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Furtado C, Stankiewicz A, Klcova J, Khan M, Bajwa S, Isa ZM. Is Breast Imaging in Male Patients With Benign Lumps Necessary? A Retrospective Study to Assess Concordance Between Clinical Diagnosis and Imaging Findings. Eur J Breast Health 2023; 19:304-310. [PMID: 37795006 PMCID: PMC10546800 DOI: 10.4274/ejbh.galenos.2023.2023-5-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/13/2023] [Indexed: 10/06/2023]
Abstract
Objective Breast imaging for male patients is a controversial topic due to the high prevalence of gynecomastia compared to male breast cancer. Worldwide, men are undergoing more breast imaging despite the low incidence of male breast cancer. Gynecomastia is a benign condition, but the anxiety it causes and unnecessary medical costs are still high. Materials and Methods In accordance with Royal College of Radiology guidelines, a retrospective study was performed in two cycles to determine if mammography or ultrasound should be included in the workup of male patients who were referred to a breast care unit for a lump that was deemed benign by doctors. Results There was 100% concordance between clinical diagnosis and imaging findings. Conclusion In this population imaging was not necessary in cases of probable gynecomastia and benign conditions found during a clinical assessment. Standardised patient assessment methods can improve care and ensure accurate evaluation.
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Affiliation(s)
- Cleofina Furtado
- Department of Diagnostic and Interventional Radiology, University Hospitals of North Midlands, Stafford, United Kingdom
| | - Aleksandra Stankiewicz
- Department of Diagnostic and Interventional Radiology, University Hospitals of North Midlands, Stafford, United Kingdom
| | - Jana Klcova
- Department of Diagnostic and Interventional Radiology, University Hospitals of North Midlands, Stafford, United Kingdom
| | - Mahrukh Khan
- Department of Diagnostic and Interventional Radiology, University Hospitals of North Midlands, Stafford, United Kingdom
| | - Saba Bajwa
- Department of Diagnostic and Interventional Radiology, University Hospitals of North Midlands, Stafford, United Kingdom
| | - Zatinahhayu Mohd Isa
- Department of Imaging, Mid Cheshire NHS Foundation Trust, Cheshire, United Kingdom
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Wu C, Jia QN, Fang K, Zeng YP. Skin diseases of the nipple and areola complex: A case series study from China. Front Med (Lausanne) 2023; 10:1136482. [PMID: 37056737 PMCID: PMC10086167 DOI: 10.3389/fmed.2023.1136482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundSkin diseases of the nipple and areola complex (NAC) are numerous and difficult to diagnose, which is a great challenge for clinicians. A better understanding of the clinical features of NAC skin diseases is of great value for the correct diagnosis.MethodsTo investigate the clinical characteristics of skin diseases of the NAC, we retrospectively analyzed the demographic data, disease constitution, rash characteristics, inconsistency between the clinical and pathological diagnosis from 260 patients with NAC lesions that were confirmed by histopathology at Peking Union Medical College Hospital, China from 2012 to 2022.ResultsThe patients’ average age was 43.6 (8 to 82) years, and the ratio of females to males was 13.4:1. Out of the 260 patients biopsied, the most common diseases were eczema, Paget’s disease (PD), adenoma of the nipple (AN), seborrheic keratosis (SK), cutaneous metastasis of breast cancer, wart, soft fibroma, and hyperkeratosis of the nipple and areola. There were 77 (29.6%) patients with inconsistency between the clinical impressions and pathological diagnoses. AN was the most clinically misdiagnosed condition, most commonly presumed to be PD or eczema.ConclusionEczema and PD are the most common biopsied NAC skin diseases. Late onset, unilateral involvement, and predilection for the nipple are several characteristics of PD, which are different from eczema. NAC skin diseases are easily misdiagnosed clinically, especially AN.
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Assessment of male patients' average glandular dose during mammography procedure. Appl Radiat Isot 2023; 193:110626. [PMID: 36640699 DOI: 10.1016/j.apradiso.2022.110626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
Breast cancer is a common malignancy for females (25% of female cancers) and also has low incidence in males. It was estimated that 1% of all breast malignancies occur in males with mortality rate about 20%, with annual increase in incidence. Risk factors include age, family history, exposure to ionizing radiation and high estrogen and low of androgens hormones level. Diagnosis and screening are challenging due to limiting effectiveness of breast cancer screening. Therefore, patients may expose to ionizing radiation that may contribute in breast cancer incidence in males. In literature, limited studies were published regarding radiation exposure for males during mammography. The objective of this research is to quantify patient doses during male mammogram and to estimate the projected radiogenic risk during the procedure. In total, 42 male patients were undergone mammogram for breast cancer diagnosis during two consecutive years. The mean and range of patient age (years) is 45 (23-80). The mean and standard deviation (SD) of the peak tube potential and tube current time product are 28.64 ± 2. and 149 ± 35.1, respectively. The mean, and range of patients' entrance surface air kerma (ESAK, mGy) per single breast procedure was 5.3 (0.47-27.5). Male patient's received comparable radiation dose per mammogram compared to female procedures. With increasing incidence of male breast cancer, proper guidelines are necessary for the mammographic procedure are necessary to reduce unnecessary radiation doses and radiogenic risk.
