Giant Breast Research Articles

Anemia and giant breast mass

Anemia and giant breast mass

Abstract PO5-26-01: Assessing the effect of multimodal therapy in massive fungating breast cancers without distant metastasis

Abstract Background: Massive fungating breast cancers (MFBCs), which comprise exudative, foul-smelling tumors, the size of a child’s head or involve extensive ulceration are classified as locally advanced breast cancers. The National Comprehensive Cancer Network guidelines recommend preoperative neoadjuvant chemotherapy in patients with locally advanced breast cancer without distant metastases. However, limited evidence is available regarding the successful treatment of fungating breast cancers. In clinical practice, many fungating breast cancer cases are treated as stage IV tumors. This study aimed to investigate whether multimodal therapy, including surgery for giant breast cancers, can improve survival rates and whether the survival rates are comparable to those of other stage III breast cancers. Subjects and methods: Out of 1480 cases of primary breast cancer diagnosed at our hospital between June 2012 and March 2020, 123 patients with clinical stages IIIA–IIIC were chosen for analysis. Furthermore, 29 of these patients with MFBC were selected. During multimodal therapy for selected patients with fungating breast cancer, difficulties were encountered in some patients with single-stage skin suturing and closure after standard neoadjuvant chemotherapy. These patients underwent surgery with an additional skin flap or skin grafting. Furthermore, radiation therapy was added as needed. We compared the survival rates of these patients with those of patients who received drug therapy only according to the therapeutic protocol for Stage IV. Survival rates of patients with MFBC and other stage III breast cancers were also compared. Statistical analyses were conducted using the Kaplan–Meier curve and the log-rank test. Results: Of the 29 patients with MFBC, 22 (75.9%) and seven (24.1%) were treated with multimodal and palliative therapies, respectively. The median age and follow-up period of the multimodal therapy group were 62 (range: 43–94) years and 67 (range, 32–131) months, respectively. The corresponding values for the palliative therapy group were 79 (range: 42–88) years and 31 (range: 2–96) months. All patients in the palliative treatment group were hormone receptor positive and HER2 negative, and treatment with hormone therapy was initiated. The 7-year survival rate was significantly higher in the multimodal therapy group than in the palliative treatment group (92.3% vs. 68.6%, p = 0.0317). Furthermore, the 5-year distant recurrence-free rate was higher in the multimodal treatment group (79.3% vs. 63.5%). Local recurrence did not occur in any patient in the multimodal treatment group. There was no significant difference in the 7-year survival rates between patients with MFBC and those with other stage III breast cancers (86.8% vs. 75.3%; p = 0.239). Triple-negative breast cancer accounted for 20.8% (20 96) of the other stage III breast cancers, but none of these were MFBCs. Conclusions: Clinically, MFBCs are often palliatively treated as stage IV tumors, even in the absence of distant metastasis. However, the survival rate was significantly higher in the multimodal therapy group than in the palliative treatment group. Furthermore, the survival and distant recurrence-free rates for MFBC were higher than those for other stage III breast cancers. Therefore, patients with MFBCs should be actively treated using curative treatments. Citation Format: Tamaki Tamanuki, Maki Namura, Tomoyoshi Aoyagi, Haruhito Sakata, Mika Iwai, Shinichirou Shimizu, Hiroshi Matsuzaki. Assessing the effect of multimodal therapy in massive fungating breast cancers without distant metastasis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-01.

A 5 kg giant breast lipoma in a 40-year-old woman: a case report

Introduction and importance: Lipomas are benign tumours composed of adipocytes surrounded by a thin fibrous capsule. Although they make up 16% of mesenchymal tumours, the occurrence of breast lipomas is uncertain. Giant lipomas, measuring 10 cm or more in diameter or weighing at least 1000 g, commonly occur in the upper back, neck, and thigh, and are rare in the breast. Given its rarity, accurately diagnosing a giant breast lipoma is crucial to prevent potential overtreatment, as it might otherwise be mistaken for a malignant tumour. Case presentation: A 40-year-old woman presented with a painless, gradually enlarging left breast mass. Physical examination and imaging studies revealed a lipoma-compatible mass. Surgery was performed, and the 5 kg mass was enucleated and identified as a lipoma on histopathology. The patient had an uneventful postoperative recovery and was satisfied with the outcome of the surgery after 2 months of follow-up. Clinical discussion: Breast lipomas are more common in the 40–60 years age group, with giant lipomas occurring more frequently in the latter half of this age range. They can mimic various breast conditions, including neoplastic and non-neoplastic conditions, and are often treated with surgical excision to avoid recurrence. The location of the lipoma in the breast can be subcutaneous or intramuscular, and preserving the future pedicle of reduction mammoplasty/mastopexy is essential. Conclusion: Giant breast lipoma is an infrequent condition that can manifests as progressive enlargement of the breast, posing a diagnostic challenge due to its resemblance to various benign or malignant pathologies.

