Type:
Educational Exhibit
Keywords:
Metabolic disorders, Endocrine disorders, Diagnostic procedure, Mammography, Breast, Anatomy
Authors:
I. Rodríguez Suárez, D. E. Cárdenas Olvera ; Mexico City, Mexico city/MX
DOI:
10.26044/ecr2019/C-3682
Findings and procedure details
- Gynecomastia is the most frequent cause of breast related signs or symptoms in men,
usually associated with pain.
Men present with a palpable abnormality,
focal tenderness,
or a burning sensation.
- This male breast pathology is the most common as well.
- There is frequent confusion between the presence of normal connective tissue and the mild forms of gynecomastia.
- This may result in unnecessary treatments.
The normal male breast
-
The adult male breast is composed predominantly of skin and subcutaneous fatty tissue in addition to atrophic ducts and stromal elements.
Cooper's ligaments are absent.
The presence of bands of connective tissue in the retroareolar region should not be confused with gynecomastia,
in the latter the density is more homogeneous and uniform. [1,2,3,4] Fig.
2
The study of choice for gynecomastia is usually mammography (MLO or MLO+CC) in men of 25 years or older. [1,2,3,4]
Phases of gynecomastia
There are three histopathological phases of gynecomastia:
- Florid/proliferative phase
- Mixed phase
- Quiescent/fibrous phase
Two of which can be observed by mammography (florid and quiescent).
Mammography patterns of gynecomastia
- Nodular (Florid/proliferative histopathological phase)
- Dendritic (Quiescent/fibrous histopathological phase)
Nodular gynecomastia
- Corresponds to the florid phase: proliferation of intraductal epithelium,
inflammation and edema.
- Less than 1 year of evolution.
- Reversible if the cause is eliminated.
- Findings on mammography: Discoid/ fan shaped retroareolar density of indistinct margins.
Fig.
3
Dendritic gynecomastia
- Corresponds to the quiescent / fibrous phase: ductal dilation and fibrosis.
- Present for one year or more.
- Irreversible.
- Findings on mammography: Flame shaped retroareolar density (finger-like extensions),
can be extended to upper outer quadrant.
Fig.
4
Diffuse gynecomastia
- It is observed in patients with estrogen therapy or the use of exogenous hormones.
- Findings on mammography: Heterogeneous density that combines the nodular and dendritic pattern,
similar to a female breast.
Fig.
5
In men under 25 years of age the ultrasound is indicated for gynecomastia. [1,2,3,4] Fig.
6
Pseudogynecomastia
- Increase of retroareolar fat
- Asymptomatic
- Feeling of breast enlargement
- Findings on mammography: Large amount of homogeneous subcutaneous fat without increase in the glandular component of the breast.
Fig.
7