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Jung HK, Lim YJ. Sonographic Features of Palpable Breast and Axillary Lesions in Adult Male Patients: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:830-845. [PMID: 36238906 PMCID: PMC9514573 DOI: 10.3348/jksr.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 11/15/2022]
Abstract
The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast cancer, male breast cancer has a low incidence, and there is no established breast cancer screening program for male patients. Therefore, the diagnostic evaluation is usually performed in male patients with symptoms such as palpability or pain in the breasts. Furthermore, most adult male patients who visit breast clinics sometimes present with not only breast symptoms but also axillary symptoms, and both the breast and axilla are usually examined during breast ultrasonography in daily clinical practice. The purpose of this pictorial essay was to present the sonographic features of various palpable breast and axillary lesions in adult male patients.
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Salemis NS. Benign cyst of the male breast. An exceedingly rare entity that may pose a diagnostic dilemma. Management and literature review. Breast Dis 2021; 40:207-211. [PMID: 33749635 DOI: 10.3233/bd-201064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cysts represent the most common cause of a breast mass in women. On the contrary, in men, the presence of a benign apocrine cyst is an exceedingly rare occurrence, with only a few cases reported in the literature. We describe herein a case of benign apocrine breast cyst without concurrent gynecomastia in a 41-year-old male. Diagnostic evaluation and management are discussed, along with a review of the literature. Given the extreme rarity of benign breast cysts in males, a thorough investigation is essential in male patients presenting with cystic breast lesions. Diagnostic breast imaging may be challenging. Surgical resection of the cyst should be considered in the presence of atypical imaging features to exclude underlying malignancy.
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Affiliation(s)
- Nikolaos S Salemis
- Breast Cancer Surgery Unit, Army General Hospital, Athens, Greece.,IASO Women's Hospital, Athens, Greece.,IASO Thessalias Hospital, Larissa, Greece
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Sinai Khandeparkar SG, Bharti N, Saragade P, Pathade S, Gogate B. CD10 positive benign stromal spindle cell tumor (not otherwise specified) of the male breast. INDIAN J PATHOL MICR 2021; 63:670-672. [PMID: 33154337 DOI: 10.4103/ijpm.ijpm_303_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Neha Bharti
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Pradnya Saragade
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Smita Pathade
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Bageshri Gogate
- Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Xia Q, Cheng Y, Hu J, Huang J, Yu Y, Xie H, Wang J. Differential diagnosis of breast cancer assisted by S-Detect artificial intelligence system. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:3680-3689. [PMID: 34198406 DOI: 10.3934/mbe.2021184] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective Traditional breast ultrasound relies too much on the operation skills of diagnostic doctors, and the repeatability in different doctors was low. This study aimed to evaluate the assistant diagnostic value of S-Detect artificial intelligence (AI) system in differentiating benign from malignant breast masses. Methods The ultrasound images of 40 patients who underwent ultrasound examination in our hospital were collected. The conventional ultrasound images, elastic images, and S-Detect mode of breast lesions were analyzed. The breast imaging reporting and data system recommended by the American Society of Radiology (BI-RADS) classification for each breast mass was evaluated both by the doctor and AI. The receiver operator characteristics (ROC) curves were drawn to compare the diagnostic efficiency. Result Among the 40 lesions, 16 were benign, and 24 were malignant. The S-Detect AI system had a high diagnostic efficiency for malignant mass, with sensitivity, specificity, and accuracy of 95.8%, 93.8%, and 89.6%. The accuracy of AI was higher than the elastic image and then than the conventional gray-scale image. With the assistance of the S-Detect AI system, the accuracy of BI-RADS classification was improved significantly. Conclusion The S-Detect AI system will enhance breast cancer diagnostic accuracy and improve ultrasound examination quality.
