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Kim G, Jang G, Song J, Kim D, Lee S, Joo JWJ, Jang W. A transcriptome-wide association study of uterine fibroids to identify potential genetic markers and toxic chemicals. PLoS One 2022; 17:e0274879. [PMID: 36174000 PMCID: PMC9521910 DOI: 10.1371/journal.pone.0274879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Uterine fibroid is one of the most prevalent benign tumors in women, with high socioeconomic costs. Although genome-wide association studies (GWAS) have identified several loci associated with uterine fibroid risks, they could not successfully interpret the biological effects of genomic variants at the gene expression levels. To prioritize uterine fibroid susceptibility genes that are biologically interpretable, we conducted a transcriptome-wide association study (TWAS) by integrating GWAS data of uterine fibroid and expression quantitative loci data. We identified nine significant TWAS genes including two novel genes, RP11-282O18.3 and KBTBD7, which may be causal genes for uterine fibroid. We conducted functional enrichment network analyses using the TWAS results to investigate the biological pathways in which the overall TWAS genes were involved. The results demonstrated the immune system process to be a key pathway in uterine fibroid pathogenesis. Finally, we carried out chemical–gene interaction analyses using the TWAS results and the comparative toxicogenomics database to determine the potential risk chemicals for uterine fibroid. We identified five toxic chemicals that were significantly associated with uterine fibroid TWAS genes, suggesting that they may be implicated in the pathogenesis of uterine fibroid. In this study, we performed an integrative analysis covering the broad application of bioinformatics approaches. Our study may provide a deeper understanding of uterine fibroid etiologies and informative notifications about potential risk chemicals for uterine fibroid.
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Affiliation(s)
- Gayeon Kim
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Gyuyeon Jang
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Jaeseung Song
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Daeun Kim
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Sora Lee
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Jong Wha J. Joo
- Department of Computer Science and Engineering, Dongguk University-Seoul, Seoul, South Korea
| | - Wonhee Jang
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
- * E-mail:
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2
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Yu SM, Hung EHY. Unknown Case: Enlarging Vulvar Mass in a Transplant Patient. JOURNAL OF BREAST IMAGING 2022; 4:331-333. [PMID: 38416976 DOI: 10.1093/jbi/wbac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Indexed: 03/01/2024]
Affiliation(s)
- Suet-Mui Yu
- Prince of Wales Hospital, Department of Imaging and Interventional Radiology, Shatin, Hong Kong
| | - Esther H Y Hung
- Prince of Wales Hospital, Department of Imaging and Interventional Radiology, Shatin, Hong Kong
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3
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Management of Multiple Breast Fibroadenomas, Literature Review. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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4
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Kim MJ, Kim BW, Yoon YC, Seo WI, Park YM, Kang SW, Kim TH, Kim YH. Effect of Converting From Calcineurin Inhibitor- to Sirolimus-Based Immunosuppressant Regimen on Breast Fibroadenoma Among Kidney Transplant Patients. Transplant Proc 2019; 51:1848-1852. [PMID: 31256869 DOI: 10.1016/j.transproceed.2019.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
The incidence rate of breast fibroadenomas is higher among female kidney transplant (KT) patients treated using cyclosporine (CsA) for immunosuppression than in the general population. As such, there is an effort to convert immunosuppression from CsA or tacrolimus to sirolimus. Our aim was to assess the reversibility of a breast fibroadenoma after conversion in a small cohort of female KT recipients. This was an open-label, single-arm study including 128 female KT recipients, with a positive finding of a breast fibroadenoma in 15. Lesions were classified according to the Breast Imaging Reporting and Data System (BIRADS). Among these 15, a total of 7 converted from tacrolimus to sirolimus and 8 converted from CsA. We measured the change in BIRADS category and hormone and cytokine levels from baseline to 12 months after conversion. The primary outcome was progression or reversal of existing fibroadenomas at 12 months after conversion. Secondary outcomes were differences in hormone and cytokine levels. Conversion from CsA or tacrolimus to sirolimus had no significant effect on the BIRADS classification. However, conversion to sirolimus did produce a significant decrease in the level of transforming growth factor β cytokine, this level being closely associated with fibroadenomas. Conversion from a calcineurin inhibitor to sirolimus can block the progression of fibroadenomas. Further research is needed to confirm our results.
