Benign+Gynecomastia


 * **Epidemiolgy:** || Gynecomastia occurs in approximately 90% of patients receiving estrogens or flutamide. It occurs in around 8% of patients undergoing orchiectomy, 3-15% of those treated with luteinizing hormone-releasing hormone agonists, and 19% of those receiving a combination of flutamide and luteinizing hormone-releasing hormone agonists. [1] The incidence of some degree of palpable breast tissue in males increases to more than 60% in those in the 7th decade of life. [2] ||
 * **Etiology:** || Prevention of gynecomastia increases if breast irradiation is given before the beginning of treatment, especially those receiving estrogens. It is strongly correlated with obesity. Pathologic gynecomastia may be due to testosterone deficiency, increased estrogen production, or increased conversion of androgens to estrogens. There are links between congenital anorchia, Klinefelter syndrome, testicular feminization or atrophy, hermaphroditism, adrenal tumors, liver disorders, pituitary tumors, and malnutrition. Pharmacological agents such as birth control pills, gonadotropins, progesterone, clomiphene, and drugs that inhibit testosterone synthesis and action have been linked as well. Chronic alcohol abuse may result in hepatocellular destruction and scarring which could also result in gynecomastia. [2] ||
 * **Signs & Symptoms:** || * Swollen breast gland tissue (button shaped lump near nipple)
 * Breast tenderness (change in size or other irregularities)
 * Tenderness/pain of breast tissue or nearby lymph structures
 * Nipple discharge in one or both breast ||
 * **Diagnostic Procedures:** || [[image:http://img.medscape.com/pi/emed/ckb/endocrinology/116364-138559-120858-2113735.jpg width="379" height="369"]]

The most valuable tool is a through family work up to establish any changes in environment or life style that could include family history, drug use or environmental factors.[1] radiation treatments for gynecomastia, are well tolerated.[4] ||
 * Blood test
 * Chemistry panel
 * Mammogram
 * Chest x-ray
 * Ct scan
 * Testicular ultrasounds( possible testicular neoplasm)
 * Tissue biopsies (fine needle) ||
 * **Histology:** || Characteristic findings include proliferation of ductules and stroma (consisting of connective-tissue elements such as fibroblasts, collagen, and myofibroblasts) and occasional acini.[5] Gynecomastia of short duration consists of a prominent ductular component with loose stroma[5]. Long-standing gynecomastia consists of dense stroma with few ductules.[5 ||
 * **Lymph node drainage:** || Lymphatics of the male breast is similar to that of the female breast (drain laterally to the axillary nodes, medially to internal mammary nodes, of superiorly to supraclavicular and infraclavicular nodes). Lymph node drainage will not be affected by a diagnosis of gynecomastia; however if breast cancer develops, the cancer may spread via these lymphatics.[5] ||
 * **Metastatic spread:** || The development of gynecomastia does not lead to metastases.[5] ||
 * **Grading:** || Grading involves analyzing the cellular structure of a lesion to determine the abnormality and rate of growth of the tissues involved. A tumors grade effects the decision to treat or not and what options may be available for the patient. Grading also effect the predicted prognosis of the patient. Since a benign diagnosis is not cancerous, grading is not available.[3] ||
 * **Staging:** || Staging describes the extent or severity of the tumor and spread. This included the primary tumor site, size, nodal involvement, cell grade, and metastasis. Benign lesions are not cancerous and no staging is available.[3] ||
 * **Radiation side effects:** || Skin may temporarily become red, dry, itchy, and scaly after treatment. Overall,
 * **Prognosis:** || This is not a cancerous or life threatening condition. ||
 * **Treatments:** || We treat Gynecomastia before or after the estrogen therapy with 9-12 MeV electrons. Before estrogen therapy we would give 9 Gy in 1 fraction, or 12-15 Gy in 3 fractions. After estrogen therapy we would treat with 20 Gy in 5 fractions. [1] We usually had a circular cut-out electron block centered on the areola. Surgery is also sometimes used.

[]. ||
 * **TD 5/5:** || The TD 5/5 is not used for gynecomastia. ||
 * **References:** || # Chao KS, Perez CA, Brady LW. Radiation Oncology: Management Decisions. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.
 * 1) Drugs, Diseases & Procedures. Medscape. http://emedicine.medscape.com/article/. Accessed June 27, 2012.
 * 2) Cancer staging/ grading. Available at: http://www.cancer.gov/cancertopics/factsheet/detection/staging. Accessed on July 2, 2012.
 * 3) Radiotherapy for prevention and therapy of gynecomastia. Available at: [|http://www.ncbi.nlm.nih.gov]. Accessed on july 4,2012.
 * 4) Ansstas, G. Gynecomastia Workup. Medscape. April 2012. Available at: []. Accessed on: July 5, 2012. ||

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