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Al Hakkak SMM, Al Faham FSM, Awwady AN, Al Hakkak MS, Al Wadees AA. One of the biggest and heaviest juvenile bilateral breast fibroadenoma: A case report. Int J Surg Case Rep 2024; 121:109954. [PMID: 38959615 DOI: 10.1016/j.ijscr.2024.109954] [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: 04/18/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Giant juvenile fibroadenomas occurring at a mean age of 13 may be multiple and bilateral, accounting for approximately 0.5 % of all fibroadenomas. The pathogenesis of these tumors is closely linked to hormonal changes during puberty, characterized by increased estrogen stimulation, heightened estrogen receptor sensitivity, and reduced estrogen antagonists. These hormonal factors are pivotal in the rapid growth and substantial size observed in giant juvenile fibroadenomas. CASE PRESENTATION An adolescent girl presented at the outpatient clinic with significant bilateral breast enlargement, causing redness and discomfort when sitting, leading to difficulty wearing age-appropriate clothing and chest wall pressure. Despite previous consultations attributing the condition to genetic causes, further investigation via radiological ultrasound indicated a probable diagnosis of bilateral breast mass fibroadenoma, occupying a substantial portion of the breast tissue. Consequently, the decision was made to perform bilateral breast surgery to remove the giant masses for histopathological analysis. DISCUSSION The delayed diagnosis accentuated the case's complexity, highlighting the challenges in effectively identifying and managing giant fibroadenomas in adolescents. Despite the initial absence of alarming symptoms, these fibroadenomas' sheer size and impact underscored the importance of early detection and comprehensive evaluation in similar clinical presentations. CONCLUSION The surgeon must emphasize meticulous planning when deciding on the surgical approach for removing a giant juvenile fibroadenoma. This planning is crucial for preserving breast functionality, achieving a satisfactory cosmetic outcome, and addressing the psychological distress of young patients. Early detection and excision are imperative to safeguard breast tissue.
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Affiliation(s)
| | | | | | | | - Alaa Abood Al Wadees
- Faculty of Medicine, Jabir Ibn Hayyan for Medical and Pharmaceutical Science, Iraq
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2
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Guo Y, Chen M, Yang L, Yin H, Yang H, Zhou Y. A neural network with a human learning paradigm for breast fibroadenoma segmentation in sonography. Biomed Eng Online 2024; 23:5. [PMID: 38221632 PMCID: PMC10787993 DOI: 10.1186/s12938-024-01198-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Breast fibroadenoma poses a significant health concern, particularly for young women. Computer-aided diagnosis has emerged as an effective and efficient method for the early and accurate detection of various solid tumors. Automatic segmentation of the breast fibroadenoma is important and potentially reduces unnecessary biopsies, but challenging due to the low image quality and presence of various artifacts in sonography. METHODS Human learning involves modularizing complete information and then integrating it through dense contextual connections in an intuitive and efficient way. Here, a human learning paradigm was introduced to guide the neural network by using two consecutive phases: the feature fragmentation stage and the information aggregation stage. To optimize this paradigm, three fragmentation attention mechanisms and information aggregation mechanisms were adapted according to the characteristics of sonography. The evaluation was conducted using a local dataset comprising 600 breast ultrasound images from 30 patients at Suining Central Hospital in China. Additionally, a public dataset consisting of 246 breast ultrasound images from Dataset_BUSI and DatasetB was used to further validate the robustness of the proposed network. Segmentation performance and inference speed were assessed by Dice similarity coefficient (DSC), Hausdorff distance (HD), and training time and then compared with those of the baseline model (TransUNet) and other state-of-the-art methods. RESULTS Most models guided by the human learning paradigm demonstrated improved segmentation on the local dataset with the best one (incorporating C3ECA and LogSparse Attention modules) outperforming the baseline model by 0.76% in DSC and 3.14 mm in HD and reducing the training time by 31.25%. Its robustness and efficiency on the public dataset are also confirmed, surpassing TransUNet by 0.42% in DSC and 5.13 mm in HD. CONCLUSIONS Our proposed human learning paradigm has demonstrated the superiority and efficiency of ultrasound breast fibroadenoma segmentation across both public and local datasets. This intuitive and efficient learning paradigm as the core of neural networks holds immense potential in medical image processing.
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Affiliation(s)
- Yongxin Guo
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 1 Medical College Road, Chongqing, 400016, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Maoshan Chen
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, 629000, China
| | - Lei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, 629000, China
| | - Heng Yin
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, 629000, China
| | - Hongwei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, 629000, China
| | - Yufeng Zhou
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 1 Medical College Road, Chongqing, 400016, China.
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
- National Medical Products Administration (NMPA) Key Laboratory for Quality Evaluation of Ultrasonic Surgical Equipment, 507 Gaoxin Ave., Donghu New Technology Development Zone, Wuhan, 430075, Hubei, China.
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Johnson BM, Dewitt J, Balanoff C, Kilgore L, Aripoli A, Collins M. Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors: A Case Series. Ann Plast Surg 2023; 91:36-41. [PMID: 37450859 DOI: 10.1097/sap.0000000000003576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
ABSTRACT Large breast fibroadenomas in pediatric females may cause discomfort, asymmetry, and psychological stress, and patients may elect for surgical excision. There are no criteria for reconstruction after the excision of these masses, and the research is limited in describing oncoplastic techniques in pediatric fibroadenoma excision. Nononcoplastic techniques, such as mastectomy with implant or flap reconstruction, have been used for pediatric fibroadenoma excision reconstruction. Oncoplastic techniques using Wise pattern or circumareolar incisions have shown to have efficacious outcomes. In addition, pediatric females undergoing breast surgery risk long-term complications such as continued breast asymmetry due to further breast growth, nipple and breast hypoesthesia, and future breastfeeding difficulty. This case series describes the oncoplastic techniques used for large benign mass excision and reconstruction of 3 pediatric females. A Wise pattern technique was used for all 3 patients, and 2 underwent a free-nipple graft. Oncoplastic techniques for pediatric breast mass excision provide satisfactory aesthetic outcomes with minimal surgical morbidity. Further research assessing the long-term effects of pediatric breast mass excision and reconstruction would be beneficial.
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Affiliation(s)
| | | | | | | | - Allison Aripoli
- Radiology, University of Kansas Medical Center, Kansas City, KS
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Zhang C, Liang M, Xia T, Yin H, Yang H, Wang Z, Zhang L. Dosimetric analysis of ultrasound-guided high intensity focused ultrasound ablation for breast fibroadenomas: a retrospective study. Int J Hyperthermia 2022; 39:743-750. [PMID: 35634911 DOI: 10.1080/02656736.2022.2074151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Cai Zhang
- College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Heng Yin
- Suining Central Hospital, Suining, China
| | | | - Zhibiao Wang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Lian Zhang
- College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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5
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Approach to Pediatric Breast Masses in Accompaniment with Current Literature. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.930896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kitazawa M, Futamura M, Tokumaru Y, Kohyama K, Nakakami A, Yoshida K. Breast reconstruction using a tissue expander after enucleation of a giant fibroadenoma: A case report. Int J Surg Case Rep 2022; 90:106723. [PMID: 34991047 PMCID: PMC8741496 DOI: 10.1016/j.ijscr.2021.106723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Fibroadenomas are among the most common benign tumors in women. Juvenile giant fibroadenomas account for nearly 0.5% of all fibroadenomas. Due to its size, a giant juvenile fibroadenoma leaves a large defect or deformity after its resection. The optimal surgical management strategy for giant juvenile fibroadenomas remains unclear. Here, we report a case of successful breast reconstruction without residual deformity through gradual deflation of a saline-filled tissue expander after resection of a giant juvenile fibroadenoma. PRESENTATION OF CASE A 14-year-old girl with a growing tumor in her left breast presented to a private clinic. Given that the tumor was 8 cm in size, phyllodes could not be ruled out. Consequently, she was referred to our hospital for further examination and treatment. Core needle biopsy confirmed the tumor to be a fibroadenoma. We resected the tumor and inserted a tissue expander filled with 120 mL of saline, matching the area of the large defect caused by tumor resection. We removed approximately 25 mL of saline every 3 weeks to aid normal mammary tissue enlargement. After completely draining saline from the tissue expander and confirming an acceptable enlargement of the residual mammary gland, we performed an operation to remove the tissue expander. Follow-up revealed that the symmetry and contour of the breast were excellent after the second operation. CONCLUSIONS Our observations suggest that using a tissue expander to enlarge normal mammary tissue may help reconstruct large defects caused by excision of benign tumors.
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Affiliation(s)
- Mai Kitazawa
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Manabu Futamura
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Yoshihisa Tokumaru
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Keishi Kohyama
- Department of Plastic and Reconstructive Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Akira Nakakami
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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Comparison of Curative Complications between Mammotome-Assisted Minimally Invasive Resection and Conventional Open Resection for Breast Neoplasm: A Retrospective Clinical Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7739628. [PMID: 34840980 PMCID: PMC8612774 DOI: 10.1155/2021/7739628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/20/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022]
Abstract
Background To know the clinical value of mammotome-assisted minimally invasive resection (MAMIR) in the treatment of patients with breast neoplasm, we performed a retrospective clinical study for the patients treated with the MAMIR and conventional open resection (COR). Methods Postoperative complications were compared between 40 patients treated with the MAMIR and 40 patients treated with the COR. The postoperative complications mainly included intraoperative blood loss, hospitalization days, operative time, surgical scar, and incidence of postoperative complications. Results We found that the amount of intraoperative blood loss, hospitalization days, operative time, surgical scar, and incidence of postoperative complications in the MAMIR group were significantly lower than those of patients in the COR group. Conclusion Our results indicated that patients with breast neoplasm treated with the MAMIR had better outcomes, which reinforced the advantage of this approach.
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Restrepo R, Cervantes LF, Swirsky AM, Diaz A. Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation. Pediatr Radiol 2021; 51:1959-1969. [PMID: 34236480 DOI: 10.1007/s00247-021-05099-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/01/2021] [Accepted: 05/02/2021] [Indexed: 10/20/2022]
Abstract
Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.
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Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA.
| | - Luisa F Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA
| | | | - Alejandro Diaz
- Division of Pediatric Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
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Gaya A, Crook T, Plowman N, Ranade A, Limaye S, Bhatt A, Page R, Patil R, Fulmali P, Datta V, Kumar P, Patil D, Akolkar D. Evaluation of circulating tumor cell clusters for pan-cancer noninvasive diagnostic triaging. Cancer Cytopathol 2021; 129:226-238. [PMID: 32996712 PMCID: PMC7984349 DOI: 10.1002/cncy.22366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Histopathologic examination (HPE) of tumor tissue obtained by invasive biopsy is the standard for cancer diagnosis but is resource-intensive and has been associated with procedural risks. The authors demonstrate that immunocytochemistry (ICC) profiling of circulating ensembles of tumor-associated cells (C-ETACs) can noninvasively provide diagnostic guidance in solid organ cancers. METHODS The clinical performance of this approach was tested on blood samples from 30,060 individuals, including 9416 individuals with known cancer; 6725 symptomatic individuals with suspected cancer; and 13,919 asymptomatic individuals with no prior diagnosis of cancer. C-ETACs were harvested from peripheral blood and profiled by ICC for organ-specific and subtype-specific markers relevant to the cancer type. ICC profiles were compared with HPE diagnoses to determine concordance. RESULTS The presence of malignancy was confirmed by the detection of C-ETACs in 91.8% of the 9416 individuals with previously known cancer. Of the 6725 symptomatic individuals, 6025 were diagnosed with cancer, and 700 were diagnosed with benign conditions; C-ETACs were detected in 92.6% of samples from the 6025 individuals with cancer. In a subset of 3509 samples, ICC profiling of C-ETACs for organ-specific and subtype-specific markers was concordant with HPE findings in 93.1% of cases. C-ETACs were undetectable in 95% of samples from the 700 symptomatic individuals who had benign conditions and in 96.3% of samples from the 13,919 asymptomatic individuals. CONCLUSIONS C-ETACs were ubiquitous (>90%) in various cancers and provided diagnostically relevant information in the majority (>90%) of cases. This is the first comprehensive report on the feasibility of ICC profiling of C-ETACs to provide pan-cancer diagnostic guidance with accuracy comparable to that of HPE.
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Affiliation(s)
| | - Timothy Crook
- Department of OncologyBroomsfield HospitalChelmsfordUnited Kingdom
| | - Nicholas Plowman
- Department of Clinical OncologySt Bartholomew's HospitalLondonUnited Kingdom
| | | | - Sewanti Limaye
- Department of Medical OncologyKokilaben Dhirubhai Ambani Hospital and Medical Research InstituteMumbaiIndia
| | - Amit Bhatt
- Department of Medical OncologyAvinash Cancer ClinicPuneIndia
| | - Raymond Page
- Department of BioengineeringWorcester Polytechnic InstituteWorcesterMassachusetts
| | - Revati Patil
- Department of Research and InnovationsDatar Cancer GeneticsNashikIndia
| | - Pradip Fulmali
- Department of Research and InnovationsDatar Cancer GeneticsNashikIndia
| | - Vineet Datta
- Department of Research and InnovationsDatar Cancer GeneticsNashikIndia
| | - Prashant Kumar
- Department of Research and InnovationsDatar Cancer GeneticsNashikIndia
| | - Darshana Patil
- Department of Research and InnovationsDatar Cancer GeneticsNashikIndia
| | - Dadasaheb Akolkar
- Department of Research and InnovationsDatar Cancer GeneticsNashikIndia
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10
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Zeeshan S, Shaikh K, Tariq MU, Vohra LM. Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation - A case report. Int J Surg Case Rep 2021; 79:450-454. [PMID: 33757260 PMCID: PMC7851354 DOI: 10.1016/j.ijscr.2021.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/23/2021] [Accepted: 01/23/2021] [Indexed: 11/23/2022] Open
Abstract
Diagnosis and management of giant juvenile fibroadenoma can be challenging. Maintaining symmetry after complete excision is tougher in developing breasts. Periareolar approach for subareolar fibroadenomas provides good cosmetic results. Benign tumor to breast size ratio up to 70% provides excellent cosmetic outcome.
Introduction Fibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5–2% of all fibroadenomas. Presentation of case In this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan. Discussion Surgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases. Conclusion The diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility.
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Affiliation(s)
- Sana Zeeshan
- Section of Breast Surgery, Department of Surgery, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Kulsoom Shaikh
- Department of Surgery, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Muhammad Usman Tariq
- Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Lubna Mushtaque Vohra
- Section of Breast Surgery, Department of Surgery, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
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Baral S, Gyawali M, Thapa N, Chhetri RK, Dahal P. Giant juvenile fibroadenoma in an adolescent female: A case report. Clin Case Rep 2020; 8:3489-3493. [PMID: 33363957 PMCID: PMC7752576 DOI: 10.1002/ccr3.3466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Giant juvenile fibroadenoma in adolescents should be dealt with utmost caution as this may be associated with anxiety, fear, and emotional factors. The treatment should aim for preserving the normal contour of the breast along with appealing scar.
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Affiliation(s)
- Suman Baral
- Department of SurgeryLumbini Medical College and Teaching HospitalTansenNepal
| | - Milan Gyawali
- Department of SurgeryLumbini Medical College and Teaching HospitalTansenNepal
| | - Neeraj Thapa
- Department of SurgeryLumbini Medical College and Teaching HospitalTansenNepal
| | - Raj Kumar Chhetri
- Department of SurgeryLumbini Medical College and Teaching HospitalTansenNepal
| | - Prahar Dahal
- Department of PathologyLumbini Medical College and Teaching HospitalTansenNepal
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Heng SSL, Yahya MM, Sulaiman WAW, Saad AZM. A harmless evil: Giant fungating benign breast mass in an adolescent mimicking malignancy - Case report. Int J Surg Case Rep 2020; 80:105202. [PMID: 33500231 PMCID: PMC7982453 DOI: 10.1016/j.ijscr.2020.10.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 11/03/2022] Open
Abstract
Fungating, ulcerating giant fibroadenomas in adolescents are rare. When breast conserving methods are impossible, breast reconstruction should be the focus. Management of these cases should be tailored to each patient. Awareness on negative effects of traditional medicine should be raised.
Introduction Juvenile giant fibroadenoma is a rare type of fibroadenoma characterized by rapid growth of a breast tumor in an adolescent. Benign in nature, they rarely present as fungating and ulcerating tumors. Benign tumors masquerading as malignancies are surgical conundrums. No co nsensus exists yet on the management of these cases. We aim to discuss the dilemma in managing a bleeding, fungating giant fibroadenoma in an adolescent female and highlight risks of alternative therapies. Presentation of case A 19-year-old lady presented with a bleeding, fungating breast mass worsened with topical herbal concoction. Examination revealed a 10 × 15 cm fungating breast mass that obliterated her nipple- areolar complex (NAC). Computed Tomography (CT) scan reported a huge heterogeneously enhancing mass 10.6 × 14.5 × 15.1 cm with loss of normal fat plane with the overlying skin but a clear fat plane with the pectoralis muscle posteriorly. Discussion Giant breast masses that fungate and ulcerate usually indicate a sinister pathology. Traditional remedies have been reported to exacerbate growth. In cases where most of the breast parenchyma and NAC has been destroyed, it is no longer possible to proceed with breast conserving techniques. Breast reconstruction is crucial in adolescents and should be tailored to the patient’s existing breast size as well as body habitus. Conclusion In juvenile giant fibroadenomas where breast parenchyma and NAC has been destroyed, breast reconstruction is the goal. The lack of consensus in both diagnosis and management further compounds the difficulty in dealing with this sensitive population. Awareness needs to be raised regarding negative effects related to traditional medicine.
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Affiliation(s)
- Sophia Si Ling Heng
- Reconstructive Sciences Unit, University of Sciences Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia; Plastic, Reconstructive and Aesthetic Unit, Department of Surgery, University Malaysia Sabah, Sabah, Malaysia.
| | - Maya Mazuwin Yahya
- Department of Surgery, University of Sciences Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia.
| | - Wan Azman Wan Sulaiman
- Reconstructive Sciences Unit, University of Sciences Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia.
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, University of Sciences Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia; Plastic, Reconstructive and Aesthetic Unit, Department of Surgery, University Malaysia Sabah, Sabah, Malaysia.
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Cheema HS, Mehta R, Slanetz PJ. Imaging and management of fibroepithelial breast lesions on percutaneous core needle biopsy. Breast J 2020; 26:1216-1220. [PMID: 31925856 DOI: 10.1111/tbj.13749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to review the clinical presentation, multi-modality appearance, and management of the most common benign and malignant fibroepithelial lesions of the breast. Fibroepithelial lesions of the breast may exhibit characteristic features on mammography, ultrasound, and MRI, although definitive diagnosis most often requires biopsy and at times, surgical excision. Knowledge of the imaging features can assist in refining the differential diagnosis and guiding appropriate management.
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Affiliation(s)
- Hena S Cheema
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rashmi Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Priscilla J Slanetz
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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Du F, Dong R, Zeng A, Liu Z, Yu N, Wang X, Zhu L. Surgical management of giant juvenile fibroadenoma with skin reducing tumor resection and immediate breast reconstruction: A single-center experience. J Surg Oncol 2020; 121:441-446. [PMID: 31907948 DOI: 10.1002/jso.25828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Giant juvenile fibroadenoma (GJF) is a rare benign tumor that disfiguring affects the breast shape and quality of life of patients. This study aimed to report the experience of GJF management. METHODS A Wise-pattern skin reducing tumor resection followed by immediate breast reconstruction with a dermal flap pocket was used. The long-term outcomes were assessed retrospectively by BREAST-Q questionnaire from 2008 to 2018. RESULTS The study included eight patients with GJF. All patients achieved satisfactory results without severe complications. The BREAST-Q revealed that postoperative scores for satisfaction with breasts (69.3 ± 17.6) and sexual wellbeing (62.3 ± 27.6) were higher than the normative scores. The psychosocial wellbeing (69.7 ± 14.6) and physical wellbeing-chest (86.8 ± 13.0) scores were slightly lower than the normative scores. CONCLUSION Although GJF is a benign tumor, it should be surgically removed. And the Wise-pattern skin reducing tumor resection with immediate breast reconstruction is a proper way to improve patients' satisfaction with breast size and shape and quality of life.
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Affiliation(s)
- Fengzhou Du
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruijia Dong
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ang Zeng
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhifei Liu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Mlees MA, El-Sherpiny WY, Moussa HR. Transaxillary endoscopic excision of benign breast tumors, early institution experience. Breast J 2019; 26:672-678. [PMID: 31448457 DOI: 10.1111/tbj.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Benign breast diseases are one of the most common diseases in females. An important goal in its treatment should be cosmesis, so a new minimally invasive technique has advanced. One of these techniques is the transaxillary endoscopic resection. The aim of this study was to assess the feasibility, safety, operative time, postoperative pain, hospital stay, and cosmetic outcome of this transaxillary approach. METHODS This study was carried out on 40 female patients presented with benign breast tumors in the surgical oncology unit at the General Surgery Department, Tanta University Hospital during the period from January 2018 to January 2019. The patients included in the study aged ≥18 years, had solitary or multiple benign breast tumors, located at any breast quadrant. The patients subjected to transaxillary endoscopic excision of the tumors. RESULTS The age of the patients ranged from 20 to 49 years with a mean age of 32 years. 60% of the lesions located in the upper half of the breast. Fibroadenoma was the most common finding in 80% of the patients, 60% of the patients had solitary tumor. The operative time ranged from 42 to 105 minutes with a mean of 61.4 minutes. 88.8% of the patients considered the cosmetic outcome excellent. CONCLUSION Endoscopic transaxillary excision of benign breast tumors is safe, feasible and has excellent cosmetic outcomes with high patient's satisfaction.
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Affiliation(s)
- Mohamed A Mlees
- Department of General Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Waleed Y El-Sherpiny
- Department of General Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hossam R Moussa
- Department of General Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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Management of Palpable Pediatric Breast Masses With Ultrasound Characteristics of Fibroadenoma: A More Conservative Approach. AJR Am J Roentgenol 2019; 212:450-455. [DOI: 10.2214/ajr.17.19482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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18
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Englert EG, Ares G, Henricks A, Rychlik K, Hunter CJ. Analysis of factors predicting surgical intervention and associated costs in pediatric breast masses: a single center study. Pediatr Surg Int 2018; 34:679-685. [PMID: 29644453 DOI: 10.1007/s00383-018-4268-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Finding a breast mass in a child provokes apprehension in parents, especially in those with a family history of breast cancer. Clinicians must decide between serial imaging or biopsy of the mass. Herein, we identify management differences in those with and without a positive family history, as well as identify cost differences. METHODS An institutional retrospective review was performed of patients (2-18 years of age) with a diagnosis of breast mass. Patient demographics, presentation, medical and surgical history, physical exam, imaging, and pathologic diagnosis were collected. Cost data were acquired from the pediatric health information system (PHIS). Costs were compared between patients managed by biopsy versus serial ultrasounds. Bivariate analyses including Pearson's Chi-square, student's t tests, and logistic regression were performed. RESULTS The probability of biopsy increases with age (p = 0.0001) and female gender (p = 0.006). Biopsy rate is higher for larger masses (p < 0.0001), growing size (p < 0.0001), and in patients with a positive family history of breast cancer (p < 0.0001). The average cost of care for management with initial excisional biopsy was $4491 versus those with serial ultrasounds ($986) (p < 0.0001). CONCLUSIONS In patients with small lesions, even with a family history of breast cancer, non-operative monitoring is a safe and cost-effective alternative to invasive biopsy.
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Affiliation(s)
- E Graham Englert
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA
| | - Guillermo Ares
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA
- Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 376-CSN, Chicago, IL, 60612, USA
| | - Andrea Henricks
- Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA
| | - Karen Rychlik
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA
| | - Catherine J Hunter
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA.
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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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Combining Breast Reduction Techniques to Treat Gigantomastia in Ghana. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1673. [PMID: 29616171 PMCID: PMC5865915 DOI: 10.1097/gox.0000000000001673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/21/2017] [Indexed: 11/27/2022]
Abstract
In this presentation of 2 consecutive cases of symptomatic juvenile breast hypertrophy in Ghana, we review the patient presentation, workup, and discuss outcomes following a combined technique of inferior pedicle stump with free nipple graft reduction mammoplasty. Surgical goals for treatment of gigantomastia were 2-fold: to resect adequate tissue to obtain symptomatic relief with improved quality of life, while avoiding a flat, boxy-appearing breast shape.
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Giant juvenile fibroadenoma of breast in adolescent girls. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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A prepubertal giant juvenile fibroadenoma in a 12-year-old girl: Case report and brief literature review. Int J Surg Case Rep 2017; 41:427-430. [PMID: 29546008 PMCID: PMC5702868 DOI: 10.1016/j.ijscr.2017.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 11/26/2022] Open
Abstract
Giant juvenile fibroadenomas are very rare and they have very low prevalence in prepubertal period. Although they should not be ruled out in differential diagnosis in premenarchal period. Breast examination in premenarchal girls and adolescents plays a pivotal role in order to prevent these peculiar giant lesions. Another remarkable point is the rapid growth of these breast lesions that should not be ruled out in the diagnostic process of the continuously growth of the adolescent breast.
Introduction Giant juvenile fibroadenomas represent only the 0.5% of all fibroadenomas, constituting a rare condition in adolescence. In prepuberty, the presence of this condition is extremely rare. Presentation of case We describe a rare case of a 12- year-old Caucasian girl who presented to our Hospital complaining of a palpable mass with rapid enlargement in her right breast that she had first noticed 3 months ago. Her menarche hadn’t occurred yet. Discussion Physical examination showed a giant mass of 15 × 13 cm in the right breast. The patient was further evaluated via ultrasonography showing a sole large lesion of 13 × 12 cm in the right breast. A surgical procedure under general anesthesia was performed. Histopathological findings after the surgical excision were suggestive of giant juvenile fibroadenoma. The patient has a normal breast development over a period of 9 month follow up. Conclusion Giant juvenile fibroadenomas should be included in differential diagnosis of a breast mass in prepubertal girls despite the fact that they are very rare in prepuberty, tend to appear later during adolescence and their prevalence is lower in Caucasians. The remarkable size and the rapid growth of the lesion should not be ruled out in the diagnostic process of an adolescent breast.
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King KS, Harrington MA, Kassira N. Recurrent giant juvenile fibroadenoma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Makkar N, Singh S, Paul S, Sandhu MS, Kumar A. Bilateral Giant Juvenile Fibroadenoma of Breast. J Clin Diagn Res 2017; 11:ED10-ED12. [PMID: 28764179 DOI: 10.7860/jcdr/2017/21136.10081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 04/20/2017] [Indexed: 11/24/2022]
Abstract
Fibroadenomas are benign lesions of breast commonly found in young age group. These focal tumours contain both mesenchymal and glandular tissue. Giant juvenile fibroma of breast is rare variant of fibroadenoma found usually in less than 20 years of age. They present with rapid enlargement of single or multiple, discrete, painless large nodule of breast. A 14-years-old premenarche girl presented with large bilateral breast lumps for two months. FNAC showed features of juvenile fibroadenoma. Breast conserving surgical excision of lumps was performed and histopathology confirmed the diagnosis of juvenile fibroadenoma. Giant juvenile fibroadenomas are characterised by rapid enlargement of encapsulated mass. The aetiology is unknown, although end-organ hypersensitivity to normal level of estrogen is postulated. We present a case of bilateral giant juvenile fibroadenoma for its rarity.
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Affiliation(s)
- Nikhil Makkar
- Junior Resident, Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Sumitoj Singh
- Associate Professor, Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Surinder Paul
- Professor, Department of Pathology, Government Medical College, Amritsar, Punjab, India
| | - Mandeep Singh Sandhu
- Senior Resident, Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Ashok Kumar
- Assistant Professor, Department of General Surgery, Government Medical College, Amritsar, Punjab, India
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Brant AR, Ye PP, Teng SJ, Lotke PS. Non-Contraceptive Benefits of Hormonal Contraception: Established Benefits and New Findings. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0205-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Lee JY. Giant phyllodes tumor of the breast with diffuse myxoid changes in an adolescent girl: a case report. J Surg Case Rep 2017; 2017:rjx019. [PMID: 28458828 PMCID: PMC5400461 DOI: 10.1093/jscr/rjx019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/24/2017] [Indexed: 12/04/2022] Open
Abstract
Giant phyllodes tumors (PT) are an uncommon fibroepithelial neoplasm and especially rare in adolescent girls. Diagnosis is difficult not only due to the rarity of PT, but also owing to the resemblance of its clinical and imaging features with fibroadenoma. The author reports a case of a giant PT in a 14-year-old girl. Clinical examination showed a large painful mass in the left breast, and an abscess was initially suspected. But magnetic resonance imaging (MRI) displayed features characteristic of PT. Following complete surgical excision of the mass, histopathology confirmed the diagnosis of a benign PT with diffuse myxoid changes, consistent with the MRI findings. This case emphasizes the importance of breast MRI, both for its ability to aid diagnosis, as well as its benefits in guiding the surgical plan.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Gyeonggi-do 10380, Republic of Korea
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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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Kupsik M, Yep B, Sulo S, Memmel H. Giant juvenile fibroadenoma in a 9-year-old: A case presentation and review of the current literature. Breast Dis 2017; 37:95-98. [PMID: 28655118 DOI: 10.3233/bd-160250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5-4% of all cases of fibroadenomas. Giant fibroadenomas are well-circumscribed, firm breast masses characterized by proliferation of epithelial and connective tissue. They are defined as being larger than 5 cm or weighing more than 500 g. The peak age has been reported between the ages of 17 and 20, with less than 5% of these in patients less than 18-years-old.We present a 9-year-old, pre-menstrual, Nigerian female with no known family history of breast masses or cancers who developed spontaneous giant fibroadenoma measuring approximately 13 cm × 13 cm. Rapid growth of a breast mass can be of great concern to such young patients whose breasts are in the early formative stages. It is important to promptly rule out malignant processes or phyllodes tumor, and educate young patients and their families on treatment options that fit their unique concerns and circumstances.
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Affiliation(s)
- Michalina Kupsik
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
| | - Brian Yep
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Suela Sulo
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
| | - Heidi Memmel
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
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Rafeek N, Rangasami R, Dhanraj K, Joseph S. Multimodality approach in the diagnosis and management of bilateral giant juvenile breast fibroadenoma. BMJ Case Rep 2016; 2016:bcr-2016-217588. [PMID: 27758851 DOI: 10.1136/bcr-2016-217588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Juvenile giant fibroadenoma is a very rare breast disease affecting young girls of premenarche and adolescent ages. It is a benign fibroepithelial tumour characterised by stromal and epithelial proliferation that causes rapidly growing breast mass. Bilateral symmetrical involvement is extremely rare. In this article, we describe this entity in a girl aged 13 years who presented with bilateral gigantically enlarged breasts. Ultrasonography and MRI showed large, multilobulated masses involving both breasts entirely. Endovascular embolisation of bilateral internal mammary arteries and lateral thoracic arteries supplying the masses was performed prior to surgery to reduce their vascularity. The patient subsequently underwent excision of bilateral breast masses and reduction mammoplasty. Histopathologically, bilateral breast masses were confirmed to be juvenile fibroadenomas.