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Affiliation(s)
- Min Ji Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Byeong Woo Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Young Chul Yoon
- Department of Transplantation, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Won Ik Seo
- Department of Urology, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Sun Woo Kang
- Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Tae Hee Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, South Korea.
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Abstract
Developmental abnormalities and malformations of the breast are rare and encompass a variety of genetic, syndromic, acquired and sporadic conditions. Abnormalities in development may include irregularities in the nipple areolar complex and/or the underlying glandular tissue, resulting in under or overdevelopment of breasts. Age of presentation and clinical severity is dependent on the underlying biologic cause. Abnormalities may involve the entirety of unilateral or bilateral breasts, particularly in association with syndromic conditions or endocrine abnormalities. Disordered development may also be focal, resulting in tumor-like lesions such as hamartomas, pseudoangiomatous stromal hyperplasia and gynecomastia. In this review, we discuss the disorders of breast development including etiologies, clinical presentations and corresponding histopathologic features.
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Affiliation(s)
- Emily Reisenbichler
- Department of Pathology, Yale School of Medicine, Yale New Haven Hospital, 310 Cedar St, New Haven, CT 06510, United States
| | - Krisztina Z Hanley
- Department of Pathology, Emory University Hospital, Atlanta, GA 30322, United States.
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6
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Shi YD, Qi FZ, Feng ZH. Bilateral reduction mammoplasty after heart transplantation. Heart Surg Forum 2014; 17:E224-6. [PMID: 25179978 DOI: 10.1532/hsf98.2014359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a bilateral reduction mammoplasty in a 15 year old female who suffered increasing back and shoulder pain and chest wall discomfort associated with bilateral breast enlargement during a 17 month period following heart transplantation. Cardiologic evaluation confirmed a structurally normal heart with good systolic and diastolic function, and ejection fraction of 80%. We performed a bilateral mammoplasty using dermal suspension flap in vertical-scar reduction. The patient recovered satisfactorily without incident, and breast morphology was excellent at the 2 year 9 month follow-up, with no recurrence of her previous symptoms or further hyperplasia.
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Affiliation(s)
- Yue-Dong Shi
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Fa-Zhi Qi
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zi-Hao Feng
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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7
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Wong G, Howard K, Tong A, Craig JC. Cancer screening in people who have chronic disease: the example of kidney disease. Semin Dial 2011; 24:72-8. [PMID: 21338395 DOI: 10.1111/j.1525-139x.2010.00804.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cancer screening in people with chronic illness has been the subject of considerable debate recently. Despite the increased incidence of cancer and higher risk of cancer deaths in selected populations, such as those with kidney disease, the benefits-to-harms ratio of cancer screening is uncertain and is likely to be different to people without chronic illnesses because of the expected higher competing risk of death from disease other than cancer, and a higher risk of complications associated with the screening, the diagnostic, and the treatment processes. Using kidney disease as an example, the authors reviewed the current evidence for early cancer detection through screening in people with two or more coexistent chronic diseases, discussed the accepted principles underpinning cancer screening, and the applicability of these concepts to individuals with chronic disease. This review suggests that future research that evaluates the screening test accuracy, quality of life of having cancer, and cancer treatment effectiveness, targeting those with chronic illnesses are necessary for the development of an effective, safe, and acceptable cancer screening program among people with two or more chronic diseases.
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Affiliation(s)
- Germaine Wong
- Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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8
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Iaria G, Pisani F, De Luca L, Sforza D, Manuelli M, Perrone L, Bellini I, Angelico R, Tisone G. Prospective study of switch from cyclosporine to tacrolimus for fibroadenomas of the breast in kidney transplantation. Transplant Proc 2010; 42:1169-70. [PMID: 20534252 DOI: 10.1016/j.transproceed.2010.03.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breast fibroadenomas may result from exposure to cyclosporine (CsA). The aim of this prospective study was to assess the reversibility of breast fibroadenomas following conversion from CsA to tacrolimus among a small cohort of female renal transplant recipients. METHODS Following renal transplantation, fibroadenomas either developed or progressed in eight Caucasian female patients with CsA-based immunosuppression. These patients were enrolled in a pilot study assessing whether conversion from a CsA-based to a tacrolimus-based regimen prevented progression of breast disease or reversed existing lumps. Patients underwent a baseline visit in which we assessed the clinical history, number and dimension of fibroadenomas, graft function and hormonal profile (FSH prolactin, estradiol and progesterone). Twenty-one lumps were described in six patients; in addition, two patients had "grapes of fibroadenomas," of nondefinable numbers. RESULTS Patients underwent conversion to tacrolimus after a mean of 63.8 +/- 37.4 months after renal transplantation. Of the 21 clearly described lumps complete reversibility was observed for eight fibroadenomas. Other fibroadenomas either decreased in size or remained stable without further progression. These changes were reported within 1 year following conversion to tacrolimus. CONCLUSION A switch from CsA to tacrolimus was effective to prevent the progression of fibroadenomas. In female renal transplant recipients with CsA-based immunosuppression suffering from breast fibroadenomas, early CsA withdrawal may avoid the need for breast surgery.
