Multiple Fibroadenomas Research Articles

Recurrent giant fibroadenomas with transformation to cystosarcoma phyllodes in a 17-year-old girl: a rare case report from Syria

BackgroundFibroadenoma is the most prevalent benign breast lesion that generally affects middle-aged women; it is rare in adolescents and younger children. The transformation into malignancy is not common. However, multiple recurrences of rapidly enlarging fibroadenomas suggest a high possibility of transforming into phyllodes tumors, which are uncommon fibroepithelial lesions that account for 0.3–0.5% of female breast tumors and typically present in premenopausal women.Case presentationWe report a case of a 17-year-old Syrian girl who previously had three episodes of recurrence of multiple rapidly enlarging fibroadenomas in her left breast and underwent three operations for complete resection of the lesions. However, a few months later, she was readmitted with multiple large masses in the same breast, and pathological findings confirmed a surprising combination of multiple fibroadenomas for the fourth time with a malignant phyllodes tumor (cystosarcoma phyllodes). The patient underwent lumpectomies followed by adjuvant radiotherapy. Long-term follow-up was recommended.ConclusionOur patient had an extraordinary number of episodes of recurrence at a young age and a rare combination of malignant and benign lesions in the same breast with multiple recurrences. We present her unique, very challenging case with the aim of highlighting the importance of clinical correlation, detailed diagnosis, and careful follow-up.

Giant Juvenile Fibroadenoma of Breast

Giant juvenile fibroadenoma occurs in adolescent girls. These tumours become enormous in size and grow rapidly, though these tumours are mostly benign. These patients are almost always treated by breast conserving surgery. Here we present a case having unilateral giant juvenile fibroadenoma with bilateral multiple small fibroadenomas in an adolescent female aged 16years. The diagnosis of the patient was made on clinical examination, USG & FNAC. Confirmatory diagnosis was made by histopathology. We removed the giant one with "Swiss-Roll" procedure and others by simple enucleation. The aesthatic appearence of the breasts were preserved.
 Journal of Surgical Sciences (2013) Vol. 17 (2) : 99-102

Recurrent Multiple Fibroadenomas: History of a Case Presented in MDT Meeting With Clinical Discussion and Decision Making

Background: Fibroadenoma is a common benign breast disorder in young women which has a low risk of malignant transformation. Most fibroadenomas present as a single mass, but the presence of multiple fibroadenomas can be seen in 15–20% of patients, with average number of 3–4 masses in one breast. In different studies and reports, various treatment modalities-including observation and follow up, surgery, radiofrequency ablation, etc- have been proposed, though the best management for these patients are not determined yet.
 Case presentation: We present the case of 33-year-old female with history of multiple bilateral benign breast lesions with a presumptive diagnosis of fibroadenomas. She had three previous surgical excisions in the past 14 years. Her case was presented to a breast MDT meeting to obtain a recommendation on appropriate management.
 Question: The proposed a question in MDT concerned the best and most appropriate management plan for the patient; Does she require further surgical excisions? And if not, how should she be followed?
 Conclusion: After reviewing past medical history, physical examination, and all documents regarding the patient, MDT members recommended that the patient should be managed with close follow up with physical examination and ultrasound every 6 months. The necessity of further surgical intervention would be determined according to any new findings.

MED12, TERT promoter and RBM15 mutations in primary and recurrent phyllodes tumours

