Citation, DOI and article data
While it can occur at any age, it tends to have greater prevalence in two groups: adolescent boys and older men (some publications describe a trimodal age distribution, occurring in neonatal, pubertal, and elderly males 8). Prevalence of "asymptomatic" gynecomastia ranges around 8:
- neonates: 60-90%
- adolescents: 50-60%
- men aged 50 to 69 years: up to 70%
Prevalence of "symptomatic" cases is markedly lower.
Palpation usually demonstrates a palpable, tender, firm, mobile, disc-like mound of tissue 8.
In gynecomastia, there is enlargement of the male breast due to benign ductal and stromal proliferation. A hallmark of gynecomastia is its central symmetric location under the nipple. Gynecomastia in most cases tends to be unilateral and/or asymmetrical 3.
The imbalance between estrogen action relative to androgen action at the breast tissue level appears to be a key etiological factor in gynecomastia 8.
The causes of gynecomastia are many and include:
- thiazide diuretics
- anabolic steroids
- estrogen treatment
- systemic disorders
- tumors: particularly oestrogenic tumors
There can be three histological forms:
May appear as an increased sub-areolar density, which may be flame-shaped.
Three mammographic patterns of gynecomastia have been described representing various degrees and stages of ductal and stromal proliferation. They are:
- nodular pattern
- dendritic pattern
- diffuse glandular pattern
Early nodular gynecomastia (florid phase) is seen in patients with gynecomastia for less than 1 year. At mammography, there is often a nodular subareolar density.
Chronic dendritic gynecomastia (quiescent phase) is seen in patients with gynecomastia for longer than 1 year. Fibrosis becomes the dominant process and is irreversible. Mammograms this phase typically show a dendritic subareolar density with posterior linear projections radiating into the surrounding tissue toward the upper-outer quadrant.
Diffuse glandular gynecomastia is commonly seen in patients receiving exogenous estrogen. At mammography, there is enlargement of the breast and diffuse density with both dendritic and nodular features.
Focal gynecomastia can variably appear as a retroareolar, triangular, hypoechoic (~80% 2) mass.
In early nodular gynecomastia, there can be subareolar fan or disc-shaped hypoechoic nodule surrounded by normal fatty tissue.
In diffuse glandular gynecomastia, both nodular and dendritic features are seen surrounded by diffuse hyperechoic fibrous breast tissue.
In chronic dendritic gynecomastia, there is often a subareolar hypoechoic lesion with an anechoic star-shaped posterior border, which can be described as fingerlike projections or "spider legs" insinuating into the surrounding echogenic fibrous breast tissue.
- pseudogynecomastia: involves breast enlargement (usually bilateral) caused by an excess of adipose tissue, which is not necessarily associated with constitutional obesity
male breast cancer 12:
- unilateral fixed painless irregular hard mass
- may occur remotely from the areola (gynecomastia does not)
- skin thickening and tethering
- 1. Wigley KD, Thomas JL, Bernardino ME et-al. Sonography of gynecomastia. AJR Am J Roentgenol. 1981;136 (5): 927-30. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Chantra PK, So GJ, Wollman JS et-al. Mammography of the male breast. AJR Am J Roentgenol. 1995;164 (4): 853-8. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Cooper RA, Gunter BA, Ramamurthy L. Mammography in men. Radiology. 1994;191 (3): 651-6. Radiology (abstract) - Pubmed citation
- 4. Conant EF, Brennecke CM. Breast imaging, case review. Mosby Inc. (2006) ISBN:0323017460. Read it at Google Books - Find it at Amazon
- 5. Cardeñosa G. Clinical breast imaging, a patient focused teaching file. Lippincott Williams & Wilkins. (2006) ISBN:0781762677. Read it at Google Books - Find it at Amazon
- 6. Eurorad teaching files : Case 8528
- 7. Paredes ES. Atlas of mammography. Lippincott Williams & Wilkins. (2007) ISBN:0781764335. Read it at Google Books - Find it at Amazon
- 8. Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin. Proc. 2009;84 (11): 1010-5. doi:10.1016/S0025-6196(11)60671-X - Free text at pubmed - Pubmed citation
- 9. Bing Z, Bai S. Open Journal of Pathology. 2012;02 (01): . doi:10.4236/ojpathology.2012.21002
- 10. Dialani V, Baum J, Mehta TS. Sonographic features of gynecomastia. J Ultrasound Med. 2010;29 (4): 539-47. J Ultrasound Med (full text) - Pubmed citation
- 11. Draghi F, Tarantino CC, Madonia L, Ferrozzi G. Ultrasonography of the male breast. (2011) Journal of ultrasound. 14 (3): 122-9. doi:10.1016/j.jus.2011.06.004 - Pubmed
- 12. Niewoehner CB, Schorer AE. Gynaecomastia and breast cancer in men. (2008) BMJ (Clinical research ed.). 336 (7646): 709-13. doi:10.1136/bmj.39511.493391.BE - Pubmed
- 13. Goldman RD. Drug-induced gynecomastia in children and adolescents. (2010) Canadian family physician Medecin de famille canadien. 56 (4): 344-5. Pubmed