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172
8 Age-Related Changes in Breast Structure: Breast Ultrasound in Children and Adolescents
They are thought to represent glandular lobules (the
shape and size are identical), while the surrounding
layers of high echodensity correspond to the supporting stroma. Such reticular pattern of mammary
glands is associated with their complete structural
development.
Individual adipose lobules in the form of
elongated fi elds of decreased echodensity with
horizontal “striation” are sometimes de fi ned
with US in breast structure, mainly in inner
quadrants, in girls of this age group. Girls of
15 and older have larger number of glandular
Fig. 8.1 Normal breast.
A girl of 8 years, prior to
menarche. Sonograms.
Gray scale, PDI, panoramic
scan, and 3D
1738 Age-Related Changes in Breast Structure: Breast Ultrasound in Children and Adolescents
Fig. 8.1 (continued)
174
8 Age-Related Changes in Breast Structure: Breast Ultrasound in Children and Adolescents
elements with tubular lobules, especially on the
periphery of the glands (Fig.
8.2 ).
The relation of glandular and adipose components in fully developed breast is variable and
depends on the loss or increase of body weight.
The process of formation of lobules is complex and is in fl uenced by many factors, including hereditary, constitutional, and physiological
features.
Hormonal disorders in puberty can induce the
appearance of breast pathology in teenagers. The
great value has an imbalance between estrogen
and progesterone. The arising pathologies form
the following groups:
Breast anomalies (amastia, polythelia, poly-•
mastia, aberrant lobes)
Age-related disturbances (premature or late •
development)
Fig. 8.2 Normal breast of
a 15-year-old girl. Sonograms.
Gray scale and PDI
Fig. 8.2 (continued)
1758 Age-Related Changes in Breast Structure: Breast Ultrasound in Children and Adolescents
Disturbance of symmetric growth of the right •
and left breasts
Hypo- or hypermastia •
In fl ammatory processes and trauma •
Mastopathy, cysts, duct ectasia •
Benign tumors ( fi broadenoma, hamartoma, etc.) •
Premature breast development is a conse-
quence of the elevated level of blood estrogen or
hypersensitivity of mammary gland to estrogen.
Late development more often results from ovarian insuf fi ciency.
Asymmetry in breast development is not a rare
pathology in puberty. To the end of puberty, it
becomes less expressed in the majority of such
girls.
Macromastia (gigantomastia) is a rare abnormality. It is associated with proliferation of lactiferous ducts, hyperplasia of epithelium, and
176
8 Age-Related Changes in Breast Structure: Breast Ultrasound in Children and Adolescents
growth of connective tissue. Hormonal status, as
a rule, is normal.
Hypomastia is registered more often. It is
characterized with the breast height (the distance
from the nipple to the base) less than 4–5 cm in
girls of 16–18 years. It is assumed as genderrelated anomaly.
Breast cysts are detected in 6 % of girls. Their
incidence is identical in healthy girls and in girls with
sex hormone disorders. US features (echodensity,
structure, borders, vascularity) are identical to the
same in adult women (see Chap. 6 ).
Anomalies of breast development are diagnosed clinically. Fluid-containing and solid
breast lesions are of particular interest for experts
in US diagnostics. They are subject to follow-up.
Scheduled complex breast US permits to do it
precisely in full.
Breast Pathology in Men
9
Boys and girls have identical breast tissue at
birth. Differentiation starts under the in fl uence
of hormones at puberty. Estrogen stimulates
proliferation of glandular tissue and androgen
counteracts this effect. The majority of boys
have 30 times higher level of testosterone and
3 times elevated level of estrogen in blood at
this time. After the fast period of puberty, the
transitive proliferation of ducts and stroma ends
with atrophy of ducts and involution of mammary gland. Hence, the breast of the adult man
is represented by adipose and fi brous tissues
with insigni fi cant subareolar residual ducts.
Interstitial lymph nodes can be observed in
some cases.
Indications for breast US in men are listed
below:
Discomfort or pain in breast •
In fi ltration or lesion within the breast •
Changes of the skin, nipple, or areola •
Contralateral breast carcinoma •
Lesions of axillary area or adjacent regions •
Normally, breast US in adult men reveals adipose tissue with variable insigni fi cant subareolar
in fi ltration due to residual ducts and fi brous tissue (Fig. 9.1 ).
One breast abnormality in men is gynecomastia. It demands complex examination and careful
differentiation from a tumor.
Gynecomastia is the enlargement of the breast
in men due to benign intraductal and stromal
proliferation.
Breast enlargement is diagnosed clinically
(Fig. 9.2a ). It often causes discomfort or pain.
Gynecomastia can be a consequence of hormonal
imbalance, such as elevated level of estrogen,
lowered level of androgen, defect of receptors to
androgen, and increased sensitivity of mammary
tissue to estrogen.
Gynecomastia can be physiological or results
from a disease. Twenty- fi ve percent of cases are
of idiopathic nature. Classi fi cations of the syndrome of gynecomastia base on the causes of
imbalance of male and female sex hormones.
One example is presented below:
I. Physiological gynecomastia
Newborn’s •
Teenager’s •
Senile •
II. True gynecomastia
Idiopathic •
Persistent teenager’s •
Familial •
III. Symptomatic gynecomastia
Hormone-secreting tumors (e.g., tumors •
of testicles, tumors of various organs
(lung, liver, intestine) that secrete chorionic gonadotropin)
Endocrine diseases, including genetic •
(e.g., true hermaphroditism, Klinefelter
syndrome, congenital adrenal hyperplasia,
Kennedy’s disease, Graves’ disease)
Primary hypoandrogenism (e.g., infec-•
tious, granulomatous orchitis, anorchism,
castration)
Renal and/or hepatic failure •
Medicinal (estrogen, human chorionic •
gonadotropin, spironolactone, fl utamide,
A.N. Sencha et al., Breast Ultrasound,
DOI 10.1007/978-3-642-36502-7_9, © Springer-Verlag Berlin Heidelberg 2013
177
178
9 Breast Pathology in Men
cardiac glycosides, tricyclic antidepressants, opiates, etc.)
IV. False gynecomastia
Adipose breast tissue hyperplasia •
V. Breast tumors
Malignant (cancer or sarcoma) •
Benign (adenoma, lipoma, fi broma, etc.) •
Physiological gynecomastia exhibits three
age peaks: in newborn, in puberty, in senile
period.
Gynecomastia of newborns is a secondary
event related with transplacental transmission of
hormones into the fetus body. It is observed in
60–90 % of all newborns. It is characterized with
Fig. 9.1 Normal breast
tissue in men. Sonograms.
Gray scale, CDI, and PDI
1799 Breast Pathology in Men
Fig. 9.1 (continued)
180
Fig. 9.2 Gynecomastia. ( a ) The
view of the enlarged breast. ( b )
Sonograms. Gray scale, CDI, 3D,
3DPD, panoramic scan, and US
elastography
9 Breast Pathology in Men
a
b1
b2
b3
1819 Breast Pathology in Men
b4
Fig. 9.2 (continued)