Dermatitis neglecta in a patient with breast fibroadenoma: case report

Dermatitis neglecta, a condition that results from inadequate skin cleansing, is still little reported in the literature and underreported. Although benign, it is aesthetically uncomfortable. It is associated with conditions that lead to fear of sanitizing a given region and may be related to psychiatric and neurological disorders. This observational study consisted of the case report of a patient followed up in a University Hospital in northeastern Brazil, with the objective of demonstrating the rare association between dermatitis neglecta and breast fibroadenoma. A young patient with a history of depressive disorder had crusted and hyperpigmented skin lesions covering the left breast and massive tumor in the same breast. The patient was oriented regarding the cleaning and removal of crusts, resulting in good clinical response. She underwent excision of the tumor, and the anatomopathological study was compatible with fibroadenoma. Interdisciplinary follow-up, including treatment for psychiatric disorder, was fundamental for the patient's recovery, considering the improvement of her mood after establishing the therapy and successful final breast reconstruction. Dermatitis neglecta can resemble other types of dermatitis, in such a way that it is essential to establish a differential diagnosis to avoid unnecessary evaluation procedures, interventions, and therapies. In this exuberant case of dermatitis neglecta, the importance of comprehensive health care is emphasized."

Pseudoangiomatous stromal hyperplasia of the breast presenting as gigantomastia: case report

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign condition generally seen as an incidental finding of biopsies for other causes. In some rare cases, it can evolve with expressive growth of breast tissue, leading to large breasts. The present study presents a case report of a patient who started with breast hypertrophy during lactation, evolving with gigantomastia, and arrived at the office 3 years after gestation with breasts of 6.2 and 4.3 kg and growth of accessory breast and axillary lymph nodes. The patient was emaciated, with bodily pain and psychological distress. Computed tomography was performed with the finding of diffuse retroglandular nodules and axillary and mediastinal lymph node enlargement, without being able to rule out the lymphoproliferative process. Then, core biopsies were made in several places on the breast whose pathological examination revealed PASH samples. Bilateral mastectomy was performed as a surgical treatment, with resection of the left accessory breast and left axillary lymph node, and breast reconstruction, with placement of silicone prostheses and graft of the areola-papillary complex, together with a plastic surgeon. She evolved in the postoperative period with good healing of the surgical wound, weight gain, necrosis of the areola-papillary complex and with severe psychiatric disorder, which was treated appropriately by psychiatrists, with remission of symptoms. This case report presents a rare evolution of PASH with gigantomastia, bringing intense physical and psychological distress to the patient, whose treatment chosen was total surgical resection of the breast tissue and aesthetic reconstruction.