Idiopathic gigantomastia in a patient on polypharmacy.

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.

Lupus mastitis as a first manifestation of systemic disease: About two cases with a review of the literature.

Lupus mastitis is an uncommon manifestation of systemic lupus erythematosus (SLE) that affects the subcutaneous fat in the breast, much like lupus panniculitis, but additionally involves the mammary gland. We report on two women for whom lupus mastitis was the initial manifestation of SLE and provide a literature review of 34 additional cases reported in the Anglo-Saxon and French literature since 1971, making this the largest review to date. Lupus mastitis (LM) can manifest clinically as subcutaneous masses that may be painful, or may present cutaneous involvement such as thickening and discolouration. The radiologic manifestations of LM are broad and include calcifications, masses and asymmetries. Most often, excluding malignancy requires percutaneous biopsy, with histologic findings that are virtually pathognomonic for SLE. Thus, surgery is avoided and medical management can begin, antimalarial drugs and corticosteroids in most cases.

Is the outcome at surgery different when flat epithelial atypia and lobular neoplasia are found in association at biopsy?

OBJECTIVE: To assess the impact on the final outcome at surgery of flat epithelial atypia (FEA) when found concomitantly with lobular neoplasia (LN) in biopsy specimens compared with pure biopsy-proven FEA. METHODS: The approval from the institutional review board of the CHUM (Centre Hospitalier Universitaire de Montréal) was obtained. A retrospective review of our database between 2009 and 2013 identified 81 females (mean age 54 years, range 38-90 years) with 81 FEA biopsy-proven lesions. These were pure or associated with LN only in 59/81 (73%) and 22/81 (27%) cases, respectively. Overall, 57/81 (70%) patients underwent surgery and 24/81 (30%) patients underwent mammographic surveillance with a mean follow-up of 36 months. RESULTS: FEA presented more often as microcalcifications in 68/81 (84%) patients and were mostly amorphous in 49/68 (72%). After excluding radio pathologically discordant cases, pure FEA proved to be malignant at surgery in 1/41 (2%; 95% confidence interval 0.06-12.9). There was no statistically significant difference in the upgrade to malignancy whether FEA lesions were pure or associated to LN at biopsy (p = 0.4245); however, when paired in biopsy specimens, these lesions were more frequently associated with atypical ductal hyperplasia (ADH) at surgery than with pure FEA (p = 0.012). CONCLUSION: Our results show a 2% upgrade rate to malignancy of pure FEA lesions. When FEA is found in association with LN at biopsy, surgical excision yields more frequently ADH than pure FEA thus warranting close surveillance or even surgical excision. Advances in knowledge: The association of LN with FEA at biopsy was more frequently associated with ADH at surgery than with pure FEA. If a biopsy-proven FEA lesion is deemed concordant with the imaging finding, when paired with LN at biopsy, careful surveillance or even surgical excision is suggested.

Acretismo placentario en el Instituto Materno Infantil (IMI) 1994- 1999 / Placenta accreta in the Instituto Materno Infantil 1994-1999

El acretismo placentario consiste en la adherencia anormal de la placenta a una decidua defectuosa o al miometrio, conduciendo a una demora en el alumbramiento o a la retención placentaria, asociada además a una hemorragia postparto que puede requerir o no histerectomía. Se realizó un estudio retrospectivo descriptivo de los casos de acretismo placentario encontrados y confirmados en el departamento de patología de nuestra institución entre el 1o. de enero de 1994 y el 31 de agosto de 1999. Se revisaron los antecedentes gineco-obstétricos, aspectos clínicos e histopatológicos y se correlacionaron con los de la literatura. Dada la alta incidencia de parto por cesárea y su fuerte asociación con placenta previa y acretismo placentario, el obstetra deberá utilizar todos los métodos disponibles para diagnosticar y tratar esta patología.