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Breast malignant, males, children

Male tumors

Gynecomastia in males


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 8 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Definition
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● Enlargement of male breast due to hypertrophy and hyperplasia of glands and stroma
● Multifactorial etiology: physiological (puberty or aging), endocrine tumors, endocrine dysfunctions, non-endocrine diseases, drug induced, idiopathic

Clinical features
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● Most common lesion of male breast
● Usually bilateral, but may be more distinct in one breast
● Caused by increase in estrogen to androgen ratio (Sao Paulo Med J 2012;130:187)
● Occurs at birth, puberty or associated with Kleinfelter’s syndrome, functioning testicular tumors (Leydig, Sertoli), lung tumors, cirrhosis (hyperestrinism), neurofibromatosis (Plast Reconstr Surg 2008;121:34e alcohol, anabolic steroids, other drugs (digitalis, dilantin, highly active antiretroviral therapy for HIV, isoniazid-J Bras Pneumol 2008;34:978, methotrexate-Mod Rheumatol 2007;17:511, spironolactone-CMAJ 2007;176:620, lavender and tea tree oils-N Engl J Med 2007;356:479)

Prognostic features
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● May recur

Case reports
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● 69 year old man with fibroadenomatoid nodules associated with spironolactone (Am J Surg Pathol 1990;14:774)

Treatment
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● Observation / reassurance (often reversible, eMedicine), tamoxifen (Rev Med Chil 2007;135:1558), surgery with liposuction (Plast Reconstr Surg 2008;121:740) or endoscopic subcutaneous mastectomy (Surg Laparosc Endosc Percutan Tech 2009;19:e85)
● Folate for methotrexate associated disease (Rheumatol Int 2010;30:1371)

Clinical images
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Grades I-IV


Spironolactone induced

Gross description
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● Button or disk-like subareolar enlargement
● Oval, elastic and with well-circumscribed borders
● Unilateral (more common) or bilateral
● Firm, gray-white cut surface

Micro description
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● Proliferation of ducts without lobules
● Dense, periductal stromal fibrosis or edema with micropapillary hyperplasia and mild lymphocytic infiltrate
● Epithelium may be surrounded by prominent swollen stroma giving “halo” effect
● Over time, less hyperplasia and more stromal fibrosis
● May have pseudoangiomatous stromal hyperplasia, focal squamous metaplasia (Arch Pathol Lab Med 1986;110:971)

Micro images
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Gynecomastia

           
Periductal stromal edema        Solid form with microlumina, different
with mild epithelial hyperplasia       cell types in central and peripheral duct

           
Post-estrogen treatment for       With atypical duct hyperplasia
prostatic carcinoma

           
Fig 1: dense fibrous stroma       Micropapillary pattern of slender strands
and dilated ductules without lobules  of cells with hyperchromatic nuclei (AFIP)

Virtual slides
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Gynecomastia

Cytology images
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Clusters of bland, cohesive epithelial cells

Positive stains
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● ER and PR are associated with Kleinfelter’s syndrome
● PSA is associated with antiandrogen therapy (but PSAP negative)

Electron microscopy description
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● Proliferation of epithelial and myoepithelial cells, intracytoplasmic lumina and squamous metaplasia
● Stroma shows fibroblasts, myofibroblasts and some pericytes (Arch Pathol Lab Med 1979;103:624)

End of Breast malignant, males, children > Male tumors > Gynecomastia in males


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