Galactocele in a male infant: case report and review of literature

Galactocele of adult male breast: A cytopathologist's perspective

Galactocele, although a common cytological diagnosis in females, is not previously reported as a cause of breast enlargement in adult males. Hyperprolactinemia is the principal cause of galactocele in male breast. Besides drug induced hyperprolactinemia, other anatomical lesions of hypothalamo-pituitary region and different medical conditions like cirrhosis and chronic kidney disease are to be considered along with a full evaluation of features revealing hypogonadism in case of galactocele. Aspirated milk from the male breast is the primary clue for this detailed investigation process. Here we are presenting the first case of galactocele of the male breast due to hypogonadotropic hypogonadism with idiopathic hyperprolactinemia.

[A rare case of giant galactocele associated with prolactinoma]

Le galactocèle est une forme kystique rare, c'est une lésion bénigne du sein, apparaissant quand un canal mammaire est obstrué et très rempli de lait. On le rencontre généralement chez les femmes en post-partum, soit allaitant ou non. Il n'y a que quelques cas signalés qui ne sont pas liées à la lactation, comme on le voit chez les femmes ménopausées ou chez les hommes; tant plus, que la relation à la surproduction de prolactine, un facteur de croissance de l'épithélium mammaire n'est pas très bien défini à ce moment. Nous présentons un tel cas inhabituel d'une patiente âgée de 30 ans qui n'a pas d'antécédents d'accouchement ou l'avortement. Elle est suivie en endocrinologie pour micro adénome hypophysaire mise sous Cabergoline* qu'elle a arrêté d'elle-même pendant un an. Même compte tenu de la rareté de l'association, il est important de souligner le rôle hormonal dans l'évolution de l'anatomie du sein.

Galactocele in a Prepubertal Girl

BACKGROUND

Galactoceles have been previously described as an unusual cause of benign breast enlargement in male infants and children.

CASE

A 3-year-old prepubertal girl presented with a right-sided breast mass and was found to have a 4.4-cm hypoechoic cyst on ultrasound imaging with otherwise normal endocrine studies including prolactin levels. She underwent cyst aspiration which revealed milky fluid. Fat globules were identified with microscopic examination, confirming the diagnosis of a galactocele. Aspiration resolved the mass.

SUMMARY AND CONCLUSION

The etiology of galactoceles in nonlactating women is poorly understood. Traditionally, treatment of these benign cysts in male children has been surgical excision. In prepubertal girls, conservative management by surveillance or needle aspiration is warranted to prevent damage to developing breast tissue.

Galactocele in a Male Infant with Transient Hyperprolactinaemia: An Extremely Rare Cause of Breast Enlargement in Children

Galactocele is a rare breast condition in infants. Here, we report a 16-month-old boy who developed progressive left breast enlargement. Ultrasonography and magnetic resonance imaging revealed a 4 cm cystic lesion at left breast. Hormonal assay showed transient hyperprolactinaemia with no known cause identified. Subsequently, galactocele was confirmed on histopathological examination after complete surgical excision. No recurrence was observed on regular follow-up.

Bilateral galactocele in a male infant with Down syndrome and congenital hypothyroidism

Galactocele is an uncommon benign breast lesion. Its cause is unknown. Here, we report a male infant with Down syndrome and congenital hypothyroidism during the newborn period. At follow up, when he was 6 months old, bilateral mammillary swelling was detected and diagnosed as galactocele. Although thyroid hormone levels were normal, serum prolactin levels were elevated. Cyst aspiration was performed on the left side and 6 months after the aspiration of the cyst on the left side, both cysts had clinically and sonographically regressed. No recurrence was observed at the end of the 4th year.

The galactocele of male infants: an intriguing entity. Study and reflection about a case, with review of the literature

In this report, the authors investigate and discuss a galactocele that developed in the breast of a 5-month-old male. Based on the histological and immunohistochemical findings, they suggest that the rare and intriguing process that is exclusively observed in males in the absence of any detectable hormonal stimulation at time of investigation could represent a developmental anomaly possibly promoted by an obstructive phenomenon involving a defect of hollowing of some primary epidermal buds, the precursors of the mammary ducts.

Persistent hyperprolactinemia and bilateral galactocele in a male infant

Galactocele is a benign breast lesion, usually occurring in nursing women. This lesion is a rare cause of breast enlargement in children. In this paper we describe the case of an infant with hyperprolactinemia (which persisted throughout 15 years of clinical observation) and bilateral galactocele. We speculate that a congenital midline defect in our patient might have impaired the normal dopaminergic inhibitory tone on pituitary lactotroph cells, thus leading to an increased prolactin secretion by the pituitary gland; this, in turn, might have favored the development of the galactocele.

