Cancer of the male breast with atypical ductal hyperplasia and contralateral gynecomastia

A case of right mammary invasive ductal carcinoma in young man with atypical ductal hyperplasia and gynecomastia of the second breast is described. The review of the existing literature stress the rarity of this observation. Nevertheless, in all cases of male mammary carcinoma the accurate examination must always include the contralateral breast to search the possible precancerous lesions or etiologic factors.     

The induction of new ductal growth in adult prostatic epithelium in response to an embryonic prostatic inductor

Tissue recombinants were prepared with a single epithelial ductal tip from adult prostate and mesenchyme from either the embryonic urogenital sinus or adult urinary bladder. Recombinants were grown in vivo beneath the renal capsule of male hosts. After 4 weeks of in vivo growth, extensive growth of arborizing ducts was apparent in recombinants composed of urogenital sinus mesenchyme and a single adult prostatic ductal tip. One-dimensional polyacrylamide gel electrophoresis indicated that these recombinants contained many of the proteins of the mature prostate. Heterospecific recombinants (rat urogenital sinus mesenchyme and mouse prostatic epithelium) showed the ductal tissue to be derived solely from the prostatic epithelium. In recombinants of a prostatic ductal tip with mesenchyme from the urinary bladder, ductal growth was absent, the ductal tip was maintained as a single, discrete, epithelial structure, and the protein composition of these recombinants more closely resembled that of the bladder. The results demonstrate that the epithelial cells of the adult prostate can participate in new ductal growth in response to an embryonic prostatic inductor. These data provide experimental evidence to support the hypothesis that human benign prostatic hyperplasia may result from the anomalous reactivation of embryonic growth potential in the adult prostate.     

Induction of islet cytodifferentiation by fetal mesenchyme in adult pancreatic ductal epithelium.

Recombinant tissue consisting of adult ductal epithelium isolated from pancreas and fetal mesenchyme was transplanted subcutaneously in the inguinal region of nude mice or epididymal fat pads of rats with a tissue chamber device for short-term (8-day) or long-term (6- to 12-wk) duration. We found that recombinant tissue underwent morphogenesis and cytodifferentiation, thereby forming islets that contained cells immunocytochemically positive for insulin and glucagon. Islet cytodifferentiation occurred in approximately 20% of the recombinants. In recombinants that developed into islets, the tissue was always in close association with an extracellular matrix, nerves, and blood vessels. Controls consisting of mesenchyme alone or duct epithelium alone showed no evidence of morphogenesis of cytodifferentiation. Pancreatic rudiments were also implanted to serve as positive controls. This is the first demonstration of islet cytodifferentiation from adult duct epithelium.     

The surgical management of high-grade gynecomastia

It is now well accepted that low grades of gynecomastia are best treated with liposuction alone. However, the surgical management of the high-grade gynecomastia (Simon's grade III) has remained problematic because both liposuction and conventional subcutaneous mastectomy (without skin excision) have frequently resulted in significant residual skin redundancy, requiring a second operation for skin resection. Our preferred approach to high-grade gynecomastia has been the single-stage subcutaneous mastectomy and circumareolar concentric skin reduction with deepithelialization. However, in the rare case of tubular breast deformity in the male and also in patients with gynecomastia who underwent massive weight loss, simple mastectomy and free nipple graft is performed. Therefore, these 2 groups of patients will be excluded from the current series. Twenty-four consecutive males with high-grade gynecomastia were reviewed. All patients underwent subcutaneous mastectomy with concentric skin resection. There were no major complications such as infection, hematoma, seroma, or nipple-areola complex necrosis. The main disadvantage of the technique was the mild residual skin redundancy, which was noted in all 24 patients. This redundancy, however, was never severe enough to require a secondary procedure, and all patients were satisfied with the final result.     

The treatment of gynecomastia without sharp excision

A new suction cannula is described that is able to dissect and aspirate breast tissue. The cannula has proven effective in treating gynecomastia without surgical resection of breast tissue.     

