 now we move on to the masses arising from normal breast tissue in the male and there are three conditions in that which is gynecomastia, lipomastia and a gynecolipomastia okay so what is gynecomastia which is the most common thing that presents in clinical practice gynecomastia is normal at two stages of development that is in neonates and adolescent at an adolescent age you will see a lot of boys normal boys with budding breast tissue in these children it is usually self-limiting and it resolves in few months to two years it may be unilateral or bilateral even normal puberty related gynecomastia might be only unilateral so that is not alarming it occurs between an imbalance the imbalance between estrogen and testosterone which occurs in neonates as i said because of the maternal estrogen as well as in adolescence when their central pituitary axis is taking over it may be drug induced and when you have ruled out all these normal conditions then definitely pathological conditions like tumors liver disease and syndromes need to be looked for if you find that this gynecomastia is abnormal or pathological now i just want to highlight again that a mammogram is never ever ever done in the pediatric age group but i have just put this up as a graphic presentation of the three different types of gynecomastia which you recognize in adult males there is a nodular type there is a dendritic type and there is a diffuse glandular type and i will show you what that looks on ultrasound so this is an eight-year-old boy with breast enlargement now is eight years the normal age for pubertal development in boys no so we see that there is breast enlargement there is a what pattern of gynecomastia is this is it nodular is it dendritic or is it diffuse glandular so this is a nodular pattern of gynecomastia where you can see a well-defined hypoechoic nodule similarly this is a 10-year-old male with breast enlargement again you see a very well defined hypoechoic nodule which you should not normally see but in 10-year-old male it is normal associated with puberty so again you take three dimensions of this nodule and you mention it this is the typical nodular pattern of gynecomastia now this is a 13-year-old boy with breast enlargement and here you can see that you see this branching tissue beneath the nipple areola complex and this is the typical dendritic pattern of gynecomastia and this is a 10-year-old boy with breast enlargement which is the diffused glandular pattern of gynecomastia so these are the three types of gynecomastia moving on to the next pathology in boys this is a 15-year-old boy with breast enlargement and here you can see that there is massive hypertrophy of the adipose tissue the pre-pictoral fat as I mentioned is increased and there is no glandular tissue so this is lipomastia and in some boys you may see both gynecomastia and lipomastia which is known as gynecolypomastia