Breast Enlargement in 13 Men Who Were Seropositive for Human Immunodeficiency Virus

Abstract

Breast enlargement, a condition that was rarely reported in the era before highly active antiretroviral therapy, is emerging as a problem in the treatment of male human immunodeficiency virus (HIV)-infected patients. Evaluation of this condition must distinguish between gynecomastia (proliferation of ducts and periductal stroma), lipomastia (adipose-tissue deposition), and malignancy. We describe 13 HIV-infected men, all of whom had exposure to antiretroviral therapy, who presented with breast enlargement. Nine of these patients had gynecomastia, only 1 had lipomastia, and 3 had lymphoma (2 had non-Hodgkin lymphoma and 1 had Hodgkin disease). Gynecomastia was unilateral in all but a single case. In addition, all but 1 of our patients with gynecomastia had prolonged exposure to protease inhibitors. Six patients had potential causes of gynecomastia other than antiretroviral therapy, including liver disease (in 2 patients), mild hypogonadism (in 1), long-term marijuana use (in 2), and use of medications that have known associations with gynecomastia (in 3). Although most causes of breast enlargement in HIV-infected men are likely to be benign, malignancies other than carcinoma are of concern.

Disfunção do eixo gonadotrófico em homens com infecção pelo HIV/Aids

“…Além disso, pode ser observada ginecomastia no cenário da síndrome de redistribuição da gordura corporal, no qual pode ser encontrado acúmulo de gordura na mama (34). Ginecomastia secundária a tumores, principalmente linfomas, também tem sido descrita (35).…”

HIV infected haemophilia a patient presented with gynaecomastia

“…Gynecomastia may also be related to a higher frequency of exposure of the HIV population to other agents that may cause gynecomastia, including antifungals, antituberculous drugs, and tricyclic antidepressants (15) in addition to drugs used for treatment of liver and renal diseases. Drugs used Magnetic resonance (MR) mammography was performed to investigate the cause and possible management choices for breast enlargement in our patient.…”

“…Typically, lipomastia has a bilateral presentation, with more generalized enlargement than gynecomastia (15). However, there is a report of unilateral lipomastia mimicking breast cancer on US (24).…”

“…Kaposi sarcoma (KS) and non-Hodgkin lymphoma, two malignancies seen frequently in HIV-infected patients, can be localized in the breast (15,29). Hodgkin lymphoma and the rare case of plasmacytoma have also been described to arise in breast tissue in HIVinfected individuals (15,30).…”

“…Hodgkin lymphoma and the rare case of plasmacytoma have also been described to arise in breast tissue in HIVinfected individuals (15,30).…”