1
|
Pandit P, Murkey SP, Agarwal A, Jaiswal A, Agrawal S. Understanding Fibroadenoma of the Breast: A Comprehensive Review of Pre-operative and Post-operative Clinicopathological Correlations. Cureus 2023; 15:e51329. [PMID: 38288219 PMCID: PMC10823311 DOI: 10.7759/cureus.51329] [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: 11/23/2023] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Fibroadenomas of the breast are common benign lesions that predominantly affect young women. This review provides a comprehensive overview of fibroadenoma management, encompassing their definition, clinical presentation, diagnostic tools, surgical management, clinicopathological correlations, treatment outcomes, complications, and emerging research. Fibroadenomas typically present as palpable breast lumps, often with no associated nipple discharge, and their diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation. Surgical interventions, including excisional biopsy and lumpectomy, offer symptom relief and favorable long-term outcomes. Minimally invasive techniques and ongoing research into genomics and molecular aspects hold promise for the future of fibroadenoma management. Multidisciplinary collaboration among healthcare providers is paramount, ensuring accurate diagnosis, personalized treatment decisions, and holistic patient care. As research advances, the management of fibroadenomas is poised to evolve, providing improved diagnostic accuracy, minimally invasive treatments, and enhanced patient outcomes.
Collapse
Affiliation(s)
- Pranam Pandit
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Siddhant P Murkey
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash Agarwal
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suyash Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|