Prepubertal unilateral gynecomastia: a report of two cases

Abstract

BackgroundGynecomastia is defined as the presence of excessive breast tissue in males, which can appear unilateral or bilateral. Bilateral gynecomastia is frequently found in the neonatal period, early in puberty, and with increasing age. Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature.MethodsWe report the cases of two otherwise healthy boys of 8 and 11 years old with unilateral breast masses. No abnormalities were found on ultrasonography and all endocrine parameters were within normal limits. Treatment consisted of peripheral liposuction followed by subcutaneous partial resection of the gland, conducted through an infra-areolar incision.ResultsMicroscopy of the subcutaneous mastectomy specimen revealed gynecomastia without signs of malignancy. Postoperative course of both patients was uncomplicated, with no signs of recurrence of breast tissue.ConclusionsAtypical presentations of gynecomastia are often not recognized, with little attention to breast development in prepubertal non-obese children. Since prepubertal gynecomastia could be a sign of possible underlying diseases, a thorough examination and further research is recommended. If there is no causal treatment, surgical resection is the therapy of first choice. Peripheral liposuction and surgical resection of the gland tissue are the mainstay of treatment. In summary, we describe two cases of prepubertal unilateral gynecomastia with a normal endocrine workup. Further research is needed to establish the pathophysiologic mechanisms of prepubertal gynecomastia, since underlying etiology in most cases remains unclear.

Oestrogen and progesterone receptors in bilateral and unilateral pubertal gynecomastia – is treatment with anti-oestrogens justified?

“…Only 10% of patients have unilateral condition, and it is unclear why some patients manifest single-sided enlargement of the breast [13]. There are a few case reports of unilateral gynecomastia, including prepubertal cases or individual adult patients, such as 1 tennis player and a patient on isoniazid therapy [14,15].…”

Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report

“…Socio-psychological affliction is another major reason to manage this side-effect intensively. Young children, especially boys, with breast development have been reported to suffer from cultural and social stigma [3,4,20,26,27]. In addition prepubertal children with gynecomastia may be considered sexually mature at too young an age.…”

Prepubertal Gynecomastia: A Rare Manifestation of Myotonic Dystrophy Type 1

“…1 It is highly prevalent and often benign during the neonatal period, puberty, and in males over 50 years-old. [2][3][4] Pubertal gynecomastia is a common and usually physiological disease, and spontaneous regression occurs within one to three years. 1,5 The prevalence of pubertal gynecomastia ranges from 3.9 to 64.6% and, typically, it appears at least six months after the onset of male secondary sex characteristics, with the peak of incidence at Tanner stages 3-4 and testicular volume of 5 to 10 mL.…”