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A 17-year-old male develops a painless, firm mass beneath the nipple of his left breast. The mass is
mobile, and no fluid can be expressed from the breast. The right breast is normal to
examination. Which of the following conditions does this mass most likely represent?
A. Fibrocystic changes
B. Gynecomastia
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C. Intraductal papilloma
D. Invasive duct carcinoma
E. Invasive lobular carcinoma
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The correct answer is B. The most common breast mass in men, especially under 25 years of age,
is gynecomastia-a benign proliferation of ductal and stromal elements of the breast. It is
generally an idiopathic condition, probably related to pubertal hormonal changes.
Fibrocystic changes (choice A) in the breast, which reflect physiological responses in the
breast to cyclical levels of sex hormones, are not observed in men. Fibrocystic changes are
most common in the late reproductive years and include fibrosis, cyst formation, and a variety
of epithelial changes such as hyperplasia and apocrine metaplasia.
Intraductal papillomas (choice C) are benign neoplasms commonly evolving in the major
lactiferous ducts beneath the nipple. They most commonly present with a bloody nipple discharge
and are rare in men.
Carcinoma of the male breast (choices D and E) is rare, and almost always develops in the
breasts of elderly men. Male breast carcinomas have a somewhat worse prognosis than their
female counterpart. Grossly and microscopically they resemble ductal carcinoma in the female.
