BENIGN BREAST DISORDERS:

Gynecomastia

Benign, abnormal proliferation of glandular tissue in the male breast: Ductal and stromal proliferation (absence of progesterone-induced terminal alveolar/lobule development in male breast)

Many etiologies, all via increase in ratio of estrogen:androgen activity:

–     50% Idiopathic (25%) or Persistent pubertal gynecomastia (25%)

–     10-25% Drugs (MJ, spironolactone, antifungals, 5-alpha reduc inhibs)

–     Remainder: Hypogonadism, Cirrhosis/malnutrition, Hyperthyroidism

Clinical presentation: Pain (adolescents) or extreme nipple sensitivity

Diagnosis: Rubbery-to-firm symmetric mobile disc >0.5 cm in diameter, central location under nipple/areolar complex; Differential includes breast cancer: which presents as a unilateral, nontender, hard/fixed mass, eccentric to nipple

Treatment: Stop offending drug(s); Plastic surgery is definitive treatment.

Mammogram features: Fan-shaped density emanating from the nipple, gradually blending into surrounding fat +/- extensions into surrounding fat with an appearance similar to a heterogeneously dense female breast

(Appelbaum 1999, Braunstein 2014)