PMC9732114_01
Initial presentation of a 23-year-old, primigravid female with bilateral breast swelling, associated with bright erythema, brownish hyperpigmentation near the areolae, peau d'orange changes, and accentuation of follicular orifices. On palpation, both breasts were diffusely indurated with numerous firm, subcutaneous nodules.
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On exam, both breasts appeared massively swollen and brightly erythematous with ill-defined brownish hyperpigmentation surrounding the areolae (Fig 1).
A, At low power magnification (40x), a punch biopsy from the right medial breast showed an increased number of small dermal blood vessels throughout the dermis. B, On higher magnification (100x), the vessels have well-formed lumens and do not demonstrate cytologic atypia. C, To highlight the vasculature, immunohistochemical staining for CD31, a vascular endothelial marker, was performed (100x).
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A punch biopsy from a nodular area revealed diffuse angioproliferative changes of the small dermal blood vessels consistent with DDA (Fig 2) without evidence of morphea or lupus.
Gestational gigantomastia with concurrent diffuse dermal angiomatosis. On hospital admission, the patient continued to exhibit breast swelling (A) and was noted to have development of white, stellate, atrophic plaques (B).
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Upon admission, we noted new white, stellate plaques on the breasts, concerning for necrosis and impending ulceration (Fig 3).