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Clinical and pathological characteristics of breast giant fibroadenoma among young females
Background: Fibroadenomas are benign tumors commonly found in the breast tissue of young women. While most fibroadenomas do not require immediate surgical intervention, some cases may necessitate excision due to rapid growth, multiple occurrences, or recurrence. In such instances, surgeons may opt for a peri areolar incision as an effective approach for removing multiple and recurrent fibroadenomas. Objective: To assess the surgical consequences after employing the peri-areolar incision technique for removing multiple and recurrent fibro-adenomas. Methodology: This cross-sectional study was conducted on a specific group of 80 female individuals, aged 15 to 35 years, diagnosed with multiple and/or recurrent fibroadenomas, and scheduled for surgical intervention who visited the surgical department at Liaquat University Hospital, Hyderabad, during a period of four years from 2017 to 2020. The periareolar incision was made along the outer border of the areola. An arc-shaped or semi-circular incision was carefully placed to ensure optimal access to the breast tissue containing the fibroadenomas. Dissection was carried out to remove the tumors while preserving the surrounding healthy breast tissue. Following successful tumor removal, meticulous wound closure was performed using absorbable sutures. Adequate pain management was provided and postoperatively, patients were closely monitored for complications, including wound healing issues, infection, and hematoma formation. The data obtained was analyzed using SPSS version 20.0. Results: The study included patients with a mean age of 26.45 ± 5.22 years. The average size of excised lesions was 5.7±2.1 cm, with most cases being unilateral (72.5%). In 16.3% of patients, the incision needed to be extended, On the first follow-up, 9.2% of patients presented with a hematoma and surgical site infection in 11.2% of patients. Numbness or loss of nipple sensation was reported by 6.3% patients and areolar necrosis was noted in 5.75% of patients.
Objective:
Oncoplastic surgery was developed to allow for large tumor excision and immediate breast reconstruction with the goal of optimal breast shape and symmetry. Although initially used in women who underwent lumpectomy for breast malignancy, these techniques can be useful for cosmetic issues caused by benign breast disease. We describe a modification of an inferior pedicle with Wise-pattern reduction mammoplasty for oncoplastic reconstruction of a giant fibroadenoma.Methods:A 30-year-old woman with size 32 DD breasts was referred by the surgical oncologist with a biopsy-proven fibroadenoma of the right breast. Surgical oncology excised the mass, and immediate reconstruction was performed with an inferolateral pedicle Wise-pattern reduction technique.Results:Immediately postoperatively, the patient showed excellent symmetry. Follow-up postoperatively showed good wound healing, preserved symmetry, and a viable, sensate nipple.Conclusions:Oncoplastic breast reconstruction in a reduction pattern technique after giant fibroadenoma removal provides an excellent outcome, allowing for improved symmetry.
Juvenile giant fibroadenoma is a benign breast tumor and rare variant of the fibroadenomas. Clinical presentation is usually a painless, solitary and unilateral breast mass. It accounts for 0.5%-2% of all fibroadenomas and exact etiology is not known; however, hormonal influences are thought to be contributing factors. We present a case of a 20 cm diameter giant juvenile fibroadenoma of the breast in a 14-year-old girl. The patient was suffering from a painless, progressively enlarging mass for 1 year. Ultrasound revealed fibroadenoma and total surgical excision was performed. The patient is doing well in ten months of follow up.
Giant juvenile fibroadenomas are rare variants of fibroadenoma, usually occurring in girls between the ages of 10 and 18 years. They are characterized by massive and rapid enlargement of a rubbery, mobile, and non-tender mass. The etiology is not well understood and believed to be an increased sensitivity to normal estrogen level. We report two cases of giant juvenile fibroadenoma in a 12 and 14 years old girls that were managed by surgical excision with conservation of normal breast tissue, nipple, and areola. The cases are followed by a literature review.
