Case Report A 14-year-old white boy was referred initially to pediatric outpatient services with a 1-year history of gynecomastia. He had started smoking at age 11 years but had no other relevant past medical history. There was no family history of breast cancer. On physical examination, he was grossly obese, weighing 95 kg (body mass index, 42.1). Bilateral symmetrical gynecomastia was evident. No axillary, supra- clavicular, or cervical lymphadenopathy was clinically evi- dent. He had fully developed secondary sexual character- istics including normal-size and descended testes (20 mls). The gynecomastia was attributed to his obesity, and he was advised to lose weight and stop smoking. By age 26 years, his weight had decreased to 84 kg (body mass index, 37.2). Despite the loss of weight, the bilateral gynecomastia had become more prominent with palpable, firm, subareolar discs of tissue approximately 8 cm in diam- eter on both sides (Figure 1). He was referred for endocri- nologic assessment. This confirmed that serum luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, prolactin, estradiol, free testosterone, α-feto-pro- tein, and β–human chorionic gonadotropin were all within the normal limits. Because of the psychosocial impact on his quality of life, the patient opted to undergo staged bilat- eral subcutaneous mastectomies. First, right subcutaneous mastectomy was carried out with a circumareolar incision; a mass of tissue measuring 8.2 × 6.2 × 8.1 cm was excised. No discrete lesions, areas of nodularity, or calcifications were identified. The specimen was fixed in 4% buffered formalde- hyde and sent for histopathologic examination. This revealed low-grade ductal carcinoma in situ (DCIS) with a cribriform pattern (Figure 2). Because of this unexpected finding, a left mammogram was performed before further surgery. This revealed no abnormalities, and a left subcutaneous mas- tectomy was performed after an interval of 1 month with a circumareolar incision, with a mass of tissue measuring 8.7 × 7.5 × 8.8 cm being excised. The histology again confirmed DCIS extending up to nipple excision margin. Because of the presence of bilateral DCIS, the patient finally underwent total bilateral mastectomies. He made an uneventful recovery and had no adjuvant treatment. He remains well and under regular review with no evidence of recurrent disease at 2-year follow-up. Discussion Of all cases of breast carcinoma, 0.5%-0.7% affect men. 1-3 Bilateral male breast cancer occurs in an estimated 1.1%-1.4% of patients. 4-6 Ductal carcinoma in situ of the male breast is a very rare entity, 5 with only 5% of all male breast carcinomas Submitted: Feb 15, 2007; Accepted: Mar 20, 2007 Department of Surgery, University Hospital of North Staffordshire and Keele Medical School, UK Address for correspondence: Ricky Harminder Bhogal, 42 Clay Ln, Oldbury, Warley, West Midlands B69 4SY, United Kingdom Fax: 44-0121-5443913; e-mail: balsin@hotmail.com Bilateral Synchronous Ductal Carcinoma In Situ in a Young Man: Case Report and Review of the Literature We report a rare case of synchronous bilateral ductal carcinoma in situ (DCIS) developing in a man with long-standing gynecomastia. He underwent bilateral staged subcutaneous mastectomies with the right side being performed first at age 26 years. Histology confirmed bilateral pure DCIS. There was no iden- tifiable causative factor for the development of bilateral DCIS, and there was no familial history of the disease. He ultimately experienced progression to total bilateral mastectomies. This case highlights the importance of remaining vigilant about the presence of malignancy in normally benign conditions. Clinical Breast Cancer, Vol. 7, No. 9, 710-712, 2007 Key words: Gynecomastia, Lymphadenopathy, Mastectomy Abstract report case Khalid Qureshi, Ruvinder Athwal, Gabriel Cropp, Abdul Basit, James Adjogatse, Ricky Harminder Bhogal Electronic forwarding or copying is a violation of US and International Copyright Laws. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP , ISSN #1526-8209, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA 978-750-8400. 710 • Clinical Breast Cancer August 2007