【病例】男性乳房发育症1例X线及CT影像表现

History: A 41-year-old man with a history of cystic fibrosis presents with a new cough.

病史:41岁男性,咳嗽,有肺囊性纤维化病史。

Previous chest radiographs and current radiographs are shown below.

之前的胸片和现在的胸片如下所示。

Posteroanterior (PA) and lateral radiographs of the chest from one year prior:

一年前胸部正侧位片

【病例】男性乳房发育症1例X线及CT影像表现

【病例】男性乳房发育症1例X线及CT影像表现

Current radiographs  现在的胸片

【病例】男性乳房发育症1例X线及CT影像表现

【病例】男性乳房发育症1例X线及CT影像表现

CT image

An enhanced CT scan of the chest wasobtained. Axial image in lung window is shown below.

行胸部CT增强,其肺窗图像如下所示。

【病例】男性乳房发育症1例X线及CT影像表现

Axial and coronal CT images of thechest in soft-tissue windows are shown below.

胸部轴位及冠状CT软组织窗图像如下所示。

【病例】男性乳房发育症1例X线及CT影像表现

【病例】男性乳房发育症1例X线及CT影像表现


Findings

Radiography: There are findings of bronchiectasis and an enlarging peripheral opacity overlying the right midlung, not definitely seen on lateral radiographs.

CT: CT demonstrates bronchiectasis with bronchial wall thickening and     asymmetric, right greater than left, gynecomastia, consistent with the right chest opacity on frontal radiography.

表现:

平片:可见支气管扩张,右中肺野外带区域见一较前增大的片状阴影,侧位上未见明确显示。

CT:可见支气管扩张并支气管壁增厚;双侧乳腺不对称,右侧大于左侧,符合男性乳房发育,与胸片正位所示的右侧阴影相一致。


Differential diagnosis

  • Asymmetric gynecomastia
  • Invasive ductal carcinoma
  • Diabetic mastopathy
  • Chest wall infection/abscess

Diagnosis: Asymmetric gynecomastia

鉴别诊断:

  • 不对称的男性乳房发育症
  • 浸润性导管癌
  • 糖尿病性乳腺病
  • 胸壁感染/脓肿

诊断:不对称的男性乳房发育症


Key points

Gynecomastia 男性乳房发育症

Pathophysiology

Gynecomastia is male breast enlargement primarily characterized by ductal and stromal hyperplasia.

It is due to hormonal imbalance or exogenous stimulation of estrogen     receptors.

Medication-induced: Common medications include androgen deprivation therapy, haloperidol, spironolactone, thiazide diuretics, nifedipine, theophylline, and isoniazid.

Illicit substance-induced: Substances include marijuana, cocaine, and heroin.

Endogenous hormonal imbalance: Puberty, cirrhosis, and congenital   hypoandrogen syndromes, including Klinefelter syndrome and congenital      adrenal hyperplasia.

Neoplastic hormonal production: Pituitary adenoma, hepatocellular carcinoma, germ cell tumors, sex-cord stromal tumors, and adrenal cortical carcinoma.

病理生理学

男性乳腺增大,首先表现为导管及间质增生。

由于激素失衡或者外来雌激素的刺激:

药物诱导:常见的药物原因包括雄性激素剥夺治疗、氟哌啶醇、螺内酯、噻嗪类、硝苯地平、茶碱、异烟肼。

违法物质诱导:包括大麻、可卡因、海洛因。

内源性激素失衡:青春期、肝硬化、先天性低雄性激素综合征(克氏综合征、先天性肾上腺增生症)。

肿瘤性激素生成:垂体腺瘤、肝细胞癌、生殖细胞瘤、性索间质肿瘤、肾上腺皮脂腺癌。


Epidemiology

Exclusively seen in males.

Estimated prevalence of 25% to 50% in U.S. men.

流行病学:

只见于男性;

在美国男性中,发病率25%-50%。


Clinical presentation

Patients present with an increase in dense subareolar breast tissue,     which may or may not be tender to palpation.

Often discovered incidentally on imaging.

May be symmetric or asymmetric.

临床表现:

乳晕下方致密的乳腺组织增多,触诊时可柔软或发硬;

常在影像检查时偶然发现;

可对称或不对称。


Imaging features

Ultrasound: Appears as mixed, predominantly hypoechoic subareolar tissue.

Mammography: Appears as subareolar mass evolving in three stages; nodular,     dendritic, and diffuse glandular.

  • Nodular phase is an early phase of the disease represented by nodular areas of subareolar tissue.
  • Dendritic phase is represented by a subareolar mass with characteristic “flame-shaped” edges extending toward the chest wall.
  • Diffuse glandular phase is represented by dense subareolar breast tissue, similar to a dense female breast.

CT: Appears as a soft-tissue density subareolar mass, classically “flame-shaped.”

Nuclear medicine: May show mild uptake on FDG-PET.

影像表现:

超声:乳晕下组织,以低回声为主。

乳腺钼靶:表现为乳腺肿物,分为三期:结节样、树枝样、弥漫样腺体。结节样腺体期为病变早期,腺体呈结节样;树枝样腺体期表现为乳晕下肿物边缘呈火焰样,并向胸壁扩展;弥漫样腺体期表现为致密的乳腺组织,类似于女性乳房。

CT:乳晕下方软组织密度肿块,典型的呈火焰状。

核医学:FDG-PET上可表现为轻度摄取。


Treatment

Treatment is usually not necessaryunless the patient is symptomatic or desires treatment for cosmetic reasons.

Initial treatment is withdrawal of the offending agent and attempted restoration of hormonal balance.

Surgical removal of gynecomastia may be performed with small areolar incisions and removal of subareolar glandular tissue.

治疗:

通常不需要治疗,除非病人有相关症状或者出于美容的需求。首先停止致病的药物治疗,并恢复激素水平。可微创移除乳晕下增生的腺体组织。


【病例】男性乳房发育症1例X线及CT影像表现

【病例】男性乳房发育症1例X线及CT影像表现

【病例】男性乳房发育症1例X线及CT影像表现

肺囊性纤维化(CPF或CF),是一种具有家族常染色体隐性遗传性的先天性疾病。在北美洲白人中最常见,其他人种则极少见。作为一种外分泌腺的病变,胃肠道和呼吸道常累及。其诊断依据是汗液中NaCl含量增高,反映外分泌腺的功能异常。由于支气管中的黏液增多,可使支气管阻塞,使某些细菌(如金黄色葡萄球菌、铜绿假单胞菌等)易于生长繁殖,进一步引起肺、支气管的反复感染,继之引起肺囊性纤维化,严重损害肺功能,随着肺部疾病及肺功能损害的加重,进一步导致右心肥大,心力衰竭。由于胰酶的缺乏,也可引起消化不良及发育障碍等临床表现。

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