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Incidental pathological findings in young men with gynecomastia
Jenna Maroney, BS1, Katelyn Dannheim, MD2, Monica Hollowell, MD3, Brian Labow, MD3, Carolyn Rogers-Vizena, MD3.
1Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA, 2Rhode Island Hospital/Hasbro Children’s Hospitals, Providence, RI, USA, 3Boston Children's Hospital, Boston, MA, USA.

Background: Adolescent gynecomastia surgery significantly improves physical and psychosocial functioning, but routine pathological examination of adolescent gynecomastia tissue is controversial.1 We aim to describe the pathological findings in adolescent gynecomastia tissue and evaluate the need for pathological analysis in this population.
Methods: A retrospective review of 268 males who underwent unilateral or bilateral mastectomy for gynecomastia at a single institution between February 2007 and November 2019 was performed. Demographics, medical history, gynecomastia risk factors, family history of breast cancer, surgical characteristics, and histopathologic findings were collected.
Results: Mean age was 16.6 years. Mean BMI was 27.8 kg/m2 and 42.5% were obese. Twenty-seven patients (10.1%) had a family history of breast cancer. The majority (83.2%) underwent bilateral gynecomastia correction. There was no abnormal histopathology in 97.4%. Abnormalities included non-proliferative change (0.4%), proliferation without atypia (e.g. florid ductal hyperplasia, pseudoangiomatous stromal hyperplasia) (1.1%), atypical ductal hyperplasia (ADH) (0.8%), and bilateral ADH with unilateral ductal carcinoma in situ (DCIS) (0.4%). None had invasive carcinoma. None of the three patients (1.2%) with ADH and/or DCIS had a personal or family history of cancer. All three were obese.
Conclusions: We are the first to describe gynecomastia histopathology in a large adolescent sample in the United States. The incidence of potentially pre-malignant lesions (ADH, DCIS) in these males (1.2%) is similar to that in young females (1.1%).2 The patients with ADH and/or DCIS had no breast cancer risk factors, other than obesity. However, although these abnormalities are well-documented risk factors in females, their significance in males is unclear. Furthermore, unlike reduction mammoplasty, male mastectomy leaves minimal breast tissue and may therapeutically reduce risk. Another consideration is that many gynecomastia patients self-pay, so patients absorb pathology costs. Thus, the argument against routine pathological analysis includes the potentially therapeutic nature of mastectomy and financial benefit. However, given that the incidence of ADH and DCIS in adolescent males is similar to that in females, but their significance in males is poorly understood, the decision regarding the financial burden of pathology should be made in conjunction with family, as an unequivocal recommendation against routine pathology cannot be made at this time.
1.Nuzzi LC, Cerrato FE, Erikson CR, et al. Psychosocial impact of adolescent gynecomastia: A prospective case-control study. Plast Reconstr Surg. 2013;131(4):890-896. doi:10.1097/PRS.0b013e3182818ea8
2.Maroney J, Collins W, Staffa SJ, Saldanha F, Labow BI, Rogers-Vizena C. Incidental Pathological Findings in Adolescent and Young Adult Reduction Mammaplasty. Plast Reconstr Surg. 2020;In press.


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