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Case 4

Case 4. Jane McNicholas Consultant Oncoplastic Breast Surgeon East Lancashire Hospitals. Case 4. 27 year old man presents with a tender lump in his right breast for the last 3 months What features of his history and examination are most relevant?. Case 4. History of the lump

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Case 4

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  1. Case 4 • Jane McNicholas • Consultant Oncoplastic Breast Surgeon • East Lancashire Hospitals

  2. Case 4 • 27 year old man presents with a tender lump in his right breast for the last 3 months • What features of his history and examination are most relevant?

  3. Case 4 • History of the lump • Testicular lumps • Liver disease • Alcohol intake • Drugs, prescribed and illicit

  4. Case 4 • On examination he has a 2 cm firm swelling behind the right nipple • No evidence of liver disease, testicular swellings • What investigations are appropriate?

  5. Case 4 • Mammogram - some units will do a mammogram in a male with a breast lump • Ultrasound scan - showed typical features of gynaecomastia - U2 • FNA - C2 • What other tests are appropriate?

  6. Case 4 • Blood tests - LFT’s, U&E’s, Prolactin, αFP, β-HCG, testosterone

  7. Gynaecomastia • Due to a net excess of oestrogens (either actual increase in oestrogens or reduction in androgens) • There are three physiological types of gynaecomastia - neonatal, pubertal and senescent • The most common cause in older men is drug related • A small number will be due to testicular disease, Klinefelter’s Syndrome, Adrenal disease, etc • The majority of the rest are Idiopathic

  8. Drugs That Cause Gynaecomastia • PPI’s • Digoxin • Spironolactone • ACE Inhibitors • Calcium Channel Blockers • Metronidazole • Tricyclic anti-depressants • Diazepam • Metoclopramide • Phenytoin • Alcohol • Cannabis • Heroin • Steroids • Anti-androgens (Zoladex) • Oestrogens

  9. Case 4 • Management depends on aetiology • The natural history is that it often resolves over a period of a few months • As far as is possible, it is conservative • If it is drug related, withdrawal of the drug may cause resolution • Medical management includes Danazol (only licensed medication) and Tamoxifen • Surgery to excise gynaecomastia is sometimes useful but cosmesis can be difficult

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