Giant breast masses are entities of great concern as they continue to pose a diagnostic as well as a therapeutic challenge. We present a case of giant fibroadenoma of the right breast in a 35-year-old woman which simulated as a phyllodes tumor, creating a diagnostic conundrum.
Breast lesions can be of various types from inflammatory to benign to malignant. Some lesions are common in young females while others are more common in
elderly age group. The study aim were intend to profiling prevalence and finding
out age-related presentation of breast lumps. To find out the prevalence of
inflammatory, benign and malignant breast lesions and age related pattern of
presentation of patients with various breast lesions. The study comprises analysis of
100 patients attending for FNA cytology at J A group of Hospitals. Detailed
history was recorded and clinical examination was conducted. Fine needle
aspiration cytology (FNAC) were done and stained by Giemsa technique and were
reported. Suspicious cases were confirmed by histopathology examination. Out of
the 100 cases analysed, 74% were benign, 20% malignant and the remaining 6%
were inflammatory. Among the benign breast disease fibroadenoma was most
common accounting for 57% of total cases followed by 9 (9%) fibroadenosis, 2
(2%) lactating adenoma, 1(1%) duct papilloma, 1(1%) mastitis, 1 (1%) apocrine
carcinoma, 1(1%) atypical ductal hyperplasia, 1(1%) lipoma. Among malignant
lesions, 19 (19%) were ductal cell carcinoma, 1(1%) was apocrine carcinoma of
breast. In the age group 15-25 fibroadenoma comprised of 81% cases. There was 1
(3%) cases of ductal cell carcinoma in the15-20 year age group.
Background:
Accurate clinical diagnosis of fibroadenoma in young females is desirable because of the possibility of nonoperative treatment for those desiring it.
Objectives:
To determine the accuracy of the clinical diagnosis of fibroadenoma in patients aged ≤ 25 years.
Patients and methods:
A prospective study of all patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008.
Results:
During the study period, 145 patients aged ≤25 years presented with breast lumps. In this group, a clinical diagnosis of fibroadenoma was made in 100 (69.0%), fibrocystic disease in 32 (22.1%), breast cancer in 4 (0.03%) patients, the remaining were benign lesions. Excision biopsy was done for 81 (55.9%) patients. Of these 81 patients, only 62 (76.5%) returned with histology report. The histological diagnosis was fibroadenoma in 45 (72.5%) patients with a mean age of 21.4 years. Their ages range from 18 to 25 years. The histological diagnosis was fibrocystic disease in 9 (14.5%) and malignant phyllodes in 1 (1.6%) patient. The remaining 7 (11.3%) patients had other types of benign lesions. For fibroadenoma, true positive cases were 42, false positive 7 and false negative 3, and true negative 10. Therefore, the sensitivity of clinical diagnosis of fibroadenoma was 93.3%, while specificity was 58.8%.
Conclusion:
The sensitivity of clinical diagnosis of fibroadenoma in patients aged ≤25 years was good, though specificity is low.
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. Given the prevalence of fibroadenomas in the adolescent population and the psychosocial morbidity of finding a mass in the adolescent breast, it is imperative for physicians treating adolescent patients to be familiar and up to date with this disease process. The goal of this article is to provide a brief review of the classification, etiology, symptoms, initial work-up, and update on the management of breast fibroadenomas in the adolescent population.
To assess the safety of a conservative approach to fibro-adenoma of the breast we prospectively studied 321 women with this clinical diagnosis, and performed aspiration cytology and excision biopsy. There was histological confirmation of fibro-adenoma in 217 (68 per cent), the remainder having various benign conditions and 4 (1.3 per cent) had carcinoma. Aspiration cytology had a sensitivity of 87 per cent and a specificity of 76 per cent for fibro-adenoma. Three cases of carcinoma were identified cytologically and the fourth was regarded as suspicious. To estimate the risk of missing carcinoma we compared the annual frequency of carcinoma with fibro-adenoma in young women and found a ratio of 1:470 between 15 and 19 years, 1:133 between 20 and 24 years and 1:9 in the 25-29 age group. To assess patients' views on non-operative treatment of benign breast masses we asked 124 women, 10 days postoperatively, whether they preferred a conservative approach for a cytologically benign lump: 26 (21 per cent) opted for conservative management in the future and 8 (7 per cent) would have preferred conservatism rather than their recent excision. A conservative approach is safe for clinically and cytologically benign breast lumps in women under 25 years, but very few will accept it.
