Papiloma intraductal metacrónico en un niño: Caso clínico / Intraductal metachronic papilloma: Clinical case

Introducción. La asociación de telorragia y ginecomastia nos orienta al diagnóstico de papiloma intraductal. Este tumor benigno es muy infrecuente en la edad pediátrica. Caso clínico. Niño de 2 años que presentó ginecomastia y telorragia en la mama izquierda. Se realizó mastectomia. A los 4 años, presentó el mismo cuadro en la mama derecha, que requirió también mastectomia derecha, con buena evolución posquirúrgica en ambas oportunidades. La anatomía patológica informó papiloma intraductal sin signos de malignidad ni atipia. Conclusión. El papiloma intraductal raramente afecta a niños; hay 15 casos reportados. La ecografía es el método de diagnóstico más empleado. En los pacientes masculinos, la mastectomia es recomendada para asegurar un diagnóstico y tratamiento definitivo.

Introduction. The association of gynecomastia and bloody nipple discharge (thelorragia) leads us to the diagnosis of intraductal papilloma. This is a very rare benign tumor in children. Clinical case. A 2 year old male child was referred due to gynecomastia and bloody nipple discharge of the left breast. A mastectomy was performed. At the age of 4 he returned with identical symptoms but in the right breast. A right mastectomy was also required. An excellent clinical outcome was present in the follow up. The pathology reported intraductal papilloma with no evidence of malignancy or atypia. Conclusion. The intraductal papilloma rarely affects children, there are 15 reported cases. Ultrasound is the most useful diagnostic method. In male patients, mastectomy is recommended to ensure definitive diagnosis and treatment.

Hiperplasia ductal atípica en paciente portador de ginecomastia: caso clínico / Atypical ductal hyperplasia in a male patient with gynecomastia: case report

Atypical ductal hyperplasia (ADH) is characterized by a proliferation of uniform epithelial cells with monomorphic round nuclei filling part but not all of the involved duct. It is a known risk factor for breast cancer. We report a 16 years old male presenting with gynecomastia, which was surgically excised. The pathological study of the surgical piece revealed an ADH without evidence of infiltrating carcinoma. After 19 months of follow up, the patient is in good conditions.

Reportamos el caso de un paciente intervenido por una ginecomastia idiopática que presentó como hallazgo histológico una zona de la mama con hiperplasia ductal atípica. Se presentan sus características clinicas, y las imágenes histológicas con detalles de la pieza quirúrgica. Se revisa el tema y llama la atención la escasa ocurrencia de estos hallazgos, no habiendo en la literatura nacional casos similares publicados.

Gynecomastia treatment should it be individualized? a prospective study

Gynecomastia is a benign enlargement of the male breast. Was to analyze a 3 year period of gynecomastia patients in Al Kindy Teaching Hospital and the surgical approach used and its outcome. A prospective study of patients consulting Al Kindy Teaching Hospital because of gynecomastia between October 2007and August 2010 was done. Data were analyzed for etiology, grade of gynecomastia, surgical technique, complications, and histological results. A total of 64 patients with 86 operations were included. Techniques included subcutaneous mastectomy alone, or subcutaneous mastectomy with wise pattern "inverted T incision". Atypical histological findings were found in 3.12% of the patients [papilloma, fibrolipoma]. Surgical revision among all patients was 7%. Body mass index higher than 25kg/m2 was found as significant risk factors for complications [p/0.043], and that higher grades of gynecomastia [grade IIb and III]had higher statistical incidence of complications p=0.01 The treatment of gynecomastia requires an individualized approach. Caution must be taken in high BMI and higher grades, which are associated with increased complication rates. Histological tissue diagnosis should be routinely performed in all true gynecomastia corrections, because histological results may reveal atypical cellular pathology

Relação da ginecomastia puberal com o índice de massa corporal em amostra de adolescentes atendidos em Unidade de Pacientes Externos de Hospital Universitário / The relation between pubertal gynecomastia and body mass index in a sample of adolescents attended at the Outpatient Health Unit of a University Hospital

