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Aripoli A, Winblad O, Balanoff C, Peterson J, Smith C, Huppe A, Hill M, Wermuth D, Gloyeske N. Atypia Involving Fibroadenomas: Outcomes and Upgrade Rates. JOURNAL OF BREAST IMAGING 2024; 6:254-260. [PMID: 38554256 DOI: 10.1093/jbi/wbae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Indexed: 04/01/2024]
Abstract
OBJECTIVE Fibroadenomas (FAs) involved by atypia are rare. Consensus guidelines for management of FAs involved by atypia when diagnosed on image-guided biopsy do not exist because of limited data reporting surgical upgrade rates to ductal carcinoma in situ (DCIS) or invasive malignancy. Therefore, these lesions commonly undergo surgical excision. METHODS This single-institution retrospective study identified cases of FAs involved by atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) diagnosed on image-guided biopsy between January 2014 and April 2023 to determine upgrade rates. Cases with incidental atypia adjacent to but not involving FAs were excluded. RESULTS Among 1736 FAs diagnosed on image-guided biopsy, 32 cases (1.8%) were FAs involved by atypia including 43.8% (14/32) ALH, 28.1% (9/32) ADH, 18.8% (6/32) LCIS, 6.3% (2/32) LCIS + ALH, and 3.1% (1/32) unspecified atypia. The most common imaging finding was a mass. Most cases, 81.3% (26/32), underwent subsequent surgical excisional biopsy. A single case of ADH involving and adjacent to an FA was upgraded to FA involved by low-grade DCIS on excision for an overall surgical upgrade rate of 3.8%. There were no cases upgraded to invasive malignancy. For those omitting surgical excision, there was no subsequent malignancy diagnosis at the FA biopsy site over a mean follow-up of 73 months. CONCLUSION Cases of radiologic-pathologic concordant FAs involved by atypia have a low upgrade rate of 3.8% and should undergo multidisciplinary review. Larger multi-institutional analysis is needed to determine whether guidelines for excision of atypia should apply to atypia involving FAs.
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Affiliation(s)
- Allison Aripoli
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Onalisa Winblad
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christa Balanoff
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jessica Peterson
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Camron Smith
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ashley Huppe
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Molly Hill
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Daniela Wermuth
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nika Gloyeske
- Department of Pathology, University of Kansas Medical Center, Kansas City, KS, USA
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Ahmad A, Najeeb E, Ul Haq MB, Bashir H, Uzair M, Mamoon N. Ductal carcinoma in situ and invasive carcinoma originating in a Fibroadenoma with concurrent benign phyllodes tumor: A case report. Int J Surg Case Rep 2024; 116:109196. [PMID: 38368667 DOI: 10.1016/j.ijscr.2023.109196] [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: 11/11/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE This case report presents a rare occurrence of multiple bilateral breast fibroadenomas, one evolving into ductal carcinoma in situ (DCIS) and invasive carcinoma, occurring simultaneously with a benign phyllodes tumor in the same breast. The importance of this case lies in emphasizing the crucial need for surveillance in patients with a long history of fibroadenomas and the necessity to investigate any rapid change in the size of fibroadenoma. CASE PRESENTATION A 35-year-old multiparous female with a 17 year history of bilateral multiple breast lumps presented with recent onset of right breast pain and yellowish nipple discharge. Two lumps in her right breast had demonstrated an increase in size. Examination revealed a significant mass in the retroareolar region of the right breast and another at the 2 o'clock position. Histopathological examination of the biopsy specimens revealed fibroadenoma and benign phyllodes tumor. The patient underwent a bilateral breast lumpectomy. Further histopathological examination revealed ductal carcinoma in situ and invasive carcinoma within a complex fibroadenoma in the right breast and benign phyllodes tumor. Sentinel lymph node biopsy was negative. She had adjuvant radiations and trastuzumab. Regular follow-ups show no recurrence. CLINICAL DISCUSSION Fibroadenomas are usually benign but rarely undergo malignant change. Quick response to size changes and early detection greatly enhance patient results. CONCLUSION Ductal carcinoma in situ and invasive breast cancer, a rare malignancy found within a fibroadenoma, necessitates histopathological specimens and immunohistochemical results for accurate diagnosis. Survival rates are significantly enhanced through a multidisciplinary approach.
