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Gynecomastia

Table of contents
Gynecomastia
Anamnesis of a gynecomastia
Physical inspection
Laboratory researches of a gynecomastia and general assessment

Close concept: a hyperplasia of mammary glands at men

The gynecomastia is a state at which at the man from one or both parties the mammary gland is palpated. Mentioning of this pathology meets in the Greek mythology in which increase in chest glands at men is described as a penalty of gods for human offenses. The expressed gynecomastia is visible on sculptural images of Tutankhamun and other Pharaohs of his dynasty from what it is possible to draw a conclusion on family predisposition to a disease. However the pathophysiological mechanism of a gynecomastia is opened only in recent years.

Clinical symptomatology

The mammary gland at men represents the rudimental organ consisting of a nipple with underdeveloped system of channels and a fatty stroma. Normal these structures at physical inspection are not palpated, however can increase and be found three certain hormonal or other changes in an organism. The patient can see a doctor concerning the increase in chest glands which both is followed, and which is not followed by painful feelings; sometimes the gynecomastia is found at routine inspection in the patient who is not showing complaints. Clinically the gynecomastia is most often shown in the form of unilateral or bilateral consolidation of fabric in subareolar area with a diameter from 2 to 5 cm which is easy for differentiating from a surrounding hypodermic fatty tissue. At histologic research the intra pro-current hyperplasia of an epithelium in a friable cellular stroma which in several months, and flying can sometimes turn into the dense hyalinized stroma without noticeable pro-current structures is found. The gynecomastia can sometimes be shown by more expressed diffusion increase in chest gland, and in such cases it is more difficult to distinguish it from hypodermic cellulose. In this situation it is reasonable to carry out mammography or an ekhografiya. Data of histologic research do not allow to judge a gynecomastia etiology, in these cases the biopsy also gives a little.

The probability of a breast cancer at men is extremely small, however it is impossible to forget about it at suspicion on a gynecomastia. The following belongs to symptoms which help to differentiate a tumor of mammary glands from a gynecomastia: localization out of an areola, bloody allocations from a nipple, fixing to skin or deep structures, increase in axillary lymph nodes, outside skin changes, an ulceration. All patients with suspicion on a new growth should do a biopsy. Carrying out a biopsy to each patient is inexpedient.

Importance of a problem of a gynecomastia

In 1963 Williams showed that the gynecomastia meets much more often than was considered earlier: data of histologic research at autopsy of 447 men found a gynecomastia in 40% of cases. In recently conducted clinical trials of Nuttal and Carlson independently from each other confirmed the high frequency of a gynecomastia (36 and 32% respectively) on material of routine inspections of adult healthy men. Due to the prevalence of a gynecomastia there is a question of need of systematic diagnosis of this state. Most of specialists answer in the affirmative as a gynecomastia:
1) can be normal physiological feature of infantile age, teenage age, an old age;
2) can be of great clinical interest at early diagnosis of some general diseases and endocrine disturbances;
3) can be a side effect of medicinal therapy;
4) can make deep psychological impact on the most sick and his family.



 
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