the main differential diagnosis would be male breast carcinoma. However, the characteristic subareolar location and flame-shaped density of the lesion exclude malignancy, which would otherwise be more eccentric in location, irregular in shape and may show ill-defined or spiculated margins. Also, male breast carcinoma is very rare and has higher mean age (around 70 years).

 

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