Background:MED12 and TERT promoter mutations have been shown to be the most common somatic mutations in phyllodes tumours (PTs). The aims of this study were to determine the frequency of these mutations in recurrent PTs, assess whether TERT promoter mutations could be helpful in distinguishing fibroadenomas (FAs) from PTs and identify novel mutations that may be driving malignant progression.Methods:MED12 and the TERT promoter were Sanger sequenced in 75 primary PTs, 21 recurrences, 19 single FAs and 2 cases of multiple FAs with benign PTs. Whole-exome sequencing was performed on one borderline PT.Results:Recurrent PTs and multiple FAs showed temporal discordance in MED12 but not TERT. Recurrent samples did acquire TERT mutations, with recurrent benign PTs more likely to have mutations in both genes. TERT mutations were not helpful in differentiating between benign PTs and FAs in cases of multiple FAs/PTs. Exome sequencing revealed a nonsense mutation in RBM15 and Sanger sequencing revealed another three RBM15 mutations in malignant/borderline PTs.Conclusions:This study has shown that MED12 mutations can be heterogeneous in both synchronous and recurrent PTs unlike TERT mutations. We have also shown that RBM15 mutations may be important in the pathogenesis of borderline/malignant PTs.

Case Report of Multiple Breast Fibroadenomas in a Young Nigerian Woman

Case Report of Multiple Breast Fibroadenomas in a Young Nigerian Woman

Aesthetic effect of removing multiple fibroadenomas of breast with periareolar incision

Objective To explore the methods and significance of section of multiple fibroadenomas of breast with better incision. Methods From may 2005 to December 2014, 21 cases were performed by removing multiple fibroadenomas of breast with a new incision. Preoperatively, the diagnostic work-up included clinical examination, breast ultrasonography and/or mammography. A new approach, for removing of multiple fibroadenomas of the breast with the incision in periareolar site, was used in our hospital. All palpable breast lumps were excised with this approach through which the fibroadenomas were removed as a whole unit. Then, the breast cavity were irrigated with normal saline solution, and strict haemostasis of the bed was done by electrocautery. If the resulted cavity was larger, interrupted sutures should be performed with the absorbable stitches; otherwise, it was unnecessary. The skin wound was sutured to the deepithelialized area with Vicryl 5-0 (Ethicon). Results There were 21 cases, who underwent surgery using the described technique through which 95 lumps (0.5 cm×0.5 cm-6.0 cm×5.0 cm) were removed and included in the study. All patients' resected tumor specimens were pathologically confirmed as fibroadenoma. No major complications were encountered in any of the patients. The incision was well concealed by the dome of the nipple and the areolar pigmented and corrugated skin. Both doctors and patients were satisfied with postoperative aesthetic effect of the incision scar. Conclusions The incision in periareolar site for excision of multiple fibroadenomatas results in minimal scarring and a better appearance than that can be achieved with traditional methods. This technique, which can improve the aesthetic outcome of breast surgery, should be performed when feasible. Key words: Incisiion in periareolar; Fibroadenoma; Multiple

Multiple bilateral fibroadenoma of the breast and axillary accessory breast: case report

Multiple bilateral fibroadenoma of the breast and axillary accessory breast: case report

Gain-of-function Prolactin Receptor Variants Are Not Associated With Breast Cancer and Multiple Fibroadenoma Risk.

In a cohort of 95 women with multiple breast fibroadenomas (MFAs), we recently identified patients harboring germline heterozygous variants of the prolactin receptor (PRLR) exhibiting constitutive activity (PRLRI146L and PRLRI176V). This study sought to better delineate the potential role of PRLR gain-of-function variants in benign and malignant mammary tumorigenesis. This was an observational study and transgenic mouse model analysis. The study took place at the Department of Endocrinology, Reproductive Disorders and Rare Gynecologic Diseases, Pitié Salpêtrière, Paris, and Inserm Unit 1151, Paris. We generated a second MFA cohort (n = 71) as well as a group of control subjects (n = 496) and a cohort of women with breast cancer (n = 119). We also generated two transgenic mouse models carrying the coding sequences of human PRLRI146L or PRLRWT. We aimed to determine the prevalence of PRLR variants in these three populations and to uncover any association of the latter with specific tumor pattern, especially in patients with breast cancer. This study did not highlight a higher prevalence of PRLR variants in the MFA group and in the breast cancer group compared with control subjects. Transgenic mice expressing PRLRI146L exhibited very mild histological mammary phenotype but tumors were never observed. PRLRI146L and PRLRI176V variants are not associated with breast cancer or MFA risk. However, one cannot exclude that low but sustained PRLR signaling may facilitate or contribute to pathological development driven by oncogenic pathways. Long-term patient follow-up should help to address this issue.

