The areas under my husband's nipples have soft lumps that are painful to the touch. His doctor didn't seem impressed but wasn't very communicative about why the lumps might exist. My husband is on Darzalex and dexamethasone monthly, his M-spike is increasing slightly now to 0.6 g/dL (6 g/l), albumin 2.8, no other markers of interest. The only other medications he takes regularly are for pain and Lovenox for blood clots. He is attempting to recover from a femur fracture that was repaired in early June.
Anybody have any idea what the lumps might be?
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vmeyer - Name: vmeyer
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 65
Re: Swelling / soft lumps under nipples (in a man)
Perhaps a case of gynecomastia?
Large, DM, et al, "Gynaecomastia complicating the treatment of myeloma," British Journal of Cancer, July 1983 (full text at PubMed Central)
Abstract:
The hormonal mechanisms involved in the development of gynaecomastia accompanying the treatment of multiple myeloma in adult men have been investigated by studying levels of circulating testosterone (T), oestrone (EI), oestradiol (E2), sex-hormone binding globulin (SHBG), prolactin (PRL) and the gonadotrophins LH and FSH, before, during and after development of gynaecomastia in 4 men. These have been compared with 5 closely matched men who did not develop gynaecomastia during similar treatment for myeloma. Levels of circulating T fell, and levels of E1 and E2 rose during treatment periods in all subjects, and the changes were statistically significant in subjects developing gynaecomastia, which resolved as levels of sex steroid returned towards normal following cessation of treatment. We conclude that treatment of adult men for myeloma results in testicular dysfunction with a reduction in circulating T and a rise in circulating oestrogens. These changes are most marked in subjects developing gynaecomastia in whom the normal breast tissue is stimulated by a subtle, transient oestrogen:androgen imbalance in favour of oestrogens.
Large, DM, et al, "Gynaecomastia complicating the treatment of myeloma," British Journal of Cancer, July 1983 (full text at PubMed Central)
Abstract:
The hormonal mechanisms involved in the development of gynaecomastia accompanying the treatment of multiple myeloma in adult men have been investigated by studying levels of circulating testosterone (T), oestrone (EI), oestradiol (E2), sex-hormone binding globulin (SHBG), prolactin (PRL) and the gonadotrophins LH and FSH, before, during and after development of gynaecomastia in 4 men. These have been compared with 5 closely matched men who did not develop gynaecomastia during similar treatment for myeloma. Levels of circulating T fell, and levels of E1 and E2 rose during treatment periods in all subjects, and the changes were statistically significant in subjects developing gynaecomastia, which resolved as levels of sex steroid returned towards normal following cessation of treatment. We conclude that treatment of adult men for myeloma results in testicular dysfunction with a reduction in circulating T and a rise in circulating oestrogens. These changes are most marked in subjects developing gynaecomastia in whom the normal breast tissue is stimulated by a subtle, transient oestrogen:androgen imbalance in favour of oestrogens.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Swelling / soft lumps under nipples (in a man)
For what it's worth, there are some reports that thalidomide, Revlimid, and cyclophosphamide may, on their own, cause gynecomastia.
For thalidomide:
Kim, KS, et al, "Thalidomide Associated Gynecomastia in a Patient with Malignant Histiocytosis: A Case Report," Journal of Breast Disease, Nov 2013 (full text of article)
For Revlimid:
Archived 2010 edition of the "Summary of Product Characteristics" (the officially approved European prescribing information) for Revlimid (PDF file) Search the document for "gynaecomastia". Interestingly, the most recent version of this document no longer includes a warning regarding gynecomastia.
For cyclophosphamide (Cytoxan):
Jajeh, A, "Gynecomastia In Multiple Myeloma Patient Treated with Cytoxan", ASH 2011 annual meeting abstract 5131 (full text of abstract)
For thalidomide:
Kim, KS, et al, "Thalidomide Associated Gynecomastia in a Patient with Malignant Histiocytosis: A Case Report," Journal of Breast Disease, Nov 2013 (full text of article)
For Revlimid:
Archived 2010 edition of the "Summary of Product Characteristics" (the officially approved European prescribing information) for Revlimid (PDF file) Search the document for "gynaecomastia". Interestingly, the most recent version of this document no longer includes a warning regarding gynecomastia.
For cyclophosphamide (Cytoxan):
Jajeh, A, "Gynecomastia In Multiple Myeloma Patient Treated with Cytoxan", ASH 2011 annual meeting abstract 5131 (full text of abstract)
Re: Swelling / soft lumps under nipples (in a man)
Thanks for the answers. I had wondered what this was likely to be. I was pretty sure it wasn't cancer because it's bilateral and pretty much the same on both sides. I'll tell my husband, and it'll be one less thing to be concerned about. (This year has been a roller coaster of medication reactions, mostly triggered by dexamethasone, and his femur fracture in June, surgery followed by blood clots followed by the bone not healing, soon to be followed by a bone stimulator).
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vmeyer - Name: vmeyer
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 65
Re: Swelling / soft lumps under nipples (in a man)
Hi Vmeyer,
Well, obviously Cheryl and I aren't doctors. So, I wouldn't take our guesses as a reason to not investigate this further. I imagine that a GP or an oncologist would be able to quickly confirm whether this may be a case of gynecomastia or not.
Well, obviously Cheryl and I aren't doctors. So, I wouldn't take our guesses as a reason to not investigate this further. I imagine that a GP or an oncologist would be able to quickly confirm whether this may be a case of gynecomastia or not.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Swelling / soft lumps under nipples (in a man)
My husband finally did have a mammogram because the lumps were getting somewhat larger. They assured him that it was, in fact, hormonal and nothing else.
His primary care physician (PCP) did some blood testing for hormone levels because he has some other problems (especially frequent urination at night and some ED) that bother him and may be related as well. The PCP's pretty medically conservative, but I think he may prescribe some kind of hormone replacement, which I think my husband would like. He still can't work because his femur isn't healing – they're going to do a hip replacement in January with a longer rod that will actually serve as an artificial bone – and he feels like he's a pretty pathetic case. (No, he doesn't whine. He's very sweet; he's just discouraged.) I think anything that helps right now will be a good thing.
His primary care physician (PCP) did some blood testing for hormone levels because he has some other problems (especially frequent urination at night and some ED) that bother him and may be related as well. The PCP's pretty medically conservative, but I think he may prescribe some kind of hormone replacement, which I think my husband would like. He still can't work because his femur isn't healing – they're going to do a hip replacement in January with a longer rod that will actually serve as an artificial bone – and he feels like he's a pretty pathetic case. (No, he doesn't whine. He's very sweet; he's just discouraged.) I think anything that helps right now will be a good thing.
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vmeyer - Name: vmeyer
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 65
6 posts
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