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Old 04-07-2012
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Question Enlarged Male Breast Tissue Histology!

A 13-year-old male presents with bilateral enlargement of his breasts. Physical exam is otherwise unremarkable, and the breast enlargement is thought to be a normal variation at puberty. Histologic sections of breast tissue would most likely reveal which of the following findings?
A. Atrophic ductal structures with increased numbers of lipocytes
B. Dilated ducts filled with granular, necrotic, acidophilic debris
C. Expansion of lobules by monotonous proliferation of epithelial cells
D. Granulomatous inflammation surrounding ducts with numerous plasma cells
E. Proliferation of ducts in hyalinized fibrous tissue with periductal edema


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Old 04-07-2012
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I am confused between C or E ....since the question states that this is a normal variation, options A, B, D can be eliminated ...A because its talking about atrophy (the question is asking about enlargement), B because it says necrotic debris and D because its talking about granulomatous inflammation ... necrotic debris and inflammation would not be a "normal variation".

Left with C or E ..but since E is hyalinized fibrous tissue, it sounds more like healing after injury ?

I would go with C)Expansion of lobules by monotonous proliferation of epithelial cells

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Old 04-08-2012
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I was thinking C too, for the same reasons. Hyalinization just doesn't sound like something that would happen as a normal variant.
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Old 04-08-2012
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Is it C? Increased estrogen at puberty because of increased conversion from testosterone causes breasts to enlarge.
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Old 04-08-2012
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"E" because in the puberty the increase of GH, insulin-like growth factor 1, and LH drive in estrogen and Test production and the estrogen stimulate the proliferation of the ducts and fibroblast this plus the stroma, fibrosis and inflamation give the histology characteristics so it's E to me.
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Default The answer is E..........

Gynecomastia (enlargement of the male breast) histologically reveals epithelial hyperplasia within the ducts that is surrounded by hyalinized fibrous tissue. It is caused by an increase in the estrogen-to-androgen ratio. This abnormality may sometimes be found in males at the time of puberty. Other causes of gynecomastia include Klinefelterís syndrome (decreased secretion of testosterone), testicular feminization (androgen insensitivity), testicular tumors, cirrhosis of the liver, alcohol abuse, increased gonadotropin levels (such as choriocarcinoma of the testis), increased prolactin levels, drugs (such as digoxin), or hyperthyroidism. Testicular neoplasms that are associated with gynecomastia are tumors that secrete human chorionic gonadotropin (hCG), which increases the synthesis of estradiol. Testicular tumors associated with the production of hCG include germ cell tumors (choriocarcinoma and seminoma), Leydig cell tumors, and Sertoli cell tumors.
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