Fibroadenoma Research Articles

Correlation analysis of breast fibroadenoma and the intestinal flora based on 16S rRNA sequencing*

Abstract Objective To analyze the characteristics of the intestinal microflora in patients with breast fibroadenoma using 16S ribosomal RNA (rRNA) high-throughput sequencing. Methods Fecal samples from 20 patients with breast fibroadenoma and 36 healthy subjects were randomly collected and analyzed using high-throughput sequencing technology for 16S rRNA V4 region sequencing, and the alpha diversity (Chao index, Shannon index) was calculated using Mothur (v.1.39.5) software. Beta diversity was analyzed using QIIME (v1.80). SPSS software (version 23.0) and the t-test of two independent samples were used to analyze differences in the abundance of bacteria between the two groups. Results Compared with that in the healthy control group, the α diversity of the intestinal microflora in breast fibroadenoma patients increased, but the difference was not statistically significant (P > 0.05). At the phylum level, significant differences were observed between the two groups. The abundance of Firmicutes was higher in the breast fibroadenoma group (P < 0.05), whereas the abundance of Synergistetes was higher in the healthy control group (P < 0.005). A total of five bacterial genera showed significant differences between the two groups: the breast fibroadenoma group showed higher levels of Bautia (P < 0.005), Coprococcus (P < 0.005), Roseburia (P < 0.05), and Ruminococcus (P < 0.005), whereas Sutterella was more abundant in the healthy control group than in the breast fibroadenoma group (P < 0.05). Conclusion The diversity and abundance of the intestinal flora in patients with breast fibroadenoma are significantly different from those in healthy subjects, suggesting that an imbalance in the intestinal flora is correlated with the occurrence of breast fibroadenoma.

Using Ultrasound-Based Multilayer Perceptron to Differentiate Early Breast Mucinous Cancer and its Subtypes From Fibroadenoma

ObjectivesMucinous breast cancer (MBC), particularly pure MBC (pMBC), often tend to be confused with fibroadenoma (FA) due to their similar images and firm masses, so some MBC cases are misdiagnosed to be FA, which may cause poor prognosis. We analyzed the ultrasonic features and aimed to identify the ability of multilayer perceptron (MLP) to classify early MBC and its subtypes and FA.Materials and MethodsThe study consisted of 193 patients diagnosed with pMBC, mMBC, or FA. The area under curve (AUC) was calculated to assess the effectiveness of age and 10 ultrasound features in differentiating MBC from FA. We used the pairwise comparison to examine the differences among MBC subtypes (pure and mixed types) and FA. We utilized the MLP to differentiate MBC and its subtypes from FA.ResultsThe nine features with AUCs over 0.5 were as follows: age, echo pattern, shape, orientation, margin, echo rim, vascularity distribution, vascularity grade, and tumor size. In subtype analysis, the significant differences were obtained in 10 variables (p-value range, 0.000–0.037) among pMBC, mMBC, and FA, except posterior feature. Through MLP, the AUCs of predicting MBC and FA were both 0.919; the AUCs of predicting pMBC, mMBC, and FA were 0.875, 0.767, and 0.927, respectively.ConclusionOur study found that the MLP models based on ultrasonic characteristics and age can well distinguish MBC and its subtypes from FA. It may provide a critical insight into MBC preoperative clinical management.

Breast fibroadenomas are less frequent in women with uterine fibroids.

The etiology and incidence of Fibroadenoma (FA) as the most frequent benign breast mass and uterine fibroma (UF) as the most benign gynecological disorders are unknown. Considering the dependency of FA and UF to sex hormones, our objective was to investigate the association of these two neoplasms. Among women attending the hospital Gynecology Clinic, those with typical uterine fibroids in their pelvic ultrasound constituted cases and those with no pathology the controls. All participants underwent breast ultrasound for FA. Criteria for diagnosis of FA were a typical image for lumps <2cm in women aged <40 and <1cm in ages ≥ 40, and a histologic diagnosis for all other participants or larger lumps. The mean age of cases and controls was 42.4 and 41.7 years, respectively. FA were detected in 140 (23%) of all participants; 19.7% of the cases, and 26.2% of the controls (p =0.07). FA and UF had a borderline reverse association (OR = 0.69, 95% CI = 0.46-1.02, p =0.07). The incidence of FA is lower in patients with UF. Further studies are needed to find the selective effects of estrogen and progesterone on hormonal receptors of these two tumors.