Incidence of Multiple Mammary Tumors and Fibroadenoma in Pathological Study of Udder Affections in Camel (Camelus dromedarius)

Incidence of Multiple Mammary Tumors and Fibroadenoma in Pathological Study of Udder Affections in Camel (Camelus dromedarius)

Evaluation of the safety and efficacy of percutaneous radiofrequency ablation for treating multiple breast fibroadenoma.

This study was conducted to evaluate the safety and efficacy of ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) for multiple breast fibroadenoma as an alternative to surgical resection. Sixty-five patients with multiple breast fibroadenoma accepted general anesthesia and US-guided percutaneous RFA in our hospital from September 2014 to January 2016. Contrast-enhanced US (CEUS) was used immediately after operation to determine whether the tumor was ablated completely. The complete ablation rate (CAR) and the change of focal volume were evaluated by CEUS at the 1st month and the 3rd month after operation. All the patients were diagnosed by needle biopsy. Among all the patients, 256 nodules were found. Forty-six nodules (17.96%) were located <5 mm from epidermis; 26 nodules (10.15%) were located below areola. Complete ablation was achieved for 251 nodules (98.04%) after the 1st month of operation. The volume reduce rate was 39.06% and 75.99% at the 1st and the 3rd month after operation, respectively, of which 45 nodules were completely absorbed (17.58%). There was a statistically significant difference of the volume reduction rate (VRR) after operation (P < 0.01) compared with preoperative breast nodules volume. There were no complications such as skin burn, hemorrhage, and hematoma, nipple discharge in the process during and after RFA. Given advantages of high CAR, mild injury, rapid recovery, and cosmetic outcome desired by the patients, RFA has the potential to become the preferred method in the treatment of breast fibroadenoma.

Idiopathic hemihypertrophy with multiple fibroadenoma.

Idiopathic hemihypertrophy with multiple fibroadenoma.

Giant Fibroadenoma in the Axilla: A Common Entity of Uncommon Size in a Rare Location

