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 nonbreast tissue origin.