The potential of jamu to relieve clinical symptoms and reduce the tumor size of patients with Fibro Adenoma Mammae (FAM) at Rumah Riset Jamu (RRJ) Hortus Medicus Tawangmangu : a pilot study

Fibro Adenoma Mammae (FAM) is a benign tumor that sometimes causes clinical symptoms like pain. Not all women who suffer from FAM in Indonesia are willing to undergo surgery and choose to drink jamu. In fact, scientific evidence regarding jamu efficacy is limited. This study aims to determine the effect of jamu consumption on the size and clinical symptoms of FAM patients. A total of 26 women with FAM who came to RRJ Hortus Medicus and met the inclusion and exclusion criteria participated in this study until finish. Subjects were asked to drink boiled water of 8 plants Simplicia with a certain dose every day for 16 weeks. A breast ultrasound to determine tumor size was performed at baseline and day-112. Clinical symptoms were assessed at baseline and every 2 weeks. The result showed that the tumor average size was decreased from 13.89+ 6.47mm to 11.79+5.74mm (paired t-test p<0.001). About 88.46% of the subjects experienced a decrease in tumor size. The pain subsided and disappeared in 69.23% and 30.77% of subjects, respectively. The itching that was complained by one subject subsided since week 6. The administration of jamu for 16 weeks has the potential to reduce tumor size and clinical symptoms.

Usefulness of Fractal Analysis of Kirsch Edge Images for the Tissue Fragment Inner Structure in Breast FNAB

Objective: Recent advances in high-precision mammography and ultrasound screening have led to an increase in the detection of early lesions (ductal carcinoma in situ and small cancers) appearing as microcalcified lesions or microcystic images, and there needs to be an improvement in the accuracy of breast fine-needle aspiration biopsy (FNAB) assessing these lesions. The objective of this study was to investigate whether fractal analysis of Kirsch edge images for the tissue fragment inner structure (FKT) is useful in breast FNAB. FKT measures tissue fragment chromasia of hyperchromatic crowded tissue fragments (HCG), tissue fragment shape unevenness, and tissue fragment inner structure complexity. Study Design Materials: Nineteen epithelial tissue fragments of fibroadenoma (FA) from 7 patients and 52 tissue fragments of invasive breast carcinoma of no special type (IBC-NST) (grade 1–2) from 11 patients were assessed. First, tissue fragments were classified into small (smaller than 60 × 102 μm²), medium, and large (100 × 102 μm² or larger), and the appearance rate of each size was determined. Second, for FKT, the luminance value of tissue fragment chromasia, the unevenness and fractal value, and the tissue fragment inner structure complexity were determined. In statistical analysis, the Steel-Dwass test, nonlinear discriminant analysis, and receiver operating characteristic analysis were performed, setting the significance level at p < 0.05. Results: “Unevenness of the tissue fragment shape,” “fractal value of the tissue fragment shape,” and “fractal value of the tissue fragment inner structure” were significantly higher in small and large tissue fragments in IBC-NST compared with those in FA. The specificity and sensitivity were the highest (100%) in small tissue fragments in multivariate analysis using 4 variables (“luminance value of tissue fragment chromasia,” “unevenness of tissue fragment shape,” “fractal value of the tissue fragment shape,” and “fractal value of the tissue fragment inner structure”). Conclusion: FKT, which evaluates “tissue fragment darkness,” “tissue fragment shape unevenness,” and “tissue fragment inner structure complexity” focusing on small tissue fragments of HCG in breast FNAB, is useful as a system that assists cytopathological assessment of breast FNAB.