Single-cell morphological and transcriptome analysis unveil inhibitors of polyploid giant breast cancer cells in vitro

Considerable evidence suggests that breast cancer therapeutic resistance and relapse can be driven by polyploid giant cancer cells (PGCCs). The number of PGCCs increases with the stages of disease and therapeutic stress. Given the importance of PGCCs, it remains challenging to eradicate them. To discover effective anti-PGCC compounds, there is an unmet need to rapidly distinguish compounds that kill non-PGCCs, PGCCs, or both. Here, we establish a single-cell morphological analysis pipeline with a high throughput and great precision to characterize dynamics of individual cells. In this manner, we screen a library to identify promising compounds that inhibit all cancer cells or only PGCCs (e.g., regulators of HDAC, proteasome, and ferroptosis). Additionally, we perform scRNA-Seq to reveal altered cell cycle, metabolism, and ferroptosis sensitivity in breast PGCCs. The combination of single-cell morphological and molecular investigation reveals promising anti-PGCC strategies for breast cancer treatment and other malignancies.

Giant breast cyst in an adolescent girl: A case report

Giant breast cyst in an adolescent girl: A case report

Clinical perspectives and outcomes of the giant breast phyllodes tumor and sarcoma: a real-world retrospective study

BackgroundGiant breast malignant phyllodes tumor or sarcoma (GBPS) are rare entities with diameter larger than 10 cm and variously histological pleomorphisms. This disease poses a significant threat to the quality of life of individuals, and its prognosis remains unclear. This study aimed to explore the differential diagnosis, treatment, and prognosis of GBPS in a real-world retrospective cohort.MethodsWe collected GBPS (diameter > 10 cm, n = 10) and BPS (diameter ≤ 10 cm, n = 126) from patients diagnosed with sarcoma or malignant phyllodes tumor between 2008 and 2022. We analyzed clinical characteristics, histological status, treatment, and local recurrence using the Fisher’s exact test between GBPS (diameter > 10 cm) and BPS (diameter ≤ 10 cm) cohort. We described overall survival (OS) and disease-free survival (DFS) using Kaplan–Meier curves and identified risk factors for local recurrence using logistic regression. The tumor size, age at diagnosis, and differential immunohistochemistry markers of breast sarcoma or phyllodes tumor to determine the prognosis of GBPS.ResultsIn our retrospective analysis of breast malignancies, we identified 10 cases of GBPS and 126 cases of BPS, corresponding to a GBPS prevalence of 0.17% (10/6000). The median age was 38.5 years (inter-quartile range, IQR: 28.25–48.5 years). During the follow-up of period (median: 80.5 months, IQR: 36.75–122 months), the local recurrence (LR) rate was 40% and 20.6%, respectively. Clinical characteristics of young age (HR:2.799, 95%CI -00.09276—0.017, p < 0.05) and cytological characteristics of marked stromal atypia (HR:0.88, 95% CI 0.39–1.40, p < 0.05) were risk factors for the poor prognosis of GBPS by COX regression model analysis. The Kaplan–Meier curves of GBPS 5-year disease-free survival (DFS) and overall survival (OS) were 31.5 months and 40 months, respectively, and were not associated with adjuvant radiation or chemotherapy.ConclusionWe recommend mastectomy with a clear surgical margin as the preferred treatment for GBPS. Age and stromal atypia are significantly associated with recurrence. Adjuvant radiation therapy is advised; however, there was no improvement in overall survival. There is no consensus on the effectiveness of adjuvant chemotherapy and genetic methods, highlighting the need for further research into this aggressive tumor. We recommend a multidisciplinary approach involving a dedicated team for the management of GBPS.

Giant breast lipoma in a lactating mother simulating lactational carcinoma or a sarcoma

30-year-old tribal lactating mother complaining of rapidly growing and painless mass at the outer aspect of her right breast

Modified Lateral Oncoplastic Surgery for Giant Breast Fibroadenoma with Flat Epithelial Atypia: A Case Report

Modified Lateral Oncoplastic Surgery for Giant Breast Fibroadenoma with Flat Epithelial Atypia: A Case Report

Giant breast fibroadenoma in an adolescent girl

Giant breast fibroadenoma in an adolescent girl

Giant breast hamartoma in a middle-aged woman: A case report

Introduction. Breast hamartomas are benign breast lesions with extremely rare, but not unseen, malignant transformation. They most often occur in middle-aged women and are usually up to 5 cm in diameter. Hamartomas of about 10 cm and larger are designated as giant and they are extremely rare. Case Report. We present a 47-year-old female patient with a giant hamartoma of the right breast. After radiological diagnosis and core biopsy, the patient underwent surgery. Histopathological findings confirmed the diagnosis of hamartoma, without signs of malignant transformation. The postoperative course was without complications. Conclusion. Regardless of the fact that breast hamartoma is a benign lesion with a low potential for malignant transformation, we believe that surgical excision of these tumors is justified along with histopathological tissue processing. Recurrence is rare and the prognosis is good.