A 20-year-old patient presented at our department with a slow-growing mass spanning from her right axilla to the medial upper arm. She had first noted the asymptomatic mass 10 months previously. Physical examination revealed a firm but relatively mobile mass measuring 8 cm×2 cm in the right upper medial arm. The mass was painless and nontender, with no fluctuation. No neurological signs and no infection signs with respect to the right arm were observed (Fig. 1). Computed tomography showed a lobulated mass measuring 8.5 cm×4.0 cm×2.1 cm with intermediate density in the subcutaneous layer of the right axilla and the upper medial arm (Fig. 2). Under the impression of a soft-tissue tumor of nerve origin, an excisional biopsy was performed through an axillary incision. A well-encapsulated, lobulated, pink, rubbery mass was found in the deep subcutaneous fat layer and was excised from the surrounding tissue (Fig. 3). Histopathologically, a biphasic pattern of epithelial and stromal proliferation was noted. The ductal epithelium was composed of an inner cuboidal/columnar epithelium and an outer myoepithelial layer. The fibrous stromal tissue showed an intracanalicular growth pattern, corresponding to the diagnosis of fibroadenoma (Fig. 3). The patient underwent sonography evaluation for any lesions in both breasts with negative findings. Fig. 1 Preoperative and intraoperative findings. (A) The bulging, palpable mass spanning from the right axilla to the upper portion of the arm is seen preoperatively. (B) A well-encapsulated, pink, rubbery, and lobulated mass was found. Fig. 2 Computed tomography findings of a lobulated mass measuring 8.5 cm×4.0 cm×2.1 cm with intermediate density in the subcutaneous layer of the right upper medial arm and the axilla. Fig. 3 (A) The excised specimen measuring 11.5 cm×5 cm. (B) Histological findings of both epithelial hyperplasia and stromal hypercellularity (H&E, ×100). Fibroadenoma is a benign, fibroepithelial tumor of the breast. While a vast majority of these tumors have been found in females, rare occurrences have been reported in males [1]. Due to their benign nature, some have thought that these lesions are not neoplasms but hyperplastic lesions. However, recent studies observing the transformation of breast fibroadenoma to malignancies have reported differently. Pacchiarotti et al. [2] reported the transformation of fibroadenoma into high-grade malignant tumors after ovarian stimulation in in vitro fertilization patients. Specific variants of fibroadenoma include giant fibroadenoma, juvenile fibroadenoma, multiple fibroadenomas, and fibroadenoma of pregnancy and lactation. Giant fibroadenomas have a diameter of more than 5 cm and/or weigh more than 500 g, as in this case. Multiple fibroadenomas are associated with a related family history or several cancer syndromes such as the Maffucci syndrome, Cowden syndrome, and Carney complex [3]. Juvenile fibroadenoma usually presents as a breast mass in patients between the age of 10 and 18 years. Jung et al. [4] reported a case found in a 13-month-old child, but such incidence is extremely rare. The incidence of breast lesions in the general adolescent population is low (2.2%), and a majority of these lesions are fibroadenomas. Definitive diagnosis is done through histopathological examination. Ultrasonography may help distinguish between solid and cystic lesions of the breast, and fibroadenomas typically have a longer width than height, surrounded by an echogenic capsule. Fine-needle aspiration is not reliable in distinguishing a fibroadenoma from a phyllodes tumor. Core-needle biopsy has strong negative (93%) and positive (83%) predictive power, but only by histopathological examination of the entire specimen can a definite diagnosis be made. The pathophysiology of this entity has not been fully established. Hormonal influences have been suggested to be a factor, due to the increase in prevalence during puberty or pregnancy, or during the intake of oral contraceptives. Suggested hypotheses are an imbalance of estrogen levels or hypersensitivity of breast tissue to estrogen, resulting in mammary gland hyperplasia [5]. Thus, a vast majority of fibroadenomas are found in the breast. Although there have been rare reports of lesions found in the axilla, this is the first report of a fibroadenoma of this dimension solitarily occurring in the axilla [5]. In this report, we have included the relevant clinical, gross, and micrographic pathological images.

Multiple Recurrences of Multiple Unilateral Giant Fibroadenoma

We present a case of a 36-year-old woman with recurrent unilateral multiple giant fibroadenomas that we investigated by FNAC, mammography and sonography. Though the lumps had an appearance of a phyllodes tumor our evaluation suggested a diagnosis of giant fibroadenoma which was confirmed by histopathology after enucleation. In an attempt to prevent recurrence we have put her on an off label therapy with Ormeloxifene.

Bilateral invasive duct carcinoma, phyllodes tumor and multiple fibroadenomas of breast associated with lymph node metastases - rare coexistence.

Concomitant occurrence of phyllodes tumor with an in situ or invasive carcinoma in the breast is an uncommon phenomenon and has been reported sparingly. We describe a rare case of simultaneous bilateral intraductal and infiltrating duct carcinoma with coexisting fibroadenomas and phyllodes tumor. To the best of our knowledge, only 19 cases of invasive carcinoma with phyllodes tumor have been reported so far and lymph node metastases has been described only once. A 43year-old woman presented with multiple bilateral breast lumps. Core biopsies revealed phyllodes tumor in the right breast and invasive duct carcinoma of the left breast. Simple mastectomy done for right breast showed foci of invasive carcinoma arising in phyllodes tumor. Metastasis was detected in the left axillary lymph nodes. This case is being reported to create awareness of this rare transformation, which has significant prognostic and therapeutic implications.