A prospective study on the role of centchroman in regression of fibroadenoma

Background: Fibroadenoma commonly present as painless breast lump in young girls. Nearly 10-15% regress spontaneously over the period of 6-60 months, rest are managed surgically. Centchroman (Saheli), a novel non-steroidal, selective anti-estrogen has been used for the treatment of mastalgia and its effectiveness in the treatment of fibroadenoma is being tested in the ongoing trials. Methods: A total of 60 patients between 15-35 years of age with painless lump breast of size 2 to 5 centimeters confirmed as fibroadenoma by fine needle aspiration cytology (FNAC) were included in the study. Detailed patient's characteristics, clinical history, physical examination (for size in 2 dimensions), ultrasound findings (for size in 3 dimensions) were assessed. All participants included in the study were given tablet Centchroman (Saheli) 30 mg thrice weekly orally for 3 months. Size of Fibroadenoma was reassessed clinically for size in two dimensions and ultrasonologically for size in three dimensions at 4 weeks and 3 months of starting of therapy.Results: Out of 60 patients, 18 patients (30%) had complete response, 40 patients (66.66%) showed a decrease in the size of fibroadenoma and only 2 patients (3.33%) had no response to this therapy. None showed an increase in size.Conclusions: It may prove to be the most effective modality for the treatment of small sized fibroadenoma breast especially in unmarried girls with minimal side effects. Ultrasonology may be relied upon for follow up measurements since it is more accurate in measuring the dimensions.

Role of multi-parametric MRI in the differentiation between mucinous breast carcinoma and fibroadenoma

BackgroundThe purpose of this study was to evaluate diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and functional MRI (diffusion and MR spectroscopy) using the latest MRI breast imaging reporting and data system (MRI-BIRADS) descriptors and non-BIRADS items for differentiation of mucinous breast carcinomas from fibroadenomas.MethodsWe included 19 cases of mucinous breast carcinoma and 37 cases of fibroadenoma. DCE-MRI, Diffusion-weighted MR imaging (DWI) and multi-voxel MR spectroscopy (MRS) were done, MRI-BIRADS (5th edition) analysis of the lesions was performed, and histopathological examination of all cases was done.ResultsAccording to univariate analysis, mucinous carcinoma was frequently detected in older age-group (COR = 1.4, 95% CI = 1.1–1.7 and p value < 0.001) and had more frequent irregular borders and non-circumscribed margins than fibroadenoma (COR = 11.6, 95% CI = 2–66.4 and p value = 0.002). All mucinous carcinoma had high T2 signal. Fibroadenomas had more frequent homogenous enhancement than mucinous carcinoma; none of the fibroadenomas had rim enhancement nor enhancing internal septations; mucinous carcinoma had more frequent rim enhancement and (n = 6, p value < 0.001) and enhancing internal septations (n = 7, p value < 0.001). Fibroadenoma had frequent dark non-enhancing internal septations than mucinous carcinoma (p value < 0.001). On multivariate analysis, mucinous carcinoma had significant combination of being common in older age, larger in size, with irregular shape, and non-circumscribed margins. On ADC map and MRS, mucinous carcinoma had higher ADC values and higher CHO.SNR than fibroadenoma. The mean ADC value of mucinous carcinoma was 1.3 ± 0.1 × 10−3mm2/s, which was significantly higher than that of fibroadenoma (1.1 ± 0.1 × 10−3mm2/s), with p = 0.002. Also, the mean CHO.SNR was significantly higher in mucinous carcinoma (3.1 ± 0.8) than fibroadenoma (0.8 ± 0.5) with p value < 0.001. According to our results, the presence of type 3 (washout curve), dark internal septations, non-circumscribed margins and irregular shape of the lesion showed the highest sensitivity and accuracy for differentiation of mucinous carcinomas and fibroadenomas (100, 78.6%), (89.4, 82%), (86.5, 80.3%) and (81, 71.4%), respectively.ConclusionThe combined use of DCE-MRI, DW-MRI and MRS with breast MRI-BIRADS descriptors and non-BIRADS items increases the diagnostic accuracy for differentiation of mucinous carcinomas from fibroadenomas.

