Idiopathic gigantomastia in a patient on polypharmacy

Abstract

Gigantomastia is an uncommon benign condition characterized by massive breast enlargement. It is most often due to hormonal imbalance secondary to puberty or pregnancy, or induced by a pharmacological agent but can also be idiopathic. Herein, we report a rare case of idiopathic gigantomastia in a 46-year-old female on antiepileptic multiple-drug therapy who underwent total bilateral mastectomy to relieve associated pain.

Figure 1.

(a-c): Mediolateral oblique mammograms of the right (a,b) and left (c) breast obtained at the time of referral, demonstrating heterogeneously dense breast parenchyma with diffuse skin and trabecular thickening. Note the asymmetrical increase in volume of the breasts compared to the previous mammogram obtained two years prior as displayed in Figure 2. Also note the vagal nerve stimulator projecting over the left major pectoral muscle.

Figure 2.

(a,b): Mediolateral oblique mammograms of the right (a) and left (b) breast obtained two years prior demonstrating symmetrical and homogeneous low-density breasts.

Figure 3.

Grayscale ultrasound image of the right breast displaying skin thickening and anechoic subcutaneous structures with thin septations that could be dilated lymphatic ducts or cystic changes, but that were most likely veins on Doppler mode.

Figure 4.

(a,b): Axial (a) and coronal (b) images of the thoracic CT angiogram demonstrating large breasts, more so on the right, partially included in the field of view.

Figure 5.

Cut surfaces of the right breast specimen displaying dense white fibrous tissue and yellowish adipose tissue.

Figure 6.

Histological examination of the right breast demonstrating diffuse edematous infiltration (blue arrow) with dilated lymphatics in the glandular parenchyma (black arrows) (H&E, original magnifications ×2 [A] and ×4 [B]).