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Eleftheriades A, Tsarna E, Toutoudaki K, Paschalidou E, Christopoulos N, Georgopoulos I, Mitropoulou G, Christopoulos P. Giant Juvenile Fibroadenoma: Case Report and Review of the Literature. J Clin Med 2023; 12:jcm12051855. [PMID: 36902642 PMCID: PMC10003210 DOI: 10.3390/jcm12051855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. An extensive PubMed search of the literature in English up until August 2022 was performed. In addition, a rare case of a gigantic fibroadenoma in an 11-year-old premenarchal girl who was referred to our adolescent gynecology center is presented here. Eighty-seven cases of giant juvenile fibroadenomas have been reported in the literature along with our case. Patients with giant juvenile fibroadenoma presented at a mean age of 13.92 years and usually after menarche. Juvenile fibroadenomas are usually unilateral, occurring either in the right or the left breast; the majority of them are diagnosed when they are already more than 10 cm in size, and they are most frequently treated with total lump excision. Differential diagnosis includes phyllodes tumors and pseudo-angiomatous stromal hyperplasia. Conservative management is feasible, but surgical excision is recommended to patients with suspicious imaging features or when the mass grows rapidly.
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Affiliation(s)
- Anna Eleftheriades
- Postgraduate Programme “Maternal Fetal Medicine”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ermioni Tsarna
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Konstantina Toutoudaki
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eleni Paschalidou
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Ioannis Georgopoulos
- Department of Pediatric Surgery, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | - Georgia Mitropoulou
- Department of Pathology, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence:
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Abstract
<br><b>Introduction:</b> Fibroadenomas are one of the most common benign tumors of the breast in the adolescent females accounting for about 2/3<sup>rd</sup> 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. <br><b>Aim:</b> 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.
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Abstract
BACKGROUND Fibroadenomas are the most common benign breast tumors in adolescents. Surgical excision is indicated when the tumor becomes large or symptomatic. Multiple approaches have been described. However, unsightly scars, excess skin, and breast asymmetry are common challenges after tumor resection. The aims of our study were to describe a concentric circumareolar approach combining the round-block technique and geometric principles in the management of large benign breast tumors. METHODS This was a retrospective review of pediatric patients who have undergone excision of large fibroadenoma with concentric circumareolar approach from June 2007 to May 2017. Preoperatively, the excess skin that needed to be resected was marked based on geometric principles. Under general anesthesia, circumareolar deepithelialization of the excess skin and tumor resection were performed. Purse-string suture technique was used to achieve the proper nipple-areola complex size. RESULTS Satisfactory breast symmetry and minimal scarring were achieved in all 6 patients. One patient developed a small seroma, which resolved spontaneously without intervention. CONCLUSIONS Concentric circumareolar approach can be used to resect large benign breast tumors while concealing the scar along the aesthetic unit boundary of the breast. The cosmetic outcome and recovery were promising. The approach is simple to execute, highly reproducible, and less dependent on intuition.
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Lai HW, Lin HY, Chen SL, Chen ST, Chen DR, Kuo SJ. Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures. World J Surg Oncol 2017; 15:19. [PMID: 28077134 PMCID: PMC5225504 DOI: 10.1186/s12957-016-1080-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endoscopy-assisted breast surgery (EABS), a technique that optimizes cosmetic outcome because it is performed through small wounds hidden in inconspicuous areas, could be an alternative surgical technique for benign breast tumors. In this study, we report the preliminary results of 323 EABS procedures performed at our institution for the management of benign breast tumors. METHODS The medical records of patients who underwent EABS for benign breast lesions during the periods August 2010 to December 2015 were collected from the Changhua Christian Hospital EABS database. Data on clinicopathologic characteristics, type of surgery, hospital stay, and complications were analyzed to determine the effectiveness of the procedure for benign breast tumors. The operating time with the number of procedure performed was analyzed for learning curve evaluation. Patient satisfaction with cosmetic outcome was evaluated with a self-report questionnaire. RESULTS A total of 323 EABS procedures were performed in 286 patients with benign breast lesions, including 249 (90.5%) patients with unilateral lesions. The mean age was 36 years, the mean tumor size was 2.2 cm, and the mean distance from the nipple to the tumor was 5.2 cm. Most (93.8%, 303/323) of these tumors were excised through a transareolar wound, 2.4% (8/323) through an axillary wound, and 0.3% (1/323) through the infra-mammary fold. Histopathologic analysis revealed that 63.5% (202/318) of the tumors were fibroadenoma-related lesions. The mean operative time was 81.4 min (59~89 min), which was decreased with experience increased. The overall rate of complications was 6.5%, and all were minor and wound-related. Among the 110 patients who participated in the self-report cosmetic outcome evaluation, 85.4% reported being satisfied with the cosmetic result, and almost all were satisfied with breast symmetry. Of the patients interviewed, 92.7% reported that they would choose the same procedure if they had to undergo the operation again. CONCLUSIONS Our preliminary results show that transareolar video-assisted breast surgery is a safe and effective procedure with good cosmetic outcome and that it could be appropriate for patients with moderate to large peripherally located breast tumors. TRIAL REGISTRATION CCH-IRB No.15115. Registered 14 December 2015 (retrospectively registered).