Diagnostic Role of Collagen Type III Alpha in Fibroepithelial Lesions of the Breast: An Immunohistochemical Study

Abstract Background The fibroepithelial lesions (FELs) are heterogeneous biphasic tumors composed of epithelial and stromal components, they include fibroadenoma (FA) and phyllodes tumor (PT). The most FAs are benign, while the PTs have unpredictable biologic behavior, where they can recur if incompletely excised, and can even metastasize. According to the WHO Classification of Tumors of The Breast, PT is classified by the histological features into benign, borderline, and malignant. There is difference in management of the FELs, where a FA is treated conservatively or by simple enucleation. While PT must be excised with wide surgical margin to avoid the recurrence of this tumor, where it can recur as high grade. For this reason the preoperative distinction between FA and PT is critical for management. On another hand, still this differentiation is difficult and challenging in some cases especially on limited sample of core needle biopsy (CNB) and also on excision due to the heterogeneity of PT and overlapping features between the FELs. Recently, the use of immunohistochemical markers may have helpful role in differentiation between FA and PT, and grading of the last one. Collagen III α (Col A ) has been emerged as a potential new diagnostic maker useful in differentiation between fibroepithelial lesions. Methodology In this retrospective study we evaluated the histopathological features of Cases of FELs including FA and PT with its subgrades. We also evaluated an immunohistochemical diagnostic potential of collagen III α (Col A) in differentiating FA from PT, and categorizing the last one. Furthermore, correlations between Col A expression and clinicopathological parameters were performed. Results The staining expression of Col A was increased significantly in PTs when compared with FAs (P&amp;lt;) . Col A expression increased with increased grade of PT but without significant difference between benign PT and borderline PT, and between borderline PT and malignant PT. By pairwise comparison, there was a significant difference between CFA and benign PT according to Col A expression (P&amp;lt;) , and also between the typical FA and FA with PT like features (P&amp;lt;) . There was a trend of increased expression but did not reach the significance between FA with PT like features and benign PT (P=) . Distinct periductal cuffing pattern of Col A staining was present in all PTs and absent in most FAs (P&amp;lt;) , and only cases of FA with PT features exhibited this pattern. Conclusion Col A is a diagnostic marker can differentiate between FA and PT, especially between CFA and benign PT, and the Col A expression increased with increased grade of PT but without significant difference. FA with PT like features might be a distinct category that should be distinguished from typical FΑ as it may an initial event of tumor progression to PT.

Pattern of breast fibroadenoma in females and its clinical approach: An observational study

Introduction: Comprehensive studies describing the histologic features of fibroadenomas are not available in literature. If hyperplasia behaves in a similar way as in the otherwise normal breast, it may contribute to the higher risk of subsequent invasive breast carcinoma. Hence the aim of this study was to make a thorough inventory of the histologic features of the epithelium and stroma within breast fibroadenomas in a large group of cases.Materials and Methods: The total period of study was 24 months. A total of hundered patients suspected of benign breast diseases were included in the study. After initial evaluation of the patient in the OPD of medical hospital, by senior residents of general surgery, patients with features suggestive of Benign Breast Diseases were subjected to a detailed history and clinical examination.Results: The youngest patients were of age 16 years diagnosed with fibroadenoma and the oldest patient was of age 40 years. The mean age of the patients with fibroadenoma was found to be 24 years. Majority of the lumps 76.19% had a size of 2 to 5 cms. The largest lump in the fibroadenoma group was seen in a 16 years old girl with 8x5 cms. Selected cases of fibroadenoma of 2-3 cms in size were reassured and asked for regular follow-up.Discussion and Conclusion: It has been known for many years that some benign breast lesions are more highly associated with breast cancer than others. In this study the types of benign breast lesions were recorded and the study has shown that benign breast lesions are common in our environment and the age incidence of benign breast lesions peaks in 2nd and third decade and with few exceptions our data was comparable to other studies on breast lesions.

Vacuum-Assisted Excision, Scarless Solution for Fibroadenoma Breast-A Single-Center Experience.

