Galactocele

1. Galactocele Done by: Dr. amanialhaddad Under supervision PROF. YASER JAMAL

2. INTRODUCTION Gyecomastia is benign condition in male which Happen duto relative changes in the androgen / estrogen ratio lead to proliferation of the glandular compnent of the breast resulting inconcentricenlargment of one or bothe breast.

3. The physiologic gynecomastia usually appears in the first weeks of life (60-90)percent of newborn infants. Its typicall resolves in several weekes and requires no therapy. The occurrence of gynecomastiain pre pubert period is extrmely rare ite absence of endocineabnormalitis

4. the presence of chromsomal abnormalities ,nurocutanous syndromes such hypomelanosis and congenital adrenal hypoplasia sought in pediatric age groug Some drugs such as metaloclopramide which used in tertment of (GERD) has been reported to cause gynecomastia.

5. Galactocele is possible complication of neo natal genital crisis and rare cause of gynecomastiathat appears in the first few months of life As progressive, painless enlargement of the breast in infant or child with out other evidence of endocrinologic abnormalities is observed and simple exsision is reported to be an effective tretment.

6. Case report (1) A23 month old boy with no history of any other disease or drug exposure was reported to have gradual enlargement of the right breast since 6 months old.

7. examination The baby was 87.5 cm tall & weighed 15 kg (both in( 75th percentile Palpation of the right breast revealed a soft ,fluctuant , nontender mass occupying the entire breast .

8. Inverted nipple was observed but there was no discharg there no physical finding indicating the onset of puberty. Endocrinologic evaluation was found to be normal.

9. Ridologic examination The ultra sound revealed the presence of cystic mass . The cyst was spherical with dia meter 4x5 cm uniloculatedwitemicrocysts in its wall.

10. Microscopic examination Fibrous cyst wall with a lining of columnar epithelium which was flattened in some areas because increased pressure inside the cyst. The lining cell exhibited pronounced secretory activity as evidenced cytoplasmic vacuolization. Tubular structures found in the cyst wite similar features.

11. Management Total excision was performed between the creamy white casule of the lesion and the surrounding tissues through awebster incision. The pattiont was followed up for 12 monthewite out evidence of recurraence.

12. Case report (2) A seven-month-old male infant was brought to our clinic with a four-month history of bilateral progressive breast enlargement. He was born at term after an unremarkable pregnancy. There was no history of nipple discharge, trauma, infection, maternal medication, contact with estrogen products, or familial breast problems.

14. physical examination his weight, height and head circumference were 10,200 g(75th percentile), 70 cm (50th percentile) and 44 cm (50th percentile), respectively. The left breast was 6 × 4 cm and the right 4 × 3 cm in size. The nipples and areolas were normal and no inflammation was noted

15. Both breasts were cystic and not tender with palpation and no nipple discharge was evident. The external genitalia and Both testes were normal in size and present in the scrotum. There was no signofhirsutism, pigmentation of the skin or other endocrinologic abnormalities.

16. Laboratory investigations complete blood count, blood glucose, serum electrolytes, renal and liver function tests, serum lipid profile, and urinalysis were within the normal limits. The serum hormone levels were as follows: The LH 0.17 mlU/ml.

17. The FSH 0.4 mlU/ml. estradiol<20 pg/ml. Total testosterone <20 ng/dl. prolactin 29 ng/ml. total thyroxin 10.1 μg/ dl. free thyroxin1.36 μg/dl and TSH 0.9 mIU/ml. All the serum hormoneconcentrationswere also within the normal range.

18. Bone age according to Greulich and Pyle was consistent with six months. Chromosomal analysis showed a normal male karyotype 46, XY. Plain chest radiography and magneticresonance(MR mammography were normal.

19. Ultrasonographic examination of the breasts revealed hypo echoic and highly echogenic cystic areas, compatible with galactocele. Histopathologic examination of the mass showed the cyst to be lined by simple columnar epithelium and surrounded by a fibro-adipose tissue and confirmed the diagnosis of galactocele

20. The cyst wall lined by apocrine-type epithelium

21. management The cystic mass was removed bilaterally by surgical exploration and The patient was followed up to six months and did not show Recurrence.

22. conclusion The cause of galactocele in male infat unclear. The transplacental hormone transmission may result in galactocele but not in male infant. The most appropriate explanation may be that small retention cyst formed in neonate remain quiescent for some time and trauma resulting in in flammatory reaction precipitates presentation.

23. But this idea does not explain the presistance of actively secreting epithelium. Visvanatan suggests that with the time the ceases with partial resorption of secertory contents & eventual replacement of the cyst by a small mass containing inspissatedsecratory material.