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Affiliation(s)
- G Iaria
- Transplant Unit, Ospedale S. Eugenio, Università Tor Vergata, Roma, Italy
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9
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Vajdic CM, van Leeuwen MT. Cancer incidence and risk factors after solid organ transplantation. Int J Cancer 2009; 125:1747-54. [PMID: 19444916 DOI: 10.1002/ijc.24439] [Citation(s) in RCA: 282] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Iatrogenic immunosuppression is a unique setting for investigating immune-related mechanisms of carcinogenesis. Solid organ transplant recipients have a 3-fold excess risk of cancer relative to the age- and sex-matched general population. Population-based studies utilizing cancer registry records indicate that a wide range of cancers, mostly those with a viral etiology, occur at excess rates. To date, cancer risk has predominantly been examined in adult kidney transplant recipients in Western countries. It is yet to be established whether a similar incidence profile exists in the long-term for other solid organ, pediatric and non-Western transplant recipients. The cancer incidence profile before and after kidney transplantation strongly suggests a relatively minor contribution by both preexisting cancer risk factors and the conditions underlying end-stage kidney disease, and points to a causal role for immunosuppression. Within-cohort risk factor analyses have largely been performed on cohorts with voluntary cancer notification, and very few have incorporated biomarkers of the level of immunosuppression, the current receipt of immunosuppressive agents, or genetic risk factors. Because of their markedly high risk of certain cancers, findings from comprehensive studies in transplant recipients have the potential to raise new avenues for investigation into causal mechanisms and preventive measures against immune-related and infectious causes of cancer.
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Affiliation(s)
- Claire M Vajdic
- UNSW Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, Randwick New South Wales 2031, Australia.
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Krimer PM, Harvey SB, Blas-Machado U, Lauderdale JD, Moore PA. Reversible Fibroadenomatous Mammary Hyperplasia in Male and Female New Zealand White Rabbits Associated with Cyclosporine A Administration. Vet Pathol 2009; 46:1144-8. [DOI: 10.1354/vp.08-vp-0314-k-cr] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
All male and female New Zealand white rabbits in a limbal cell graft study developed marked generalized mammary gland hypertrophy. Postprocedural medications included ophthalmic 0.1% dexamethasone, ophthalmic 0.5% cyclosporine, and subcutaneous cyclosporine A. Cytologic examination revealed epithelial clusters with minimal malignant criteria. On histologic evaluation, there was diffuse glandular hyperplasia with mild cellular atypia and ductal ectasia separated by abundant hypercellular fibrous stroma, consistent with fibroadenomatous mammary gland hyperplasia. The hyperplasia resolved within 2 weeks of cessation of cyclosporine, and at necropsy identifiable mammary masses were not found. Very little has been reported about the use of cyclosporine in laboratory rabbits and its association with development of mammary gland hyperplasia. This is the first report in which administration of cyclosporine to male and female rabbits at a dose as low as 5 mg/kg/day induced benign fibroadenomatous mammary gland hyperplasia. This change regressed after cessation of the drug.
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Affiliation(s)
- P. M. Krimer
- Athens Veterinary Diagnostic Laboratory, University of Georgia College of Veterinary Medicine, Athens, GA
| | - S. B. Harvey
- Department of Population Health and University Research Animal Resources, University of Georgia College of Veterinary Medicine, Athens, GA
| | - U. Blas-Machado
- Athens Veterinary Diagnostic Laboratory, University of Georgia College of Veterinary Medicine, Athens, GA
| | - J. D. Lauderdale
- Department of Cellular Biology, University of Georgia, Athens, GA
| | - P. A. Moore
- Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA
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11
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Binokay F, Balal M, Demir E, Paydas S, Soyupak S, Sertdemir Y, Akgul E. Risk of Developing Fibroadenoma with the Use of Cyclosporine A in Renal Transplant Recipients. Ren Fail 2009; 27:721-5. [PMID: 16350824 DOI: 10.1080/08860220500243197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7+/-9.2 years in the transplant group and 33.95+/-9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found.
