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Lozito A, Gemelli M, Micello D, Vinci V, Pelosi G, Ricotta R. Immune-related gigantomastia: a case study. Immunotherapy 2023; 15:1001-1007. [PMID: 37431623 DOI: 10.2217/imt-2023-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
PD-1/PDL-1 inhibitors have revolutionized cancer treatment, especially in lung cancer. Despite their efficacy, a new spectrum of side effects, called immune-related adverse events, may occur and their management could be difficult. Gigantomastia, a rare condition characterized by excessive growth of the breasts, has been associated with some drugs, but no correlation with immunotherapy has ever been reported. Here, we report the case of a possible immune-related gigantomastia.
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Affiliation(s)
- Alessia Lozito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, 20090, Italy
| | - Maria Gemelli
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, 20099, Italy
| | - Donata Micello
- Inter-Hospital Division of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, 20090, Italy
- Humanitas Clinical & Research Center, IRCCS, Rozzano, Milan, 20089, Italy
| | - Giuseppe Pelosi
- Inter-Hospital Division of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
- Department of Oncology & Hemato-Oncology, University of Milan, Milan, Italy
| | - Riccardo Ricotta
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, 20099, Italy
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Vashistha A, Rundla M, Khan F, Om P. Idiopathic gigantomastia with Pseudoangiomatous stromal hyperplasia: A case report. Int J Surg Case Rep 2020; 77:915-919. [PMID: 33162384 PMCID: PMC7775963 DOI: 10.1016/j.ijscr.2020.09.151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gigantomastia is a rare condition characterized by excessive diffuse enlargement of both breasts and can be physically and psychosocially disabling for the patient. Despite an extensive search, the etiology remains poorly understood with most common being pubertal and gestational gigantomastia, with incidence of Idiopathic gigantomastia associated with bilateral PASH being extremely rare. METHODS A 37 year old lady with bilateral gigantomastia and severe back pain with a normal radiological, hormonal and histopathological evaluation underwent reduction mammoplasty with objective of weight and volume reduction of the breasts along with aesthetic enhancement. RESULTS The excised specimen weighed 3.5 and 5 kg respectively in left and right breast with uneventful post operative period and symptomatic relief to the patient. The histopathology was suggestive of macromastia with pseudoangiomatous stromal hyperplasia like areas with focally PR positive status on IHC. CONCLUSION Most commonly etiological factor for gigantomastia is endogenous hormone stimulation. While idiopathic gigantomastia is rare those associated with PASH are still rarer with around 13 cases reported in the literature till date. PASH is a beingn mesenchymal proliferative lesion of the breast, mostly found in premenopausal women and rarely manifests clinically. Reduction mammoplasty can make a significant improvement in life of such young patients with explained risk of probability of recurrence. Among the various techniques available inverted T scar pattern with superiomedical pedicle are preferred as the learning curve is shorter, have greater versatility, and is reproducible with consistent results.
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Affiliation(s)
| | - Manish Rundla
- Department of General Surgery, Sawai Mansingh Hospital, Jaipur, India
| | - Farukh Khan
- Department of General Surgery, Sawai Mansingh Hospital, Jaipur, India
| | - Prabha Om
- Department of General Surgery, Sawai Mansingh Hospital, Jaipur, India
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Das L, Rai A, Vaiphei K, Garg A, Mohsina S, Bhansali A, Dutta P, Tripathy S. Idiopathic gigantomastia: newer mechanistic insights implicating the paracrine milieu. Endocrine 2019; 66:166-177. [PMID: 31502211 DOI: 10.1007/s12020-019-02065-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Gigantomastia refers to pathological breast enlargement usually occurring in the peripubertal or peripartum period. Idiopathic gigantomastia, however, is a rare entity with hypotheses citing local expression of hormones and growth factors in causing this disease, none of which have been systemically analysed. The purpose of this study was to delve deeper into the mechanistic pathways causing this condition. METHODS Herein, we describe three patients of idiopathic gigantomastia, all of whom had had normal puberty and uneventful pregnancies. Further, one of the patients had postmenopausal gigantomastia which is extremely rare, with only four cases described in the literature. Serum markers of autoimmunity, incriminated hormones and growth factors analysed, were normal in all the cases. Breast tissue specimens were subjected to histopathological examination and immunohistochemistry for ER, PR and Her-2-Neu. Quantitative immunofluorescence for aromatase, IGF2, EGFR, TGF-β, PDGFR-α, β, IGF1 and PTHrP was also performed. RESULTS Of these, the tissue expression of aromatase, IGF2, EGFR, TGF-β, PDGFR-α and β were found to be upregulated, whereas IGF1 and PTHrP were comparable to normal breast. CONCLUSION This observation that paracrine overexpression of these factors is responsible for the pathogenesis of apparently idiopathic gigantomastia may have therapeutic ramifications in the future for patients with this debilitating condition.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Ashutosh Rai
- Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India
| | - Kim Vaiphei
- Department of Pathology, PGIMER, Chandigarh, India
| | - Akhil Garg
- Department of Plastic surgery, PGIMER, Chandigarh, India
| | - Subair Mohsina
- Department of Plastic surgery, PGIMER, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India.