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Affiliation(s)
- Qun Xia
- Department of Ultrasound, Anqing First People's Hospital Affiliated to Anhui Medical University, Anhui 246004, China
| | - Yangmei Cheng
- Department of Ultrasound, Anqing First People's Hospital Affiliated to Anhui Medical University, Anhui 246004, China
| | - Jinhua Hu
- Department of Ultrasound, Anqing First People's Hospital Affiliated to Anhui Medical University, Anhui 246004, China
| | - Juxia Huang
- Department of Ultrasound, Anqing First People's Hospital Affiliated to Anhui Medical University, Anhui 246004, China
| | - Yi Yu
- Department of Ultrasound, Anqing First People's Hospital Affiliated to Anhui Medical University, Anhui 246004, China
| | - Hongjuan Xie
- Department of Ultrasound, Anqing First People's Hospital Affiliated to Anhui Medical University, Anhui 246004, China
| | - Jun Wang
- Department of Ultrasound, Anqing First People's Hospital Affiliated to Anhui Medical University, Anhui 246004, China
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Male Breast Cancer in Togo: Imaging and Clinicopathological Findings. Int J Breast Cancer 2020; 2020:3056067. [PMID: 32934847 PMCID: PMC7479472 DOI: 10.1155/2020/3056067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Breast cancer in men is a rare condition, often diagnosed late. The purpose of this study was to describe its epidemiological, histopathological, and radiographic aspects in Togo. Materials and Methods This was a descriptive retrospective study on cases of breast cancer in humans diagnosed histologically at the Laboratory of Anatomy Pathological and Imagery of the University Hospital in Lomé, over a period of 25 years (1995 to 2019). The parameters studied were epidemiological, anatomopathological, and imaging. Results Eighty-two (82) cases were diagnosed, an annual frequency of 3.28 cases. The mean age was 45 ± 2.5 years; the range was 27-63 years. The family history of 47 patients (57.32%) was known. Carcinomas represented the predominant histological group with predominantly nonspecific invasive carcinoma (87.5%). These cancers were diagnosed at late stages (75.71% grade II). They were mainly of luminal B profile (38.75%) and associated with mutations of the BRCA2 and BRCA1 genes in 14.63% of the cases. The lesions were classified ACR 5 in 61.5% (11/18). Two cases of breast angiosarcoma were diagnosed by the identification of CD31 markers and factor VIII in immunohistochemistry. Hormone therapy such as tamoxifen was prescribed in all luminal patients (43 patients). Radiotherapy was administered to 15 patients (18.3%), with acute toxicity in 20% of the cases. After a median follow-up of 36 months, the evolution was complete remission in 27 patients (32.93%). Conclusion Breast cancer in men is rare, often diagnosed late with a poor prognosis.
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Male Breast Cancer with Radiological and Histopathological Findings. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:375-379. [PMID: 33312039 PMCID: PMC7729722 DOI: 10.14744/semb.2020.01643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/21/2020] [Indexed: 01/21/2023]
Abstract
Objectives We aimed to remind and emphasize the importance of male breast cancer with radiological and histopathological results of the patients diagnosed in our institution. Methods Men who had proven breast cancer by histopathological analysis between February 2010-April 2018 were reviewed retrospectively. The mammographic, ultrasonographic, magnetic resonance and positron-emission-tomography imaging features and histopathological results of the masses were noted. Results Twenty-five men were included in this study. Mean age of the patients was 62.9 (min:42; max: 82) with a mean size of lesions was 26.4 mm (min:10 mm; max: 70 mm). All the lesions were presented as a palpable mass. According to imaging features of the five patients who had mammography, all the four patients were presented as a mass but one patient as asymmetrical density. According to imaging features of the 20 patients who had an ultrasound, 16 (80%) lesions were presented as hypoechoic solid masses with irregular margins, while four (20%) were presented as complex-cystic masses with irregular margins. All the patients were diagnosed as invasive ductal cancer with luminal subtype by histopathological analysis. Conclusion Even at young ages, the palpable lesion may be the only symptom of male breast cancer. Male breast cancer is generally presented as retroareolar mass and detected in advanced stages, probably due to low awareness and lack of screening programme. Invasive ductal cancer is the most common type of male breast cancer with the luminal subtype.
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Shi A, Dong Y, Xie X, Du H, Yang M, Fu T, Song D, Han B, Zhao G, Li S, Du Y, Jia H, Wu D, Fan Z. Opening label, dynamic prospective cohort study on the small focus less than 1.0 cm shown by type B ultrasound in breast. Medicine (Baltimore) 2020; 99:e20158. [PMID: 32384506 PMCID: PMC7220247 DOI: 10.1097/md.0000000000020158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A consensus has not been achieved regarding the treatment of small nonpalpable breast lesions, and the purpose of this study was to prospectively investigate nonpalpable lesions less than 1.0 cm in diameter to explore the risk factors for such lesions and determine appropriate treatment of such kind of lesions. METHODS A total of 1039 patients with small lesions less than 1.0 cm in diameter who underwent mammography and ultrasound from 2009 to 2010 in our institution were prospectively enrolled. Among them, 80 patients underwent biopsy, whose lesions grew by more than 30% of its original size, with an unclear boundary or irregular shape. All patients were followed-up for an average of 24 months, and lesions identified as high-risk types, such as cancer or atypical hyperplasia, of tumors on pathological examination were labeled "meaningful lesions." Then relevant factors affecting the detection of meaningful lesions were analyzed. RESULTS In total, 40 meaningful lesions including 2 breast cancers were detected, accounting for 3.8% and 0.2% of all patients, respectively. Univariate analysis identified smoking (P = .030), irregular shape (P = .018), unclear boundary (P = .024), and vascularization (P = .023) as risk factors for the detection of meaningful lesions (P < .05). On multivariate analysis, smoking and irregular shape were further identified as independent risk factors for the detection of meaningful lesions. CONCLUSION The overall incidence of cancer among nonpalpable lesions with a diameter less than 1.0 cm is low. Biopsies are strongly recommended for patients who are smokers or who have small lesions with an irregular shape, whereas regular follow-up observation is likely safe for other patients with small, non-palpable breast lesions.
