Gynecomastia is the enlargement of male breast tissue due to an imbalance between estrogen and androgen levels. During puberty, fluctuations in testosterone levels can allow estrogen levels to stimulate breast growth. Later in life, gynecomastia may be caused by testicular tumors, hormone-secreting cancers, lung cancer, alcohol or drug use like marijuana or anabolic steroids. On examination, gynecomastia typically appears as a button-like or oval mass under the nipple that is usually unilateral for idiopathic or drug-induced cases and bilateral for pubertal or hormonal causes. In rare cases, extreme epithelial hyperplasia within the breast ducts can

1. Gynecomastia
Dr. Naila Awal

2. Definition
• Enlargement of male breast
due to
hypertrophy & hyperplasia of
both
glandular & stromal component.

3. Pathogenesis
Estrogen
Activity (stimulate
breast tissue)
Androgen
activity
(counteracts that effect)
Fig- Imbalance b/w estrogen & androgen

4. Cause
• <25years of age- Hormonal pubertal change .
( During puberty, testosterone level varies. When
testosterone levels are very low, higher levels of
estrogen will affect the breast tissue, causing the breasts
to grow larger )

5. • Later age-
Testicular tumor-Leydig cell tumor, Sertoli cell tumor
hCG secreting germ cell tumor
Lung carcinoma
Drugs- Alcohol Marijuana Heroine
Anabolic steroid
Hormonal- Klinefelter syndrome
Idiopathic

6. Morphology
Site- Usualy unilateral (Idiopathic & Drug medication)
Bilateral –Pubertal & hormonal induced.
Gross-
Button like subareolar mass. (Carcinoma- ecentricaly)
Oval, Disc shaped, well circumscribed.
M/E-
Micropapillary epithelial hyperplasia of duct
Dense collagenous connective tissue
Long duration- Prominent stromal fibrosis.

7. Gynecomastia

8. Outcome
• In rare case,
If intraductal epithelial hyperplasia is too extreme
Stimulate carcinoma