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Gynecomastia, or breast enlargement in men, may be caused by cirrhosis of the liver, a chronic disease characterized by accumulation of fatty substances, structural changes, and degeneration of liver tissue. The prevalence of gynecomastia was shown to be associated with body mass and age. The body mass and prevalence of gynecomastia were similar in patients with cirrhosis without edema or fluid accumulation and normal subjects. However, patients with severe cirrhosis and edema within the abdomen or other body sites, are generally thin or have low body mass. The prevalence of gynecomastia and levels of the sex hormones testosterone, estrogen, and estradiol, were assessed in 18 patients with severe cirrhosis and 18 nonobese subjects. Gynecomastia was detected in 50 percent of normal subjects and correlated with body mass, and in 44 percent of patients with severe cirrhosis, but was not associated with body mass. Patients with cirrhosis had lower levels of testosterone, but higher estrogen to testosterone and estradiol to testosterone ratios, compared with normal subjects. However, these ratios were similar among cirrhotic patients with or without gynecomastia. The results suggest that factors other than the estrogen to testosterone ratio are involved in the development of gynecomastia in cirrhotic patients and normal subjects. It is also possible that the sensitivity of the breast tissue to the increased estrogen-testosterone ratio may vary widely. (Consumer Summary produced by Reliance Medical Information, Inc.)

The presence of receptors for estrogen (estrogen receptor, ER) or progesterone (PR), two female sex hormones, in the tumors or lymph nodes of patients with breast cancer is known to have implications for treatment and prognosis. In general, tumors that are ER-positive (possess ERs) have a better prognosis, since they respond to hormone therapy. Twenty percent of the patients with both ER- and PR-positive tumors, however, do not respond to such treatment. It is possible that the hormone receptor status of tissue other than the primary tumor also needs to be considered in planning treatment. To address this issue, researchers studied 38 women (median age, 54) with breast cancer whose hormone receptor status was known. Thirty-seven had ER and PR assays performed on both the primary tumor and one lymph node; one patient had only PR assays performed. Correlations between results for the tumor and the lymph node were then calculated. Results showed that there was no difference in the overall frequency of receptor-positive tissue in nodes and in tumors. There was 82 percent agreement between results for tumors and for nodes; however, six patients with ER-positive tumors had ER-negative nodes. One patient with an ER-negative tumor had an ER-positive nodal metastasis. For progesterone, the overall concordance between results from the two specimens was 84 percent. Four patients with PR-positive tumors had PR-negative nodes, and two patients with PR-negative tumors had PR-positive nodes. Twenty-five of these 38 women would have undergone hormonal therapy based on results from the tumor assay. However, based on results from the lymph node assays, only six of these 25 would be labeled as having hormonally insensitive tumors. Only one patient judged as having an unresponsive tumor according to the tumor assay would have been re-assigned to receive treatment, based on the nodal assay. In evaluating the hormone receptor character of tumors for the development of appropriate treatments, accuracy is critical. It appears that evaluation of the receptor content of nodal metastases may be more important than that of the primary tumor, since these may lack hormone receptors even when the tumor is receptor-positive. (Consumer Summary produced by Reliance Medical Information, Inc.)