Background: Mammary duct ectasia is a bening breast condition which affects primarily middle-aged to elderly women. However, it can occurs wherever there is breast ductal epithelium.
Case presentation: A 9-years-old boy was referred to the regional paediatric endocrine clinic from the General Practicioner due to gynaecomastia. Pubic hair development started at the age of 8. Personal and family history were unremarkable except for a history of coping with potential distress caused by his breast condition. His mother noticed bilateral breast enlargement at the aged of 6. No discharge from the nipples since then. On examination: normal height (p79) and weight (p56), Tanner stage 1 and bilateral gynaecomastia with no signs of inflammation. Genitalia: normal male configuration. In particular, no stigmata of liver disease. Rest of the general examination was unremarkable. Initial investigations: liver, kidney and thyroid function test were within normal range. Testosterone 0.16 ng/ml [1.88], oestradiol 9 pg/ml [<25], prolactin 8.7 ng/ml , LH 0.06 UI/L [<0.3] and FSH 0.9 UI/L [<3] and human chorionic gonadotropin (hCG) <1.2 mUI/ml . Karyotype 46XY. Mammography was reported as compatible with gynaecomastia. Normal scrotum ultrasound scan. Diagnosis: idiopathic gynaecomastia. Follow-up (6 months later): he complaint about breast pain and redness. On the examination: left mobile, tender and fluctuate on palpation mass under the nipple and redness, no discharge. Second mammography: complicated breast cyst (8.8 × por 43.6 × 42.7mm). After surgical resection, anatomo-pathological features revealed the diagnosis of left duct ectasia (estrogen receptors: positive 10%). Secondary diagnosis: duct ectasia in a boy with gynecomastia self-limiting.
Conclusion: We described one of the few cases reported of duct ectasia in a 9-year-old male. It is well known that in the vast majority, gynaecomastia is self-limiting, however it is necessary to be aware of its posible complicactions in order to avoid mistakes and familial stressed as mammary duct ectasia can mimic invasive carcinoma clinically.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology