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Pseudocyesis or false belief of pregnancy is the emergence of classical manifestations of pregnancy—nausea, breast enlargement and pigmentation, abdominal distention, amenorrhea, and labor pains—in a nonpregnant woman. It is a multifactorial disease and its development is influenced by many different elements such as neuroendocrine, social, psychodynamic, and cultural issues. “Folie-à-deux,” is shared psychotic disorder, describes a syndrome in which delusion is transferred to another person who is more susceptible. Both individuals are closely related or know each other for a long time and typically live together in relative social isolation. In its commonest form, the individual who first develops the delusion (the primary case) is often chronically ill and typically is the dominant member in a close relationship with a more suggestible person (the secondary case) who also develops the delusion. Treatment options should also be kept in mind as antipsychotics themselves can increase prolactin levels and can lead to amenorrhoea and galactorrhea and can further strengthen patient’s belief about her pregnancy. This case highlights that the most important therapeutic step in the treatment of folie-à-deux is separation of the inducer and the induced. Here we describe a case of folie-à-deux of a married couple in which the female had delusional pregnancy while the husband shared and supported her delusion against substantial medical evidence.

Objective: Gynecomastia is benign enlargement of breast in male. It is postulated that its development is primarily due to a mismatch in ratio of oestrogen and androgen at breast tissue. The aim of this study was to highlight the clinical features, presentation and hormonal parameters at the time of consultation. Methods: All adolescent patients who attended endocrinology department with the complaint of breast enlargement were taken into study. We analysed their thyroid function test, oestrogen, testosterone, prolactin, alpha-fetoprotein, follicle-stimulating hormone, luteinizing hormone, beta HCG (human chorionic gonadotropin) and liver function. Clinical features and anthropometry were recorded. Results: Out of 50 patients enrolled, 34 (68%) had bilateral gynaecomastia while 16 patients (32%) had unilateral disease. Mastalgia was seen in 44 patients (88%). Psychological disturbance in the form of depression was seen in 60% of adolescent boys with gynecomastia. Tanner stage B had positive correlation with oestrogen to testosterone (E2/TTE) ratio (r = 0.47; P = 0.034). All other hormonal parameters were normal. Conclusion: Mastalgia was one of the presenting complaints in majority of patients and many had bilateral enlargement. Altered oestrogen to testosterone ratio is altered in majority of patients thus may be reason for pubertal gynecomastia.

Gynecomastia is a common disease in male patients that is characterized by benign breast enlargement. Gynecomastia may involve fibroglandular tissue (FGT), supramammary fat tissue, and retromammary fat tissue (RMFT). Gynecomastia is usually treated surgically; however, some patients undergo reoperation because of dissatisfaction with the results of the first operation. This study aimed to analyze the breast conditions requiring reoperation and to identify factors requiring attention during the first gynecomastia surgery. We retrospectively evaluated 98 patients who underwent reoperation because of unsatisfactory esthetic outcomes from January 2014 to April 2020. According to the reasons for dissatisfaction, patients were divided into undercorrection and overcorrection groups. Patients with remnant breast tissue were assigned to the undercorrection group, while those in whom excess breast tissue was removed and was assigned to the overcorrection group. The undercorrection and overcorrection groups comprised 81 and 17 patients, respectively. In the undercorrection group, 49 (60.5%) patients had residual FGT and fat tissue necessitating simultaneous FGT excision and liposuction, while 32 (39.5%) patients had no residual FGT and were treated with liposuction only. In the overcorrection group, 13 (76.5%) patients had undergone excessive removal of RMFT at the inferolateral aspect of the pectoralis major muscle margin and were treated by autologous fat grafting. The most common cause of undercorrection was incomplete FGT removal, and the most common cause of overcorrection was excessive RMFT removal. Complete FGT excision and proper RMFT preservation can reduce the reoperation rate after gynecomastia surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Complete androgen insensitivity syndrome (CAIS) is caused by mutations in the androgen receptor gene. Patients with this syndrome have a 46,XY karyotype, male gonads, and normal female external genitalia. While the pre-pubertal risk of developing gonadal tumors is low in these patients, it increases with age. Most gonadal tumors arise from germ cells; stromal cell tumors are uncommon. Herein, we report a CAIS patient with a feminizing Sertoli cell tumor. The patient presented at 8 yr of age with breast enlargement and growth acceleration, concomitant with elevated serum estradiol levels and suppressed serum gonadotropin levels; these findings were inconsistent with CAIS. The patient underwent gonadectomy at 10 yr of age, and histology demonstrated presence of a non-malignant Sertoli cell tumor in the right gonad. We conclude that this is the first reported case of CAIS with accelerated onset of puberty resulting from a Sertoli cell tumor.

Highlights • This is one the first published cases of gestational gigantomastia in Saudi Arabia. • Gestational gigantomastia is a very rare disease (1 in 100 000 pregnancies). • This case of gestational gigantomastia is complicated by ulceration and discharge. • The treatment options are skin-sparing mastectomy and breast reconstruction. • Immediate reconstruction by pre-pectoral implant and ADM is an option., Introduction Gestational gigantomastia (GG) is a rare condition manifesting as a fast and excessive growth of the breasts in pregnant women. Its etiology is still unclear, with theories ranging from hormonal imbalances, unregulated immune response, to hypersensitivity. Medical interventions are mainly surgical in nature, though some pharmacological medications are of debatable efficacy. Case presentation A 33-year old Saudi gravida 3 para 2 presents continuous breast enlargement since the start of her pregnancy. She complains of skin ulcerations and discharge which was initially treated conservatively with topical antibiotics. Days after she came back with worsening GG symptoms, and was admitted for bilateral skin sparing mastectomy and reconstruction, and successfully recovered. The patient came back with problems concerning the surgical implant and wound infection. Emergency operation was performed for implant removal and wound treatment. Labor induction was performed by the OB-GYN on her 39 week. The patient opted for autogenous reconstruction by bilateral latissimus dorsi flap months after delivery. After treatment of minor surgical complications, the patient successfully recovered. Discussion Surgery is one of the most effective interventions for GG. Total mastectomy is preferred due to lesser risk of recurrence in subsequent pregnancies. Reduction mammoplasty offers the breastfeeding option if conducted before the delivery, but poses higher risk of recurrence in future pregnancies. Conclusion The patient’s gestational gigantomastia condition was complicated by several ulcerations and infections. Surgery was conducted alongside antibiotic treatment. This report also highlights the importance of follow ups in managing complications.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign hyperplastic condition of the breast that can lead to macromastia. The standard treatment for PASH is focal excision or rarely reduction mammoplasty. We present a rare case of postpartum bilateral rapid breast enlargement and axillary growth that was refractory to reduction mammoplasty. Ultimately, the patient required bilateral mastectomy and two-stage implant-based breast reconstruction. This more extensive form along with its management represents one of the few reported cases in the literature. The decision to pursue bilateral mastectomy was undertaken after exhausting more conservative options. Excellent aesthetic outcome and pain relief was obtained following definitive extirpative and reconstructive surgery.

Graphical abstract, Highlights • Gestational gigantomastia presents in early pregnancy as huge continuous breast size enlargement. • Axillary involvement is not mentioned in medical literature before. • Conservative management of Gestational gigantomastia is a valid option depending on patient condition and tolerance., Background Gestational gigantomastia presents in pregnancy as a rapid and excessive enlargement of the breast reducing the quality of life and causing psychological and physical impairment. Huge axillary enlargement due to Gestational gigantomastia is not mentioned in the literature before. Best treatment remains unclear as conservative and medical management are options beside the more aggressive surgical treatment. Case presentation This is a special case of Gestational gigantomastia presented by huge axillary and breast enlargement in a 34-year-old female. Treated successfully in a conservative manner, a near complete spontaneous resolution happened two months post-delivery. Conclusion Axillary involvement is not mentioned in the limited literature discussing the rare disease of gestational gigantomastia. Not only breast but also axillary area can be involved and enlarge due to this disease. Conservative non-operative management was successful.

Objective Gynecomastia is defined as a benign proliferation of male breast glandular tissue. Its prevalence during puberty varies between 50-60% and is also common in neonatal and elderly males. It develops mainly due to the disequilibrium between estrogen and androgen activity in breast tissue, where estradiol (E2) binds to estrogen receptors and stimulates ductal and glandular cells. The aim of this work was to investigate the relationship between sex hormone alterations and the natural history of gynecomastia. Methods Participants in this study were young males referred to an outpatient clinic, between January 2011 and February 2016, with breast enlargement. Thyroid function, liver function, hormone concentrations and tumor markers were measured and anthropometric assessment was conducted. Results Subjects comprised 93 males, aged 9 to 18 (mean±standard deviation age 13.8±2.6) years. In 63 of 93 (67.7%) the gynecomastia was confirmed and 28 were followed-up for a median period of three months. None of the boys showed any reduction in breast size during follow-up. There was no correlation between body mass index Z-score and breast size. Breast enlargement progressed in nine boys (32.1%). A positive correlation between estrogen to testosterone (E2/TTE) ratio and Tanner B stage (r=0.47; p=0.034) was observed. Conclusion The E2/TTE ratio may be a helpful tool in diagnosing gynecomastia. Altered E2/TTE ratio might be responsible for a proportion of cases described previously as idiopathic. Additionally, weight loss does not imply reduction of breast size in boys. Nonetheless it should be the first step in the management of prolonged gynecomastia.

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. 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. 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. 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.

Background Gynecomastia (GM) is a benign proliferation of the glandular tissue of the breast in men. It is a frequent condition with a reported prevalence of 32-65%, depending on the age and the criteria used for definition. GM of infancy and puberty are common, benign conditions resolving spontaneously in the majority of cases. GM of adulthood is more prevalent among the elderly and proper investigation may reveal an underlying pathology in 45-50% of cases. Objectives The aim was to provide clinical practice guidelines for the evaluation and management of GM. Materials and methods A literature search of articles in English for the term 'gynecomastia' was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Results A set of five statements and fifteen clinical recommendations was formulated. Conclusions The purpose of GM assessment should be the detection of underlying pathological conditions, reversible causes (administration/abuse of aggravating substances), and the discrimination from other breast lumps, particularly breast cancer. Assessment should comprise a thorough medical history and physical examination of the breast and genitalia (including testicular ultrasound). A set of laboratory investigations may integrate the evaluation: testosterone (T), estradiol (E2), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicular stimulating hormone (FSH), thyroid stimulating hormone (TSH), prolactin, human chorionic gonadotropin (hCG), alpha-fetal protein (AFP), liver and renal function tests. Breast imaging may be used whenever the clinical examination is equivocal. In suspicious lesions, core needle biopsy should be sought directly instead. Watchful waiting is recommended after treatment of underlying pathology or discontinuation of substances associated with GM. T treatment should be offered to men with proven T deficiency. The use of selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs) and non-aromatizable androgens is not justified in general. Surgical treatment is the therapy of choice for patients with long-lasting GM. Summary of statements (s) and recommendations (r) S1. Gynecomastia (GM) is a benign proliferation of glandular tissue of the breast in males. S2. GM of infancy is a common condition that usually resolves spontaneously, typically within the first year of life. S3. GM of puberty is a common condition, affecting approximately 50% of mid-pubertal boys; in more than 90% of cases, it resolves spontaneously within 24 months. S4. The prevalence of GM in adulthood increases with increasing age; proper investigation may reveal an underlying pathology in approximately 45-50% of the cases. S5. Male breast cancer is rare; GM should not be considered a premalignant condition. The following recommendations are divided into 'strong', denoted by the number 1 and associated with the terminology 'we recommend', and 'weak' denoted by the number 2 and associated with the phrase 'we suggest'. The grading of the quality of evidence is denoted as follows: ⊕○○○ for very low-quality evidence; ⊕⊕○○ for low quality; ⊕⊕⊕○ for moderate quality; and ⊕⊕⊕⊕ for high quality. R1. The presence of an underlying pathology should be considered in GM of adulthood. We recommend that the identification of an apparent reason for GM in adulthood, including the use of medication known to be associated with GM, should not preclude a detailed investigation (1 ⊕⊕⊕○). R2. We suggest that the initial screening to rule out lipomastia, obvious breast cancer, or testicular cancer might be performed by a general practitioner or another non-specialist (2 ⊕○○○). R3. We recommend that in those cases where a thorough diagnostic workup is warranted, it should be performed by a specialist (1 ⊕○○○). R4. We recommend that the medical history should include information on the onset and duration of GM, sexual development and function, and administration or abuse of substances associated with GM (1 ⊕⊕⊕○). R5. We recommend that the physical examination should detect signs of under-virilization or systemic disease (1 ⊕⊕⊕⊕). R6. We recommend that breast examination should confirm the presence of palpable glandular tissue to discriminate GM from lipomastia (pseudo-gynecomastia) and rule out the suspicion of malignant breast tumor (1 ⊕⊕⊕⊕). R7. We recommend that the physical examination should include the examination of the genitalia to rule out the presence of a palpable testicular tumor and to detect testicular atrophy (1 ⊕⊕⊕⊕). R8. We recommend that genitalia examination is aided by a testicular ultrasound, as the detection of a testicular tumor by palpation has low sensitivity (1 ⊕⊕○○). R9. We suggest that a set of evaluations may include T, E2 , SHBG, LH, FSH, TSH, prolactin, hCG, AFP, and liver and renal function tests (2 ⊕⊕○○). R10. We suggest that breast imaging may offer assistance, where the clinical examination is equivocal (2 ⊕⊕○○). R11. We suggest that, if the clinical picture is suspicious for a malignant lesion, core needle biopsy should be performed (2 ⊕⊕○○). R12. We recommend watchful waiting after treatment of underlying pathology or discontinuation of the administration/abuse of substances associated with GM (1 ⊕⊕○○). R13. We recommend that T treatment should be offered only to men with proven testosterone deficiency (1 ⊕⊕⊕○). R14. We do not recommend the use of selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), or non-aromatizable androgens in the treatment of GM in general (1 ⊕⊕○○). R15. We suggest surgical treatment only for patients with long-lasting GM, which does not regress spontaneously or following medical therapy. The extent and type of surgery depend on the size of breast enlargement, and the amount of adipose tissue (2 ⊕⊕○○).

Summary:. Polyacrylamide hydrogel (PAAG) has been widely used in Russia and China as an injection material for cosmetic surgery. We report the case of a 36-year-old woman who noted breast enlargement subsequent to breastfeeding, after a PAAG injection. In 2016, a PAAG injection was administered to her under both mammary glands at a nearby cosmetic surgery clinic for breast augmentation. After she started breastfeeding following delivery in 2020, she was admitted to our hospital because of a rapid left breast enlargement and unbearable pain. Contrast-enhanced chest computed tomography revealed marked fluid retention in the left breast, and the mammary gland tissue had been pushed outward. A skin incision revealed a significant amount of yellowish-white odorless fluid accumulation. On surgery, a foreign body remained around the pectoralis major muscle, but complete removal was impossible. Currently, 3 months have passed since the operation; however, the patient has not experienced any further pain. There have been many reports on complications caused by PAAG injection. In our case, commencing breast feeding after receiving PAAG injections resulted in a rapid unilateral breast enlargement, and there is no similar report from Japan. In this case, suppressing lactation and rapid removal of the foreign body is the most important measure. It is difficult to completely remove PAAG once it has been injected. PAAG injections for breast augmentation should be avoided in all patients.

Neonatal breast enlargements have varying number of presentations on imaging and these have been underreported in the literature. Our case report profiles a 2-week-old female who presented with a history of bilateral breast enlargement with redness and clear, non-bloody, milk-like discharge, who was clinically diagnosed and managed for neonatal mastitis, which was actually a neonatal breast enlargement only. Awareness on neonatal breast enlargement that can be just physiological without any associated mastitis or inflammatory/infective changes can prevent unnecessary hospitalization and treatment with parenteral antibiotics.

Background Gynaecomastia, although rarely related to testicular tumours, in boys with Peutz-Jeghers syndrome (PJS) usually occurs due to large-cell calcifying Sertoli cell tumour (LCCSCT). Case presentation A 4-year-old boy, with a genetic diagnosis of PJS, presented gynaecomastia since the age of 2, associated with increased height velocity (HV). He exhibited bilateral breast enlargement (Tanner-B4) and a testicular volume of 4 mL. Testicular ultrasound revealed multifocal microcalcifications in both testicles. A laboratory evaluation showed undetectable gonadotrophins, testosterone and oestrogen and inhibin A of 4.6 pg/mL (0.9–1.7). The boy was subjected to therapy with anastrozole. In the last follow-up, 2 years after the start of therapy, he experienced a less tense Tanner-B2 and a decrease in HV; serum inhibin A had become negative. Conclusions This is one of the most precocious PJS-related gynaecomastia treated with aromatase inhibitors (AIs) reported in the literature. Oestrogen levels, although under the detection limit, may be sufficient to stimulate breast tissue/growth plates. Inhibin A is a good marker of LCCSCT and an indicator of response to AIs.

Summary Introduction Since the beginning of the 21st century, three-dimensional imaging systems have been used more often in plastic surgery, especially during preoperative planning for breast surgery and to simulate the postoperative appearance of the implant in the patient's body. The main objective of this study is to assess the patients’ attitudes regarding 3D simulation for breast augmentation. Method A study was conducted, which included women who were operated on for primary breast augmentation. During the consultation, a three-dimensional simulation with Crisalix was done and different sized implants were fitted in the bra. Results Thirty-eight women were included. The median age was 29.4, and the median prosthesis volume was 310 mL. The median rank given regarding the final result was 9 (IQR: 8–9). Ninety percent of patients agreed (66% absolutely agreed, and 24% partially agreed) that the final product after breast augmentations was similar to the Crisalix simulation. Ninety-three percent of the patients believed that the three-dimensional simulation helped them choose their prosthesis (61% a lot and 32% a little). After envisaging a breast enlargement, patients estimated that the Crisalix system was absolutely necessary (21%), very useful (32%), useful (45%), or unnecessary (3%). Regarding prosthesis choice, an equal number of women preferred the 3D simulation (19 patients) as preferred using different sizes of implants in the bra (19 patients). Conclusion The present study demonstrated that 3D simulation is actually useful for patients in order to envisage a breast augmentation. But it should be used as a complement to the classic method of trying different sized breast implants in the bra.