Fibroadenoma is a common cause of discrete breast lumps in young women. There is agreement that fibroadenomas can be diagnosed preoperatively with a high degree of confidence and that some of the lesions thus diagnosed will resolve, possibly obviating the need for excision. There is, however, wide disagreement over the proportion of fibroadenomas that resolve spontaneously and therefore the benefit that accrues from an expectant policy. The aim of this study was to audit the management of fibroadenomas on one unit and clarify their natural history over a 5-year period. A cohort of 70 women with 87 fibroadenomas diagnosed using a triple assessment of clinical examination, cytology and imaging (sonomammography) have been followed for a minimum of 5 years. In all, 53 of the 'fibroadenomas' have been excised. In four cases the histology revealed benign disease other than fibroadenoma; there were no neoplasms. The sensitivity of cytology and sonomammography for the diagnosis of fibroadenoma were 84% and 98% respectively. Thirty-four fibroadenomas have not been excised. Of 25 fibroadenomas that have been reassessed after at least 5 years of follow-up, 13 (52%) have reduced in size, 4 (16%) are unchanged in size and 8 (32%) have grown. No patient has developed a carcinoma at the site of the presumed fibroadenoma. This study confirms that an expectant management policy of fibroadenomas has not resulted in misdiagnosis of carcinomas. Further, since a significant proportion of fibroadenomas remain static or reduce in size over a 5-year period many women can avoid excision.
Unlabelled:
To minimise delay in diagnosis and reduce patient anxiety, triple assessment with immediate reporting has been used in our symptomatic breast clinic since 1991. This article examines the accuracy of the diagnostic modalities used and the efficacy of the "one-stop" diagnostic policy. The data on 1,110 new patients presenting to the symptomatic breast clinic between January and July 1993, were analysed and subsequent three year follow-up and outcome established. Fine needle aspiration cytology (FNAC) gave the highest predictive value (97.3%) with a sensitivity of 93.5% and a specificity of 98.1%. Ultrasonography provided a 97.0% prediction with a sensitivity of 88.9% and a specificity of 97.4%, whereas mammography had a prediction of 96.4% with sensitivity of 93.2% and a specificity of 96.7%. When the mammogram or ultrasound scan were reported as unequivocally benign (M1), there were no missed cancers. The false positive and false negative rates for FNAC were 0% and 1.4%, respectively. Following assessment, a diagnosis was made in 96% of patients. Sixty-two percent of the patients were discharged at the first clinic visit. Four breast malignancies were subsequently diagnosed in the discharged group; two with new microcalcifications due to ductal carcinoma in situ, one with invasive disease in a different quadrant of the breast from that originally investigated, and in one patient the cancer was missed.
Conclusion:
A "one-stop" symptomatic breast clinic provides an accurate and effective means of establishing a correct diagnosis.
Case Report Multiple and giant juvenile fibroadenoma: a case report and literature review
- C Chen
- D Gao
Chen, C, Gao, D, Luo and L-b: Case Report
Multiple and giant juvenile fibroadenoma: a
case report and literature review. Int J Clin Exp
Med 2018; 11(5): 5206-5211.
Breast mass evaluation: factors influencing the quality of US elastography
Chang J.M, Moon W.K, Cho N and Kim S.J:
Breast mass evaluation: factors influencing the
quality of US elastography. Korean Radiology
2016; (259): 59-64.