Giant fibroadenoma and phyllodes tumour - A diagnostic conundrum

Giant breast masses are of great concern as they have diagnostic as well as therapeutic challenges. Owing to the close morphological resemblance between giant fibroadenoma and Phyllodes tumor, here we are reporting a case of a young lady who was diagnosed with giant fibroadenoma clinically and by Fine Needle Aspiration Cytology (FNAC). Simple mastectomy was performed, and histopathology examination revealed a Giant Phyllodes. Thus, this report focuses on the rarity of the age of presentation, misleading clinical features and the diagnostic accuracy of FNAC compared to histopathology in differentiating these two close entities.

Giant Myofibroblastoma of the Breast: A Case Report and Clinicopathological Analysis

Myofibroblastoma of the breast (MFB) is a rare benign mesenchymal tumor of the breast. A case of giant breast myofibroblastic tumor, which is rarely reported in literature, was recently diagnosed in our department. We also analyzed the clinicopathological features of MFB to improve the understanding of the tumor and avoid misdiagnosis.

Patient Satisfaction in the Complete Removal of Giant Breast Fibroadenoma under Vacuum-Associated Breast Biopsy Procedure

INTRODUCTION: Fibroadenomas are one of the most common benign tumors of the breast in the adolescent population. They account for 68% of all breast masses and 44–94% of all biopsied breast lesions. Fibroadenomas can range from asymptomatic masses to painful and rapidly growing tumors that can cause significant esthetic distortions of the breast. With breast examinations becoming common in women as young as their 20s, excision of benign breast tumors using vacuum-assisted breast biopsy (VABB) became more common. The VABB procedure with ultrasound guiding is still used for removal benign breast tumors. CASE REPORT: A 24-year ago woman presents with complaints of a lump in the right breast for 3 years, the lump is slow growing. The mass diameter is about 6 cm and no ulcers. Ultrasound examination found a solid mass, firm boundaries, regular contours, mobile in the outer quadrant of the right breast, no specific microcalcification size 6.13 cm × 3.11 cm × 5.33 cm (BIRADS 4a). Core biopsy examination showed fibroadenoma mammae intracanalicular and pericanalicular. We used an 8G needle and got 458 slices about 100 g. After the procedure, a total removal is obtained by ultrasound examination from a previously existing mass of 6 cm. CONCLUSIONS: The VABB procedure is very effective and efficient in removing breast fibroadenoma (benign lesion) and the results are satisfactory. The advantage of this procedure apart from the cosmetic aspect which does not leave any marks is also a high level of safety. From our case, we can take complete removal with a diameter of 6 cm, whereas in the previous literature, it can only remove a mass of 3–4 cm in size.

Giant lipoma of breast-a diagnostic dilemma

Lipoma is the most common benign tumor of adipose tissue. Giant lipoma of breast is very rare.Majority of them are small in size, slow growing and asymptomatic until they reach large size. Most patients seek medical advice due to asymmetry in the breast and due to fear of malignancy. Breast lipomas pose a diagnostic challenge due to similarity of their texture to normal breast parenchyma and make it difficult to distinguish from other common breast lesions. The clinical and radiographic identification of breast lipoma remains challenging. Complete surgical excision with the capsule is essential to prevent recurrence. Breast reconstruction may require, to prevent asymmetry following surgical excision of giant breast lipoma. High degree of clinical suspicion and histolopathological correlation will help in preopertaive diagnosis of this clinical condition. Here, we report a case 50- year -old woman with left breast lump which clinically, radiologically and on fine needle aspiration cytology was diagnosed as phyllodes tumor, but after surgical excision it was reported as breast lipoma on final histopathology.

Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report

BACKGROUNDPhyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.CASE SUMMARYA 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.CONCLUSIONThis case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.