Background Fibroadenoma is one of the most common benign breast lesions that is frequently surgically excised in breast practice. Aim The aim of this study was to determine the efficacy and safety of ultrasound-guided (USG) vacuum-assisted excision biopsy (VAEB) of fibroadenoma. Settings and Design A retrospective observational study. Methods and Materials A total of 113 patients with 163 fibroadenomas who underwent USG-guided VAEB under local anesthesia with 7G and 10G probes using an Encor Enspire equipment were included in the study. The patients were followed up after 1, 6, and 12 months. The fibroadenomas up to 4 cm were excised as per the U.S. Food and Drug Administration-approved guidelines of the American Society of Surgeons for percutaneous removal of benign breast lesions. Results The percentage of complete excision rate was 98.8% and the most frequent complication encountered was hematoma including immediate and delayed accounting for 3.06%. There were no recurrent lesions in our study. Conclusion USG-guided VAEB of benign breast lumps can be a safe and effective alternative to surgical excision and had better patient satisfaction in terms of efficacy and cosmesis.

The role of Sonoelastography in characterization of solid breast lesions

Abstract Background Mammography and Sonography are the important sensitive imaging modalities available in detection of breast cancer. Sonoelastography is a relatively new imaging technique which acts as a complementary tool to improve the diagnostic ability of ultrasound for evaluating patients with breast masses. Objective To evaluate the role of sonoelastography characterization information on solid breast lesions over conventional sonography and mammography either benign or malignant lesions to reduce the number of benign biopsies performed. Methods A prospective study was carried at private centers, starting from august 2019 till december 2019. Results The study conducted on 40 patients with palpable breast lesions classified to BIRADS 3 and 4a according to conventional ultrasound and mammographic criteria. Their ages ranged from 18 to '75 years with a mean age 47.72 14.91, 22 cases (55%) had no family history of pervious breast disease, and 18 cases (45%) had family history of pervious breast disease. All patients were subjected to full history taking, clinical examination, conventional gray scale ultrasound, and mammography and ultrasound elastography. All patients underwent histopathological assessment to reach the final diagnosis. Among Studied cases , 28 lesions were sampled by fine needle biopsy (70%) and 12 lesions were sampled by true cut needle (30%) .the results revealed 27 breast lesions were benign (67.5%), 9 malignant lesions (22.5%) and 4 lesions shows atypia (10%) according to histopathological assessment. Among final diagnosis of breast lesions fibro adenoma was the most frequent benign breast lesion detected as 12 lesions from 27 benign breast lesions were fibroadenoma., Also infiltrative ductal carcinoma was the moste frequent among malignant breast lesions as 5 lesions from 9 malignant lesions were infiltrative ductal carcinoma. Conclusion Ultrasoundelastography has significant complementray role beside conventional mammogram and ultrasound in characterization of solid breast lesions.

Diagnosis on Excision Biopsy of Breast Tissues Labeled As Fibroepithelial Tumors on Trucut Samples in a Developing Country.

Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to have malignant transformation in many instances. It is a challenge to diagnose the phyllodes by conventional trucut biopsy technique.Objective: To evaluate the histological characteristics of tumors labeled as fibroepithelial lesions of breast tissues on trucut biopsy and compare with a diagnosis on excision biopsy.Methods and materials: It was a descriptive cross-sectional study that was carried out in Shaukat Khanum Memorial Hospital and Research Centre within six years from January 2015 to January 2021. In trucut samples, stromal cellularity, stromal cell nuclear atypia, mitotic count, stromal overgrowth, the enhancement of stromal cellularity adjacent to epithelium were scrutinized. In each category, the activity was seen as absent, mild, moderate, or severe. Mitotic activity was graded as 0-1, 0-5, 5-10, >10.Results: A total of 125 patients were registered for the study. The mean age of patients in our study was 33.86 ± 9.95 years. The mean size was 41.02 ± 27.38 mm with a mean lump duration of 7.52 ± 5.34 months. In the FA group, the trucut sampling report showed the stromal cellularity as mild in 62 (69.7%) and stromal cell nuclear atypia as absent in 68 (76.4%) cases. But in the phyllodes tumor group, the stromal cellularity was severe in 10 (27.8%) patients and stromal cell nuclear atypia was severe in five (13.9%). The ultimate outcome showed that 89 (71.2%) patients had FA and 36 (28.8%) had PT at excision.Conclusion: Assessment of tumor size, stromal cellularity, mitoses, and enhancement of stromal cellularity adjacent to epithelium are useful markers for diagnosing the PT in trucut needle biopsy.

