Gynecomastia of the male breast
- Gynecomastia is the benign hypertrophy of the male breast
- asymptomatic or painful
- unilateral or bilateral
- just below the areolar region
- transiently during neonatal period due to motherly estrogrens
Causes of Gynecomastia
- Illicit drug use, especially marijuana
- Renal, Liver disease
Gynecomastia’s association with cancer
- Testicular cancer
- BRCA2 genetic multation may lead to male breast cancer
Diagnostics for Gynecomastia
For the older patient with no obvious etiology consider:
- Thyroid hormone
- Prolactin level
- FSAH, LH, DHEA
- Bilateral mammorgram
- FNA (fine needle aspiration) can be diagnostic or core needle biopsy, usually not a need for excisional biopsy. Thus an excisional biopsy wouldn’t be a first line diagnostic tool in gynecomastia.
Breast Masses in Children and Adolescence
Classification of the breast masses in children/adolescence
The process in parethesis below represents an example.
- Physiological (Gynecomastia)
- Inflammatory (Abscess)
- Benign neoplastic (Fibroadenoma, Cystosarcoma phyllodes)
- Primary malignant (Cystosarcoma phyllodes)
- Secondary malignant (Lymphoma)
Neonatal breast nodules
Usually due to stimulation by maternal hormones
- Fibroadenomas and cystosarcoma phyllodes are the most common lesions of the breast in childhood.
- Cystosarcoma phyllodes present as either benign or malignant but 95% in children are benign.
Best test for initial assessment in pediatric patients with breast mass?
Then what modality for diagnosis of the breast mass?
Fine needle aspiration. FNA is preferred over core needle biopsy because of the possibility of deformity of the breast in the future with core needle biopsy.
What about excision biopsy in the pediatric breast?
Excisional biopsy should be avoided as an initial diagnostic procedure because the developing breast bud can be mistakenly removed, leading to deformity.