超声引导下Mammotome真空辅助乳腺微创旋切术治疗男性乳腺增生症

目的:探讨超声引导下Mammot ome真空辅助乳腺微创旋切术治疗男性乳腺增生症的临床价值。方法:总结超声引导下Mammot ome微创旋切治疗21例37个男性乳腺增生症的疗效,并记录术后病理结果及其随访情况。结果:21例男性乳腺增生症37个增生腺体均被完全切除,2出现例皮下瘀血,术后3个月皮肤淤血自行消失。全部病例均未发生感染。全部病例均于术后3～12个月随访未发现残留腺体,乳房外形正常。结论:Mammot ome是一项创伤小、并发症少、安全有效的乳腺微创技术,对男性乳腺增生症腺体能够进行完全切除。     

超声诊断男性乳腺发育症

目的探讨超声诊断男性乳腺发育症的价值。方法分析2005年1月-2012年12月经病理证实或临床诊断的106例男性乳腺发育症患者的声像图特点。根据年龄将患者分为≤19岁、20～39岁、40~59岁、60--79岁、≥80岁5组;根据检查年份分为2005年1月-2006年12月、2007年1月-2008年12月、2009年1月一2010年12月、2011年1月--2012年12月4组;采用x2检验分析比较各组间计数资料。结果男性乳腺发育症声像图特点：乳头下方、乳晕周围可见增厚的乳腺腺体组织,呈低回声或稍高回声,边界尚清,无包膜,与前方皮下脂肪组织及后方胸大肌分界清晰,内部回声尚均匀或欠均匀,无明显强回声钙化灶;CDFI显示腺体内及周边血流信号不丰富。男性乳腺发育症患者多发于20～39岁年龄段及2011--2012年,单侧乳腺发育最常见（66／106,62．26％）。结论近年来男性乳腺发育症患病率呈增长趋势。超声可诊断和鉴别诊断男性乳腺发育症,是首选检查方法。·     

男性乳房发育症的肿胀双环单蒂缩乳术

目的 探讨男性乳房发育症肿胀双环单蒂缩乳整形术式。方法 5年来采用肿胀局麻技术、乳房双环形切口、乳头乳晕外上真皮乳腺单蒂、乳房缩小术治疗男性乳房发育症，共42例80侧乳房。方法 每侧乳房切除100－500g组织，无乳头、乳晕坏死等并发症。随访3－48个月，除乳晕切口处有轻度瘢痕增生、边缘不整齐外，余无异常，效果较为满意。结论 肿胀局麻技术下乳房双环形切口、乳头、乳晕外上真皮乳腺单蒂、乳房缩小术治疗男性乳房发育症，操作简便，安全，损伤轻，出血少，恢复快。     

Morphologic evidence of interactions between adult ductal epithelium of pancreas and fetal foregut mesenchyme

First, tissue recombinants were used to determine the residual capability of adult endodermal pancreatic ductal epithelium to form islets. Second, adult epithelium was challenged by placing it between adult stroma and fetal mesenchyme to investigate the epithelial response (subsequently called challenge grafts). Trypsin was used to isolate adult mouse (heteroplastic) or rat (homoplastic) pancreatic ductal epithelium and fetal rat mesenchyme. All the adult epithelium was maximally stressed with alloxan to control for beta-cell contamination. Fetal mesenchyme was layered with epithelium in vitro for at least 48 h. Subsequently, the recombinants were grafted into nude mice and allowed to develop for 4-6 wk. To assess development, grafts were removed and fixed for both light and electron microscopy. In general, the grafts became organized into vesicles, tubules, and buds, many of which were in the form of vascularized isletlike structures. Epithelium responded with mitosis and intercellular adhesion. the range of cytodifferentiation varied. Culture time, age, and adhesiveness of the fetal mesenchyme and the amount of adult epithelium used in making the recombinants influenced the degree of differentiation. Analysis of fine structure of isletlike structures revealed cells with small electron-dense granules. These observations provide evidence for activation of endodermal epithelium taken from an adult mammal.     