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Affiliation(s)
- Aiping Shi
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Yi Dong
- Department of Breast Surgery, Jilin Province Cancer Hospital, Changchun
| | - Xinpeng Xie
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Haiying Du
- Department of Ultrasonic Diagnosis and Treatment Center, Jilin Provincial Central Hospital, Jilin, China
| | - Ming Yang
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Tong Fu
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Dong Song
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Bing Han
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Gang Zhao
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Sijie Li
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Ye Du
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Hongyao Jia
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Di Wu
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
| | - Zhimin Fan
- Department of Breast Surgery, First Hospital of Bethune of Jilin University
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Önder Ö, Azizova A, Durhan G, Elibol FD, Akpınar MG, Demirkazık F. Imaging findings and classification of the common and uncommon male breast diseases. Insights Imaging 2020; 11:27. [PMID: 32072386 PMCID: PMC7028902 DOI: 10.1186/s13244-019-0834-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023] Open
Abstract
Male breast hosts various pathological conditions just like "female breast." However, histo-anatomical diversities with female breast lead to many differences regarding the frequency and presentation of diseases, the radiologic appearance of lesions, the diagnostic algorithm, and malignity features.Radiological modalities may play an important role in evaluating male breast lesions. Although some imaging findings are non-specific, having knowledge of certain imaging characteristics and radiologic patterns is the key to reduce the number of differential diagnoses or to reach an accurate diagnosis.Male breast imaging is mostly based on physical examination and is required for the complaints of palpable mass, breast enlargement, tenderness, nipple discharge, and nipple-skin changes. The majority of the male breast lumps are benign and the most common reason is gynecomastia. Although it is difficult to exclude malignancy in some cases, gynecomastia often has distinguishable imaging features. Pseudogynecomastia is another differential diagnosis that may be confused with gynecomastia. The distinction is important for the treatment plan.Apart from gynecomastia, other male breast lesions form a highly heterogeneous group and can be classified based on "Tissue origin," "Histopathological type and behavior," and "Radiologic features" for both simplification and comprehensive understanding.This article mainly focuses on emphasizing the results of basic histo-anatomical differences of male and female breasts, classifying male breast lesions, covering the spectrum of male breast diseases, and assisting radiologists in recognizing the imaging findings, in interpreting them through a holistic approach, in making a differential diagnosis, and in being a part of proper patient management.
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Affiliation(s)
- Ömer Önder
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Aynur Azizova
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gamze Durhan
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Funda Dinç Elibol
- Department of Radiology, School of Medicine, Muğla Sıtkı Koçman University, 48000, Muğla, Turkey
| | - Meltem Gülsün Akpınar
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Figen Demirkazık
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Hwang EJ, Cha JH. A Review on Gynecomastia and Male Breast Cancer for Radiologists. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1096-1108. [PMID: 36238022 PMCID: PMC9431879 DOI: 10.3348/jksr.2019.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Eun Jin Hwang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Abstract
This study aimed to report a unique case of primary adrenal insufficiency that was accompanied by painful gynecomastia, which was resolved by treatment with prednisone. Enlargement of the left breast with continuous weakness and generalized nausea in a male was discovered 3 months before admission. Magnetic resonance imaging of the brain was normal 1 month before presentation. A physical examination revealed that the diameter of the left breast was 5 cm and the height was 3 cm. Laboratory investigations revealed hyponatremia, with a low serum cortisol level and an elevated prolactin level. Hyperprolactinemia was suspected because of adrenal deficiency that was directly or indirectly associated with increased prolactin levels. Thus, a diagnosis of hyperprolactinemia was confirmed. Ultrasonography of the left breast showed glandular tissue hyperplasia. In the present study, treating adrenal insufficiency with prednisone relieved both gynecomastia and hyponatremia. However, gynecomastia regression and hyponatremia resolution were observed when prednisone was stopped. Gynecomastia completely resolved by re-administering prednisone. Therefore, treating the underlying disease is essential so that prednisone can be given in a timely manner.
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