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Affiliation(s)
- Figen Binokay
- Department of Radiology, Faculty of Medicine, Cukurova University, Balcali Adana, Turkey.
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12
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Webster AC, Wong G, Craig JC, Chapman JR. Managing cancer risk and decision making after kidney transplantation. Am J Transplant 2008; 8:2185-91. [PMID: 18782291 DOI: 10.1111/j.1600-6143.2008.02385.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients are at higher risk of cancer at most sites, and cancer after transplantation causes considerable morbidity and mortality. To optimize long-term patient outcomes, clinicians balance the prospect of graft failure and dialysis, with competing risks of diabetes, cardiovascular and cerebrovascular disease and the risk of malignancy. In this paper we critically examine the assumptions underpinning primary prevention, immunization, chemoprevention and screening programs, and highlight considerations when applying evidence to the kidney transplant population, and suggest a clinical research agenda that aims to define a rational approach to managing posttransplant cancer risk.
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Affiliation(s)
- A C Webster
- School of Public Health, University of Sydney, Westmead Hospital, NSW Australia.
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13
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Eom M, Han A, Yi SY, Shin JJ, Cui Y, Park KH. RHEB expression in fibroadenomas of the breast. Pathol Int 2008; 58:226-32. [PMID: 18324915 DOI: 10.1111/j.1440-1827.2008.02215.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although fibroadenoma is one of the most common types of benign breast tumor, genes specific to the tumor have not been identified. Microarrays were used to identify differentially expressed genes between fibroadenoma and infiltrating ductal carcinoma. The comparative expression of one of the identified genes, RAS homolog enriched in the brain (RHEB), was further explored using reverse transcriptase-polymerase chain reaction (RT-PCR). Microarray analysis was performed on tissue samples from five patients with fibroadenoma. In the fibroadenoma samples, the genes HDAC1, ROS1, TNFRSF10A, WASP2, TYRP1, WEE1, and RHEB were expressed at levels more than twofold higher than in the normal tissues. RT-PCR for RHEB indicated increased expression of RHEB in fibroadenoma compared to breast cancer. When studied with real-time PCR, the average RHEB/beta-actin ratio in fibroadenoma samples was 1.99, 2.46-fold greater than the average RHEB/beta-actin ratio in breast carcinoma of 0.81 (P < 0.01). Immunohistochemistry and PCR followed by microdissection shows increased expression of RHEB in epithelial cells compared to the stromal cells of fibroadenoma. Therefore, RHEB could be used cytopathologically to distinguish fibroadenoma from malignant breast carcinomas as a secondary diagnostic tool.
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Affiliation(s)
- Minseob Eom
- Department of Pathology, Wonju College of Medicine, Yonsei University, Wonju, Korea
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14
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Yarak S, Floriano M, Decico JE, Konishi CT, Michalany NS, Enokihara MY, Tomimori-Yamashita J. First report of a fibro-adenoma in axillary mammary tissue of a renal transplant patient taking cyclosporin. Int J Dermatol 2007; 46:407-9. [PMID: 17442085 DOI: 10.1111/j.1365-4632.2006.02979.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Yarak
- Department of Dermatology and Pathology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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15
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Schmid N, De Greef C, Calteux N, Duhem C, Faverly D. [Vertical reduction mammaplasty for gigantomastia with massive fibroadenomatosis: a case report]. ANN CHIR PLAST ESTH 2006; 51:536-41. [PMID: 16677750 DOI: 10.1016/j.anplas.2006.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 03/10/2006] [Indexed: 11/15/2022]
Abstract
Vertical reduction mammaplasty is one of the most debated << short-scar >> breast reduction technique. Advantages and drawbacks of the technique are discussed; most of the authors do not accept it as the technique of choice for high glandular resection weights. In our case report we achieve it for a resection weight up to two kilograms with an areolar transposition distance of more than ten centimetres. We show that it is reasonable to realize it dealing with gigantomastia. The massive fibroadenomatosis is observed following immunosuppressive treatment for kidney transplantation. Cyclosporine intake, even sporadic, is at the origin of the growth of these multiple, bilateral and large fibroadenomas. Drug-induced cytokines stimulate their development.