da Vinci Si机器人治疗男性乳房发育症的临床研究

目的:探讨da Vinci Si外科手术系统治疗男性乳房发育症的安全性及可行性。方法:2014年1月至2015年12月行da Vinci Si机器人手术治疗男性乳房发育症患者4例。取距离双乳乳腺腺体边缘2 cm的4点、6点、8点位做长约5 mm、8 mm、5 mm切口,双乳6点位切口作为da Vinci Si手术系统镜头入路,4点、右8点位接da Vinci Si手术系统1、2臂,1臂接超声刀,2臂接抓钳。术中止血及腺体切除均采用超声刀,标本于摄像臂切口取出,术毕于术区留置负压引流管并关闭手术切口。结果:4例均成功完成机器人男性乳房发育症皮下腺体切除术,无中转开放或腔镜手术及手术并发症发生,术中出血量20~30 ml,手术时间120~148 min,建立皮下隧道用时10~15 min(单侧)。结论:应用da Vinci Si外科手术系统行男性乳房发育症皮下腺体切除术安全、可行,手术美容效果较好。     

青春期与青年男性乳房发育临床流行病学调查分析

目的:了解目前国人青春期及青年男性乳房发育的临床流行病学特点。方法:用SPSS软件建立数据库,分析山东省某高校1998例18~25岁青年男性人群问卷式调查资料。结果:①青春期男性乳房发育发生率为71.4%,平均发生年龄为(12.6±1.9)岁,持续时间为(1.33±0.52)年。乳房发育以乳房结节表现为主(76.1%),乳房触痛、乳头溢液发生率分别为71.2%和21.7%,发育的乳房以1~2cm大小为最多见(80.1%),发育部位以双侧发育最多(87.6%),自行消退率为97.8%。②青年男性乳房发育症发病率为4.15%,发生年龄(13.3±2.2)岁,持续时间(6.30±3.86)年,乳房直径(7.9±4.8)cm,乳晕直径(2.5±1.2)cm,弥漫增大和局限结节者所占比例分别为32.5%和67.5%。双侧乳房增大表现者为78.6%,左侧增大者为12.1%,右侧增大者为9.3%。乳房触痛和乳头溢液者发生比例分别为21.6%和15.7%。③青春期男性乳房发育和青年男性乳房发育症人群在发生率、自行消退情况、持续时间、乳房增大部位及伴有乳房疼痛方面差异有统计学意义。结论:青春期男性乳房发育和青年男性乳房发育症各有其流行病学特点。     

Incidental finding of synchronous bilateral ductal carcinoma in situ associated with gynecomastia in a 15-year-old obese boy: case report and review of the literature

Carcinoma of the breast is rarely encountered in the male population and is even less prevalent in the pediatric male population. Studies have suggested an association between male breast carcinoma and gynecomastia, but conflicting results have been shown. Only 3 cases of carcinoma in situ associated with bilateral gynecomastia during puberty have been described in the literature. Here, we present the case of a 15-year-old boy with bilateral gynecomastia who was found to have synchronous bilateral ductal carcinoma in situ.     

经乳晕切口治疗男性乳腺增生症的美容效果

目的:探讨经乳晕切口切除男性乳腺增生症的美容效果.方法:在肿胀麻醉下,经乳晕下部分乳晕边缘做半周切口,皮下剥离至增生腺体边缘,再刺离其基底部,整块切除,术后伤口内置引流管一根,加压包扎.结果:随访6个月,术后无复发,伤口瘢痕不明显,胸部平坦,外形美观.结论:经乳晕切口治疗男性乳腺增生症优于其他手术方法,值得临床推广应用.     

男性乳房发育症的外科治疗进展

男性乳房发育症(gynecomastia,GYN),又称男性乳腺增生症或男子女性型乳房,是指男性乳房组织异常发育、乳腺结缔组织异常增殖的一种临床病症,通常表现为乳房无痛性进行性增大或乳晕深部团状肿块,有时可伴疼痛或触痛,偶有乳汁样分泌物,占男性乳房疾病的60%～80%。目前对该病的治疗术式繁多,为进一步提高治疗水平,现对其外科治疗进展综述如下。