Fibroadenoma Research Articles

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.

Algorithm of Examination and Management of Patients in the Detection of Fibroadenomas of the Breast

The article is devoted to the determination of the examination algorithm and management tactics for patients with various types of breast fibroadenomas based on a review of foreign literature and our own clinical experience.

Breast fibroadenoma and its clinical perspectives: a prospective observational study

Background: To study the patterns of breast fibroadenoma in females and to co-relate them with the pathological findings.Methods: Sixty six females who attended the Surgery Department in Darbhanga Medical College, Bihar, a tertiary centre in rural area, with benign breast lump during the period Bihar during period of November 2009 to November 2011, were studied. Early diagnoses by doing a triple assessment like a clinical examination, FNAC or a core needle biopsy and imaging methods like ultrasonography or mammography. The clinical diagnoses were compared with the cytological or histological findings wherever possible and their accuracies were evaluated.Results: Out of the 66 confirmed fibroadenoma female patients who were studied, most patients presented as a painless lump which is need to be differentiated from carcinoma. Most of the patient (63%) presented within 6 months of development of breast lesion showing increasing awareness in females of rural India. The maximum number of patient presented (55%) is of 2nd to 3rd decade. It was found that maximum number of patients have upto three children due to early marriage in rural background.Conclusions: Fibroadenoma is a common cause for breast lump even in rural background. Triple assessment provided a quick diagnosis and it alleviated unnecessary anxiety from the patients about breast cancer. The clinical diagnosis of a breast lump, as confirmed by cytology and histology, was accurate in most of the cases.

Prevalence and characteristics of mouse mammary tumor virus-like virus associated breast cancer in China

BackgroundDespite extensive molecular epidemiological studies, the prevalence and characteristics of Mouse Mammary Tumor Virus-Like Virus (MMTV-LV) in Chinese women breast cancer are still unclear. Besides, the prevalence of MMTV-LV in women breast cancer tissue varies in different countries and its dependent factors remain inconclusive.MethodsIn the first part of the study, a case-control study was performed. 119 breast cancer samples (84 from Northern China and 35 from Southern China) and 50 breast fibroadenoma specimens were collected from Chinese women patients. MMTV-like env sequence and the homology to MMTV env gene were analysed by semi-nested polymerase chain reaction (PCR). We also explored the association of MMTV-LV prevalence with sample sources (Southern and Northern China) and patients’ clinicopathological characteristics. To investigate the dependent factors of the prevalence of MMTV-LV in breast cancer worldwide, a meta-analysis was conducted in the second part of the study.ResultsWe found that the prevalence of MMTV-LV was much higher in breast cancer tissues (17.65%) than that in breast fibroadenoma specimens (4.00%) (P < 0.05). MMTV-LV prevalence in Chinese women breast cancer tissues was significantly different between Southern China (5.71%) and Northern China (22.62%) (P < 0.05). The prevalence of MMTV-LV also associates significantly with expression of HER2, but shows no significant correlation with other parameters. In the meta-analysis, we found that MMTV-LV prevalence in breast cancer tissue was dependent on the distribution of M. domesticus mouse (M. d), M. musculus mouse (M.m) and M.castaneus mouse (M.c) worldwide (P < 0.05).ConclusionThe distribution of house mice may be a crucial environmental factor that explains the geographic differences in human breast cancer incidence. Our findings may provide a potential avenue of prevention, diagnosis and treatment for breast cancer.

Removal of fibroadenoma of the breast augmentation and breast implants. Analysis of the possibility of simultaneous and delayed execution of these operations

