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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Gynecomastia-like Lesion of the Female Breast

Definition

  • Lesion of the female breast formed by increased ducts and prominent stroma, histologically identical to gynecomastia of the male breast

Alternate/Historical Names

  • Gynecomastia-like areas of the female breast
  • Gynecomastia-like changes of the female breast
  • Gynecomastia-like hyperplasia of the female breast
  • Gynecomastoid hyperplasia

Diagnostic Criteria

  • Displays features typical of gynecomastia of the male breast
    • Poorly circumscribed
    • Ductal hyperplasia with micropapillae
      • Thin tips, wider at base
      • Smaller, hyperchromatic cells at tip but not at base
    • Periductal stromal edema or fibrosis may be present
    • No lobules
  • Reported sizes range from two high power fields to 5 cm
  • Gynecomastia-like change has been suggested to fall within the spectrum of fibrocystic disease
    • It is frequently associated with fibrocystic disease
  • It has been variously designated as gynecomastia-like lesions, areas, changes and hyperplasia
    • Some such distinctions are based on the presence of a mass, size and association with other processes
    • We do not make such distinctions

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: October 4, 2006

Supplemental studies

Immunohistology

  • No reported studies

Differential Diagnosis

Mammary Hamartoma Gynecomastia-like Lesion of the Female Breast
Circumscribed Not circumscribed
Contains lobules No lobules
No periductal stromal changes Periductal stromal fibrosis or edema
May contain stromal smooth muscle or cartilage No stromal smooth muscle or cartilage

 

Pubertal Macromastia Gynecomastia-like Lesion of the Female Breast
Diffuse, massive enlargement Focal lesion or area
Lobules are typically absent (or poorly formed) in both

 

Gynecomastia-like lesion lacks the circumscription of fibroadenoma or juvenile fibroadenoma

 

Gynecomastia-like lesion probably falls within the spectrum of fibrocystic disease but differs from the usual by its distinct periductal stroma and its lack of lobules

 

Micropapillary Ductal Carcinoma In Situ Gynecomastia-like Lesion of Female Breast
Micropapillae have bulbous, expanded ends Micropapillae have thin tips, wider base
Uniform cells throughout Smaller cells at top
Hyperchromatic throughout Hyperchromatic at top, not base
Often associated with other DCIS patterns Often associated with other hyperplastic patterns

Clinical

  • Mean age 44
  • Incidence reported from 4/2709 to 4/1242
  • May form palpable mass or a mammographic abnormality
    • Described lesions are 5 cm or less
  • No associated medical disorders or drug therapy reported
  • No recurrences reported

Lists

Biphasic lesions of the breast

Bibliography

  • Rosen PP, Oberman HA. Tumors of the Mammary Gland, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 7, 1993
  • Kang Y, Wile M, Schinella R. Gynecomastia-like changes of the female breast. Arch Pathol Lab Med. 2001 Apr;125(4):506-9.
  • Umlas J. Gynecomastia-like lesions in the female breast. Arch Pathol Lab Med. 2000 Jun;124(6):844-7.
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