Clinicopathological study of gynecomastias – Description of 60 cases and pathological study of 81 surgical specimens
Keywords:
Gynecomastia, Ductal hyperplasias, Precursors of breast cancer, Immunohistochemical examinationAbstract
Objectives: In this retrospective study we considered to analyze clinical and pathological features in
gynecomastia cases. Methods: We recovered 60 hospital records and 81 pathological specimens from
excision of the mammary glands of 45 patients, all revised and analyzed according signs of lobular
differentiation, presence and type of columnar cells lesions, epithelial hyperplasia, epithelial atypias,type of estromal component and presence ofpseudo-angiomatous stromal hyperplasia. Immunohistochemical detection of estrogen receptor was done in cases related to adolescence and detection of basal
and luminal cytokeratins in cases of atypia. Results: The age of the patients varied from 11 to 60 years
old. The majority (60%) was related the appearance of the illness in the period of the adolescence,
mostly associated to obesity. However, practically all the commonly causes described in literature could
be identified, such as hypogonadism, functional tumors, hepatopathy, adrenal pathology, use of anabolic drugs, drugs and medicines, including a case of antiviral therapy. More than 80% ofthe cases
had bilateral presentation, the majority with similar pathological features in both breasts. Lobular
differentiation was observed in the majority ofour cases (76.2%). The mostfrequent histological features were microcystic changes (79%), columnar cell lesions (82.7%), epithelial hiperplasia (58.0%)
and pseudo-angiomatous stromal hyperplasia (75.3%). We could not observe any relation between
histological and clinical presentation. Estrogen receptor was present in more than 90% of epithelial
cells. Cases with atypia (9/81 specimens) showed co-expression ofbasal and luminal cytokeratins. Conclusions: Gynecomastia is morefrequent in physiological and pathological conditions associated direct
or indirectly to hyperestrogenism. Epithelial atypias, morphologically similar to the precursors lesions
in thefemale breast, are identified in gynecomastias, but it is possible that they do not have the same
biological significance if we take into account the low frequency of breast male cancer associated to
gynecomastia and the imunoistochemical profile.
Downloads
References
1. Nuttall FQ. Gynecomastia as a physical finding in normal men. J
Clin Endocrinol Metab. 1979;48(2):338-40.
2. Braunstein GD. Gynecomastia. N Engl J Med. 2007;357:1229-37.
3. Evans DL, Pantanowitz L, Dezube BJ, Aboulafia DM. Breast enlargement in 13 men who were seropositive for human immunodeficiency virus. Clin Infect Dis. 2002;35(9):1113-9.
4. Narula HS, Carlston HE. Gynecomastia. Endocrinol Metab Clin
North Am. 2007;36(2):497-519.
5. Günhan-Bilgen I, Bozkaya H, Ustün EE, Memis A. Male breast
disease: clinical, mammographic, and ultrasonographic features.
Eur J Radiol. 2002;43(3):246-55.
6. Mathur R, Braunstein GD. Gynecomastia: pathomechanisms and
treatment strategies. Horm Res. 1997;48(3):95-102.
7. Kang Y, Wile M, Schinella R. Gynecomastia-like changes of the
female breast. Arch Pathol Lab Med. 2001:125(4):506-9.
8. Rosen PP. Rosen's breast pathology. 3ª ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
9. Harigopal M, Murray MP, Rosen PP, Shin SJ. Prepubertal gynecomastia with lobular differentiation. Breast J. 2005;11(1):48-51.
10. Simpson PT, Gale T, Reis-Filho S, et al. Columnar cell lesions ofthe
breast: the missing link in breast cancer progression? A morphological and molecular analysis. Am J Surg Pathol. 2005;29(6):734-46.
11. Shoker BS, Jarvis C, Clarke RB, et al. Abnormal regulation of
the oestrogen receptor in benign breast lesions. J Clin Pathol.
2000:53(10):778-83.
12. Degnim AC, Visscher DW, Berman AK, et al. Stratification of breast cancer risk in women with atypia: a Mayo cohort study. J Clin
Oncol. 2007;25(19):2671-7.
13. Handschin AE, Bietry D, Hüsler R, et al. Surgical management of
gynecomastia - A 10-year analysis. World J Surg. 2008;32(1):38-44.
14. Elston CW, Sloane JP, Amendoeira I, et al. Causes of inconsistency
in diagnosing and classifying intraductal proliferations of the breast. European Commission Working Group on Breast Screening
Pathology. Eur J Cancer. 2000;36(14):1769-72.
15.
16.
17.
Otterbach F, Bànkfalvi, Bergner S, Decker S, Krech R, Boecker
W. Cytokeratin 5/6 immunohistochemistry assists the differential
diagnosis of atypical proliferations of the breast. Histopathology.
2000;37(3):232-40.
Boecker W, Buerger H, Schimitz K, et al. Ductal epithelial proliferations of the breast: a biological continuum? Comparative genomic hybridization and high-molecular-weight cytokeratin expression patterns. J Pathol. 2001;195(4):415-21.
Lerwill MF. Current practical applications of diagnostic immunohistochemistry in breast pathology. Am J Surg Pathol. 2004; 28(8):1076-91.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Gabriella Paiva Bento, Kátia Maciel Pincerato, Domingos Auricchio Petti, Filomena Marino Carvalho
This work is licensed under a Creative Commons Attribution 4.0 International License.