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Affiliation(s)
- N Schmid
- Service de Chirurgie Plastique, Centre Hospitalier de Luxembourg, 4, rue Barblé, 1210 Luxembourg, Grand-Duché de Luxembourg.
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16
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Iaria G, Urbani L, Catalano G, De Simone P, Carrai P, Petruccelli S, Morelli L, Coletti L, Garcia C, Liermann R, Mosca F, Filipponi F. Switch to tacrolimus for cyclosporine-induced gynecomastia in liver transplant recipients. Transplant Proc 2006; 37:2632-3. [PMID: 16182769 DOI: 10.1016/j.transproceed.2005.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report herein on two male liver transplant (LT) recipients who presented with cyclosporine (CsA)-related gynecomastia 6 and 10 months after transplantation. The clinical workup showed increased luteinizing hormone (LH), associated with a slight reduction in testosterone blood levels in one patient and increased prolactin levels in the other. After excluding concomitant primary endocrine and/or malignant disease, conversion to tacrolimus (TAC) was performed resulting in clinical improvement of gynecomastia and return of hormone blood levels to normal range within 3 months. Our report confirms a putative role of CsA in post-LT gynecomastia, reversible however upon conversion to TAC.
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Affiliation(s)
- G Iaria
- Liver Transplant Unit, University of Pisa, Cisanello Hospital, Pisa, Italy
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17
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Seo YL, Choi CS, Yoon DY, Yun EJ, Lee YJ, Park SJ, Moon JH, Cho SJ, Lee S, Han H, Kim SS, Lee JY. Benign Breast Diseases Associated With Cyclosporine Therapy in Renal Transplant Recipients. Transplant Proc 2005; 37:4315-9. [PMID: 16387108 DOI: 10.1016/j.transproceed.2005.10.111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE Our aim was to correlate the radiologic characteristics of cyclosporine-induced benign breast diseases with clinical and pathologic findings. MATERIALS AND METHODS The clinical, mammographic, and ultrasonographic records of 33 female renal transplant recipients who received cyclosporine were retrospectively reviewed. Eleven patients had 46 breast masses on ultrasonography. We performed core needle biopsies on 20 masses and reviewed the pathologic findings. RESULTS Among 33 female renal transplant recipients, 11 (33%) had 46 benign breast lesions detected on ultrasonography. We performed core needle biopsies on 20 of the 46 masses. On pathologic examination, 12 were fibroadenomas, 6 showed fibrocystic changes, and 2 revealed dense fibrosis. Regardless of the final pathologic diagnosis, more than half of the lesions revealed severe lymphatic and venular swellings. Among 11 patients with breast lesions on ultrasonography, 10/11 (91%) showed multiplicity, and 7/11 (64%) bilaterality. Mammographically, patients with breast lesions revealed heterogeneous or extremely dense breast patterns, and 8 of 11 patients, circumscribed masses. Twenty-two patients without breast lesions showed scattered fibroglandular densities (n = 7), or heterogeneously dense (n = 11) or extremely dense (n = 4) breast patterns, and 3 of 22 patients showed vague or asymmetric densities that needed further evaluation. CONCLUSION The development of new breast lesions in patients after renal transplantation should suggest a diagnosis of cyclosporine-induced benign breast disease including fibroadenoma, fibrocystic changes, and dense fibrosis.
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Affiliation(s)
- Y L Seo
- Department of Radiology, Kangwon National University School of Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Democratic People's Republic of Korea.
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18
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Abstract
Breast fibroadenomas are the most common solid lesions found in young women. We report on four patients who underwent renal transplantation and developed bilateral fibroadenomas while on cyclosporine (CsA). One patient developed symptomatic giant fibroadenomas and underwent bilateral mammoplasty. A significant decrease in the size of the breasts was noticed after switching to tacrolimus in three patients. Awareness of the association between CsA and fibroadenomas should help to achieve the correct diagnosis in transplant patients without subjecting them to unnecessary procedures.
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Affiliation(s)
- A M Alkhunaizi
- Nephrology Section, Department of Internal Medicine, Dhahran Health Center, Dhahran, Saudi Arabia.