Evolución inusual de fibroadenomas mamarios múltiples en adolescente con metrorragia disfuncional

SUMMARY We describe the unusual evolution of multiple fibroadenomas (FA) in a 11-years old adolescent during treatment of an abnormal uterine bleeding with cyclic progestins. Inicially ultrasound demonstrated more than 10 masses in each breast, up to 2,6 cm diameter, compatible with fibroadenomas. After 13 month follow up lesions decreased in number and size. We discuss the natural history of FA, the hormonal influence in FA etiology, the ultrasound diagnosis and the managment of this pathology in adolescents. We hypothesized that there is an estrogen/progestin imbalance, due to the anovulatory cycles of the post menarche period that caused the AUB and FA. Cyclic progesterone balanced the E/P relation, thus managing both AUB and causing regression of the breast masses.

Multiple Fibroadenomas in Single Breast

Multiple Fibroadenomas in Single Breast

Round block technique is a useful oncoplastic procedure for multicentric fibroadenomas

PurposeMulticentric fibroadenomas, defined as multiple fibroadenomas located at different quadrants of the breast, occur in 10–20% of women with fibroadenoma. The surgical management of multicentric fibroadenomas may be troublesome for surgeons and patients. In this study, we report our preliminary experience using the “round block technique” in the management of women with multicentric fibroadenomas of the breast. Materials and methodsRecords of patients with breast diseases managed with the round block technique were searched for in the Changhua Christian Hospital oncoplastic breast surgery database. The patients' clinicopathologic characteristics, type of surgery, operation time, blood loss, and complications were recorded. The cosmetic outcome was evaluated by the patient and operating surgeon two months after the surgery. ResultsTwenty patients with multicentric fibroadenomas managed by the round block technique comprised the current study cohort. The mean age of the subjects was 36.5 ± 10.4 years. Twelve (60%) patients had tumors on one side of the breast, and eight (40%) had bilateral breast lesions. The average number of tumors removed was 3.3 ± 1.2 (range 2–6) per breast, and mean tumor size was 2.2 ± 0.5 cm. Three (15%) patients developed mild ecchymosis of the breast undergoing operation, which resolved spontaneously. One (5%) patient had partial nipple ischemia/necrosis due to 2 tumors excised near the nipple–areolar complex. The aesthetic results were evaluated as good in 19 (95%) patients and fair in 1 (5%). ConclusionsThe round block technique is a useful oncoplastic procedure for the management of multicentric fibroadenomas excised at the same time.

Mystery within a fibroadenoma

Fibroadenomas (FA) are the most common benign biphasic neoplasms in young women. Occurrences of malignant changes within FA are rare. A 32-year-old female patient presented with a lump in the left breast since 1 month. On clinical and ultrasound examination, patient was diagnosed as having multiple FAs. Cytology revealed atypical cells and excision of the lump was suggested. Histopathological examination (HPE) of the lump diagnosed as infiltrating ductal carcinoma with FA. Patient thereafter underwent modified radical mastectomy and further treatment. Patient remained well on follow-up. The present case highlights the need for extensive sampling on fine-needle aspiration and conscientious search for malignancy during the HPE.

Congenital synmastia with concurrent fibroadenomas in a pediatric patient

Congenital synmastia, or absence of the intermammary sulcus, is a rare breast anomaly in the pediatric population. While acquired synmastia after breast augmentation is a well-documented entity, congenital synmastia is a rare condition with only four previous cases reported in the surgical literature. We describe the first patient with concurrent presentation of congenital synmastia and multiple fibroadenomas. A combined technique was used to both address the patient's breast lesions and correct the defect.

Unusual Presentation of Multiple Fibroadenomas in Bilateral Breasts and Axillary Accessory Breast

We report an extremely rare case with a total of 50 fibroadenomas simultaneously presented in bilateral breasts and left axillary accessory breast, up to 8 cm in size, in a 20 year-old Chinese woman. The histopathologic and immunophenotypic features of the fibroadenomas are described and possible underlying pathogenesis is discussed. To our knowledge, this is the first case with such a large number of bilateral multiple breast fibroadenomas in a young female reported in the literature.