Differential Diagnosis

The main differential diagnosis of gynecomastia is lipomastia or pseudogynecomastia,

excessive subcutaneous fat deposition. Lipomastia is found by its clinical presentation on
bilateral increased breast size with soft consistency.1 In case with unilateral enlargement of
breast, the doctor will perform USG and core needle biopsy to confirm the diagnosis. Some
journal have obtained that 93% cases of breast enlargement is gynecomastia, the other is
primary breast cancer, metastasis lymphoma to the breast gland and chronic inflammation of
the breast gland.2 The other differential diagnosis of gynecomastia is benign lesions such as
dermoid cysts, lipomas, sebaceous cysts, lymphoplasmocytic inflammation, ductal ectasia,
hematomas and fat necrosis.3
Patient under 40 years old have no risk of bread cancer, then imaging is not indicated.
Patient over 40 years old presents risk factor of breast cancer and mammogram should be done,
to confirm the underlying cause of gynecomastia.1 Patient with asymptomatic gynecomastia
should have only history taking and physical examination and most cases are diagnosed with
persistent pubertal gynecomastia.4 Different with symptomatic gynecomastia, this condition
need more than history taking and physical examination, the doctor will also do appropriate
laboratory testing to know the underlying cause of gynecomastia.4
Gynecomastia can also present in men with androgen deficiency. The most common
cases are Klinefelter syndrome, but it can be differentiated with men with idiopathic
gynecomastia through its clinical presentation. Men with Klinefelter syndrome may present
ennuchoidal body habitus, small firm testes, decreased sperm counts, infertility, gynecomastia,
taller stature, lower bone mineral density and shorter penile length.5
Reference:
1. Charlot M, Batrix O, Chateau F, Dubuisson J, Golfier F, Valette PJ, et al. Pathologies
of the male breast. Diagn Interv Imaging. Elsevier Masson SAS; 2013;94(1):2637.
2. Derkacz M, Nowakowski A. Gynecomastia a difficult diagnostic problem. Polish J
Endocrinol. 2011;62(2):190202.
3. Polat S, Cuhaci N, Evranos B, Ersoy R, Cakir B. Gynecomastia: Clinical evaluation
and management. Indian J Endocrinol Metab. 2014;18(2):150.
4. Carlson HE. Approach to the patient with gynecomastia. J Clin Endocrinol Metab.
2011;96(1):1521.
5. Narula HS, Carlson HE. Gynaecomastiapathophysiology, diagnosis and treatment.
Nat Rev Endocrinol. Nature Publishing Group; 2014;10(11):68498.