Introduction. Fibroadenomas (FA) are the most common benign breast neoplasms that are diagnosed in 25% of women. Dissatisfaction with the size of the breast and the desire to increase it occurs in 40%. For this reason, in the practice of a plastic surgeon, there are cases when the patient wants to remove fibroadenomas (FA) and increase the size of the breast. In this situation, there are two options for managing the patient- the simultaneous execution of two operations and the delayed one.Aim. To evaluate the possibility of simultaneous FA removal and augmentation mammoplasty, to analyze possible complications and methods of their correction.Materials and methods. We have analyzed the experience of simultaneous interventions of FA removal and augmentation mammoplasty on the example of 10 cases performed in the period from 2014-2019, as well as FA removal after implant placement-3 cases.Results. Performing a simultaneous operation has advantages due to the minimization of injuries (the ability to perform from a single access - submammary or periareolar), reducing psychological stress and better cosmetic effect. Two patients had postoperative complications in the form of capsular contracture, manifested in the asymmetry of the mammary glands, corrected by performing capsulotomy and forming a new submammary fold. When performing invasive diagnostic tests and surgical intervention in three patients after endoprosthesis augmentation mammoplasty, extreme caution was required due to the risk of violating the integrity of the implant. It was found that the incision of the posterior leaf of the MJ capsule with a large number of removed neoplasms in the postoperative period leads to the development of breast asymmetry. The fact of FA recurrence was also confirmed (2 patients), who subsequently underwent repeated surgical intervention.Conclusion. Performing simultaneous operations for benign breast tumors can be surely practiced by plastic surgeons, including as one of the options for simultaneous treatment of breast FA and augmentation mammoplasty. The occurrence of FA in the long-term period after breast augmentation surgery is associated with difficulties in diagnostics (mammography and fine needle aspiration biopsy under the control of ultrasound), as well as in the course of surgery itself, due to the presence of the implant and the risk of violation of its integrity.

Giant juvenile fibroadenoma: experience from a rural medical college

Giant juvenile fibroadenoma: experience from a rural medical college

A Comparative Study Assessing Surgical Outcome of Excision of Giant or Multiple Benign Breast Lesions Using Circumareolar Incision versus Round Block Technique

Abstract Background: Breast disease seriously affects the physical and mental health of women. In recent years, the incidence rates of Benign Breast Tumors (BBTs) and malignant tumors have been rising. The traditional surgical resection method for the various types of BBT leaves obvious scars and affects the appearance of the breast, with the continuous development of the social economy and the gradual improvement of living standards, demands for breast appearance are higher. Surgery should not only cure the breast disease, but it should also avoid damage to the functions and appearance of the breasts. Benign breast lesions, especially when multiple or giant, constitute a difficulty in obtaining complete wide excision with minimal breast deformity and minimal small scars in addition to the high risk of recurrence. In cases of benign breast lesions, bad cosmetic results are unacceptable neither by the patients nor by the surgeons. Aim of Study: The aim of the study is to compare between post-operative outcome of surgical excision of giant or multiple benign breast lesions (giant fibro adenomas or phylloids tumors) through a circum-areolar incision versus round block technique as regard cosmetic & oncological outcome & patient satisfaction. Patients and Methods: It was a prospective randomized study that included 20 patients aiming to compare between post-operative outcome of surgical excision of giant or multiple benign breast lesions (giant fibro adenomas or phylloids tumors) through a circum-areolar incision versus round block technique as regard cosmetic & oncological outcome & patient satisfaction. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Circum-areolar incisions and Round block techniques were proposed for patients in whom breast conservative treatment is possible on oncologic grounds but where a standard resection without reconstruction would lead to a poor cosmetic outcome. Study period: March 2020 to October 2020. Results: It was found that there is a rapid progress in the development of diagnostic methods and interventional methods of diagnosis. This increased the accuracy of these methods and their ability to differentiate benign from malignant tumors. Also the round block techniques proved to have a better outcome than the circumareolar technique in all the previous mentioned criteria. Conclusion: The application of oncoplastic surgery to benign breast disease is a new revolution in the surgical management of cases and should be the standard of care for selected cases.

Neuroendocrine Breast Cancer. Clinical Observation. Personalized Approach

Introduction. Neuroendocrine breast tumors represent a rare subtype of breast cancer, accounting for less than 1 % of all neuroendocrine neoplasms. Starting from their pathology definition, and going through their prevalence, prognosis and treatment, our knowledge is still really uncertain.Materials and methods. The article presents a rare clinical observation of a neuroendocrine breast tumor. A breast fibroadenoma was diagnosed at the initial diagnosis stage in a private clinic; after a surgical treatment and further morphological study, it was estimated: a diagnosis of Cancer in situ of the left breast T1N0M0, stage I. Next, 3D-conformal remote radiation therapy was performed on the area of the left breast.Results and discussion. After conducting positron emission tomography, multiple metastases were detected in the lymph nodes, bones, and liver. Additionally, micropreparations were consulted at the Federal Reference Center in St. Petersburg and at an independent third-party molecular biological laboratory in Germany (Munich). Given all the instrumental, molecular biological, histological and immunohistochemical studies of the patient, an individual regimen of drug therapy was selected.Conclusion. After 18 months of personalized drug therapy, we observed a positive trend and a significant decrease in metabolic activity according to positron emission tomography.

The Influence of rs1859168 Polymorphism on Serum Expression of HOTTIP and Its Target miR-615-3p in Egyptian Patients with Breast Cancer.

Background: Polymorphisms of long noncoding RNAs are lately documented as hazardous factors for the development of numerous tumors. Furthermore, the evaluation of noncoding RNAs has emerged as a novel detector of breast cancer patients. We aimed to genotype the HOXA transcript at the distal tip (HOTTIP) rs1859168 and assess its relationship with the levels of the serum HOTTIP and its target miR-615-3p in patients with breast cancer (BC). Methods: One hundred and fifty-one patients with BC, 139 patients with fibroadenoma (FA), and 143 healthy participants were incorporated into the current study. The genotyping of rs1859168 and the measurements of the HOTTIP and miR-615-3p levels were assessed using quantitative real-time PCR. Results: We revealed a significant association between each of the CC genotypes, C allele, dominant and recessive models, and the increased risk of BC (p = 0.013, p < 0.001, p < 0.001, and p < 0.001, respectively) relative to the healthy controls. Similarly, the CC genotype, C allele, and recessive model were observed to be related to the increased incidence of BC with respect to FA (p < 0.001 for all). A significant upregulation of HOTTIP and a marked decrease of miR-615-3p were verified in patients with BC compared to each of the healthy individuals, patients with FA, and the non-BC group (healthy subjects + FA) (p < 0.001 for all). A significant negative correlation was demonstrated between the expression of HOTTIP and miR-615-3p in the serum of patients with BC. The HOTTIP expression was upregulated, while that of miR-615-3p was downregulated in patients with BC who carried the CC genotype with respect to those who carried the AA or AC genotypes (p < 0.05 for all). Conclusions: The genetic variants of rs1859168 are linked to an increased susceptibility to BC. Moreover, HOTTIP and miR-615-3p may be used as novel indicators and targets for the treatment of patients with BC.

Breast fibroadenomas: a review in the light of current literature

Fibroadenomas are one of the most common benign tumors of the breast in the adolescent females accounting for about 2/3rd of all the breast lumps and more than half of all the biopsied breast lesions. They come into being due to overgrowth of glandular tissue under the influence of hormonal changes that the girls undergo at the time of puberty. Due to the wide prevalence of fibroadenomas and the psychosocial morbidity associated with the finding of a breast mass, it is imperative for physicians treating adolescent patients to be thoroughly familiar and updated with this disease. The article aims at providing a brief review of the classification, presentation, diagnosis, and update on the management of breast fibroadenomas on the basis of recent literature.

Clinical practice guideline for breast fibroadenoma: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021.

Clinical practice guideline for breast fibroadenoma: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021.

Differential diagnosis between small breast phyllodes tumors and fibroadenomas using artificial intelligence and ultrasound data.

