A Boy with a Breast Mass

Posted by • April 22nd, 2016

2016-04-19_10-08-13When evaluating a boy with breast enlargement, diagnostic considerations include gynecomastia, benign breast lesions, and cancer.

An 8-year-old boy presented with a mass in the right breast that had been present for 18 months and had enlarged during the previous 6 months. On examination, a firm, mobile mass (2 cm by 2 cm) was present under the right areola. Diagnostic procedures were performed. A new Case Records of the Massachusetts General Hospital summarizes.

Clinical Pearl

• What are some of the drugs or herbal compounds that may cause gynecomastia?

Drugs and herbal compounds that cause gynecomastia include estrogens and estrogen-like compounds (e.g., tea tree and lavender oils and weak estrogens and antiandrogens that are found in certain lotions, soaps, and shampoos), drugs that inhibit testosterone secretion or action (e.g., ketoconazole, spironolactone, androgen-receptor blockers, metronidazole, cimetidine, and alkylating agents), drugs that increase endogenous estrogen production (e.g., fertility-inducing therapies), and other agents that operate through unclear mechanisms (e.g., marijuana, heroin, growth hormone, calcium-channel blockers, isoniazid, and tricyclic antidepressants).

Clinical Pearl

• What are some of the causes of gynecomastia associated with decreased testosterone secretion and high gonadotropin levels?

Causes of decreased testosterone secretion include conditions associated with hypergonadotropic hypogonadism (high gonadotropin levels), such as anorchia, testicular trauma, mumps orchitis, use of alkylating agents, radiation to the testes, and disorders of testosterone biosynthesis. Klinefelter’s syndrome is another cause of hypergonadotropic hypogonadism; when elevated gonadotropin levels are found in a patient with gynecomastia, a karyotype analysis should be performed to rule out this sex-chromosome disorder.

Morning Report Questions

Q: What is the most common primary breast malignancy in children?

A: Primary breast cancer in children is exceedingly rare; only 0.1 to 0.3% of all breast cancers occur in the pediatric age group. Approximately 80% of primary breast cancers in children are secretory carcinomas, which is an unusual histologic tumor type among adults with breast cancer. Primary breast cancers that occur in children less commonly and behave more aggressively than secretory carcinomas include medullary and inflammatory carcinomas. In addition, metastases from other primary cancers may cause breast masses; in fact, this occurs more commonly than does primary breast cancer in pediatric patients.

Figure 1. Ultrasound Images of the Breasts.

Q: What are some of the features of secretory carcinoma of the breast?

A: Invasive secretory carcinoma is a rare variant of invasive ductal carcinoma that accounts for less than 0.15% of all diagnosed breast cancers. Secretory carcinomas frequently harbor the t(12;15) (p13;q25) translocation and ETV6-NTRK3 gene fusion. Secretory carcinomas are slow-growing, and although approximately 10% of affected patients have nodal involvement at the time of diagnosis, the prognosis is typically good. The available literature on secretory carcinoma suggests that local excision is the preferred initial treatment in children.

Figure 3. Excisional-Biopsy Specimen of the Mass in the Right Breast.

One Response to “A Boy with a Breast Mass”

  1. Saleh Awdaly says:

    Exact the breast enlargement is common in young adults but it is mostly bilateral and painful.