Comparative Analysis of Eosin-based Fluorescence Microscopy of Non-neoplastic Breast Tissue and Fibroadenoma

Background: Fibroadenoma (FA) is one of the most frequently diagnosed benign neoplasm in women. Various researches have reported increased risk of breast cancer in females with FA. It stems from the proliferation of epithelial and stromal contents of the terminal duct lobular units (TDLU`S) of breast tissue, that are the primary sites for the histopathologic assessment which is the gold standard for the diagnosis of disease. However, this method is subjective and possess interobserver variability. Therefore, new quantitative methods are required to aid in diagnosis. Hence we evaluated fluorescence light intensity and its use in histopatholgic evaluation.&#x0D; Aim: The goal of this research was to compare and quantify red and green fluorescence light intensities of ductal cells and stroma of non-neoplastic breast tissue with fibroadenomatous tissue.&#x0D; Method: A cross-sectional study was done in the Cell biology and histology lab of Ziauddin University. 44 slides of normal breast tissue and 44 slides of diagnosed fibroadenomatous tissue were taken from Dr Ziauddin Hospital, North Campus. Hematoxylin and eosin (H&amp;E) staining of the slides were done following standard protocols. On microscopic examination, the changes in light intensities of ductal cells and stroma of normal breast tissue and fibroadenoma were quantified using dual channel fluorescence microscopy using Nikon NIS imaging software.&#x0D; Results: The results demonstrated statistically significant increase (p-value &lt;0.05) in mean red (37.22±5.9) and green (22.47±6.6) light intensity of stroma in FA when compared with red (32.71± 6.7) and green (17.01±4.3) light intensity of normal breast tissue. Whereas, R/G ratio for normal tissue was higher (1.95±0.11) than R/G for FA (1.74±0.37) with a p value of &lt;0.05. Similarly, for ductal cells; statistically significant (p value &lt;0.05) increase in mean red (38.86±5.4) and green (15.54±2.51) light intensity for FA was found when compared with red (29.62±1.89) and green (12.60±1.67) intensity of normal tissue. R/G ratio for FA (2.5±0.24) was compared to be higher than normal tissue (2.36±0.3) with a p value of &lt;0.05.&#x0D; Conclusion: The study suggests that fluorescence microscopy combined with quantitative assessment fluorescence light intensities may may be a helpful tool for histomorphic evaluation of the breast tissue.

Fibroepithelial tumours of the breast-a review.

Fibroepithelial tumours of the breast are biphasic neoplasms composed of both epithelial and stromal elements, including the common fibroadenoma and the infrequent phyllodes tumour. The admixture of epithelium and stroma in the fibroadenoma shows intra- and pericanalicular patterns, and may display a variety of histological changes. Fibroadenoma variants include the cellular, juvenile, myxoid and complex forms. The cellular fibroadenoma may be difficult to distinguish from the benign phyllodes tumour. Stromal mitotic activity can be increased in fibroadenomas in the young and pregnant patients. Phyllodes tumours, neoplasms with the potential for recurrence, show an exaggerated intracanalicular growth pattern with broad stromal fronded architecture and stromal hypercellularity. They are graded into benign, borderline and malignant forms based on histological assessment of stromal features of hypercellularity, atypia, mitotic activity, overgrowth and the nature of the tumour borders. Classification of phyllodes tumours is imperfect, compounded by tumour heterogeneity with overlapping microscopic features among the different grades, especially in the borderline category. Malignant phyllodes tumours can metastasise and cause death. Determining which phyllodes tumours may behave aggressively has been difficult. The discovery of MED12 mutations in the pathogenesis of fibroepithelial tumours, together with other gene abnormalities in the progression pathway, has allowed refinements in diagnosis and prognosis.

