Gestational gigantomastia with fatal outcome

Rakislova, Natalia; Lovane, Lucilia; Fernandes, Fabiola; Gonçalves, Emília; Bassat, Quique; Mocumbi, Sibone; Ordi, Jaume; Carrilho, Carla

doi:10.4322/acr.2020.213

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Autopsy Case Report and Review • Autops. Case Rep. 10 (4) • 2020 • https://doi.org/10.4322/acr.2020.213 copy

Gestational gigantomastia with fatal outcome

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Gigantomastia is a rare disease defined by an extreme and rapid enlargement of the breast, generally bilateral. The majority of cases are reported in pregnant women. Ninety-eight cases of gestational gigantomastia have been identified in electronic databases, and those with fatal outcomes comprised only 2 cases (2%). Despite its benign nature, it can lead to severe complications and even death. Its etiology has not been fully elucidated, but it has been speculated that a hormonal component may play a role in the pathogenesis. Currently, treatment options are limited, and surgery is gaining importance, but it is often not feasible in low-resource settings. Herein, we describe a case of a 30-year-old HIV-positive female with no relevant past medical history, who died due to the complications of gestational gigantomastia at the Maputo Central Hospital, in Mozambique.

Keywords
Gigantomastia; Breast Diseases; Pregnancy; Pregnancy Complications; HIV

Reference	Age	Clinical presentation	Laboratory findings	Histology/microbiology	Treatment and outcome
Ibrahim et al.⁹9 Ibrahim A, Enesi P, Abur P, Oguntayo A, Garba E. Bilateral gestational gigantomastia complicated by severe sepsis; case report of a preventable mortality. Niger J Surg Res. 2013;15(1):29-29. http://dx.doi.org/10.4103/1595-1103.141392. http://dx.doi.org/10.4103/1595-1103.1413...	18	Pregnant woman with immunoendocrine insufficiency syndrome, admitted with enlargement of the mammary glands.	High blood prolactin level	Breast biopsy: proliferation of intralobular connective tissue and ducts; marked interstitial edema	The patient developed severe adrenal insufficiency due to the use of parlodel Surgical abortion was conducted. Death occurred hours after the surgery.
Zaĭrat’iants²⁹29 Zaĭrat’iants OV. Gigantomastia in pregnancy developing in a case of status thymicolymphaticus. Arkh Patol. 1984;46(9):87-91. PMid:6508579.	27	Admitted at 20 weeks of gestation with bilateral enlargement of the mammary glands, massive ulcerations and necrosis of the lower pole of the breasts. Discrete axillary lymphadenopathy was present.	Hemoglobin of 8 g/dL Neutrophilia, elevated prolactin and luteinizing hormones Blood culture: repeatedly positive for Staphylococcus aureus	Breast biopsy: chronic non-specific inflammation Breast culture: Proteus spp	Surgery was declined by the patient. At 22 weeks of gestation patientdelivered a dead fetus, developing severe sepsis within the next 48 hours. The patient died of sepsis

Hospital Universitário da Universidade de São Paulo Hospital Universitário da Universidade de São Paulo, Av. Prof. Lineu Prestes, 2565 - Cidade Universitária, 05508-000 - São Paulo - SP - Brasil, (16) 3307-2068, (16) 3307-2068 - São Paulo - SP - Brazil
E-mail: autopsy.hu@gmail.com

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[1] Authors’ contributions: Lucilia Lovane, Natalia Rakislova, Carla Carrilho, and Jaume Ordi conceptualized and designed the study. Sibone Mocumbi and Emília Gonçalves participated in the ante-mortem clinical management of the patient. Lucilia Lovane and Fabiola Fernandes were involved in conducting the autopsy and analyzing pathological findings. Natalia Rakislova and Quique Bassat were involved in the preparation of the manuscript. All authors proofread the final version and approved it for publication.