Clinicopathological and radiological characterization of myofibroblastoma of breast: A single institutional case review

Myofibroblastoma is a rare type of benign myofibroblastic neoplasm in the breast. It is clinically presented as a well-circumscribed mass, usually small in size (usually less than 4.0 cm), and can mostly be cured by local excision. Rare cases of giant myofibroblastoma greater than 10 cm have been reported, but also follow a benign clinical course. Histologically, breast myofibroblastoma is featured by bland fascicles of spindle cells intermixed with thick hyalinized collagen bundles. Mast cells are frequently found within the stroma. However, a wide spectrum of morphological variants can occur in myofibroblatoma, making its diagnosis challenging sometimes. Differential diagnosis of myofibroblastoma with other spindle cell lesions in the breast, either benign or malignant, is also important in practice. In this study, we collected 15 cases of breast myofibroblastoma diagnosed in our institution during a 20 year period. The sizes of these cases range from 0.4 cm to 35.2 cm (mean is 3.7 cm). To our knowledge, the case of giant breast myofibroblastoma we presented here is the largest one reported to date. The histological examination of the cases show great morphological variations. Besides the classical type, features of cellular, collagenized, palisading, epithelioid, myxoid, myoid, solitary fibrous tumor-like are also identified in the case series. Immunohistochemical staining patterns as well as clinical features of the cases are also summarized and compared. All cases in this study show no recurrence on follow-up. In addition, cases that are important differential diagnosis for breast myofibroblastoma are also studied. Their key histological characteristics are compared with myofibroblastoma, and their immunohistochemical and molecular features are discussed.

Giant Breast Hypertrophy in Juvenile: A Rare Case

Introduction: Juvenile hypertrophy of the breast (JHB) is a benign condition that can lead to gigantomastia in adolescence. The development of breast enlargement in adolescence can cause both physical and psychosocial problems. Therefore, appropriate investigation and proper management at an early stage of the disease are very important. One of the treatment modalities is breast reduction surgery which ideal and offers an improvement in the quality of life. Case Presentation: A 13-year-old female with massive bilateral breast enlargement for a period of 8 months. The patient also complained of severe back pain and neck discomfort since her breast progressively enlarged. Psychosocial problems were recorded. Right breast reduction was performed and closed with inverted-T mammoplasty. The post-operative period was uneventful, and the patient was discharged on day 5 after the operation. Conclusions: Reduction mammoplasty is well accepted by adolescents with juvenile breast hypertrophy and can improve physical and psychological outcomes.

Application of periareolar mastopexy technique for giant phyllodes tumor resection in an adolescent female with breast asymmetry: a case report and literature review

BackgroundThe phyllodes tumors are rare neoplastic disease which exhibits a benign behavior in adolescents female. After resection of a large benign breast tumor, insufficient breast contour may result with nipple areola complex malposition. As symmetry of the breast is psychologically extremely crucial, especially in adolescents, in such cases, an immediate mammoplasty-like breast reduction or mastopexy technique of the affected breast will be necessary to provide symmetry of the bilateral breasts at the initial surgery.Case presentationA 16-year-old woman reported rapid enlargement of a large mass in her left breast over 12 months. The physical examination revealed a huge mass that occupied the lower quadrants of her left breast causing expansion of both the overlying skin and the nipple areolar complex. A biopsy was constant with a benign phyllodes tumor. We have applied a periareolar mastopexy technique to allow tumor resection through exposure incision at the lower half of the outer periareolar circular incision. At the same time, we reduced the expanded skin envelope and mobilized the nipple–areola complex to restore breast symmetry.ConclusionThe periareolar mastopexy approach provides a wide surgical exposure, allows excision of benign giant breast tumor, and simultaneous restoration of the breast shape with favorable aesthetic results and minimal postoperative scarring.

Multidisciplinary surgical intensive treatment of an extended thoracic wall infiltration by a giant breast sarcoma: a case report

: Primary breast sarcoma represents less than 0.1% of breast cancers and less than 5% of all sarcomas. It derives from the mesenchymal tissues of the breast and can originate a histologically heterogeneous group of neoplasms. It has a poor prognosis and the median 5-year overall survival is 63.5% (range, 55–73%). Currently, diagnosis and treatment of this neoplasm are a challenge for pathologists, surgeons and oncologists. We describe the case of a 56-year-old Macedonian woman, who presented with local recurrence of a high-grade chondrosarcoma of the right breast. She had been treated elsewhere six months earlier with radical mastectomy and ipsilateral axillary dissection. The actual heteroplasia was 29 centimeters wide, ulcerated and infected. The computed tomography (CT) scan documented infiltration of pectoralis muscles, of III and IV right ribs and sternal body, but no distant metastases. Considering the patient’s clinical conditions and stage of the disease, a multidisciplinary discussion lead to the decision to attempt surgery. A multidisciplinary surgical teamwork was indispensable for attempting such a highly complex and demolitive surgery and a challenging reconstruction of the thoracic wall and an intensive post-operative monitoring of the patient was needed to manage complications related to tissue loss. Nowadays it is difficult to find patients suffering from tumors of this size and consequently the treatment is made more complicated by the lack of experience. With this case report we share our experience in the treatment of an infrequent pathology that has presented itself to us with dimensions rarely reported in the literature.

A Case of a Giant Breast Phyllodes Tumor 13 cm in Diameter in a 17-year-old Woman

A Case of a Giant Breast Phyllodes Tumor 13 cm in Diameter in a 17-year-old Woman