Gynecomastia.

GYNECOMASTIA

• It is a benign lesion characterised by enlargement of male breast due to imbalance of estrogen and testosterone hormones

• It can be unilateral or bilateral

• Age: Gynecomastia occurs in infants, during puberty and in old age

• Etiopathogenesis

  • Caused by decrease in the amount of testosterone and increased estrogen activity

  • Gynecomastia can occur in certain conditions like

    • Hypogonadism – as in Kleinfelters syndrome

    • Aging

    • Tumors involving testis, adrenal gland and pituitory gland

    • Hyperthyroidism

    • Renal failure – Patient treated by dialysis develops hormonal changes

    • Liver failure and cirrhosis

    • Malnutrition 

    • Drugs – alcohol, antiretroviral therapy, anabolic steroids, antidepressants, Heroine, marijuana etc.

• Microscopy 

  • Lobule formation is absent in male breast

  • Ducts show proliferation and epithelial hyperplasia forming micropapillae

  • Increased dense collagenous connective tissue sroma

• Differential diagnosis 

  • Lipoma

  • Breast cancer

  • Breast abscess

• Treatment 

  • Most cases regress by themselves without treatment

  • If there is underlying cause like drugs, liver failure, hypogonadism etc they should be corrected

  • Surgical resection of excess breast tissue is treatment of choice for patients who cannot be corrected medically. 

References

1. Vinay kumar, Abul K.Abbas, Nelson Fausto, Jon C. Aster. The Breast. In: Robbins and Cotran Pathologic basis of disease. 8th edition.