“A Prospective Study Clinicopathological Factors of Benign Breast Diseases”

Background: Benign breast lesions represent a wide spectrum of disorders that come to clinical attention either as palpable lumps or as imaging abnormalities. Some of these are clinically suspected as malignant lesions but diagnosed as benign after histopathological examination. Objective: To study benign breast lesions to correlate their clinicopathological parameters and to study incidence of benign breast lesions in different age groups. Materials and Methods: A descriptive study with cross sectional design was conducted in the Department of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh between Januarys to December-2019. All patients male and female with any benign breast lesions reported were included in the study. The patients reported as malignant tumors were excluded from this study. A total of 90 benign breast specimens received for histopathological study were analyzed during this period. In each case detail history and clinical data was collected. Results: A total of 90 cases were analyzed during this period. Benign breast lesions were studied in detail with relation to available clinical data. Incidence of benign breast lesions reported in our study was 65.21%. Fibroadenoma was the most common benign lesion found with incidence 71.11%, followed by fibrocystic change and benign phyllodes tumors. The most common age group for fibro adenoma was 11 to 20 years. Conclusion: Benign breast lesions are common in females and fibroadenoma being the most common of them all. The most common presenting complaint was painless breast lump.

Breast-conserving surgery in giant juvenile fibroadenoma: a case report

: Giant juvenile fibroadenoma (GJF) represents 0.5% of fibroadenomas and the usual age range of occurrence is 10 to 18. GJF definition describes a benign tumor that measures more than 5 cm, weighs more than 500 grams or occupies more than 80% of the mammary gland. In this report, we present the case of a 14-year-old patient’s GJF with six months of evolution. The examination proved skin and the Nipple-Areola Complex (NAC) involve, resulting in the identification of a smooth, firm and mobile tumor of 20 cm with negative local lymph nodes. The diagnosis used Mammography (MG), Ultrasound (US), and Magnetic Resonance Imaging (MRI). In addition, Breast Conservative Surgery (BCS) required making an incision in the breast groove, resulting in good aesthetic results. To the best of our knowledge, there is no standard surgical approach. In practice, the treatment options for BCS are enucleation, Wide Local Excision (WLE) and oncoplastic techniques, and Simple Mastectomy (SM) considering or excluding reconstruction. This case challenged medicine itself since human skin gained elasticity after six months, it did not reach full breast development, and hormonal action exposition was present all time, which can generate recurrences, for instance, pregnancy or psychological factors. Whilst GJF is a pathology that requires Therapeutic Board (TB) criteria for adequate BCS, it needs a multidisciplinary team including a Gynecology Oncologist specialist, Plastic and Reconstructive Surgery (PRS) specialist, and a psychologist, where the aesthetic result of the patient should always be priority. This case shows the importance of making adequate differential diagnosis (DD) and respecting oncological principles. In a year of follow-up, skin retraction improved due to normal breast development suggesting effectiveness of the technique.

Metformin as a new option in the medical management of breast fibroadenoma; a randomized clinical trial

BackgroundFibroadenoma (FA) is the most common benign solid breast mass in women, with no definite method of management. Because fibroadenoma is dependent on female sex hormones and comprises hypertrophic changes at cellular levels, we investigated the effects of metformin (MF), a safe hypoglycemic agent with anti-estrogenic and anti-proliferative properties, in the management of fibroadenoma.MethodsIn this randomized clinical trial study, eligible women with fibroadenomas were assigned randomly to the metformin (1000 mg daily for six months) or the placebo group. Breast physical and ultrasound exam was performed before and after the intervention, and the changes in the size of fibroadenomas were compared in the two groups.ResultsOverall, 83 patients in the treatment, and 92 in the placebo group completed the study. A statistically significant difference in changing size between the two groups was observed only in the smallest mass. In the largest FAs, the rate of size reduction was higher in the treatment group (60.2 % vs. 43.5 %); while a higher rate of enlargement was observed in the placebo group (38 % vs. 20.5 %). In the smallest FAs, the rate of the masses that got smaller or remained stable was about 90 % in the treatment group and 50 % in the placebo group. We categorized size changes of FAs into < 20 % enlargement and ≥ 20 % enlargement. The odds ratio (OR) for an elargemnt less than 20% was 1.48 (95 % CI = 1.10–1.99) in the treatment group in comparison with the placebo group; the odds for an enlargement less than 20% was higher in women with multiples fibroadenomas (OR = 4.67, 95 % CI: 1.34–16.28). In our study, no serious adverse effect was recorded, and the medicine was well-tolerated by all users.ConclusionsThis is the first study that evaluates the effect of MF on the management of fibroadenoma, and the results suggest a favorable effect. Larger studies using higher doses of MF and including a separate design for patients with single or multiple FAs are suggested in order to confirm this effect.Trial registrationThis trial (IRCT20100706004329N7) was retrospectively registered on 2018-10-07.