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan. .,Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. .,School of Medicine, National Yang Ming University, Taipei, Taiwan.
| | - Hui-Yu Lin
- Division of Breast surgery and General Surgery, Department of Surgery, Cardinal Tien Hospital, Xindian Dist., New Taipei City, Taiwan
| | - Shu-Ling Chen
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Jen Kuo
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY, Weissler JM, Rodriguez ED. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Gland Surg 2015; 4:312-21. [PMID: 26312217 DOI: 10.3978/j.issn.2227-684x.2015.06.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/28/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Currently, there is a lack of clear guidelines regarding evaluation and management of giant juvenile fibroadenomas. The purpose of this study was to conduct a systematic review of giant juvenile fibroadenomas and to evaluate the most common diagnostic and therapeutic modalities. METHODS A systematic literature search of PubMed and MEDLINE databases was conducted in February 2014 to identify articles related to giant juvenile fibroadenomas. Pooled outcomes are reported. RESULTS Fifty-two articles (153 patients) met inclusion criteria. Mean age was 16.7 years old, with a mean lesion size of 11.2 cm. Most patients (86%) presented with a single breast mass. Imaging modalities included ultrasound in 72.5% and mammography in 26.1% of cases. Tissue diagnosis was obtained using a core needle biopsy in 18.3% of cases, fine-needle aspiration (FNA) in 25.5%, and excisional biopsy in 11.1% of patients. Surgical treatment was implemented in 98.7% of patients (mean time to treatment of 9.5 months, range, 3 days to 7 years). Surgical intervention included excision in all cases, of which four were mastectomies. Breast reconstruction was completed in 17.6% of cases. There were no postoperative complications. CONCLUSIONS Diagnosis and treatment of giant juvenile fibroadenoma is heterogeneous. There is a paucity of data to support observation and non-operative treatment. The most common diagnostic modalities include core needle or excisional biopsy. The mainstay of treatment is complete excision with an emphasis on preserving the developing breast parenchyma and nipple areolar complex. Breast reconstruction is uncommon, but may be necessary in certain cases.
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Affiliation(s)
- Michael Sosin
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Marisa Pulcrano
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Elizabeth D Feldman
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Ketan M Patel
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Maurice Y Nahabedian
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Jason M Weissler
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Eduardo D Rodriguez
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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Karagulle E, Turk E, Erinanc OH, Moray G. Giant fibroadenoma growing rapidly during pregnancy. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e9531. [PMID: 25389498 PMCID: PMC4222024 DOI: 10.5812/ircmj.9531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 11/16/2013] [Accepted: 06/17/2014] [Indexed: 11/16/2022]
Abstract
Introduction: Giant fibroadenoma is a rare disease with unknown etiology. During pregnancy, fibroadenomas increase in size and may show lactational histologic changes. High concentrations of estrogen, progesterone, and prolactin promote the ductal growth and formation of tubuloalveolar structures. This may be a reason for the significant enlargement in this period. Case Presentation: We presented a case of giant fibroadenoma, first detected at the onset of pregnancy, which grew rapidly and was excised surgically two months after the birth. There was no marked deformity in the breast nor a need to reconstruct it, despite the giant mass was excised and the mother was lactating. Discussion: We presented a rare case of giant fibroadenoma in a lactating woman. A progressively growing mass in breast can lead to structural damages. The current management approach for giant fibroadenomas is still surgical excision.