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19
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Son EJ, Oh KK, Kim EK, Cho N, Lee JD, Kim SH, Jung WH. Characteristic imaging features of breast fibroadenomas in women given cyclosporin A after renal transplantation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:69-77. [PMID: 14750137 DOI: 10.1002/jcu.10233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This retrospective study was conducted to determine the characteristic imaging and histopathologic features of breast fibroadenomas in kidney-transplant recipients given chronic cyclosporin A immunosuppressive therapy after the transplantation and to compare these characteristics with those from a control group. METHODS From January 1, 1990, through December 31, 1999, 486 women underwent renal transplantation at our institution. All patients subsequently received immunosuppressive therapy with cyclosporin A and prednisolone. Ten (2%) of these women had developed breast fibroadenomas during this chemotherapy. We compared the data obtained on this group's fibroadenomas with those obtained from those in the control group, which comprised 100 women with fibroadenomas but who had never undergone organ transplantation or immunosuppressive therapy. RESULTS Twenty-two fibroadenomas developed in the 10 transplant recipients. Eight of those 10 had multiple lesions, and 7 were affected bilaterally. The mean diameter of the fibroadenomas was 4.2 +/- 2.5 cm. Mammographically, the lesions were round or oval high-density masses with well-circumscribed margins and no calcification or spiculation. Sonographically, the lesions were relatively highly echogenic and had a lower ratio of the longitudinal to the anteroposterior diameter (L /AP) than did those in the control group. Histopathologically, the features of these lesions were generally typical of fibroadenomas, but some were more typical of malignant lesions. Among the 100 control patients, 146 fibroadenomas developed; 33 women had multiple lesions, and 12 were affected bilaterally. Their fibroadenomas had a mean diameter of 2.1 +/- 1.5 cm, and the imaging features of these lesions were typical of fibroadenomas. CONCLUSIONS The fibroadenomas that developed in kidney-transplant recipients given chronic cyclosporin A and prednisolone immunosuppressive therapy had a tendency to be multiple, bilateral, and larger than those that developed in the control patients. These fibroadenomas also exhibited some imaging features that differed from those of typical fibroadenomas that develop in women who have not undergone organ transplantation or immunosuppressive therapy.
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Affiliation(s)
- Eun Ju Son
- Department of Diagnostic Radiology, The Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270, South Korea
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20
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Balal M, Seyrek N, Karayaylali I, Paydas S. Report of a renal transplanted patient with fibroadenoma occurring in a short time. Transplant Proc 2003; 35:1408-9. [PMID: 12826173 DOI: 10.1016/s0041-1345(03)00442-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The incidence of breast cancer in renal transplant patients is similar to that of general population. But fibroadenomas may be seen as a result of exposure to cyclosporine (CyA). Herein we report the case of a 32-year-old woman who received a renal transplant and had a breast fibroadenoma. She had been prescribed CyA, azathioprine, and steroids for 4 years. At the end of the first year a palpable mass had been detected in her right breast; the pathologic diagnosis was fibroadenoma. At the 4th year after transplantation, immunosuppressive treatment was switched to CyA and mycopholate mofetil (MMF) because of an increased serum creatinine level. Two years later seven breast nodes from both breasts were detected by ultrasonography. Totally excision was performed revealing a histopathologic diagnosis of fibroademata as before. In this case, the combination of CyA and MMF administration seemed to cause an increase in the number of nodules in a short time. The cause of fibroadenomas may be related to drug-induced secretion of proliferative or anti-apoptotic cytokines.
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Affiliation(s)
- M Balal
- Cukurova University, Medical Faculty, Department of Nephrology, Adana, Turkey
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21
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Zhang JW, Dry J, Moroz K. Pathologic quiz case: post-lung transplantation patient with bilateral breast masses. Arch Pathol Lab Med 2003; 127:375-6. [PMID: 12653591 DOI: 10.5858/2003-127-0375-pqc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jing W Zhang
- Department of Pathology, Tulane University Medical Center, New Orleans, LA 70112, USA
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22
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Abstract
In a retrospective study of giant breast masses over a period of 20 years (1980-2000), we encountered 18 patients with fibroadenomas. Most of them were adolescents and young adults. The bimodal age incidence seen in Caucasians was not observed. The masses ranged from 6 to 15 cm in size and in the youngest patient, they were bilateral. All 18 patients were examined by mammography and 10 of them by ultrasonography (US) as well. The right breast was involved in 12 patients and the left in six. The diagnosis was confirmed pathologically in all patients, by excision biopsy in 17 patients and by fine needle aspiration cytology and excision biopsy in one patient. The radiological findings were the same as those previously described. All patients were treated by simple enuculation. There was only one recurrence over a follow-up period from 2 months to 3 years.
