Benign+Gynecomastia

Gynecomastia results in patients that are receiving estrogen or flutamide treatments. 1 These patients have a likelihood of developing gynecomastia at a rate of 90% compared to those patients that just have an orchiectomy. 1 As a result, these patients begin to develop breast tissue as most females would. This can be avoided if the patient decides to undergo treatment prior to receiving estrogen therapy. 1 || The cause of gynecomastia is due to a hormone imbalance. This imbalance is due to a lack of testosterone and an increase in estrogen. 2 In infants, this may be due to the amount of estrogen they receive from their mothers. 2 This usually subsides within a few weeks after birth. In adolescents, this is due to the hormonal and chemical changes that take place within the male's body throughout puberty. 2 This will also subside in roughly 6 months to two years. 2 In Adulthood, this will affect 1 in 4 men from the ages of 50 to 80 years old. 2 This is due to the lack of testosterone in the body during this time period. Another cause of gynecomastia is due to steroid use which of produces testosterone and then leaves a depletion after the individual stops using the drug. || Gynecomastia is a benign condition in males that causes the breast tissue to swell. Signs and symptoms include swollen or tender breast tissue bilaterally or unilaterally. 3 These signs usually raise concern for male breast cancer. In addition, the diameter of the areola may increase or grow asymmetrically. 3 Changes in any breast tissue can be attributed to this condition and is the most obvious sign. The image below indicates swollen breast tissue and bilaterally enlarged areola tissue.
 * **Epidemiolgy:** || Brandon
 * **Etiology:** || Brandon
 * **Signs & Symptoms:** || Ashley

|| To diagnose the condition, an ultrasound is performed to exclude breast cancer, lipoma, sebaceous cyst, dermoid cyst, hematoma, metastasis, ductal ectasia, fat necrosis and other conditions that may appear with similar signs and symptoms. 3 Usually the ultrasound will successfully diagnose gynecomastia. If necessary, a fine needle aspiration may be conducted to pathologically identify the condition. 3 || *Histology is independent of cause. 4 Early phase: 4 - Intraductal epithelial proliferation - Periductal stroma typically edematous Late phase: 4 - Less epithelial proliferation - Periductal fibrosis
 * **Diagnostic Procedures:** || Ashley
 * **Histology:** || Amanuel
 * Both epithelial or myepithelial
 * May be micropapillary or cribriform
 * May show squamous metaplasia
 * May be atypical

Lobule formation is infrequently seen || <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Lymphatic drainage of male breast is similar to that of the female breast. It includes axillary, internal mammary, and supraclavicular/infraclavicular nodes. <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif; vertical-align: super;">5 || Since gynecomastia is a benign condition, there is no metastasis as there is in malignant tumors. 6 || The American Society of Plastic Surgeons has adopted the following grading system: 7
 * **Lymph node drainage:** || <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Amanuel
 * **Metastatic spread:** || Lindsey
 * **Grading:** || Lindsey

Grade 1: Small breast enlargement with localized increase in tissue around the areola Grade 2: Moderate breast enlargement exceeding areola boundaries with no skin excess Grade 3: Moderate breast enlargement exceeding areola boundaries with minor skin excess Grade 4: Marked breast enlargement with significant skin excess and feminization of the breast || Staging describes the extent or severity of the tumor and spread. This included the primary tumor site, size, nodal involvement, cell grade, and metastasis. Benign lesions are not cancerous and no staging is available. 8 || Skin may temporarily become red, dry, itchy, and scaly after treatment. Overall, radiation treatments for gynecomastia, are well tolerated. 9 || This is a benign condition, it is not physically harmful but in some cases it may be an indicator of other more serious underlying conditions. 10 || Treatment modalities include orthorvoltage irradiation, 9 to 12 MeV electrons, 60Co, or 4 MV photons using tangential fields. A single dose of 9 Gy or 4 to 5 Gy daily for three treatments is effective in controlling gynecomastia. Patients that are treated after estrogen therapy, 20 Gy in 5 fractions is recommended. Radiation is less effective if given after estrogens have been started. 11 || In the case of gynecomastia, the TD 5/5 is not used. ||
 * **Staging:** || Kevin
 * **Radiation side effects:** || Kevin
 * **Prognosis:** || Jenn
 * **Treatments:** || Jenn
 * **TD 5/5:** || Rachel
 * **References:** || # Chao K, Perez C, Brady L. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott William & Wilkins; 2002: 685.
 * 1) Gynecomastia (enlarged breasts in men). Mayo Clinic. Web site. []. Accessed July 9, 2013.
 * 2) Gynecomastia. Wikipedia Web site. [|http://en.wikipedia.org/wiki/Gynecomastia#Signs_and_symptoms]. Updated June 21, 2013. Accessed July 3, 2013.
 * 3) <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Gynecomastia. Stanford school of medicine. []. Accessed July 8, 2013.
 * 4) <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Breast cancer in male. American cancer society. http://www.cancer.org/cancer/breastcancerinmen/detailedguide/breast-cancer-in-men-what-is-breast-cancer-in-men. Accessed July8, 2013.
 * 5) Understanding cancer series. National Cancer Institute Web Site. []. Accessed on July 9, 2013.
 * 6) Gynecomastia grading system. http://drdadvandplasticsurgery.com/blog/gynecomastia-grading-system/. Accessed on July 10, 2013.
 * 7) Cancer staging/ grading. Available at: []. Accessed on July 10, 2013.
 * 8) Radiotherapy for prevention and therapy of gynecomastia. Available at: [|http://www.ncbi.nlm.nih.gov]. Accessed on July 10, 2013.
 * 9) Gynecomastia. Wikipedia, the free encyclopedia. Available at: [] . Accessed on July 12, 2013.
 * 10) Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd . Philadelphia, PA: Lippincott, Williams & Wilkins; 2011: 789. ||

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