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Comparison of Ultrasound, Mammography and Histopathology Findings of the Cases with Gynecomastia

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Comparison of Ultrasound, Mammography and Histopathology Findings of the Cases with Gynecomastia International Journal of Research in Medical Sciences Ç eliker FB et al. Int J Res Med Sci. 2017 Nov;5(11):4708-4714 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174920 Original Research Article Comparison of ultrasound, mammography and histopathology findings of the cases with gynecomastia Fatma Beyazal Çeliker1*, Ercan Inci2, Nurten Sever3, Ahmet Tan Cimilli4, Arzu Turan1 1Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey 2Department of Radiology, 3Department of Pathology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey 4Department of Radiology, Bağcılar Training and Research Hospital, İstanbul, Turkey Received: 09 September 2017 Accepted: 06 October 2017 *Correspondence: Dr. Fatma Beyazal Çeliker, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Gynecomastia is the development of a fibroepithelial structure in the male breast as a result of many benign and malignant effects. In this study, after the confirmation of gynecomastia diagnosis in the male cases with swelling, mass and tenderness in the breast using ultrasound and mammography examinations, its etiology was clarified by laboratory tests. In case of suspicion, the diagnosis was confirmed using Fine-Needle Aspiration Biopsy (FNAB). The adequacy of ultrasound and mammography was discussed with the obtained information and the information in the literature, and the etiological and radiological classification was done. Methods: Ultrasound and mammography examinations were performed on 74 male patients with growth, palpable masses or pain in the breast. Biochemistry and hormone analysis were performed with imaging methods in the cases of possible gynecomastia. Biopsy was performed on the cases with the suspicion. Results: Gynecomastia were divided into three types in ultrasonic and mammographic examination. The most frequent gynecomastia was observed as Type 3 (51.43%) in ultrasonic examination and as diffuse type (61.42%) in mammographic examination. Pain and tenderness accompanied with swelling at the breast were present in 37.84% of the cases. 31.42% had pubertal gynecomastia, 25.71% had gynecomastia secondary to drug use, and 15% had idiopathic gynecomastia. Conclusions: Combined use of ultrasound and mammography in the diagnosis and classification of gynecomastia is highly sufficient and biopsy should be performed if malignancy is suspected. Keywords: Gynecomastia, Mammography, Ultrasound INTRODUCTION than gynecomastia, can be classified as breast cancer, lipoma, fat necrosis, lymph nodes, inclusion cyst, Gynecomastia was first described by Basedow in 1848; subcutaneous leiomyoma and sub areolar abscess. and can be defined as the development of fibroepithelial structures in the male breast with the influence of various While the diagnosis of these lesions is partly possible factors. Gynecomastia affects ductal structures and the with the clinical examination, combined use of ultrasound stroma, and lobules are rarely found.1 Gynecomastia is a and mammography in the differential diagnosis provides symptom rather than a disease, and may develop as a high diagnostic accuracy. In this study, we made the result of physiological changes, diseases, tumors and diagnosis and classification and also etiologic some medications. However, the main mechanism is the classification of gynecomastia. increased estrogen stimulation. Male breast lesions other International Journal of Research in Medical Sciences | November 2017 | Vol 5 | Issue 11 Page 4708 Çeliker FB et al. Int J Res Med Sci. 2017 Nov;5(11):4708-4714 METHODS analyzed by SPSS (Statistical Package for Social Sciences), version 10.0 for Windows (IBM/SPSS Inc. Seventy-four male patients aged between 10-94 years Chicago/IL, USA). Ki-square and ANOVA were used for (40.9+/-22), who were clinically diagnosed with growth, the comparison of the data and p<0.05 was accepted mass and/or tenderness in breast, were included in the significance. study. Ultrasound (US) and mammography examinations were performed in all cases. The mammograms were This study has been approved by the Ethics Committee of taken in the mediolateral oblique (MLO) position. Dr. Sadi Konuk Training and Research Hospital and Ultrasound and mammography were evaluated by two informed consents of the patients were obtained from different radiologists. their parents or legal representatives. According to their ultrasonic appearance, the RESULTS gynecomastia was divided into three types as hypoechoic area in retro areolar region (Type 1), hypoechoic area Symptoms were often in the form of breast tenderness, surrounded by hyperechoic zone (Type 2), mixed echo