Gynecomastia may show a range of pathologic change. The goal is to identify a patient with atypical or neoplastic change.
Gynecomastia may be unilateral or bilateral. Unilateral gynecomastia tends to have a higher rate of significant pathology.
Gross features:
(1) palpable mass that may be tender or painful
(2) rubbery to firm in consistency
(3) may be a discrete mass or ill-defined
(4) usually centrally located and subareolar
Key histologic features:
(1) fibrous proliferation
(2) ductal epithelial proliferation
Stages:
(1) florid epithelial proliferation (early or immature)
(2) intermediate (transitional)
(3) fibrous (late or mature or inactive)
It is important to detect the presence of:
(1) atypical epithelial hyperplasia
(2) ductal carcinoma in situ
(3) adenocarcinoma
Differential diagnosis - causes of pseudogynecomastia:
(1) adipose tissue
(2) soft tissue tumor
