gynecomastia
Introduction
Introduction to male mammary gland development Men's mammary gland development, also known as male breast hypertrophy, refers to male unilateral or bilateral breast hypertrophy due to different reasons at different ages and different ages. It may have breast pain and can be touched under the areola. Shaped nodules, individual visible nipple retraction, nipple discharge, and some of the shape is similar to the adolescent girl's breast, so the clinical has adolescent breast hypertrophy, middle-aged breast hypertrophy, idiopathic male breast hypertrophy and other titles. basic knowledge The proportion of patients: 0.03% - 0.09% (obesity rate of obese men is about 0.03% - 0.09%) Susceptible people: male Mode of infection: non-infectious Complications: male breast cancer, male breast development
Cause
Male mammary gland development etiology
(1) Causes of the disease
According to the cause of the disease, male breast hypertrophy has primary and secondary types.
1. Primary male breast hypertrophy is more common in children, puberty, often due to endocrine physiological disorders, plasma estradiol content is higher than testosterone, resulting in a transient ratio of estrogen and androgen, or breast tissue to estrogen Caused by increased sensitivity, also known as physiological male breast hypertrophy.
2. Secondary male breast hypertrophy can be seen in young, middle-aged, and elderly, and can be caused by the following reasons.
(1) Endocrine diseases:
1 testicular disease: due to hypogonadism, androgen secretion is very low, blood testosterone, estrogen ratio changes, causing men's breast hypertrophy.
A. Congenital testicular hypoplasia (Klinefelter syndrome): oral mucosal chromatin-positive, small testis, chromosome 47XXY, low blood testosterone, elevated gonadotropin, significantly reduced sperm in semen, abnormal sperm morphology and activity, may appear Mental retardation, breast hypertrophy and pain during puberty.
B. Complete testicular feminization: female vulvar, testis in the labia majora or intraperitoneal cavity, chromosome 46XY, testosterone can not function due to abnormal and quantitative androgen receptor, testosterone in blood or normal, estradiol Normal high limit, gonadotropin increased, adolescent breast development or hypertrophy, incomplete testicular feminine vulva can be male, or small penis or pseudo-hermaphroditism, normal pubic hair, but also adolescent breast development or hypertrophy.
C.Kallmann syndrome: hypothalamic and partial pituitary dysfunction, decreased gonadotropin, decreased olfactory sensation, poor testicular development, and adolescent breast development.
D. Testicular inflammation, trauma and tumor: orchitis, traumatic testicular atrophy, can cause excessive androgen secretion, feedback caused by excessive gonadotropin, testicular seminoma, teratoma, choriomas , can produce chorionic gonadotropin (HCG), can cause male breast hypertrophy.
E. Reifenstein syndrome: Leptospiral interstitial cells are insufficiency in the fetal period, and there may be malformations such as breast development and hypospadias after birth.
2 adrenal diseases: such as adrenal hyperplasia, benign tumors, malignant tumors and dysfunction, this tumor can directly secrete estrogen or produce excessive estrogen precursors (such as androstenone), which is converted into effective in tissues. Estrogen, elevated blood estradiol, causes breast hypertrophy.
3 thyroid disease: such as hyperthyroidism, increased plasma concentration of sex hormone binding globulin, combined with androgen, free estradiol (unbound estradiol) increased, estrogen / testosterone ratio increased The imbalance of hormones causes stimulation of breast tissue hyperplasia, leading to male breast hypertrophy.
(2) Other non-endocrine diseases:
1 liver diseases: such as hepatitis, cirrhosis, liver cancer, etc., accompanied by liver dysfunction, often cause breast hypertrophy, ethanol cirrhosis, the body's estrogen is more increased, easy to cause breast hypertrophy, the reason is liver Decreased function, the ability to inactivate estrogen is weakened, the content of estrogen in the body is relatively increased, the bound steroidal globulin is elevated in the blood, and the free testosterone in the blood is further reduced, and the androstenedione in the microcirculation And the testosterone precursor transforms, producing a large amount of estrogen, so the concentration of estrogen in the blood is increased, acting on the breast tissue, causing hyperplasia of the breast and hypertrophy.
