Gynaecomastia is defined clinically as abnormal enlargment of the breast in men.It is the most important diseases of male breast ,it is the commonest problem affecting the male breast, accounting for about 85% of breast masses .
It has been reported in 36% of normal male adults . Gynecomastia is characterized by hyperplasia of the ductal and stromal elements of male breast tissue . It manifest clinically by soft mobile tender mass in the retroareolar region (6).
Gynaecomastia has been associated with increased serum level of oestradiol & decreased level of testosterone. This decreased oestradiol-to-testosterone ratio may arise from the physiologic changes at puberty and senescence, but it may also be caused by endocrine and hormonal disorders , systemic disease , neoplasm and certain drugs (table 1).
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(Table 1)
Causes of Gynecomastia :
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· Semi-physiological ,neonatal & pubertal.
· Systemic disease : liver cirrhosis , DM , renal disease , SEP, chronic lung disease ,adrenal disease ,hypogonadism & KF syndrome.
· Malignancy of liver, lung, testis, adrenal & pituitary origin.
· Drugs :
Oestrogen containing, metocloperamide,
resepine,amphetamine & prednisolone.
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At histologic analysis, gynaecomastia has been classified into two types depending upon the duration and not the cause.
The florid type :
Florid gynaecomastia is thought to be the early phase of gynaecomastia . It is characterized by hyperplasia of the intraductal epithelium with loose cellular stroma and surrounding odema .
The fibrous type :
Fibrous gynaecomastia which is thought to occur when gynaecomastia has been long standing . The histologic characteristics of fibrous gynaecomastia are ductal proliferation with dense fibrotic stroma .
Gynecomastia tends to be reversible in the florid phase but once fibrosis is established , it is often irreversible ( 3).
Mammography is recommended for the evaluation of the male breast if the differential diagnosis between gynecomastia and lipomastia (fatty enlrgment of the breasts) is not clinically evident and in all cases of unilateral breast symptoms.
Ultrasound is used as a complementary study adding to the diagnostic criteria of mammography and as well is useful to guide FNB in suspicious cases .