Galactocele: an unusual cause of breast enlargement in children

Galactoceles in children, either cystic or pseudotumors, are described in the literature as a rare cause of increasing breast size and can appear in males. We report a case of galactocele in a 15-month-old male, treated at our institution. The patient presented with a tumor in the right breast that had appeared 6 months earlier with no pain, signs of inflammation, or nipple secretion. Twelve cases found in the literature emphasize the importance of including galactocele in the differential diagnosis of benign breast masses in infancy.

Galactocele and prolactinoma--a pathogenic association?

A galactocele is a rare form of cystic, benign lesion of the breast, appearing when a mammary duct becomes obstructed and over filled with milk. It is usually found in postpartum women, either lactating or not. There are only a few cases reported that are not immediately linked to the lactation, as seen in postmenopausal women or in men. Furthermore, the relationship to overproduction of prolactine, a growth factor for the breast epithelium is not very well defined at this moment. We present such an unusual case of a 37-year-old female patient who has no history of birth or abortion. She was diagnosed with both microprolactinoma and galactocele whose dimensions seemed to be related to the evolution of the pituitary tumor and serum prolactine. Because no other etiology could be found in the young patient for the mammary galactocele, the prolactine excess is the most probable cause. Even considering the rarity of the association it is important to point the hormonal role in changing the anatomy of the breast.

Galactoceles mimicking suspicious solid masses on sonography

OBJECTIVE

The purpose of this study was to evaluate the sonographic appearance of a galactocele that can sonographically mimic a suspicious solid mass and to differentiate between a galactocele and a solid mass.

METHODS

From September 2002 to February 2004, 33 galactoceles classified as Breast Imaging Reporting and Data System category 4 were included. They were all confirmed by sonographically guided core biopsies. Their sonographic imaging and clinical findings were reviewed retrospectively.

RESULTS

The lesions had a round or irregular shape in 26 patients (78.8%), a noncircumscribed margin in 31 (93.9%), a nonparallel orientation in 22 (66%), and posterior shadowing in 13 (39.4%). Twenty-five nodules (75.8%) had internal hypoechogenicity or mixed echogenicity. Twenty-nine (87.9%) of 33 lesions showed a relatively sharp convex echogenic rim on the anterior or posterior wall.

CONCLUSIONS

Galactoceles have various sonographic findings, many of which are similar to those of suspicious solid breast masses. However, there is a tendency for a galactocele to appear as a small, round hypoechoic nodule with an indistinct or microlobulated margin and mild posterior shadowing. It is helpful to search for a partial anterior or posterior echogenic rim to identify a galactocele.

Sonography of pediatric male breast masses: gynecomastia and beyond

BACKGROUND

Palpable breast masses are rare in the pediatric male population. Prior reports have described the ultrasound findings of the normal pediatric breast, masses seen primarily in female pediatric patients, and masses seen in adult males.

OBJECTIVE

To describe and illustrate the sonographic findings in gynecomastia and other causes of breast masses in a group of pediatric males.

MATERIALS AND METHODS

We reviewed the ultrasound database of a large tertiary-care children's hospital for male pediatric patients presenting with breast masses from 1994 to 2000. The findings were correlated with additional imaging and pathology results.

RESULTS

Twenty-five pediatric patients ranging in age from 1 month to 18 years were referred for breast ultrasound. Eighteen patients (72%) had gynecomastia. Two patients each (8%) had galactocele(s) or had postoperative hematoma. One patient had ductal ectasia, which resolved. One patient had periductal hemangioma. One patient with neurofibromatosis and a solid mass was lost to follow-up.

CONCLUSION

Palpable breast masses are rare in the male pediatric patient and sonography is the primary imaging modality. The overwhelming majority of these cases are adolescent boys presenting with gynecomastia. Other diagnoses such as galactocele(s), hemangiomas, and ductal ectasia should be considered when young male patients present with a palpable mass. Malignant breast lesions are rare and are likely to be metastatic or primary tumors of non-breast tissue origin.

Galactocele in a male infant with congenital hypopituitarism

Galactocele is an uncommon benign breast lesion usually occurring in young lactating women. It is a rare cause of breast enlargement in children. We report a galactocele in a male child with congenital hypopituitarism and propose an association between the two conditions.

Bilateral galactocele in a male infant: a rare cause of gynecomastia in childhood

A galactocele is a rare benign breast lesion usually occurring in females during or following lactation. These lesions are a rare cause of breast enlargement in infants and children. In this article we present a 10 month-old boy who was admitted with a two-month history of bilateral progressive breast enlargement, and diagnosed as having galactocele. Our purpose was to emphasize the importance of galactocele as a benign condition in the differential diagnosis of gynecomastia in childhood.