Analysis of Saliva Lipids in Breast and Prostate Cancer by IR Spectroscopy.

We have developed a method for studying the lipid profile of saliva, combining preliminary extraction and IR spectroscopic detection. The case–control study involved patients with a histologically verified diagnosis of breast and prostate cancer and healthy volunteers. The comparison group included patients with non-malignant pathologies of the breast (fibroadenomas) and prostate gland (prostatic intraepithelial neoplasia). Saliva was used as a material for biochemical studies. It has been shown that the lipid profile of saliva depends on gender, and for males it also depends on the age group. In cancer pathologies, the lipid profile changes significantly and also depends on gender and age characteristics. The ratio of 1458/1396 cm−1 for both breast and prostate cancer has a potential diagnostic value. In both cases, this ratio decreases compared to healthy controls. For prostate cancer, the ratio of 2923/2957 cm−1 is also potentially informative, which grows against the background of prostate pathologies. It is noted that, in all cases, changes in the proposed ratios are more pronounced in the early stages of diseases, which increases the relevance of their study in biomedical applications.

Fibroadenoma gigante juvenil y cirugía de reconstrucción: reporte de un caso y revisión de la bibliografía

Fibroadenoma is the most common benign breast lesion in young women, being the giant juvenile fibroadenoma an entity that appears mainly in those under 25 years. With an etiology currently not well established, it is described as a mass type lesion greater than 5cm or that occupies more than 80% of the breast and presents significant growth, with the physical and psychological consequences that this entails. Despite being a benign lesion, its fast evolution and growth makes it necessary to rule out malignancy, which occurs in less than 0.2% of the cases. The diagnosis is based on a correct anamnesis, physical examination and complementary tests, preferable with ultrasound. The anatomopathological study by biopsy allows to confirm the clinical diagnosis of benignity or to rule out malignancy in the event of a suspicious evolution. Its management is surgical and consists of complete excision of the lesion, varying the surgical technique performed (from conservative surgery to mastectomy with reconstruction) according to the size of the lesion, the characteristics of the breast, and the age of the patient.

A giant juvenile fibroadenoma in a 12-year-old girl: Case report and brief literature review

Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5–4% of all cases of fibroadenomas. Giant fibroadenomas are rare variants and represent only 0.5% of all fibroadenomas, usually occurring in girls between the ages of 10 and 18. They are characterized by massive and rapid enlargement of a rubbery, mobile, and non-tender mass and defined as being larger than 5 cm or weighing more than 500 g. The aetiology is not well understood and is believed to be an increased sensitivity to normal oestrogen level. We present a 12-year-old Asian girl treated at the age of 8 for idiopathic precocious puberty, without known family history of breast masses or cancers, who developed spontaneous giant fibro-adenoma measuring 15cm X 17 cm. The patient was further evaluated via ultrasonography showing a sole large lesion of 15 X 17 cm in the left breast. Surgical excision with conservation of the developing breast parenchyma and nipple-areolar complex under general anaesthesia was performed. Histopathological findings after the surgical excision were suggestive of juvenile fibroadenoma. The patient has a normal breast development throughout 4 years follow-up. The rapid growth of a breast mass in such young patients can be of great concern causing a considerable impact on these patients’ psychological and emotional condition. One of the most important concerns is the impact on potential future mammary gland development. Therefore, it is crucial to promptly rule out malignant processes or phyllodes tumors and educate young patients and their families on treatment options that fit their concerns. In addition, the final cosmetic result is essential after the surgical excision; although the primary cause of asymmetrical breast enlargement is a benign mass, early surgical excision is efficient concerning the best possible cosmetic outcome. Keywords: Breast mass; juvenile fibroadenoma; giant fibroadenoma.