Patient: Female, 51 Final Diagnosis: Breast implant associated anaplastic large cell lymphoma Symptoms: Breast swelling Medication: — Clinical Procedure: Surgery Specialty: Oncology Objective: Rare disease Background: Anaplastic large cell lymphomas (ALCL) are a rare type of primary breast lymphoma. The association between breast implants and ALCL was first described in 1997 and since then 34–173 cases have been presented. The annual incidence of breast implant-associated ALCL (BI-ALCL) is 0.1–0.3 per 100 000 women who undergo breast reconstruction, and cases are often underreported due to the rarity of these tumors. BI-ALCL arises from the inflammatory T cells surrounding the fibrous capsule, and most tumors are in situ. Case Report: Here, we present the case of a 51-year-old woman with ALCL following bilateral silicone breast implants. The patient presented with breast enlargement and tenderness 9 years following reconstructive surgery. Imagining studies showed fluid collection surrounding the affected breast implant. Staging studies and histocytopathology examination confirmed the presence BI-ALCL without capsular invasion or metastasis. Complete surgical excision was performed. The patient continues to be in complete remission. Conclusions: Due to the rarity of these tumors, establishing the diagnosis of BI-ALCL can be challenging and requires a multidisciplinary approach. Clinicians should be aware of the relationship between breast implants and BI-ALCL.

Multiple symmetric lipomatosis is a rare disease characterized by a symmetrical accumulation of massive adipose tissue on the neck, the superior part of the trunk, and limbs. Here, we reported an extremely rare case of multiple symmetric lipomatosis in a 46-year-old Chinese man, who has a history of heavy drinking and smoking and presented with diffuse lipomatosis and bilateral breast enlargement. Hyperuricemia and impaired glucose tolerance test were all found in this patient. A brief review of the literature was also made in this article.

Breast cancer is one of the most commonly diagnosed malignancies in women. Along with increasing demands for breast reconstruction, the attention given to the psychological and aesthetic benefits of breast reconstruction has also increased. As breast reconstruction and augmentation demands increase, biomaterials for breast reconstruction are being developed, and the related industry is growing quickly worldwide. Among the various biomaterials used for breast enlargement, breast implants have undergone a remarkable evolution since the 1960s. Despite unsatisfactory results and unexpected complications, research dedicated to achieving an ideal breast implant has progressed. In accordance with attention to tissue engineering, a three-dimensional (3D) bioprinting technique for breast tissue regeneration has emerged to overcome the current limitations of breast biomaterials. Along with solid implants, injectable liquid-type fillers are also part of ongoing studies.

Background: Gynecomastia during adolescence is common though etiology is not clear. We studied the clinical and hormonal profile of adolescent patients with gynecomastia. Methodology: Patients who had onset of breast development between age 10 and 20 years were included in this study. Their clinical profile, biochemical, and hormonal parameters were studied. Results: Of 94 patients with gynecomastia, 4 had hypogonadotropic hypogonadism, 4 had hypergonadotropic hypogonadism, and 1 had fibroadenosis, but in majority (90.4%), no apparent cause for breast enlargement was evident. In the idiopathic group, majority were obese (63%). Fourteen (16%) patients had impaired fasting glucose or impaired glucose tolerance. Another twenty patients had subtle abnormalities (high 1 h glucose or glucose peak at 2 h). Twenty-nine percent of lean and 38% of obese patients had mild abnormalities in glucose profile. Sixty percent of patients had family background of diabetes. Obese patients had lower testosterone as compared to lean patients; however, estradiol, luteinizing hormone, and follicle-stimulating hormone levels were similar in the two groups. Conclusion: Gynecomastia during adolescence is associated with obesity, dysglycemia, and family background of diabetes mellitus.

