Bock E, Bock C, Campioni P, Goletti S, Pastore G, Romani M
Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma.
Radiol Med. 1998 Jan-Feb;95(1-2):44-8.
Gynecomasty is usually classified as normal of abnormal, except for 25% of cases which are classified as idiopathic because their causes and pathogenesis remain unknown. Gynecomasty is diagnosed mainly on clinical grounds, while integrated imaging, sometimes combined with cytology, is used to distinguish benign from malignant forms. Bilateral gynecomasty is easy to diagnose, especially when patients report assuming particular drugs or present other risk factors, but unilateral or asymmetrical gynecomasty is a diagnostic problem. Primary male breast cancer usually presents as a unilateral hard mass, often infiltrating the dermis and with early lymph node metastases; it is associated with gynecomasty in 20% of cases.
We examined 76 men (age range, 15-75 years) referred for breast enlargement; the patients with radiologic findings of breast adiposis were not included in our series. All patients were submitted to standard projection mammography with a high resolution dedicated film and to real time US with high frequency probes (7.5-12 MHz).
Breast enlargement was unilateral in 48% of cases and bilateral in 52%. The radiologic patterns, compared with histologic or clinical-therapeutic follow-up, permitted the correct diagnosis in 72 of 76 patients (94%). The extant four patients had chronic inflammation (3 cases) and a malignant tumor with questionable imaging features. Overall imaging findings were: 55 cases (72%) of actual gynecomasty--unilateral in 17 and bilateral in 38 cases--9 unilateral malignant tumors (12%), eleven cases of inflammation (14%) and 1 case (2%) of unilateral metastasis from plasmocytoma. Sixteen (29%) actual gynecomasty patients (21% of the whole series) had a nodular form (unilateral in 6 and bilateral in 10 cases), 23 (42% and 30% of the whole series) had a dendritic form (unilateral in 7 and bilateral in 16 cases) and 16 (29%, 21% of the whole series) had a glandular form.
Diagnosing gynecomasty is relatively easy in the patients with bilateral forms with a positive history of associated exogenous or endogenous factors, while focal unilateral or asymmetrical forms are difficult to distinguish into benign and malignant. The radiologic pattern may be questionable especially in chronic inflammation and in some malignant forms and must therefore be integrated with cytologic or surgical findings.
男性乳房肥大通常分为生理性或病理性，除25%的病例病因和发病机制不明而归为特发性。男性乳房肥大主要依靠临床诊断，有时结合影像学及细胞学检查来鉴别良恶性。双侧男性乳房肥大易于诊断，尤其是当患者有特定药物服用史或其他危险因素时，但单侧或不对称性男性乳房肥大则是一个诊断难题。原发性男性乳腺癌通常表现为单侧硬块，常侵犯真皮并早期出现淋巴结转移；20%的病例伴有男性乳房肥大。
我们检查了76例因乳房增大前来就诊的男性患者（年龄范围15 - 75岁）；乳房脂肪沉积的放射学表现患者未纳入本研究系列。所有患者均接受了高分辨率专用胶片的标准投照乳腺摄影及高频探头（7.5 - 12MHz）实时超声检查。
48%的病例乳房增大为单侧性，52%为双侧性。与组织学或临床治疗随访结果相比，放射学表现使76例患者中的72例（94%）得到了正确诊断。其余4例患者有慢性炎症（3例）和1例影像学特征可疑的恶性肿瘤。总体影像学表现为：55例（72%）为真性男性乳房肥大——单侧17例，双侧38例；9例单侧恶性肿瘤（12%）；11例炎症（14%）；1例单侧浆细胞瘤转移（2%）。16例（29%）真性男性乳房肥大患者（占整个系列的21%）呈结节状（单侧6例，双侧10例），23例（占整个系列的42%和30%）呈树枝状（单侧7例，双侧16例），16例（占整个系列的29%，21%）呈腺体型。
双侧性男性乳房肥大且有相关外源性或内源性因素阳性病史的患者，诊断相对容易，而局灶性单侧或不对称性乳房肥大难以鉴别良恶性。放射学表现可能存在疑问，尤其是在慢性炎症和某些恶性病变中，因此必须结合细胞学或手术结果进行综合判断。
