Gynecomastia

Case contributed by Ali Abougazia
Diagnosis certain

Presentation

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

Patient Data

Age: 55 years
Gender: Male

Left breast

mammography

A left breast subareolar flame-shaped lesion is noted. No macro- or micro-calcific foci. Normal skin thickness and contour. Normal areola/nipple complex.

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 asymmetrical 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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