OBJETIVO: Avaliar a associação entre a ginecomastia puberal e o índice de massa corporal (IMC) por idade. MÉTODOS: Uma amostra de 109 casos de indivíduos com idades de 11 a 19 anos foi selecionada na unidade ambulatorial de adolescentes do Hospital Universitário Pedro Ernesto, no período de 2003 a 2006. Os dados antropométricos coletados foram: peso, altura, diâmetro mamário e estágio de maturação sexual. A análise do IMC por idade foi baseada no NHANES I e nos pontos de corte de Cole para sobrepeso e obesidade. O nível de significância foi de p < 0,005. RESULTADOS: A porcentagem de adolescentes com sobrepeso e obesidade foi de 50,4%. O diâmetro mamário aumentou de 1,5 ± 1,0 a 4,86 ± 2,20 cm, mostrando correlação significante com os percentis do IMC por idade (Pearson = 0,59). CONCLUSÕES: O estudo confirmou a correlação significante do diâmetro mamário com os percentis de IMC, demonstrando a associação entre a ginecomastia puberal e IMC mais altos.

OBJECTIVE: To evaluate the association between pubertal gynecomastia and body mass index for age. METHODS: A sample of 109 cases was selected from the adolescent outpatient health unit, with ages between 11 and 19 years old at Pedro Ernesto University Hospital. Anthropometric measures of weight, height, mammary horizontal diameter and sexual maturation stage were collected. The analysis of the body mass index for age was based on the NHANES I and cutt-off points of Cole. The significance level was p < 0.005. RESULTS: The percentage of adolescents with overweight and obesity was 50.4%. The mammary diameters increased from 1.5 ± 1 to 4.86 ± 2.20 cm, with significant correlation to body mass index for age (Pearson = 0.59). CONCLUSIONS: The study confirmed significant correlation of mammary diameters to BMI percentiles and demonstrated that pubertal gynecomastia is associated with a higher IMC.

Estudo clinicopatológico das ginecomastias: apresentação de 60 casos e estudo anatomopatológico de 81 espécimens / Clinicopathological study of gynecomastias: description of 60 cases and phatological of 81 surgical specimens

Objetivos: Neste estudo retrospectivo, a proposta foi analisar características clínicas e histopatológicas nos casos de ginecomastia. Métodos: Foram recuperados 60 prontuários de pacientes e 81 espécimens correspondentes ao produto de exérese das glândulas mamárias de 45 dos pacientes, todos revisados e analisados quanto a sinais de diferenciação lobular, presença e tipo de lesões com células colunares, hiperplasia epitelial, atipias epiteliais, tipo de componente estromal e presença de hiperplasia pseudoangiomatosa do estroma. Foi realizada a pesquisa imunoistoquímica de receptor de estrogênio nos casos relacionados à adolescência e de citoqueratinas basais e luminais nos casos com atipias epiteliais. Resultados: A idade dos pacientes variou de 11 a 60 anos. A maioria (60%) esteve relacionada a aparecimento da doença no período da adolescência e associada à obesidade. Entretanto, praticamente todas as causas comumente descritas na literatura puderam ser identificadas, como hipogonadismo, hepatopatia, tumores funcionantes, patologia adrenal, uso de anabolizantes, drogas e medicamentos, inclusive um caso associado à terapia antiviral. Mais de 80% dos casos tiveram apresentação bilateral, a maioria com padrões histológicos similares em ambas as mamas. O desenvolvimento lobular foi observado na maioria dos casos do presente estudo (76,2%). As características histológicas mais frequentes foram alterações microcísticas (79%), lesões com células colunares (82,7%), hiperplasia epitelial (58,0%) e hiperplasia pseudoangiomatosa do estroma (75,3%). Não se pôde observar nenhuma relação entre características histológicas e apresentação clínica. O receptor de estrogênio esteve presente em mais de 90% das células epiteliais. Os casos com atipias (9/81 espécimens) mostraram coexpressão de citoqueratinas luminal e basal. Conclusões: A ginecomastia é mais frequente em condições fisiológicas e patológicas normalmente associadas a hiperestrogenismo direta ou indireta...