The incidence of reported pseudoangiomatous stromal hyperplasia (PASH), as well as the variability and severity of clinical presentations, is increasing in the literature. In parallel, several authors posit the need for an improved classification of PASH to avoid possible variables associated with this diagnosis. Here, we present a 25-year-old woman with PASH accompanied by severe bilateral and symmetrical breasts enlargement, highlighting an uncommon clinical presentation of PASH as much as the careful interdisciplinary review and correlation of histology and all available imaging studies to confirm the definitive diagnosis.

Gynecomastia is a benign enlargement of the male breast which can be a source of significant anxiety and embarrassment for the patients. A great variety of etiologic factors have been investigated and discussed. However, only few studies in the literature have accentuated on the possible role of the chronic tissue trauma for the de novo development of gynecomastia. Nevertheless, the exact mechanism of its onset in such cases remains unclear. The authors report on a case of posttraumatic unilateral progression of preexisting stable gynecomastia. The possible role of a single episode of acute trauma as a trigger mechanism for the new onset of the breast enlargement is discussed. Level of Evidence: Level V, risk/prognostic study.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative mesenchymal lesion of the breast. PASH presents as a palpable or mammographically detectable mass or is an incidental microscopic finding in up to 23% of breast biopsies. Its pathogenesis is unclear but may involve hormonal factors, as recently postulated. Its clinical, cytological, and radiological characteristics resemble those of other benign tumors, including low-grade angiosarcomas and phyllodes tumors. Because of its uncertain pathogenesis, PASH is usually treated via surgical excision, with post-excision recurrence rates ranging from 7% to 22% [1]. Although several cases of PASH have been recently reported, cases of PASH involving large, rapidly growing lesions refractory to surgical incision are rare [2]. In this study, we report our experience with a case of PASH that presented as rapidly growing bilateral breast enlargement refractory to surgical excision. We also review the pertinent literature, including the clinical and histopathological features, pathogenesis, imaging findings, treatment, and prognosis of PASH.

Objective: Pseudocyesis is a rare condition in which a non-pregnant woman has all signs and symptoms of pregnancy, such as abdominal and breast enlargement, cessation of menses and sensation of foetal movement. We hereby present a case of a young woman who presented with pseudocyesis while experiencing anorexia nervosa.Methods: After psychiatric examination, psychopharmacotherapy including cognitive behavioural therapy (CBT) techniques and medication for ongoing depression and eating disorder was provided.Results: After six months of psychopharmacotherapy, depressive mood and belief of being pregnant were diminished; but after two years, she presented to psychiatry for depression and pseudocyesis symptoms again.Conclusions: Etiologic risk factors and treatment approaches including psychotherapy and psychopharmacology are addressed in this case report.

Mammary ductal ectasia (MDE) with bloody nipple discharge (BND) appears to be exceptionally rare and presents a challenge for management to the consulting physician. We report A 5-month-old boy presented with a 3 weeks history of unilateral breast enlargement associated with intermittent spontaneous bloody nipple discharge. Ultrasound evaluation showed a 1.0 cm × 0.57 cm cystic mass in the right subareolar region with dilated ducts. Cytological evaluation of nipple discharge showed no malignant cells. The breast swelling and nipple discharge resolved spontaneously after 1 months without recurrence during the following 7 months. We conclude that mammary ductal ectasia is a benign and self-limited disorder in infancy and can be manged conservatively without any specific treatment to avoid unnecessary invasive surgical intervention.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a pathology that is usually diagnosed by accident during pathological examination of other breast lesions. PASH is an uncommon and benign tumoral lesion of the mammary stroma that can be pathologically mistaken for other tumours, such as phyllodes, fibroadenoma, and sometimes even angiosarcoma. We report the case of a 45-year-old woman with complaints of huge bilateral breast enlargement. This is a rare case of PASH presenting with gigantomastia and involving bilateral breasts and axillae simultaneously. Mammography, ultrasonography, and MRI features are illustrated with histopathological correlation.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign mesenchymal lesion with incidental histologic findings. Surgical excision is recommended as the treatment of choice for PASH, although the recurrence rates after excision range from 15% to 22%. A 46-year-old-female presented with a six-month history of bilateral breast enlargement and painful sensation mimicking inflammatory carcinoma. Imaging studies demonstrated innumerable enhancing nodules in both breasts. Due to the growth of the lesions and progressive clinical symptoms, bilateral subcutaneous mastectomy was performed. Grossly, the specimens were round and well-circumscribed, and the histologic examination revealed PASH. After mastectomy, we created a pocket with the pectoralis major muscle and a lower skin flap, which was deepithelized. Anatomical mammary implants were inserted, and the nipple areolar complex was transferred to a new position as a free graft. The aesthetic result was satisfactory after twelve months of follow-up.