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Jabaiti S, Fayyad L, Isleem U. Prednisolone-induced virginal mammary hypertrophy: Case report. Int J Surg Case Rep 2019; 59:140-143. [PMID: 31146195 PMCID: PMC6541761 DOI: 10.1016/j.ijscr.2019.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/22/2019] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
Virginal Mammary Hypertrophy is a rare condition. Virginal Mammary Hypertrophy can be physically and psychologically debilitating. A 17-year old with breast hypertrophy following prednisolone treatment is discussed. The patient was treated with a bilateral mammaplasty following appropriate counseling. Four years after the original procedure, there was no recurrence of hypertrophy.
Introduction Virginal mammary hypertrophy (VMH) is a rare benign disorder of the breast characterized by excessive enlargement of one or both breasts. It usually presents during adolescence. Drug-induced VMH has been scarcely reported in case reports. Review of the literature showed that prednisolone-induced gigantomastia was reported in a single study on a 47-year-old female. In this study, a case of VMH in a 17-year-old girl following prednisolone treatment will be described. Clinical presentation, clinical findings, diagnostic work-up, management and follow up are discussed. Presentation of case A 17-year-old, single female presented to the plastic surgery department at our institute with progressive enlargement of both breasts, 2 months following treatment with prednisolone. Incisional biopsy excluded other breast differential diagnoses. The patient was managed surgically with bilateral mammaplasty with free nipple-areola graft. A total of 8.325 kg of breast tissue was resected. Follow-up 48 months postoperatively revealed good patient satisfaction with no recurrence of breast hypertrophy. Discussion Although the estrogen theory is regarded as the most credible explanation for VMH, several cases of drug-induced mammary hypertrophy have been reported. This study may be the first reported case of adolescent prednisolone-induced VMH. Mammaplasty is an accepted treatment despite its possible association with a higher recurrence rate. Conclusion VMH may be a rare complication of prednisolone treatment. It should be considered in patients presenting with breast hypertrophy following steroid administration.
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Affiliation(s)
- Samir Jabaiti
- Department of Plastic and Reconstructive surgery, Jordan University Hospital, Amman, Jordan.
| | - Luma Fayyad
- Department of Pathology, Jordan University Hospital, Amman, Jordan; Department of Pathology, King Hussein Medical Center, Amman, Jordan.
| | - Ula Isleem
- Faculty of Medicine, University of Jordan, Amman, Jordan.
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Traoré B, Kamate B, Conde M, Keita AM, Kourouma T, Dem A. An exceptional case of bilateral gestational gigantomastia with multiple breast lumps. Pan Afr Med J 2015; 20:309. [PMID: 26161232 PMCID: PMC4489944 DOI: 10.11604/pamj.2015.20.309.6544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/26/2015] [Indexed: 11/24/2022] Open
Abstract
Bilateral gigantomastia is a rare condition, often associated with pregnancy that is characterized by a diffuse enlargement of both breasts. Here we present a case of a late 20s woman in her seven months pregnancy with a bilateral gestational gigantomastia associated with multiple breast lumps. Histological analysis revealed a fibroadenoma. Her prolactin level after caesarean delivery was found particularly high. A significant decrease in breast size was achieved with bromocriptine treatment in conjunction with a bilateral lumpectomy. This case report highlights the diversity of gigantomastia and emphasizes the importance of a tailored, multidisciplinary approach to the diagnosis and treatment of this condition.
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Affiliation(s)
- Bangaly Traoré
- Unit of Surgical Oncology, Donka University Hospital Centre, Conakry, Guinea
| | | | - Mamoudou Conde
- Unit of Surgical Oncology, Donka University Hospital Centre, Conakry, Guinea
| | | | - Tidiane Kourouma
- Unit of Surgical Oncology, Donka University Hospital Centre, Conakry, Guinea
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Shi YD, Qi FZ, Feng ZH. Bilateral reduction mammoplasty after heart transplantation. Heart Surg Forum 2014; 17:E224-6. [PMID: 25179978 DOI: 10.1532/hsf98.2014359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a bilateral reduction mammoplasty in a 15 year old female who suffered increasing back and shoulder pain and chest wall discomfort associated with bilateral breast enlargement during a 17 month period following heart transplantation. Cardiologic evaluation confirmed a structurally normal heart with good systolic and diastolic function, and ejection fraction of 80%. We performed a bilateral mammoplasty using dermal suspension flap in vertical-scar reduction. The patient recovered satisfactorily without incident, and breast morphology was excellent at the 2 year 9 month follow-up, with no recurrence of her previous symptoms or further hyperplasia.