2 Chronic malnutrition recovery period: when dystrophy, gonadotropin secretion is reduced, when malnutrition is corrected, gonadotropin secretion and gonadal function return to normal, resulting in a side-effect second puberty phenomenon, breast hypertrophy, called "feeding Increased breast hypertrophy."
3 bronchial lung cancer and chronic lung diseases: such as oat-like cell carcinoma, tuberculosis, empyema, etc., often accompanied by testicular atrophy, or the secretion of ectopic hormones, leading to breast hypertrophy.
4 Chronic renal failure: patients with uremia caused by chronic renal failure, after testing, found that the blood estrogen is relatively elevated, prolactin concentration also increased, leading to breast development, hypertrophy.
5 nervous system diseases: such as paraplegia caused by high spinal cord disease, syringomyelia, hereditary movement disorders, may be associated with breast hypertrophy.
6 prostate hyperplasia or prostate cancer: patients with long-term use of estrogen for treatment, often cause male breast hypertrophy.
7 lymphatic system diseases: lymphoma, malignant histiocytoma, myeloma and other reticuloendothelial diseases, etc., also rarely seen track and field breast development.
8 drug-induced breast hypertrophy: gonadotropin, chlorpromazine, cimetidine (cimetidine), methyldopa, metoclopramide (gastric ampoules), metronidazole (metidazole), Isoniazid, risepine (reserpine), sleep and pass, griseofulvin, methadone, acetone, phenytoin, digitalis, vincristine, thyroid extract, etc., can bind to estrogen receptors, Causes the body's secretory dysfunction, can cause male breast development, but increased breasts can be restored after stopping the drug.
9 other diseases: such as cardiovascular disease (hypertension, heart disease), severe skin disease (leprosy, exfoliative dermatitis), autoimmune diseases (rheumatoid arthritis, rheumatoid arthritis), leptospirosis, ulcerative Colitis and the like can sometimes be associated with male breast development.
(two) pathogenesis
The pathological changes in male breast hypertrophy have the following characteristics:
General form
(1) Dispersed male breast hypertrophy patients, the affected breast can be sputum and the edge is neat, the boundary is clear, the mass does not adhere to the skin, the activity is good, the quality is hard.
(2) In patients with diffuse male breast hypertrophy, the margin of the mammary gland is unclear, and the diffuse hyperplasia of the breast tissue is fused with the surrounding tissue, and no limiting mass is formed.
The cut surface is grayish white and pinkish white translucent small particles, or occasionally small pores of pinhole size.
2. Histological morphology in the proliferating fibrous tissue, there are scattered mammary ducts, but no glandular lobular structure is formed, the ductal epithelium is multi-layered hyperplasia, papillary, dilated lumen with a little pink secretion, no gland The vesicular structure, loose fibrous tissue around the catheter, and a small amount of lymphocytes, plasma cell infiltration (Figure 1).
Prevention
Men's mammary gland development prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Male mammary gland developmental complications Complications Male breast cancer, men's breast development
This disease is generally uncomplicated.
Symptom
Men's mammary gland development symptoms Common symptoms Nipple discharge pain and visual impairment Breast hypertrophy
1. Symptoms and signs Male unilateral or bilateral mammary gland is female development, hyperplasia, hypertrophy, nipple, areola development, can be touched under the areola, the texture is hard and tough, the edge is clear diffuse mass, the diameter is more 2 ~ 3cm, there is a certain activity and no adhesion to the skin, a small number of patients have pain or mild tenderness, very few may also have nipple discharge, occasionally the hyperplasia of the breast is not in the center of the breast, but in a certain quadrant The quadrant is more common.
2. Clinical classification According to the hyperplasia, hypertrophy of the breast site and size, clinically divided into 3 types.
(1) diffuse type: hyperplastic mammary gland is diffuse, often in the form of a disk under the areola, does not form isolated nodules, accompanied by mild pain and tenderness is its characteristics, medium volume.
