Neurofibromata of the chest wall simulating prepubertal gynecomastia

Endocrine implications of neurofibromatosis 1 in childhood

In 1882, von Recklinghausen described a group of patients with multiple tumors arising from the 'endoneurium' of peripheral nerves, and called them 'neurofibromas'. The term von Recklinghausen disease was used up to the end of the 20th century, when the gene of neurofibromatosis (NF1) was cloned on chromosome 17q11.2. The gene product is a cytoplasmic protein termed neurofibromin, regulating proliferation and maturation of both glial and neuronal progenitors during embryogenesis. Loss of neurofibromin function determines the hyperactivation of the proto-oncogene RAS, leading to an increased risk of tumor formation, predominantly affecting the skin, bone and the nervous system. NF1 is clinically and genetically distinct from neurofibromatosis type 2, characterized by bilateral vestibular schwannomas and other nervous system tumors. An increased incidence of central precocious puberty, diencephalic syndrome, GH deficiency and GH hypersecretion has been described in NF1 children. These conditions are commonly complications of optic pathway gliomas (OPG) involving the hypothalamic and sellar region. Nevertheless, these endocrine disorders have been observed also in children without evidence of OPG at magnetic resonance imaging. Clinical and laboratory follow-up is crucial in all children with NF1, particularly in those with an OPG, aiming at the early identification of signs suggestive of secondary endocrine alterations.

Unilateral gynaecomastia in a 16-month-old boy with neurofibromatosis type 1 - case report and brief review of the literature

Neurofibromatosis type 1 (NF1) is an autosomal dominant disease that shows high penetrance with a wide variability in the phenotype. Prepubertal enlargement of the breast in male subjects affected by this condition is well known, but rarely reported. The present case report describes diagnosis and therapy of unilateral gynaecomastia in a toddler showing integumental stigmata of NF1. Furthermore, the report provides a brief review of the literature concerning this finding in NF1. According to this review, the present case appears to be one of the youngest NF1-affected males affected by gynaecomastia that has been reported.

Bilateral breast enlargement in a male toddler: an unusual cause

We report a case of a two and a half yr old boy who presented with complaint of bilateral asymmetrical breast enlargement since infancy. On examination, he had features of neurofibromatosis type 1 (NF1). Complete endocrinological evaluation was normal. Trucut biopsy of the breast revealed overgrowth of fibrocollagenous and adipose tissue without hyperplasia of breast parenchyma. Thus a diagnosis of NF1 with pseudogynecomastia was made.

Neurofibromatosis: a cause of prepubertal gynecomastia

BACKGROUND

Atypical presentations of gynecomastia not associated with obesity are often underappreciated. Unilateral manifestation, prepubertal onset, and a history of associated disorders may contribute to a unique clinical presentation for which the diagnosis and management may remain uncertain. This report reviews neurofibromatosis as a cause for atypical presentation of gynecomastia in prepubertal boys to help establish guidelines for diagnosis and management.

METHODS

Six nonobese male patients (body mass index <or=20) had an onset of gynecomastia at younger than 9 years and were referred for evaluation between June of 1994 and December of 2006.

RESULTS

The median age of onset of breast enlargement was 7(1/2) years (range, 4 to 8 years). Three had bilateral involvement, four had localized involvement of the nipple-areola complex, and two had diffusely involved breast tissue. Five of the six patients were African American (compared with 20 percent for classic gynecomastia). Median postoperative follow-up was 7 years, and all were followed beyond puberty. No recurrences were seen, although one patient developed a metachronous lesion in the contralateral breast. No patient had an abnormal endocrine metabolic workup.

CONCLUSIONS

Atypical gynecomastia may present in the prepubertal boy and appears more prevalent in African Americans. For neurofibromatosis, it is more likely unilateral, can be localized to the nipple-areola complex, or entails diffuse breast involvement. An endocrine workup appears to be noncontributory.

Pseudogynecomastia due to neurofibromatosis--a light microscopic and ultrastructural study

A six year old boy with bilateral breast enlargement was found to have a normal endocrine status. Resected tissue revealed the features of pseudogynecomastia due to a proliferation of fibrous tissue traversed by neuroid structures. Multinucleated giant cells were present within the fibrous tissue. Ultrastructural study revealed organized nerve elements in a collagenous stroma. The multinucleated giant cells appeared to be variants of the predominant stromal fibroblasts.