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Affiliation(s)
- R M Hanna
- Department of Diagnostic Radiology and Imaging, Al-Sabah Hospital, Kuwait.
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23
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Kleer CG, Tseng MD, Gutsch DE, Rochford RA, Wu Z, Joynt LK, Helvie MA, Chang T, Van Golen KL, Merajver SD. Detection of Epstein-Barr virus in rapidly growing fibroadenomas of the breast in immunosuppressed hosts. Mod Pathol 2002; 15:759-64. [PMID: 12118114 DOI: 10.1038/modpathol.3880602] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fibroadenomas are the most common benign tumors of the female breast and are associated with a slight increase in the risk of subsequent breast cancer. Multiple fibroadenomas have been described in patients after renal transplantation and are thought to be secondary to drug-related growth stimulation. Epstein-Barr virus (EBV) has been detected in many neoplasms, including breast cancer. We set out to investigate whether EBV plays a role in the development of rapidly growing fibroadenomas in immunocompromised patients. We studied 19 fibroadenomas and one invasive ductal carcinoma that developed after organ transplantation or treatment for lupus erythematosus. As a control group we included 11 fibroadenomas from non-immunocompromised patients. DNA was amplified using polymerase chain reaction (PCR) of the EBV-encoded small RNA (EBER-2) DNA sequence. EBV latent membrane protein 1 (LMP-1) transcripts were amplified using reverse transcription (RT) PCR. Immunohistochemical (IHC) staining for LMP-1 protein was performed. A total of 9 out of 20 tumors (45%) were concordantly positive by PCR and IHC. IHC stained exclusively the epithelial cells. All the fibroadenomas in non-immunocompromised patients were negative for LMP-1 (Fisher's exact test P =.0006). These data suggest that EBV is associated with fibroadenomas in this immunosuppressed population and that the infection is specifically localized to epithelial cells. This is the first study suggesting a role for EBV in the pathogenesis of fibroadenomas.
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Affiliation(s)
- Celina G Kleer
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.
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24
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Caetano Stefenon C, de Oliveira Lima R, Gualandi Murad AL. Cyclosporine and the development of multiple mammary nodules. Breast J 2002; 8:177-9. [PMID: 12047475 DOI: 10.1046/j.1524-4741.2002.08310.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report here the case of an immunosuppressed patient who developed multiple nodules in both breasts while on cyclosporine therapy. In this case, the benign appearance on imaging and benign clinical course made possible conservative management, thus avoiding invasive diagnostic procedures. For evaluation of these nodes, after cyclosporine was discontinued, the nodules involuted.
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25
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Eardley KS, Wan DIM, Thomas ME, Banerjee AK, Radojkovic M, Taylor JL. Transplant-associated inflammatory breast disease. Nephrol Dial Transplant 2002; 17:512-5. [PMID: 11865105 DOI: 10.1093/ndt/17.3.512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kevin S Eardley
- Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
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26
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Sangthawan P, Fox J, Atkins RC, Kerr PG. Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin. ANZ J Surg 2002; 72:222-5. [PMID: 12071457 DOI: 10.1046/j.1445-2197.2002.02352.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied. METHODS The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year. RESULTS In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25-70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25-18.5 years). Eighty-seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had 'dense mammograms', all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study. CONCLUSION The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.
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Affiliation(s)
- Pornpen Sangthawan
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
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27
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Muttarak M, Peh WC, Chaiwun B, Lumlertgul D. Multiple bilateral giant fibroadenomas associated with cyclosporine A therapy in a renal transplant recipient. AUSTRALASIAN RADIOLOGY 2001; 45:517-9. [PMID: 11903190 DOI: 10.1046/j.1440-1673.2001.00970.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 31-year-old woman developed a right breast mass following cyclosporine A therapy after a renal transplant. Several large breast masses continued to grow bilaterally. Mammography and ultrasonography showed features of giant fibroadenomas. The diagnosis was confirmed by biopsy of one of the masses. Awareness of the association between cyclosporine A therapy and fibroadenoma development in renal transplant recipients is highlighted.