(2) adenoma type: the mass is isolated nodules, good activity without adhesion, clear surrounding, small volume, this type should be differentiated from male breast cancer.
(3) Female type: bilateral breasts are well-proportioned hypertrophy, no obvious nodules, squeezed nipples can have white milk-like nipple discharge, large volume, looks like puberty girls breasts.
Examine
Men's mammary gland development check
Laboratory inspection
1. Thyroid function test blood T3, T4, TSH.
2. Adrenal function tests ACTH, urinary 17-ketosteroids, 17-hydroxyprogesterone.
3. Liver function test to check liver function, 5 indicators of hepatitis B virus.
4. Renal function tests E2, T, PRL, LH, renal function, etc.
5. Pancreatic function blood sugar, blood insulin concentration.
6. Genetic examination of oral mucosal chromatin and chromosome, karyotype and other examinations.
7. Histopathological examination When the above examination can not confirm the diagnosis of primary lesions, it is feasible to use a fine needle to absorb cell examination or biopsy.
Film degree exam
1. X-ray examination of mammography The shape of the mammary gland is normal. Except for normal fatty fibrous tissue, hyperplastic glands can be seen. The posterior area of the areola is flocculent, fan-shaped or disc-like dense shadow, uniform density, and most gland edges are blurred. It can be seen that the brush is radiating around, and the edge of the gland that is distributed in a cluster can be clear.
2. Suspected hypothalamic-pituitary disease or tumor, X-ray cranial slices, saddle slices, CT scan of the head
3. Suspected adrenal diseases or tumors, feasible renal air angiography, adrenal CT, abdominal organs B-ultrasound and other tests.
4. Suspected thyroid, testicular dysfunction, feasible thyroid or testicular B-ultrasound.
Diagnosis
Diagnosis and diagnosis of male mammary gland development
Diagnostic criteria
History
Conduct a detailed medical history survey according to the systemic signs and diseases, focusing on family history, medication history, history of hepatitis contact, sexual function, etc., pay attention to whether there is headache, vomiting, visual impairment and other medical history.
2. Physical examination
The contents include: characteristics and signs of breast hypertrophy, body weight, body length, presence or absence of secondary sexual characteristics, penis size, testicular atrophy or mass, size, shape, activity, thyroid enlargement, presence or absence of nodules and tumors , liver size, texture and tenderness.
Auxiliary inspection.
Differential diagnosis
1. Male breast cancer unilateral male breast hypertrophy should be differentiated from male breast cancer. Breast cancer mass often deviates from the areola, hard and the boundary is unclear. It can be fixed with the skin or deep fascia, and there are many nipple depressions or deviations. There is swollen axillary lymph nodes.
2. False male breast hypertrophy Obese men often increase due to chest fat accumulation, which is similar to men's breast development syndrome. The biggest difference from true male breast hypertrophy is that the tissue is soft when the breast is percussed, and there is a kind of intrusion hole. In the sense of emptiness, the patient is often accompanied by hip fat deposition, and mammography can confirm the diagnosis.
3. Breast lipoma is generally located under the skin of the breast, mostly single hair, different shape, soft texture, clear boundary, surface often lobulated, slow growth, irrespective of menstrual changes, generally 3 ~ 5cm size, relatively rare.
4. Breast hemangioma is rare, mainly found in breast skin or subcutaneous, can be single or multiple hair, soft texture, can be sponge-like, slightly elastic, can be flattened, can draw hemorrhagic fluid, can be diagnosed.
5. Breast lymphangioma is a congenital benign tumor composed of lymphatic vessels and connective tissue. It is rare. The size of the tumor is different. The appearance can be lobulated, the texture is soft and cystic, the sense of fluctuation is unclear, and the boundary is unclear. A case report of a 3-year-old boy with a right breast hypertrophy, surgery and pathology confirmed as a right breast lymphangioma, the disease is positive for light transmission, puncture can be seen in pale yellow lymph, it is not difficult to identify.
6. According to the different causes of male breast development.