breast enlargement or mass. Pain or tenderness pattern with hyperechoic-hypoechoic areas (Type 3) at accompanied breast enlargement in 28 patients. On different ratios. Mammographic appearances were ultrasonic examination, 20 cases (28.57%) were classified as dendritic, nodular, and diffuse. Liver, evaluated as Type 1, 14 cases (20.00%) as Type 2, and 36 kidney, thyroid function tests, estrogen, testosterone, cases (51.43%) as Type 3. On mammographic prolactin, FSH, LH, TSH hormone analysis were examination, 8 cases (11.43%) were evaluated as performed for the etiology on the cases with the dentritic, 16 cases (22.86%) as nodular and 43 cases suspected gynecomastia. Drug use history, presence of (61.42%) as diffuse type (Figure 1-5). On mammographic congenital or chronic illness, exposure to major trauma examination of 3 cases (4.29%), suspicious density and radiation, and eating habits were questioned. enhancement for gynecomastia in retro areolar area was observed and gynecomastia diagnosis was confirmed in According to the results of the laboratory tests, further these cases by with fine needle aspiration biopsy. tests such as testis and abdomen ultrasound, thorax CT Although clinically unilateral breast enlargement was and cranial MR were added. Findings that could lead to present in 5 cases (7.14%), bilateral gynecomastia was gynecomastia were researched. Fine-Needle Aspiration detected on mammographic examination. Not to be able Biopsy (FNAB) was made to the suspected cases. to clinically be detected was attributed to gynecomastia Gynecomastia was classified as radiological and etiologic being asymmetric and fresh onset in the other breast. under the light of the obtained data. The data were Table 1a: LH, FSH, prolactin levels between age groups; there is no statistically significant difference. p>0.05. Age group <=25 26-50 51 and over N % N % N % Χ2 P LH 1 26 92.9 15 100.0 28 90.3 2 1 3.6 3 9.7 3 1 3.6 - - FSH 1 28 100.0 15 100.0 28 90.3 2 3 9.7 4.33 0.114 Prolactin 1 28 100.0 15 100.0 31 100.0 - - In 10 (14.28%) cases, clinically bilateral asymmetric were clinically and radiologically symmetric. Symmetric gynecomastia was present and there was pain and gynecomastia was classified as 9 (12.85%) diffuse, 4 tenderness in the bigger breast. Although there were (5.71%) nodular and 5 (7.14%) dendritic types. Fine- suspicious findings for gynecomastia in 1 case (1.35%) needle aspiration biopsy accompanied by ultrasound was with painful breast enlargement and 3 cases with painless performed on 15 patients suspected to be hypoechoic on breast enlargement (4.05%) on ultrasonic examination, a sonographic examination and diffuse type on homogenous radiolucent area compatible with mammographic examination, and surgical resection was adipomastia (increase in fibrous tissue-free fatty tissue) performed on 6 cases. was observed on mammography. 18 patients (25.72%) International Journal of Research in Medical Sciences | November 2017 | Vol 5 | Issue 11 Page 4709 Çeliker FB et al. Int J Res Med Sci. 2017 Nov;5(11):4708-4714 Table 1b: TSH, estradiol and testosterone levels between age groups; there is no statistically significant difference. p>0.05. Age group <=25 26-50 51 and over N % N % N % Χ2 P TSH 1 28 100.0 15 100.0 31 100.0 - - Estradiol 1 25 89.3 13 86.7 27 87.1 2 3 10.7 2 13.3 4 12.9 0.09 0.956 Testosterone 1 26 92.9 15 100.0 30 96.8 3 2 7.1 1 3.2 1.37 0.503 Table 1c: Diabetes between age groups; there is no statistically significant difference. p>0.05. Age group <=25 26-50 51 and over N % N % N % Χ2 P Diabetes mellitus Type 2 diabetes 1 3.2 Normal 28 100.0 15 100.0 30 96.8 1.40 0.495 Table 1d: Lung tumors between age groups; there is no statistically significant difference. p>0.05. Age group <=25 26-50 51 and over N % N % N % Χ2 P Lung tumor With lung tumor 4 12,9 No lung tumor 28 100,0 15 100,0 27 87,1 5,86 0,053 Table 2a: Right and left side ultrasonography findings between age groups; there is no statistically significant difference. p>0.05. <=25 26-50 51 And Over Ultrasonography Average SS Average SS Average SS P Right 29.21 10.20 28.33 14.86 28.45 10.65 0.958 Left 29.50 12.06 31.33 16.24 28.77 10.13 0.803 Table 2b: Right and left side mammography findings between age groups; there is no statistically significant differences. p>0.05. <=25 26-50 51 and over Mammography Average SS Average SS Average SS P Right 26.36 8.38 26.33 9.90 24.55 8.77 0.691 Left 25.54 9.09 28.67 12.34 27.16 8.51 0.581 Table 3: Mammography density findings between age groups; there is no statistically significant difference. p>0.05. <=25 26-50 51 And Over Mammography Average SS Average SS Average SS P density Right 29.93 11.00 35.00 12.98 32.29 12.31 0.412 Left 31.29 11.84 32.00 14.14 31.61 9.79 0.981 International Journal of Research in Medical Sciences | November 2017 | Vol 5 | Issue 11 Page 4710 Çeliker FB et al.
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