Objectives: In this retrospective study we considered to analyze clinical and pathological features in gynecomastia cases. Methods: We recovered 60 hospital records and 81 pathological specimens from excision of the mammary glands of 45 patients, all revised and analyzed according signs of lobular differentiation, presence and type of columnar cells lesions, epithelial hyperplasia, epithelial atypias, type of estromal component and presence of pseudo-angiomatous stromal hyperplasia. Immunohistochemical detection of estrogen receptor was done in cases related to adolescence and detection of basal and luminal cytokeratins in cases of atypia. Results: The age of the patients varied from 11 to 60 years old. The majority (60%) was related the appearance of the illness in the period of the adolescence, mostly associated to obesity. However, practically all the commonly causes described in literature could be identified, such as hypogonadism, functional tumors, hepatopathy, adrenal pathology, use of anabolic drugs, drugs and medicines, including a case of antiviral therapy. More than 80% of the cases had bilateral presentation, the majority with similar pathological features in both breasts. Lobular differentiation was observed in the majority of our cases (76.2%). The most frequent histological features were microcystic changes (79%), columnar cell lesions (82.7%), epithelial hiperplasia (58.0%) and pseudo-angiomatous stromal hyperplasia (75.3%). We could not observe any relation between histological and clinical presentation. Estrogen receptor was present in more than 90% of epithelial cells. Cases with atypia (9/81 specimens) showed co-expression of basal and luminal cytokeratins. Conclusions: Gynecomastia is more frequent in physiological and pathological conditions associated direct or indirectly to hyperestrogenism. Epithelial atypias, morphologically similar to the precursors...

Dismorfias mamarias en la población pediátrica y adolescente / Pediatric and adolescent breast dysmorphias

El desarrollo de la mama se presenta entre los 8 y los 13 años de edad y es primer signo de desarrollo sexual secundario. La alteración de las características normales de los senos en una adolescente mujer y el crecimiento mamario en los varones deen ser considerados y en consecuencia estudiados. El cirujano plástico pediátrico debe estar entrenado para diagnosticar y tratar este tipo de dismorfias, así como también contener el impacto psicosocial asociado; para ello debe trabajar interdisciplinariamente con psicólogos y pediatras especialistas en crecimiento y desarrollo.

The development of the breast shows up between 8 and 13 years old in the female patient and is the first sign of sexual development. The distortion of the normal characteristics of the breasts in the adolescent female, as well as the mammary growth in the males must be considered and in consequence studied. The plastic pediatric surgeon must be trained in order to diagnose and manage this type dismorfias holding the associated psicosocial impact working interdisciplinaryly with psychologists, pediatricians and pediatric endocrinologists.

Lipoaspiração ultrassônica em ginecomastia / Ultra-sound assisted liposuction in gynecomastias

A lipoaspiração ultrassônica vem se tornando bastante indicada no tratamento das ginecomastias, devi- do à boa qualidade dos resultados obtidos. O presente estudo relata 11 casos de ginecomastia glandular e glândulo-gordurosa, no período de 1999 a 2002, submetidos à lipoaspiração ultrassônica e lipoaspiração convencional complementar, com cânulas de médio e pequeno calibres. Foi utilizado o equipamento Lisonix 2000, numa amplitude de 5, ou seja, 50 da potência do aparelho, com cânulas de 32 cm de comprimento e 3 mm de diâmetro. O volume médio aspirado, pela lipoaspiração ultrassônica, foi de 222 ml na mama direita e de 225 ml na mama esquerda, enquanto que o volume aspirado por lipoaspiração convencional foi de 200 ml e de 205 ml, respectivamente, totalizando em média, 852 ml por paciente. O tempo médio de lipoaspiração ultrassônica foi de 7 minutos e 12 segundos. Podemos concluir que, a lipoaspiração ultrassônica tem sua indicação, tanto em ginecomastia gordurosa quanto glandular, com uma evolução pós- operatória mais rápida, sem a necessidade de uma incisão na aréola e ressecção cirúrgica da glândula ma- mária.

