40 yo with Gynecomastia--few questions

[gch]

I'm 40 y.o. male.  My weight-378 in late Jan.  My mother died from colon cancer at 47.  No breast cancer in the family that I'm aware of.

I was on prescribed Prilosec briefly (almost a month) for suspected reflux (never had heartburn-coughing usually after eating).  Because of weight/health concerns and also having a routine blood test showed 102 fasting blood sugar, I finally got serious on health and began dieting, and I also stopped taking Prilosec.  Today, I'm down to 325 and still eating healthy (went from high carb and red meat to low carbs, chicken/fish and fruits and vegetables).

About 2 months ago, I noticed tenderness in my left breast, I found a small lump.  I also noticed a very small hard (maybe half the size of a raisin) spot 2.5 inches above my nipple and towards the center of my chest.  I was worried about cancer and didn't know anything about gynecomastia, so I went in and saw my primary care doctor.  He did a physical exam of my chest area and told me I most likely had gynemcomastia and the other lump was likely a lipoma or something benign. He just told me to come back in 3 months--ordered no mammogram--did no workup of any kind.

2 weeks ago, I had a pulmonologist ordered CT scan of my chest to check my lungs (I had been sick--had seen some trace amounts of blood in mucus a few times--it was likely nasal).  The CT was clear for lungs, but the report noted moderate asymmetric left gynecomastia.  It noted no enlarged mediastinal, hilar, or axillary lymph nodes.  It made no mention at all at the 2nd lump--only commenting that limited evaluation of the upper abdomen is unremarkable.  It also noted that I had mild coronary arterial and thoracic aortic atherosclerotic calcification.  Because of the last finding, my primary doctor called in a prescription for simvastatin (I'm eating much healthier--but he though I should get on this for now to get my LDL down).  I've been on this new med only a week (along with flonase and zyrtec, which I've been on longer term).

I have 3 questions...

1. While I have had some tenderness this whole time, today I've had an episode of some minor pain in my breast area that felt like a muscle strain/cramp.  I don't recall having this before.  It lasted 1-2 hours and was not severe but noticeable.  Is this typical of gynecomastia?  Or could this be related to the simvastatin?  Or bad posture at the computer, aging, something else?  I am sure that I am paying more attention than in the past.

2. I'm a bit nervous about the wait and see approach.  Since the diagnosis, I have read a lot online.  What I've seen mentions workups and mammograms, etc.  I hate to 2nd guess my doctor, but I'd hate to wait if it was something worse.

3. If there was malignancy (in nipple or the other spot), would the CT be able to distinguish it from gynecomastia?  As I said, the CT report noted gynecomastia--and nothing else related to the second lump.

I apologize for this being a bit long, but I was trying to provide enough info.  Thank you in advance for any guidance you can give.

[George Pope, M.D.]

The CT scan should give the radiologist a good look at the breast tissue, and the fact that gynecomastia was diagnosed is a good thing, as that's a benign process.  Suspicious masses in the breast look different, even on CT, so you should be good there.

Regarding the second, newer type of pain, it's hard to say.  But given your age, your excess weight, and your coronary atherosclerosis, you should have your heart checked out.  Be sure that the new pain is not heart-related, like angina.

Congrats on the weight loss and change in lifestyle.  I hope you keep it up.

Dr. Pope, MD

[Litlriki]

I would agree with Dr. Pope regarding the CT findings, though I'm not sure how definitive CT is as compared with MRI, which is used more commonly to evaluate breast cancer.  That said, history will also be helpful, since as you get leaner, any growth if the process in your breast would be more obvious.  In fact, some patients who have mostly fatty breast tissue become more aware of "lumps" as they drop body fat.  Pain can be less meaningful in long-standing gynecomastia, though if you're manipulating the mass, it might be more tender.  Breast cancer is not so common in men, whereas gynecomastia is very common. Nonetheless, you should keep an eye on it, and make sure that your cardiac issues are not the source of your chest pain.

Rick Silverman