The Male Breast

Front 1

A 35 year old male presents with a button like subareolar mass. Blood tests show low serum testosterone and high FSH and LH. The patient also has microorchidism. What is the most likely cause of these symptoms?

Back 1

Klinefelter syndrome

button like subareolar mass = gynecomastia

Front 2

A karyotype of Klinefelter syndrome will reveal what?

Back 2

XXY (an extra X chromosome)

Front 3

Which hormone is elevated in gynecomastia?

Back 3

estrogen (hyperestrisnism)

Front 4

Gynecomastia is an indicator of hyperestrinism. Hyperestrinism is a suggestion of what disorders?

Back 4

Cirrhosis of liver or possible existence of a functioning testicular tumor (leydig cell and rarely, Sertoli cell tumors)

Liver is responsible for metabolizing estrogen

Front 5

Morphologic features of gynecomastia.

Back 5

Proliferation of dense collagenous connective tissue
Marked micropapillary hyperplasia of the ductal linings
"terminal ducts (without lobule formation) are lined by a multilayered epithelium with small papillary tufts.

Front 6

What is the etiology of gynecomastia in athletes and body builders?

Back 6

use of anabolic steroids.

Front 7

Drugs that cause gynecomastia?

Back 7

alcohol, marijuana, heroin, anti-retroviral therapy, spirinolactone, digitalis, cimitedine, ketoconazole.

Front 8

Gynecomastia is a risk factor for carcinoma. T/F?

Back 8

False

Risk factors for males:
First degree relatives with breast cancer
Decreased testicular function (klinefelter syndrome)
exposure to exogenous estrogens
increasing age
infertility
obesity
exposure to ionizing radiation
prior benign breast disease
residency in western countries.

Front 9

Which germ line mutation is more common in male breast cancer?

Back 9

BRCA2 mutations

Male breast cancer is less commonly observed in BRCA1 families.

Front 10

Which type of carcinoma is more common in males compared to women?

Back 10

papillary carcinomas (both invasive and in situ) are more common and lobular carcinomas are less common

Front 11

ER positivity is less common in male breast cancer and the incidence of ER positive tumors increases with age. T/F?

Back 11

FALSE.

ER positivity is MORE common in male breast cancer and unlike in women, the incidence of ER positive tumors does not increase with age.

Front 12

A 55 year old male presents with a palpable subareolar mass, 2-3 cm in diameter. Other symptoms include nipple discharge and ulceration through the overlying skin. What is the most likely diagnosis?

Back 12

Breast cancer

Front 13

Most common Tx of male breast cancer?

Back 13

mastectomy and axillary node dissection

Front 14

A 55 year old man presents with a solitary breast mass and biopsy reveals malignant cells. Immunohistochemical staining experiments show that the tumor cells are positive for HER2/neu and cytokeratins 4 and 11 and negative for estrogen receptors. What is the most likely Dx?

Back 14

Invasive ductal carcinoma

Front 15

The most common carcinoma in males?

Back 15

invasive ductal carcinoma