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Affiliation(s)
- Yue-Dong Shi
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Fa-Zhi Qi
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zi-Hao Feng
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Breast Reduction in Gigantomastia Using the Posterosuperior Pedicle: An Alternative Technique, Based on Preservation of the Anterior Intercostal Artery Perforators. Plast Reconstr Surg 2010; 125:32-43. [DOI: 10.1097/prs.0b013e3181c49561] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lanzon AE, Navarra SV. Gigantomastia in a patient with systemic lupus erythematosus successfully treated by reduction mammoplasty. Lupus 2009; 18:1309-12. [PMID: 19850663 DOI: 10.1177/0961203309106690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of the study was to describe a Filipino woman with systemic lupus erythematosus (SLE) who developed gigantomastia associated with hyperoestrogenemia and successfully treated by reduction mammoplasty. A 37-year-old Filipino woman with SLE of 5-year duration presented with enlargement of breasts, which became more noticeable and progressive during disease flares requiring increased steroid dose (+ or - 40 mg/day). Following control of the last SLE flare, with prednisone effectively tapered to 15 mg/day, she consented to surgical breast reduction. Preoperative physical examination recorded the right and left breast measurement of 61 cm and 54.5 cm from sternal notch to nipple tip, respectively. serum oestrogen assay was elevated. She successfully underwent reduction mammoplasty with free nipple graft, with an uneventful postoperative course. The breast tissue oestrogen and progesterone receptor assays were strongly positive. In the succeeding months, SLE disease remained stable with prednisone tapered to 10 mg daily. This case illustrates a rare occurrence of gigantomastia associated with hyperoestrogenemia in a patient with SLE, successfully treated with reduction mammoplasty.
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Affiliation(s)
- A E Lanzon
- Section of Rheumatology, Clinical Immunology and Osteoporosis, University of Santo Tomas, Manila, Philippines.
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Dancey A, Khan M, Dawson J, Peart F. Gigantomastia – a classification and review of the literature. J Plast Reconstr Aesthet Surg 2008; 61:493-502. [DOI: 10.1016/j.bjps.2007.10.041] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 05/13/2007] [Accepted: 10/18/2007] [Indexed: 11/28/2022]
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Schmid N, De Greef C, Calteux N, Duhem C, Faverly D. [Vertical reduction mammaplasty for gigantomastia with massive fibroadenomatosis: a case report]. ANN CHIR PLAST ESTH 2006; 51:536-41. [PMID: 16677750 DOI: 10.1016/j.anplas.2006.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 03/10/2006] [Indexed: 11/15/2022]
Abstract
Vertical reduction mammaplasty is one of the most debated << short-scar >> breast reduction technique. Advantages and drawbacks of the technique are discussed; most of the authors do not accept it as the technique of choice for high glandular resection weights. In our case report we achieve it for a resection weight up to two kilograms with an areolar transposition distance of more than ten centimetres. We show that it is reasonable to realize it dealing with gigantomastia. The massive fibroadenomatosis is observed following immunosuppressive treatment for kidney transplantation. Cyclosporine intake, even sporadic, is at the origin of the growth of these multiple, bilateral and large fibroadenomas. Drug-induced cytokines stimulate their development.
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Affiliation(s)
- N Schmid
- Service de Chirurgie Plastique, Centre Hospitalier de Luxembourg, 4, rue Barblé, 1210 Luxembourg, Grand-Duché de Luxembourg.
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Arscott GD, Craig HR, Gabay L. Failure of bromocriptine therapy to control juvenile mammary hypertrophy. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:720-3. [PMID: 11728119 DOI: 10.1054/bjps.2001.3691] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rapid massive breast hypertrophy occasionally occurs at the time of puberty or during pregnancy, with breast size eventually becoming burdensome or incapacitating to the patient. Pregnancy-related breast hypertrophy is often arrested or reversed by reducing serum prolactin levels with bromocriptine therapy. Unfortunately, breast enlargement in our 12-year-old patient with massive juvenile mammary hypertrophy was unaffected by bromocriptine therapy despite a reduction of her prolactin to normal levels. Two reduction mammaplasties followed by subcutaneous mastectomy were required to control breast hypertrophy. Breast-tissue hypersensitivity to prolactin appears to be a characteristic of pregnancy-related gigantomastia. Our pubertal patient with juvenile mammary hypertrophy failed to respond to bromocriptine therapy, so the aetiology of this syndrome may involve breast-tissue hypersensitivity to hormones other than prolactin.
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Affiliation(s)
- G D Arscott
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Maricopa Medical Center, Phoenix, Arizona, USA
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