It is challenging to differentiate between phyllodes tumors (PTs) and fibroadenomas (FAs). Artificial intelligence (AI) can provide quantitative information regarding the morphology and textural features of lesions. This study attempted to use AI to evaluate the ultrasonic images of PTs and FAs and to explore the diagnostic performance of AI features in the differential diagnosis of PTs and FAs. A total of 40 PTs and 290 FAs <5 cm in maximum diameter found in female patients were retrospectively analyzed. All tumors were segmented by doctors, and the features of the lesions were collated, including circularity, height-to-width ratio, margin spicules, margin coarseness (MC), margin indistinctness, margin lobulation (ML), internal calcification, angle between the long axis of the lesion and skin, energy, grey entropy, and grey mean. The differences between PTs and FAs were analyzed, and the diagnostic performance of AI features in the differential diagnosis of PTs and FAs was evaluated. Statistically significant differences (P<0.05) were found in the height-to-width ratio, ML, energy, and grey entropy between the PTs and FAs. Receiver operating characteristic (ROC) curve analysis of single features showed that the area under the curve [(AUC) 0.759] of grey entropy was the largest among the four features with statistically significant differences, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.925, 0.459, 0.978, and 0.190, respectively. When considering the combinations of the features, the combination of height-to-width ratio, margin indistinctness, ML, energy, grey entropy, and internal calcification was the most optimal of the combinations of features with an AUC of 0.868, and a sensitivity, specificity, PPV, and NPV of 0.734, 0.900, 0.982, and 0.316, respectively. Quantitative analysis of AI can identify subtle differences in the morphology and textural features between small PTs and FAs. Comprehensive consideration of multiple features is important for the differential diagnosis of PTs and FAs.

Pathogenicity of CYP17α mutations in the occurence of uterine fibroids and breast fibroadenomas

Background. Uterine fibroids and breast fibroadenomas are a real public health problem. Despite the efforts made, the etiological factors are still unknown. In addition, these tumors share histopathological similarities, including a higher prevalence in black women. To better understand the factors involved, we set out to assess the genetic characteristics of uterine fibroids and breast fibroadenomas in Senegalese women using CYP17α genes. Results. For the CYP17α gene, 196 mutations were found among which, 65 are specific to uterine fibroids, 112 mutations specific to breast fibroadenomas and 19 common to both pathologies. Analysis of the pathogenicity of missense mutations reveals that many mutations are considered to be a simple polymorphism and 21 non-synonymous mutations appear to be potentially damaging, including 6 specific to patients with uterine fibroids; 14 found in patients with breast fibroadenomas. Conclusion. As a genetic marker of risk, the codons 12, 17, 20, 60 and 72 of CYP17α can be a tool to identify high-risk groups of women for prevention and treatment protocols.

Clinicopathological study of benign breast diseases a study of 50 cases

Background: Benign breast diseases are a neglected entity in developing countries despite the fact that they involved in the majority of breast complaints. Benign breast disorders can be defined as any non-malignant breast condition and involved wide range of clinical and pathological disorders. Breast diseases present as swellings. It is a symptom/sign for a different lesion varying from developmental abnormality, inflammatory lesions, epithelial and stromal proliferation to malignancy. Patients were studied on the basis of i.e., clinically, and histopathological ultrasound has done. Our purpose of study is to document various benign Brest diseases to study different mode of presentations of diseases and correlation of clinical and pathological diagnosisMethods: The given study was a prospective and observational study, undertaken in the department of general surgery, govt. medical college Surat, during the study period of March 2018 to September 2019.All the female and male patients with breast related disease were included in this study. Female patients with biopsy proven malignancy were excluded from the study.Results: The study comprised of 50 patients with benign breast diseases; the most common is Fibro adenoma which formed 68% then fibrocystic diseases 20%. With most common age group involved in our study is 21-30 years.Conclusions: Benign breast diseases are more common but ignored entity though it carries majority of complaints and occur mainly in young women less than 30 years of age and were mostly fibro adenoma and fibrocystic change.

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.

Complex fibroadenoma with focal ossification- an enigmatic finding in a less common tumor

Breast lumps have diverse causes including benign as well as malignant lesions. Fibroadenoma (FA) is a common cause of breast lump. Complex fibroadenomas, a particular subtype, pose diagnostic dilemmas due to confusing the radiological findings and hold higher incidence of transformation to malignancy. A 49 year old female presented with a painless lump in right breast for 2 years which appeared calcified on radiology. Excision biopsy was performed which grossly revealed an encapsulated grey-white firm to hard with cystic areas. Microscopically the sections showed a well encapsulated fibroepithelial tumor showing areas of sclerosing adenosis, hyalinization, cysts lined by cuboidal cells with eosinophilic secretions, areas of calcification and ossification. No evidence of lobular hyperplasia or in-situ carcinoma was seen. Patient was advised follow up. This case represents the unusual occurrence of complex fibroadenoma in a middle-aged female showing with ossification.

