In male breast ultrasound, which pattern is most specific for gynecomastia?

• A. Triangular Retroareolar Glandular Tissue
• B. Hyperechoic Nodular Mass Away From Areola
• C. Spiculated Mass With Calcifications
• D. Simple Cyst Near The Nipple

Answer: (A)

Focusing on what gynecomastia looks like on ultrasound, the hallmark pattern is a wedge-shaped, subareolar glandular tissue directly behind the nipple-areolar complex. This triangular, retroareolar proliferation reflects the glandular tissue expanding from the nipple outward toward the chest wall and is the most specific sign of gynecomastia in men.

Why this pattern fits best: gynecomastia arises from proliferation of ductal/glandular tissue beneath the areola, so seeing a triangular patch of tissue in that location directly behind the nipple is highly characteristic. Other patterns point away from gynecomastia: a hyperechoic nodular mass away from the areola suggests a different lesion (such as a fat-containing or other non-glandular process); a spiculated mass with calcifications raises concern for malignancy; a simple cyst near the nipple is cystic rather than glandular tissue. The subareolar, triangular configuration is the most indicative of gynecomastia.