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Affiliation(s)
- M Muttarak
- Departments of Radiology, Pathology and Medicine, Chiang Mai University, Chiang Mai, Thailand
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28
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Weinstein SP, Orel SG, Collazzo L, Conant EF, Lawton TJ, Czerniecki B. Cyclosporin A-induced fibroadenomas of the breast: report of five cases. Radiology 2001; 220:465-8. [PMID: 11477253 DOI: 10.1148/radiology.220.2.r01au45465] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Five female patients undergoing cyclosporin A therapy had newly developed breast masses. Masses were bilateral in three of the five patients and palpable in four patients. The imaging findings were suggestive of fibroadenomas, and biopsy results were used to confirm the diagnosis. With the development of new breast lesions in patients after transplantation surgery, the diagnosis of cyclosporin A-induced fibroadenomas should be considered.
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Affiliation(s)
- S P Weinstein
- Departments of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, 1 Silverstein Bldg, Philadelphia, PA 19104, USA
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29
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Cervelli V, Orlando G, Giudiceandrea F, Grimaldi M, Pisani F, Strati F, Iaria G, Piccione E, Torri E, Carluccio C, Tisone G, Casciani CU. Gigantomastia and breast lumps in a kidney transplant recipient. Transplant Proc 1999; 31:3224-5. [PMID: 10616452 DOI: 10.1016/s0041-1345(99)00701-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- V Cervelli
- Clinica Chrurgica-Universita di Roma Tor Vergata, Ospedale Sant'Eugenio Piazzale, Rome, Italy
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30
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Cyrlak D, Pahl M, Carpenter SE. Breast imaging case of the day. Multiple giant fibroadenomas associated with cyclosporin A therapy. Radiographics 1999; 19:549-51. [PMID: 10194798 DOI: 10.1148/radiographics.19.2.g99mr24549] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D Cyrlak
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange 92868-3298, USA
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31
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Kollias J, Gill PG, Leong AS, Clarkson AR. Gynaecomastia presenting as fibroadenomatoid tumours of the breast in a renal transplant recipient associated with cyclosporin treatment. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:679-81. [PMID: 9737269 DOI: 10.1111/j.1445-2197.1998.tb04844.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Kollias
- Department of Surgery, Royal Adelaide Hospital, South Australia, Australia
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32
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Campbell A, Moazami N, Ditkoff BA, Kurtz E, Estabrook A, Schnabel F. Short-term outcome of chronic immunosuppression on the development of breast lesions in premenopausal heart and lung transplant patients. J Surg Res 1998; 78:27-30. [PMID: 9733613 DOI: 10.1006/jsre.1998.5414] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The risk of development of breast lesions in patients on chronic immunosuppression is unknown. In order to assess this risk, a retrospective review was performed of the records of 87 women between the ages of 12 and 47 years who received thoracic organ transplant from 1987 to 1996 at our institution. Inclusion criteria consisted of patients who were premenopausal, had no previous history of breast disease, and survived for at least 1 year posttransplantation. All patients were on a triple immunosuppressive regimen consisting of cyclosporine, steroids, and azathioprine. Mean follow-up was 4 +/- 1.2 years with a range of 1-6 years. During this period, 21 patients (24%) with a mean age of 38 +/- 10 years had screening or diagnostic mammography. The remainder of patients with a mean age of 24 +/- 9 years were followed clinically. Overall, 10 patients (11%) developed a total of 17 palpable, solid lesions at 33 to 72 months posttransplantation. Fifteen of these lesions were surgically excised. Five of the patients had multiple lesions. Pathological examination of the specimens revealed fibroadenoma in nine, fibrocystic disease in four, low grade phylloides tumor in one, and T-cell lymphoma in one case. None of the patients have developed primary breast cancer during follow-up. In conclusion, short-term immunosuppression does not increase the risk of the development of benign breast lesions in young women after thoracic organ transplantation, but rather the distribution of benign lesions is similar in an age-matched population. There were several cases of multiple fibroadenomas in the transplant population, but mammography revealed no malignant disease in this age group and does not need to be utilized in this population beyond what is considered standard for immunocompetent patients. The long-term effect ofimmunosuppressive therapy on the developmentof breast cancer in this group remains to be defined.
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Affiliation(s)
- A Campbell
- Comprehensive Breast Center, Columbia-Presbyterian Medical Center, 622 West 168th Street, New York, New York, 10032, USA
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