Pediatric Endocrinology and Diabetes Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura University Children's Hospital, Gomhoria Street, Mansoura, Dakahlia, 35516, Egypt.
Department of Pediatric Surgery, Faculty of Medicine, Mansoura University, Mansoura University Children's Hospital, Mansoura, Egypt.
Eur J Pediatr. 2021 Mar;180(3):977-982. doi: 10.1007/s00431-020-03799-x. Epub 2020 Sep 25.
Although pubertal gynecomastia is a common clinical presentation of adolescent males, prepubertal gynecomastia is uncommon and mostly idiopathic. However, pathological causes of prepubescent gynecomastia are encountered in clinical practice. This manuscript carries an important message to general pediatricians, to care about exclusion of pathological causes for every patient of prepubertal gynecomastia. We present four different patients with pathological gynecomastia. One of them revealed to be secondary to Sertoli cell tumor, while the second patient describes trauma as a rare cause of prepubertal true gynecomastia. To the best of our knowledge, this is the first time to report occupational trauma as a cause of true gynecomastia as confirmed by pathological specimen, in a prepubertal boy. The third patient presented with retro-areolar mass and bloody nipple discharge secondary to mammary duct ectasia and had favorable self-limited course. Hyperprolactinemia secondary to neglected congenital hypothyroidism was the cause beyond gynecomastia in the fourth patient and this cause has been reported only once in the literature.Conclusion: Despite being rare, pathological causes of prepubertal gynecomastia are encountered in clinical practice, and full investigations including breast and testicular ultrasound are needed to exclude any pathology before diagnosing idiopathic gynecomastia. Repeated friction of the breast can lead to true gynecomastia not only to pseudogynecomastia as previously known. What is Known: • It has been reported that trauma can cause pseudogynecomastia due to hematoma or fat necrosis. • Prepubertal gynecomastia is mostly idiopathic. What is New: • Long-term breast trauma can cause true gynecomastia (adenosis). • Although being mostly idiopathic, pathological causes of prepubertal gynecomastia must be ruled out.
虽然青春期男性的乳腺发育是一种常见的临床表现，但青春期前的乳腺发育并不常见，且大多为特发性的。然而，临床上也会遇到病理性原因导致的青春期前乳腺发育。本文向普通儿科医生传达了一个重要信息，即应关注每一位青春期前乳腺发育患者，排除病理性病因。我们介绍了 4 位不同的病理性乳腺发育患者。其中 1 位患者的病因是支持细胞肿瘤，第 2 位患者描述了创伤是导致青春期前真性乳腺发育的罕见病因。据我们所知，这是首次报道职业性创伤是经病理证实的青春期前真性乳腺发育的病因，在一位青春期前男孩中。第 3 位患者因乳腺导管扩张出现乳晕后肿块和血性乳头溢液，病情呈自限性。第 4 位患者因未治疗的先天性甲状腺功能减退导致高催乳素血症，除乳腺发育外还存在其他症状，该病因仅在文献中报道过 1 次。结论：尽管罕见，但病理性原因导致的青春期前乳腺发育在临床上也会遇到，在诊断特发性乳腺发育之前，需要进行全面的检查，包括乳房和睾丸超声，以排除任何病变。反复摩擦乳房不仅会导致假性乳腺发育，还会导致真性乳腺发育，这与之前的认知不同。已知：• 据报道，创伤可因血肿或脂肪坏死导致假性乳腺发育。• 青春期前乳腺发育大多为特发性的。新发现：• 长期乳房创伤可导致真性乳腺发育（腺病）。• 尽管大多为特发性的，但必须排除青春期前乳腺发育的病理性病因。