The ultrasound assisted liposuction is becoming more popular in treating gynecomastias. This paper reports 11 cases of fatty-glandular breasts treated from 1999 to 2002 at private clinic, which were undertaken to ultrasound-assisted lipoplasty and complementary conventional liposuction, with small and medium canulas. Lisonix 2000 was used with 32 cm length canulas and diameter of 3 mm.The medium volume aspirated by ultrasound- assisted lipoplasty in the right breast was 222 ml and 225 ml were aspirated from the left breast, while the volume aspirated by conventional liposuction was 200 ml and 205 ml, respectively, with a total of 852 ml per patient. The medium time of liposuction for each side was 7 minutes and 12 seconds. The ultrasound-assisted lipoplasty is indicated either in fatty or glandular gynecomastia, with better results when compared with conventional liposuction. It has a faster recovery period without the need for glandular tissue resection.

Ginecomastía correlación clínico-patológica / Gynaecomastia: clinico-pathologic correlation

Se denomina ginecomastía a la hipertrofia de la glándula mamaria masculina. Puede ser fisiológica, familiar, patológica o inducida por drogas, aunque en muchos casos su etiología es desconocida, la ginecomastía es usualmente unilateral y asintomática. Los mecanismos que se involucran son: incremento de la estimulación de estrógenos, disminución de los niveles de testosteronay disminución de la relación andrógrenos/estrógenos. El tratamiento puede ser dirigido a la causa subyacente cuando ésta es identificada. Se estudiaron 24 pacientes con diagnóstico de ginecomastía comprendidos entre las edades de 14 a 30 añnos a quienes se les efectuó mastectomía subcutánea con incisión periareolar. Hubo dos complicaciones que consistieron en hematoma e infeción del área quirúrgica y remanente de tejido mamario redundante. Los análisis de laboratorio no fueron concluyentes para determinar la etiología

Ginecomastia / Gynecomastia

A ginecomastia é um achado freqüente, tanto em sua forma fisiológica, como patológica. Revisam-se, neste artigo, suas principais causas e relacionam-se as drogas a ela comumente associadas. A avaliaçäo diagnóstica é comentada, especialmente em relaçäo aos aspectos hormonais. Nos casos em que näo ocorre involuçäo espontânea da hipertrofia mamária, está indicada a abordagem terapêutica. Na análise dos tratamentos disponíveis, fica evidenciado que as drogas testadas apresentam benefício reduzido, abrindo espaço para a indicaçäo cirúrgica.

Stromal cellular response in breast tumours and allied lesions.

Histopathological study for stromal cellular response was made on 200 cases of benign and dysplastic lesions and malignancy of breast. Infiltrations with lymphocytes and plasma cells were observed in 64% cases of fibroadenoma, 66.6% cases of giant fibroadenoma, 61% cases of mammary dysplasia and 33.3% cases of gynaecomastia. While mast cell infiltration was not observed in giant fibroadenoma, its presence was observed in 92% cases of fibroadenoma, 77.8% cases of mammary dysplasia and 33.3% cases of gynaecomastia. Lymphocytes and plasma cells infiltrations were observed in 100% of cases of invasive duct carcinoma, medullary carcinoma and fibrosarcoma. Comedocarcinoma showed infiltration with these cells in 75% of cases while that for colloid carcinoma and Paget's disease of breast were observed in 50% of cases of each. Infiltrations with mast cells were observed in 92.3% cases of invasive duct carcinoma, 75% cases of comedocarcinoma and 25% cases of medullary carcinoma. Other malignant conditions of breast did not show mast cell infiltration. Degree of infiltration with lymphocytes and plasma cells was mainly of low grade in benign and dysplastic lesions compared to high degree of infiltration in malignancy. Mast cell infiltration was of low degree in both the types of lesions.

Assessment of testicular volume in bacilliferous leprosy: correlation with clinical parameters.

Testicular involvement in leprosy was studied in 30 multi-bacillary (BL/LL) patients. Ten (33.3%) gave past history of type II reactions, of whom nine (30%) gave history of testicular pain and/or swelling. Decreased libido was a common complaint (63.3%). Gynaecomastia was noted in 3 patients (10%) and altered hair pattern in 11 patients (36.7%). Testicular sensation was impaired in 10 (33.3%) patients. Testicular volume was assessed objectively using the Prader orchidometer and found to be reduced in nine (30%) patients. Reduction in testicular volume correlated with longer duration of disease and a past history of type II reaction.