Background: Hyperprolactinemia can be caused by medications, primarily antipsychotics, or by anterior pituitary tumors. The consequences of hyperprolactinemia including gynecomastia, galactorrhea, and sexual dysfunction are very disturbing for males and females. It is sometimes difficult to differentiate the etiology of hyperprolactinemia from a clinical perspective. Objective: Identification of the etiology of hyperprolactinemia requires a careful review of the causes and appropriate work-up. Methods: A 55-year-old African American male with extensive psychiatric history and non-adherence to treatment was admitted from nursing home for aggression and psychotic symptoms. The patient was noted to have mild bilateral breast enlargement about ten days after hospitalization. Prolactin level done on August 26, 2014 was 93.8 ng/mL, and on September 5, 2014 was 112 ng/mL. The patient’s medications included haloperidol decanoate 150 mg q28d, haloperidol 10 mg po bid and benztropine 0.5 mg po bid. He did not have any other clinical signs or symptoms of hyperprolactinemia. He was also seen by an endocrinologist. MRI of the pituitary gland done on September 3, 2014, showed a 2.4 mm pituitary microadenoma. Bromocriptine was started at 1.25 mg qhs and titrated to 2.5 mg bid. Results: Prolactin level dropped from 112 ng/mL on September 5, 2014 to 99 ng/mL on September 9, 2014, 61.2 ng/mLon September 23, 2014 and 3.0 ng/mL on February 9, 2015. Conclusion: Diagnosis and etiology of hyperprolactinemia were complicated by the minimal nature of clinical symptoms, the type of antipsychotic agent and the prolactin level. The MRI facilitated the diagnosis of pituitary microadenoma and further treatment option with bromocriptine. MRI of the pituitary is indicated for patients with hyperprolactinemia where the etiology is not clearly due to medication.

The incidence of male breast cancer is far lower than that of breast cancer in female patients, and usually has a worse prognosis. The incidental discovery of breast cancer in patients undergoing surgery for gynecomastia is rare, but has previously been reported by several authors [1]. However, bilateral atypical ductal hyperplasia in men is far less frequent, and this is the first report to describe the occurrence of this finding with associated microcalcifications in the histopathological analysis. We present the case of a 39-year-old male patient who attended a plastic surgery consultation complaining of long standing bilateral gynecomastia (Fig. 1). He had no personal history of any significant medical conditions or family history of breast cancer. He also denied the use of medication and recreational drugs. Physical examination revealed bilateral breast enlargement with palpable glandular tissue below and surrounding the nipple-areolar complex, with adjacent fat tissue. A testicular examination was normal. Fig. 1 Preoperative photograph with evident breast enlargement. Routine preoperative laboratory tests did not show any alterations in transaminase, plasma creatinine, or thyroid hormone levels. The presence of bilateral glandular breast tissue was confirmed using ultrasound imaging. A combined technique was used to correct this patient's gynecomastia by performing tumescent liposuction of the thorax followed by transareolar resection of the breast tissue. The operation was uneventful, with 45 g of glandular tissue on the left side and 23 g on the right side. The surgical outcome and the patient's postoperative course were satisfactory, and he was discharged the following day without further complications (Fig. 2). Fig. 2 Postoperative photographs six weeks after surgery. Although the swelling had not completely resolved at this stage, the satisfactory nature of the results can be appreciated. The histopathological analysis reported several samples in which stromal fibrosis with hyaline parts was found. Irregular ductal structures were identified, inlaid with hyperplastic epithelium following a cribriform pattern. The cells contained hyperchromatic, pleomorphic, and enlarged nuclei with minimal overlaying and well-defined cytoplasmic borders. Some calcium carbonate microcalcifications were also identified in both samples. No evidence of intraductal or invasive neoplasia was found (Fig. 3). Fig. 3 (A) Hematoxylin and eosin (H&E)-stained section in which ductal structures can be identified following a cribriform pattern, with cells showing varied degrees of atypia (×100). (B, C) Microcalcifications (black arrows) can be seen as groups ... Male breast cancer accounts for 1% of all cases of breast cancer. Although no causal relationship between gynecomastia and male breast cancer has been shown, it is a common association. Up to 40% of patients with male breast cancer present with gynecomastia, most likely because elevated estrogen levels are present in both conditions [1]. Due to its lower prevalence, screening for male breast cancer in the general population it is not advised. However, imaging tests are an important part of the preoperative evaluation of patients with gynecomastia, not just for screening purposes but also to differentiate between true gynecomastia and pseudogynecomastia. Although mammography is widely available and has a specificity and sensibility of greater than 90% for finding malignancies in the male breast, it is usually uncomfortable and poorly tolerated by men with mild breast enlargement. Ultrasound is a reliable alternative that does not involve those disadvantages of mammograms, and has the advantage of allowing ultrasound-guided biopsies if needed [2]. Atypical ductal hyperplasia is a disorder that increases the risk of suffering from both ipsilateral and contralateral breast cancer by up to five times in female patients. It is usually found incidentally in biopsies of suspicious mammographic abnormalities. The current recommendations are to provide advice about cancer risk reduction strategies to female patients suffering from this condition. Breast examinations every six months and yearly mammography are indicated, along with the avoidance of oral contraceptives and hormone replacement therapy. Microcalcifications are not a rare phenomenon, as they are associated with a wide range of breast conditions, such as benign, precancerous, and cancerous lesions. The presence of microcalcifications aids in the histopathological diagnosis of female breast biopsies because they are associated with comedonecrosis in intraductal neoplasms [3]. Furthermore, core biopsies with microcalcifications are more likely to be reported as cancer than are samples without microcalcifications. To our knowledge, this is the first report of atypical ductal hyperplasia with microcalcifications in a male patient [4]. Consequently, insufficient evidence exists to support the hypothesis that this condition is a risk factor for male breast cancer, as it is for females. This explains why no current recommendations exist for the care of these patients. In the case presented in this article, the patient was referred to a breast cancer specialist for annual follow-ups with ultrasound imaging. Without the routine histopathological analysis of the resected specimens from gynecomastia surgery, it would have been impossible to detect this premalignant condition. This standard of practice is of the foremost importance not just for this reason, but also in order to accurately diagnose male breast cancer as early as possible in a larger number of patients.