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Affiliation(s)
- Noora Rafeek
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Rajeswaran Rangasami
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Kamakshi Dhanraj
- Department of Plastic and Reconstructive Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Santhosh Joseph
- Department of Neuro and Interventional Radiology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
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Austin RE, Lista F, Ahmad J. Management of Recurrent or Persistent Macromastia. Clin Plast Surg 2016; 43:383-93. [DOI: 10.1016/j.cps.2015.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lai HW, Lee CW, Li YH, Chen CJ, Chen DR, Kuo SJ, Chen ST. Juvenile giant fibroadenomas with apparent breast asymmetry successfully managed by round-block technique. JPRAS Open 2015. [DOI: 10.1016/j.jpra.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bendifallah S, Canlorbe G. [Common benign breast tumors including fibroadenoma, phyllodes tumors, and papillary lesions: Guidelines]. ACTA ACUST UNITED AC 2015; 44:1017-29. [PMID: 26547891 DOI: 10.1016/j.jgyn.2015.09.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning common benign breast tumors: fibroadenoma (FA), phyllodes breast tumors (PBT), and papillary lesions (BPL). METHODS Bibliographical search in French and English languages by consultation of PubMed, Cochrane and international databases. RESULTS In case of percutaneous biopsy diagnosis of FA, clinico-radiologic and pathologic discordance or complex FA or proliferative lesions or atypia with FA, a family history of cancer, it seems legitimate to discuss management in a multidisciplinary meeting. When surgery is proposed for FA, periareolar compared to direct incision is associated with more insensitive nipple but better aesthetic results (LE4). When surgery is proposed for FA, indirect incision is preferable for better cosmetic results (Grade C). Techniques of percutaneous destruction or resection can be used (Grade C). The WHO classification distinguishes three categories of phyllodes tumors (PBT): benign (grade 1), borderline (grade 2) and malignant (grade 3). For grade 1 PBT, the risk of local recurrence after surgical excision increases when PBT lesion is in contact with surgical limits (not in sano). After in sano resection, there is no correlation between margin size and the risk of recurrence (LE4). For grade 2 PBT, local recurrence after surgical excision increases for margins under 10mm margins (LE4). For grade 1-2 PBT, in sano excision is recommended. For grade 2 PBT, 10-mm margins are recommended (Grade C). No lymph node evaluation or neither systematic mastectomy is recommended (Grade C). Breast papillary lesion (BPL) without atypia, complete resection of radiologic signal is recommended (Grade C). For BPL with atypia, complete excisional surgery is recommended (Grade C).
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Affiliation(s)
- S Bendifallah
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 1136, institut Pierre-Louis et de santé publique (IPLESP), 56, boulevard Vincent-Auriol, 75646 Paris cedex 13, France.
| | - G Canlorbe
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 938, université Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75012 Paris, France
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Hille-Betz U, Klapdor R, Henseler H, Soergel P, Länger F. Treatment of Giant Fibroadenoma in Young Women: Results after Tumor Excision without Reconstructive Surgery. Geburtshilfe Frauenheilkd 2015; 75:929-934. [PMID: 26500369 DOI: 10.1055/s-0035-1546108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction: Giant fibroadenoma (GFA) of the breast is defined as fibroadenoma larger than 5 cm, usually presenting unilaterally and manifesting as breast asymmetry or deformity of the breast. Material and Methods: A retrospective database search was done of all patients with giant fibroadenoma who underwent surgery for GFA in the breast center of Hanover Medical School between 2007 and 2014; all patients with GFA were followed up. Data were analyzed with regard to tumor and patient characteristics and esthetic outcome. Results: A total of 13 patients with symptomatic GFA underwent surgery between 2007 and 2014. Mean patient age was 21.2 years (range 14-31 years). In 8 of 13 patients the tumor had resulted in breast deformity and/or breast asymmetry. Average size of the mass was 10.2 cm (range 8.5-12 cm) and average weight was 203.6 g (range 151.2-323.5 g). Initial clinical suspicion of GFA was confirmed by ultrasound examination. Preoperative core biopsy revealed fibroadenoma in 8/13 cases, cellular fibroepithelial lesions with a differential diagnosis of benign phyllodes tumor in 3 cases and unspecific histological findings in the remaining 2 cases. Conclusion: Excision was done using an inframammary or periareolar approach without reconstructive plasty. The cosmetic results were good, as were the outcomes on follow-up. We therefore favor this surgical technique to treat giant fibroadenoma of similar size to those described above.
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Affiliation(s)
- U Hille-Betz
- Frauenklinik, Medizinische Hochschule Hannover, Hannover
| | - R Klapdor
- Frauenklinik, Medizinische Hochschule Hannover, Hannover
| | - H Henseler
- Klinik für Plastische Chirurgie, Medizinische Hochschule Hannover, Hannover
| | - P Soergel
- Frauenklinik, Medizinische Hochschule Hannover, Hannover
| | - F Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover
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Gaurav K, Chandra G, Neelam K, Kumar S, Singla H, Yadav SK. A pre-pubertal girl with giant juvenile fibroadenoma: A rare case report. Int J Surg Case Rep 2015; 16:87-9. [PMID: 26433926 PMCID: PMC4643459 DOI: 10.1016/j.ijscr.2015.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Fibroadenomas are benign neoplasms usually arising between the ages of 15-25 years. Approximately 0.4% fibroadenomas arise in juvenile age group. Usually the diagnosis is straightforward by clinical examination and FNAC. But sometimes rapid growth and giant size may pose difficulty in clinical approach. CASE PRESENTATION In this paper we are presenting a rare case of giant juvenile fibroadenoma in a 10 years old girl which was diagnosed by FNAC and treated by excision. Diagnosis was confirmed by histopathology. DISCUSSION Giant juvenile fibroadenomas are over 5cm in diameter and tend to show rapid growth mimicking a carcinoma. But histological features are similar to smaller fibroadenomas and can be enucleated. CONCLUSION Through this case we want to emphasize that these giant benign neoplasms should be suspected in any pre-pubertal girl with breast lump and should always be treated with breast conserving surgery.
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Affiliation(s)
| | | | - Kumari Neelam
- Dept. of Surgery, Rajendra Institute of Medical Sciences Ranchi, Jharkhand 834009, India
| | | | | | - Sanjay Kumar Yadav
- Dept. of Surgery, Rajendra Institute of Medical Sciences Ranchi, Jharkhand 834009, India.
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Lee M, Soltanian HT. Breast fibroadenomas in adolescents: current perspectives. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2015; 6:159-63. [PMID: 26366109 PMCID: PMC4562655 DOI: 10.2147/ahmt.s55833] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Michelle Lee
- Department of Plastic and Reconstructive Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Hooman T Soltanian
- Department of Plastic and Reconstructive Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
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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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Ciftci I, Sekmenli T, Ozbek S, Karamese M, Ugras S. Inframammarial Giant Fibroadenoma Removing and a Nipple-sparing Breast Reconstruction in an Adolescent: A Case Report. Prague Med Rep 2015; 116:161-6. [PMID: 26093670 DOI: 10.14712/23362936.2015.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Fibroadenomas are common, benign breast tumors that usually affect women in the second and third decade of life. Giant fibroadenomas often cause significant concern for the patient or family regarding malignant potential and altered breast development. Most fibroadenomas are benign. Local excision of small lesions through a circumareolar or inframammary incision rather than radical surgery is appropriate. Breast ultrasound represents the most commonly used imaging modality for the study of pediatric female breast masses and fibroadenomas. Detailed descriptions of the sonographic appearances of fibroadenomas in young girls are sparse. We believe that surgical treatment for the patient should include tumor extirpation and immediate restoration of breast appearance, minimizing visible scars, protection of the developing breast bud, nipple, and areola. This modality reduces psychosocial comorbidity.
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Affiliation(s)
- Ilhan Ciftci
- Department of Paediatric Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey.
| | - Tamer Sekmenli
- Department of Paediatric Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Seda Ozbek
- Department of Radiology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mehtap Karamese
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Ugras
- Department of Pathology, Konya Training and Research Hospital, Konya, Turkey
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Cerrato FE, Pruthi S, Boughey JC, Simmons PS, Salje B, Nuzzi LC, Lemaine V, Labow BI. Intermediate and Long-term Outcomes of Giant Fibroadenoma Excision in Adolescent and Young Adult Patients. Breast J 2015; 21:254-9. [PMID: 25772491 DOI: 10.1111/tbj.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Giant fibroadenomas (5 cm or greater) are benign breast masses that often present in adolescence and require surgical excision. Long-term outcomes, recurrence rates, and the need for additional reconstructive surgery in this population are unknown. Patients aged 11-25 years whose pathology reports indicated the presence of a giant fibroadenoma were eligible for this study. Medical records were reviewed for presentation, treatment, and outcomes. A subset of patients completed an investigator-designed long-term outcome survey to measure additional outcomes and the desire or need for subsequent reconstructive surgery. Forty-six patients with at least one giant fibroadenoma (mean size 7.4 ± 2.8 cm) were identified. Most patients underwent excision with a periaroeolar incision (n = 31), and an enucleation technique (n = 41), and four patients underwent immediate breast reconstruction. Thirty-three patients had complete medical records with a mean follow-up time of 2.2 ± 4.1 years and no complaints of asymmetry, additional breast deformities, or reconstructive surgery procedures documented. In addition, nine patients completed the investigator-designed survey with a mean follow-up time of 10.1 ± 8.7 years (range 1.5-27.0). Three of these patients reported postoperative breast asymmetry and the desire to pursue reconstructive surgery. Aesthetic outcomes of giant fibroadenoma excision may be satisfactory for many patients without immediate reconstruction, but for others, the need for reconstructive surgery may arise during development. Providers should address this potential need prior to discussing treatment options and during postoperative follow-up. Caution should be exercised before recommending immediate reconstruction.
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Affiliation(s)
- Felecia E Cerrato
- Department of Plastic and Oral Surgery and Adolescent Breast Clinic, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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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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Abstract
Fibroadenomas are benign breast masses that can present a management challenge in adolescent populations. Most fibroadenomas may be managed conservatively without surgery, but those masses that are symptomatic or increasing in size may require surgical excision. In adolescents, the implications of surgical intervention in the breast are unclear, and there is little outcomes data. In this article, the authors discuss the presentation, diagnosis, and management of fibroadenoma in adolescents. Key considerations for physicians in treating these masses in this population are reviewed.
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Affiliation(s)
- Felecia Cerrato
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian I Labow
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Pruthi S, Jones KN. Nonsurgical management of fibroadenoma and virginal breast hypertrophy. Semin Plast Surg 2014; 27:62-6. [PMID: 24872742 DOI: 10.1055/s-0033-1343997] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The management and treatment of an adolescent presenting with a fibroadenoma or virginal breast hypertrophy can be challenging as there is a paucity of original research on these conditions. Although surgical therapies are often discussed as first-line therapy in adolescents presenting with a breast mass, it is prudent that nonsurgical interventions and medical therapies be considered as initial therapy with the goal of maintaining an acceptable cosmetic outcome.
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Affiliation(s)
- Sandhya Pruthi
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Katie N Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Abstract
Breast masses in children and adolescents are uncommon and most often benign. Occasionally, however, they require surgical intervention for lifestyle limiting symptoms or malignant potential. These masses are best evaluated with physical exam and ultrasound. Breast masses likely to be encountered by the surgeon in the pediatric and adolescent population include intraductal papillomas, phyllodes tumors, primary breast cancer, and metastatic lesions. Unlike adults, pediatric and adolescent breast cancer tends to be of the secretory variety and typically have less metastatic potential. However, cases of inflammatory and medullary breast cancers have also been reported in girls and appear more aggressive. Radiation exposure during breast development is a risk factor to subsequent development of breast cancer. Surgical objective for a concerning pediatric and adolescent breast mass is complete resection while preserving normal breast development, when appropriate. The need for routine axillary dissection for malignant cases in children appears unnecessary from the limited data available, and the authors favor sentinel lymph node sampling and reserve axillary dissection for positive lymph nodes.
