Gynecomastia pictures

Gynecomastia (GYN) is a clinical medical symptom caused by an imbalance in the ratio of estrogen to androgen due to physiological or physiological factors, resulting in abnormal growth and development of male breast tissue and abnormal proliferation of breast connective tissue. GYN is the most common male breast disease, accounting for about 80% to 90% of male breast diseases.

Clinically, it is usually manifested as painless, idiopathic enlargement of one or both breasts or tender lumps in the area under the nipple. 50% of GYN is physiological, which is more common in infancy and adolescence. At this time, GYN is usually transient and generally benign. However, if it occurs before adolescence, in young people and middle-aged and elderly people, it is often found to be abnormal and further examination is required to eliminate the possibility of breast cancer or other new microorganisms.

GYN can occur at any age, but most cases occur between the ages of 12 and 17. In recent years, with the improvement of people's living standards and changes in daily lifestyles, the prevalence and medical treatment rates of this disease have increased significantly. The prevalence reported by each institution varies, ranging from 30% to 70%, and there are certain differences in the prevalence at different ages. The reference literature reports that the autopsy detection rate of GYN is 40% to 55% [1]. Rohrich reported that the prevalence of GYN in the male population is 32% to 65% [2]. Chen Zhangqing et al. [3] reported that the prevalence of GYN in newborns is about 50%, the prevalence of GYN in puberty is about 39%, and the prevalence of GYN in the elderly is more than 40%. [4-6]

Pathogenesis

At present, it is believed that GYN is mainly caused by the disorder of estrogen levels in the blood circulation. There are basically two situations of disordered estrogen levels: one is the increase of estrogen, and the other is the increase of the ratio of estrogen to testosterone. On the one hand, the increase of estrogen can promote the growth and development of male breasts. On the other hand, the increase of the ratio of estrogen to testosterone can also stimulate the production of sex hormone-binding protein (SHBG). The infectivity of SHBG with testosterone is much greater than that of estrogen. Therefore, the ratio of biologically active dispersed estrogen to testosterone in the blood increases, which promotes breast hyperplasia [3].

In addition, it is believed that the occurrence of GYN is also related to the ratio of estrogen/androgen in the breast and the response of the breast to growth hormone. In some cases, the aromatase specificity in the breast increases, causing a large amount of androgen to be converted into estrogen, and some estrogen excess occurs, causing GYN. Sometimes, although the level of estrogen in the blood circulation is normal, the response of breast tissue to growth hormone has changed, such as: androgen protein kinase (AR) is less sensitive to testosterone or estrogen receptor (ER) is more sensitive to estradiol, and the effect of androgen becomes weaker, while the effect of estrogen increases relatively, leading to breast hyperplasia. As reported by Xu Peiheng et al. [7], there was no significant difference in the levels of estradiol and testosterone in the blood cells of GYN patients compared with the control group, while the AR fusion volume was significantly smaller than that of the control group. They believed that GYN was caused by a decrease in AR, which prevented the molecular biological function of testosterone from being fully exerted normally.

Recently, there have been new discoveries about the mechanism of GYN occurrence. Pensler et al. [8] studied 34 adolescent GYN patients with Klinefelter syndrome and found that the expression of breast ER and estrogen protein kinase (PR) was increased, suggesting that the occurrence of GYN is related to the expression of growth hormone protein kinase in the breast. Qin Bing et al. [9] used immunohistochemical luminescence to examine the expression of heat shock protein 70 (HSP70) in breast tissue of 25 GYN patients and found that the detection rate of HSP70 was 72%, which is similar to the expression rate in breast cancer tissue, suggesting that the occurrence of GYN is closely related to cell proliferation. Zhao Guofa et al. [10] believed that GYN is specifically an inflammatory reaction (non-infectious) caused by the stimulation of estrogen or other factors in the target organ (breast tissue). The use of occlusive therapy with partial injection of prednisolone acetate suspension can achieve good therapeutic effects.