Introduction. Galactocele, generally occuring in young women during or after lactation, is an extremely rare cause of breast enlargement in infants and children of exclusively male gender. Only 26 cases have been published so far, including two our cases. Case report. We described unilateral, cystic, breast enlargement, without any endocrinologic and other abnormalities in a 29-month-old boy. A typical clinical and histopathologic presentation of galactocele was followed with a complete excision. Conclusion. This was a 27th well documented case of galactocele in a male infant with typical clinical and histopathologic presentation. There are several hypotheses regarding etiology of the lesion, but it is likely to be multifactorial. Because of its extreme rarity, there are some difficulties in differential diagnosis and treatment options of galactocele in male infants.

Men referred for breast imaging most frequently present with a unilateral palpated breast lump or breast enlargement. In the vast majority of these cases, the cause is benign and the most common etiology is gynecomastia. This pictorial review illustrates the appearance by full field digital mammography and digital breast tomosynthesis of gynecomastia as well as additional findings in the male breast including sternalis muscle and hypertrophied pectoralis muscle, lipoma, intramammary lymph node, fat necrosis, breast cancer, and atypical ductal hyperplasia.

Summary Introduction Hyaluronic acid has come to represent the most widely used injectable cosmetic product in the world. Brought into being by the Swedish company Q-Med, in 2007 Macrolane™ was authorized for use in France, and the year after, it received official European approval as a means of breast augmentation. Since then, however, numerous controversies pertaining to its side effects have led to its withdrawal from the worldwide breast augmentation market. The objective of this article is to carry out a review of the literature providing updated information on Macrolane™ and its recent indications. Materials and methods We carried out a review of the literature on the PubMed and PubMed Central data bases through use of the keywords “Macrolane™”, “NASHA”, “hyaluronic acid” and “soft filler”, and subsequently analyzed the levels of evidence and possible biases of the different publications. The official sites of the French, English, Spanish and American scholarly organizations of plastic surgery were likewise consulted. Perusal of the notifications and recommendations for use brought out by the Q-Med company completed our study. Results A large majority of the available clinical series on Macrolane™ with regard to not only breast augmentation, but also its other indications, offer an insufficient level of evidence and present a number of conflicts of interest. Since April 2012 Macrolane™ has been temporarily withdrawn by its distributors from the worldwide breast augmentation market. In point of fact, Macrolane™ injections have been found to interfere with breast imaging and screening for breast cancer. As regards the latest indications for this controversial product, it is not yet possible to step back and take stock. Conclusions Present-day scientific data fail to justify the market reappearance of Macrolane™ breast augmentation products. Q-Med has shown full awareness of the problem by imposing worldwide restrictions on products aimed at penis as well as breast enlargement. Larger cohorts of female patients are more necessary than ever, as is an approach based on stepping back and taking stock.