P91 Phyllodes Tumours: Looking for Predictive Features from Multidisciplinary Assessments

IntroductionThe breast triple assessment enables rapid evaluation of breast abnormalities. Lesions are assessed via the assessments based on clinical examination, imaging and histological sampling. Fibroepithelial lesions (FELs) are amongst the most common breast lesions of uncertain malignant potential. They encompass a spectrum of entities ranging from benign fibroadenomas (FA) to malignant phyllodes tumours (PT), with contrasting clinical management approaches. Unfortunately, the distinction between various FELs is often difficult, despite recent diagnostic advances. This is especially so between FAs and PTs. Nevertheless, understanding how to prioritise key characteristics of PTs, both radiologically and histologically may ease this challenge. In our opinion, a multidisciplinary approach including radiological input is probably the most helpful in reaching an accurate diagnosis.MethodsWe, retrospectively studied data from breast lesions which were initially diagnosed pre-operatively as R3/B3 FELs, and those with a final diagnosis of PT on excision. 71 suitable cases were identified from 2009 to 2019. Information was extracted from reports made by specialists at the pre-operative and post-excision stages. Statistical analysis will be applied to quantify the significance of features evaluated.ResultsPreliminary results suggest diagnoses made by pathologists on pre-operative samples correlated well with the eventual final diagnosis made on post-operative specimens. Adequate sampling appears to be a significant factor in influencing the pre-operative core biopsy diagnosis.ConclusionWe anticipate to acquire a comprehensive knowledge of various predictive features of PTs, and the correlation between the key radiological features, thereby allowing accurate pre-operative diagnosis of these interesting and challenging lesions.

Homoeopathic treatment of fibroadenoma breast: A case report

Fibroadenoma is the most common benign tumor occurring in young to middle aged women which disappear after the menopause. Though few cases remain asymptomatic throughout, but the tumor may progress to carcinoma. The conventional treatment includes surgical excision and cryoblation [1]. Symptomatic treatment through homoeopathy can be effective as seen in previous studies [2, 3]. In this case report, a female aged 33 years of age suffering from fibroadenoma breast, diagnosed in 2015 is given constitutional homoeopathic treatment. After three months of treatment the sonographic report shows normal findings.

Giant Juvenile Fibroadenoma in a Young Female-A Diagnostic Dilemma

Background: Fibroadenoma is the most common breast lesion among pediatric female population. A giant fibroadenoma is rare, characterized by a rapidly growing tumor, with a mass &gt;5 cm diameter in greatest dimension and/or weighing more than 500 gm. Phyllodes tumor range from benign to malignant. Both have similar presentation. Clinical Description: An 11-year-old girl presented with rapidly progressive, painless increase in the size of the left breast over 2 months. Local examination revealed a firm nontender mass involving the upper inner and outer quadrants of the left breast along with the retro-areolar region. The mass was mobile and measured approximately 11 cm × 10 cm. The overlying skin was normal, although with dilated veins and free from underlying mass. The clinical phenotype was suggestive a phyllodes tumor in view of rapid progression and large size. However, the ultrasonogram and fine-needle aspiration cytology favored a fibroadenoma. Management: It was decided to perform a “Nipple-areolar complex sparing lumpectomy” with deferment of reconstructive surgery. Adequate lump excision was achieved while maintaining proper cosmesis. The histopathological findings of the excision biopsy confirmed the final diagnosis of fibroadenoma. Conclusion: A large breast mass in a pediatric/adolescent girl poses a diagnostic dilemma to the treating surgeon. Proper evaluation is needed to differentiate between several benign breast masses from malignant ones. The definitive diagnosis is made histologically. Total excision of the lump with conservation of nipple and areola is indicated to make a definitive diagnosis and to relieve the compression of the normal breast tissue.