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Affiliation(s)
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Lai HW, Kuo YL, Su CC, Chen CJ, Kuo SJ, Chen ST, Chen DR. Round block technique is a useful oncoplastic procedure for multicentric fibroadenomas. Surgeon 2014; 14:33-7. [PMID: 24766915 DOI: 10.1016/j.surge.2014.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/23/2014] [Accepted: 03/11/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Multicentric 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 METHODS Records 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. RESULTS Twenty 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%). CONCLUSIONS The round block technique is a useful oncoplastic procedure for the management of multicentric fibroadenomas excised at the same time.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yao-Lung Kuo
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan and Dou-Liou Branch, Taiwan
| | - Chin-Chen Su
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Jung Chen
- Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichuang, Taiwan; Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Sou-Jen Kuo
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Department of Surgery, YuanSheng Hospital, Changhua, Taiwan.
| | - Dar-Ren Chen
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichuang, Taiwan.
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Goyal S, Garg G, Narang S. Giant fibroadenoma of the breast in a pre-pubertal girl: a case report. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0201.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ugburo AO, Olajide TO, Fadeyibi IO, Mofikoya BO, Lawal AO, Osinowo AO. Differential diagnosis and management of giant fibroadenoma: comparing excision with reduction mammoplasty incision and excision with inframammary incision. J Plast Surg Hand Surg 2013; 46:354-8. [PMID: 22998148 DOI: 10.3109/2000656x.2012.697066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Giant fibroadenoma (GFA) may present with breast asymmetry and can be excised with an inframammary incision (IFI) or reduction mammoplasty incision (RMI). This study investigated the clinical presentation and compared excision with the IFI and RMI. All patients with benign breast tumours greater than 5 cm underwent core needle biopsy and a histopathological diagnosis. All confirmed GFA had their clinical details documented and randomised into two groups for excision with an IFI or RMI. Twenty-two patients were studied. The age range was 12-46 years, mean 21.18 ± 2.22 years. The patients were divided into two groups: a juvenile group (n = 16) (73%) aged 12-18 years, mean age 14.06 ± 0.42 years, and a perimenopausal group (n = 5) aged 28-46 years. The juvenile group showed cyclic increases in breast size monthly with menstruation while the perimenopausal showed an initial slow growth of 6-24 months followed by a rapid growth. Fifteen patients (68%) had excision biopsy with IMI and seven patients with RMI. Seven of the patients treated with IFI had minimal preoperative asymmetry and satisfactory aesthetic outcome. Among the patients with severe preoperative asymmetry treated with IFI (n = 8) and RMI (n = 7), those treated with IFI had persistent postoperative skin redundancy and asymmetry, which was not found in those treated with RMI. In conclusion, for patients with significant asymmetry, excision with the IFI was associated with persistent asymmetry while excision with RMI was associated with restoration of symmetry.
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Affiliation(s)
- Andrew O Ugburo
- Department of Surgery, Plastic Surgery Unit, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria.
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Izadpanah A, Karunanayake M, Izadpanah A, Sinno H, Gilardino M. An atypical growth of a giant fibroadenoma after trauma. J Pediatr Adolesc Gynecol 2012; 25:e115-7. [PMID: 22980414 DOI: 10.1016/j.jpag.2012.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fibroadenomas are the most common benign breast lesion in female adolescents. However, it is important to recognize that a small percentage have been shown to progress to giant fibroadenomas. Giant fibroadenomas can spontaneously infarct leading to significant morbidity and are also difficult to distinguish from the more aggressive phyllodes tumors. CASE We describe the first case, to the best of our knowledge, of a 12-year-old girl who presented with a giant fibroadenoma complicated by a central infarct and an intra-lesional hemorrhage from a trauma to the breast. SUMMARY AND CONCLUSION The complicated giant fibroadenoma with an intra-lesional hemorrhage has characteristics of both benign and malignant lesions, and is difficult to distinguish by history and physical alone. Ultrasonography is a valuable tool yet the core needle biopsy remains the gold standard to confirm the diagnosis.
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Affiliation(s)
- Ali Izadpanah
- Division of Plastic and Reconstructive Surgery, McGill University, McGill University Health Centre, Montreal, Quebec, Canada.
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Ng WK, Mrad MA, Brown MH. Juvenile fibroadenoma of the breast: Treatment and literature review. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2012; 19:105-7. [PMID: 22942662 DOI: 10.1177/229255031101900308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is uncommon to find palpable breast masses in young patients. Generally, such masses are benign. Juvenile fibroadenoma is the most frequent benign tumour of the breast. The present report describes a case involving a 17-year-old girl with unilateral right breast hypertrophy, for whom resection and breast reduction was effectively achieved.Resection was combined with an aesthetically pleasing outcome through breast reduction, via a wise pattern of reduction with a superior pedicle.While young patients rarely present with breast masses, the consideration of fibroadenoma in these cases is always warranted. The disconcerting appearance of the breasts for adolescents afflicted by such benign masses underscores the importance of achieving aesthetically optimal outcomes and attaining adequate tumour resection for diagnostic purposes through pathological specimens. In the present case, the young patient underwent a procedure that fulfilled both of these valuable goals through careful pre-operative planning, pedicle selection and skin resection patterns.
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Kömürcü F, Schwarz C, Bartsch R, Deutinger M. Reduction mammaplasty as a secondary therapy option for chronic pain after lumpectomy in the breast: a case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2011. [DOI: 10.1007/s00238-010-0480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oncoplastic breast surgery for the management of giant and multiple benign breast lesions. Eur Surg 2011. [DOI: 10.1007/s10353-011-0021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nikumbh DB, Desai SR, Madan PS, Patil NJ, Wader JV. Bilateral giant juvenile fibroadenomas of breasts:a case report. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:482046. [PMID: 21660274 PMCID: PMC3108471 DOI: 10.4061/2011/482046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 11/20/2022]
Abstract
Juvenile fibroadenoma constitutes only 4% of the total fibroadenomas. The incidence of giant juvenile fibroadenomas is found to be only 0.5% of all the fibroadenomas. Bilateral giant juvenile fibroadenomas are extremely rare, and only four cases have been reported in the literature. To the best of our knowledge, we are presenting the fifth case of bilateral giant juvenile fibroadenomas in a 12-year-old prepubertal girl. The diagnosis was made on fine-needle aspiration cytology which was confirmed on histopathology. In this paper, we present this rare case to illustrate the diagnosis and management of this tumour and to emphasize that these tumours are almost always benign and should be treated with breast-conserving surgery to provide a healthy physical and social life to the patient.
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Affiliation(s)
- D B Nikumbh
- Department of Pathology, Krishna Institute of Medical Sciences, Karad, District Satara, Maharashtra 415110, India
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