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Affiliation(s)
- Erdal Karagulle
- Department of General Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
- Corresponding Author: Erdal Karagulle, Department of General Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey. Tel: +90-03322570606, Fax: +90-03322570637, E-mail:
| | - Emin Turk
- Department of General Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ozgur Hilal Erinanc
- Department of Pathology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Gokhan Moray
- Department of General Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
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Lai HW, Wu HS, Chuang KL, Chen DR, Chang TW, Kuo SJ, Chen ST, Kuo YL. Endoscopy-Assisted Total Mastectomy Followed by Immediate Pedicled Transverse Rectus Abdominis Musculocutaneous (TRAM) Flap Reconstruction. Surg Innov 2014; 22:382-9. [PMID: 25118202 DOI: 10.1177/1553350614546003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background. Endoscopy-assisted breast surgery performed through minimal axillary and/or periareolar incisions is a viable option for patients with breast cancer. In this study, we report the preliminary results of patients with breast cancer who underwent endoscopy-assisted total mastectomy (EATM) followed immediately by pedicled transverse abdominis musculocutaneous (TRAM) flap reconstruction. Methods. Patients in this study comprised women with breast cancer who received EATM and pedicled TRAM flap reconstruction. Clinicopathologic characteristics, type of surgery, complications, and rate of recurrence were recorded. The cosmetic outcomes were evaluated objectively by the surgeons and subjectively by the patients at 3-month postoperative follow-up. Results. A total of 48 patients underwent 49 EATM procedures followed by pedicled TRAM flap reconstruction. Of them, 79.6% underwent endoscopic-assisted nipple-sparing mastectomy and 20.4% received endoscopic-assisted skin-sparing mastectomy. The types of cancer among these patients included ductal carcinoma in situ in 34.7%, stage I cancer in 36.7%, stage II cancer in 24.5%, and stage IIIa cancer in 4.1% patients. Mean tumor size was 2.1 ± 1.4 cm. There were no cases of flap failure. Partial nipple areolar complex ischemia/necrosis occurred in 4 (10.3%) patients; however, all cases resolved after conservative treatment. In the aesthetic outcome evaluation, EATM + TRAM were associated with 89.8% good, 8.2% fair, and 2% unsatisfactory result. No local recurrence was observed during the follow-up period. Conclusion. EATM followed immediately by pedicled TRAM flap reconstruction is a safe procedure and results in good cosmetic outcome in women with early-stage breast cancer.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China
- National Yang Ming University, Taipei, Taiwan, Republic of China
| | - Hurng-Sheng Wu
- Show-Chwan Memorial Hospital, Changhua, Taiwan, Republic of China
- Asian Institute of TeleSurgery/IRCAD Taiwan Training Center, Changhua County, Taiwan, Republic of China
- National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Kun-Lin Chuang
- National Cheng-Kung University Hospital, Tainan and Dou-Liou Branch, Taiwan, Republic of China
| | - Dar-Ren Chen
- Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China
| | - Tsai-Wang Chang
- National Cheng-Kung University Hospital, Tainan and Dou-Liou Branch, Taiwan, Republic of China
| | - Shou-Jen Kuo
- Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China
| | - Shou-Tung Chen
- Endoscopy and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan, Republic of China
| | - Yao-Lung Kuo
- National Cheng-Kung University Hospital, Tainan and Dou-Liou Branch, Taiwan, Republic of China
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Lakoma A, Kim ES. Minimally invasive surgical management of benign breast lesions. Gland Surg 2014; 3:142-8. [PMID: 25083508 DOI: 10.3978/j.issn.2227-684x.2014.04.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/02/2014] [Indexed: 11/14/2022]
Abstract
Benign breast disease is common among women, and when symptomatic, definitive surgical management is preferred by both clinicians and patients. Given the nonmalignant nature of these lesions, an important factor in treatment is cosmesis. Novel minimally invasive techniques for breast lesions are rapidly emerging and demonstrate good efficacy, safety and cosmesis. This review will describe minimally invasive techniques of breast lesions via surgical and percutaneous approaches and discuss the outcomes, advantages and limitations for each. Based on promising initial results, the future standard of care for benign breast lesions may focus on one or more of these minimally invasive techniques.
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Affiliation(s)
- Anna Lakoma
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Eugene S Kim
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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