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Affiliation(s)
- Afaq Ahmad
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan.
| | - Erum Najeeb
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Muhammad Burhan Ul Haq
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Humaira Bashir
- FCPS gynaecology and obstetrics, Pakistan; College of Physicians and Surgeons, Pakistan
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3
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Xu L, Luo S, Mao Q, Gao Y, Luo L, Qu W, Cao Y. Breast carcinoma arising in a fibroadenoma: A case series of 16 patients and review of the literature. Oncol Lett 2024; 27:39. [PMID: 38116580 PMCID: PMC10728692 DOI: 10.3892/ol.2023.14172] [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: 02/18/2023] [Accepted: 09/25/2023] [Indexed: 12/21/2023] Open
Abstract
Breast carcinoma arising from a fibroadenoma is an uncommon entity and is frequently detected incidentally during pathological examination or excisional biopsy of a benign breast tumor. Due to only sporadic cases being reported, evidence-based guidelines are not well-established to date. The present report describes 16 patients diagnosed with breast carcinoma arising within a fibroadenoma in the Third Hospital of Nanchang (Nanchang, China) between January 2019 and December 2021 and discusses the clinicopathological characteristics, imaging findings and treatment. The age of patients at diagnosis ranged between 19 and 58 years and a well-defined asymptomatic mass was the most common clinical presentation. Carcinoma occurring in fibroadenoma generally mimics a benign tumor and potential carcinomatous changes may not be detected. Pathologically, carcinoma in situ was the predominant subtype in the present study. Additionally, ductal carcinoma in situ was more common compared with lobular carcinoma in situ in the present case series. Regarding the molecular phenotypes, the majority of cases were categorized as luminal subtype, although other subtypes such as triple-negative and HER2 positive breast cancer were also identified. In the present study, seven patients were treated with breast-conserving surgery and nine patients were treated with mastectomy. Sentinel lymph node biopsy was performed in all patients and none exhibited axillary node metastasis. Additionally, six patients underwent radiotherapy and two received chemotherapy. During the follow-up, all patients were alive and no evidence of disease relapse was observed. In summary, clinicians should be aware of the possibility of carcinoma within a fibroadenoma, which could alter the therapeutical course. Adequate biopsy or excision should be performed in patients with indicators of malignant transformation in a presumed benign breast tumor.
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Affiliation(s)
- Liang Xu
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Shuya Luo
- Outpatient Department, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Qixin Mao
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan 450002, P.R. China
| | - Yufeng Gao
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Lihua Luo
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Wei Qu
- Department of Pathology, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
| | - Yali Cao
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, Jiangxi 330009, P.R. China
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4
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Chen A, Kanakaratne S, Britten-Jones P, Bingham J. Incidental DCIS within a fibroadenoma. BMJ Case Rep 2023; 16:e254609. [PMID: 37751969 PMCID: PMC10533689 DOI: 10.1136/bcr-2023-254609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
A female in her early 20s was referred to the breast-endocrine surgeons with a self-detected tender left breast lump on the background of a family history of breast cancer. A physical examination revealed a rubbery and mobile mass in the left upper breast. Ultrasound demonstrated a solid hypoechoic mass with a likely differential diagnosis of fibroadenoma, with a subsequent core needle biopsy (CNB) confirming a fibroadenoma. Given the size and tenderness of the lump, an excisional biopsy was performed. Histology revealed a fibroadenoma with components of low-grade ductal carcinoma in situ, contained within the fibroadenoma and excised with clear margins.Following surgical excision, a multidisciplinary review determined that no further local therapy was required and recommended a genetics referral. This case was interesting as it raised important questions, including what the best surveillance strategies are for female patients with breast cancer within fibroadenoma and determining the risk and probability of missing epithelial atypia via CNB.
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Affiliation(s)
- Arnold Chen
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shaveen Kanakaratne
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Breast and Endocrine Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Philip Britten-Jones
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Breast and Endocrine Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Janne Bingham
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Breast and Endocrine Surgical Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Fraker JL, Clune CG, Sahni SK, Yaganti A, Vegunta S. Prevalence, Impact, and Diagnostic Challenges of Benign Breast Disease: A Narrative Review. Int J Womens Health 2023; 15:765-778. [PMID: 37223067 PMCID: PMC10202205 DOI: 10.2147/ijwh.s351095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Benign breast diseases, which are commonly seen in clinical practice, have various clinical presentations and implications, as well as management strategies. This article describes common benign breast lesions, presentations of these lesions, and typical radiographic and histologic findings. Also included in this review are the most recent data and guideline-based recommendations for the management of benign breast diseases at diagnosis, including surgical referral, medical management, and ongoing surveillance.
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Affiliation(s)
- Jessica L Fraker
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Caroline G Clune
- Center for Breast Care, Mayo Clinic Health System — Southwest Wisconsin Region, La Crosse, WI, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sabrina K Sahni
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA
| | - Avani Yaganti
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Suneela Vegunta
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Brunetti N, Valente I, Pitto F, Calabrese M. Triple-negative Breast Cancer Arising in a Fibroadenoma in BRCA 1 Mutated Patient. J Med Ultrasound 2023; 31:63-65. [PMID: 37180614 PMCID: PMC10173821 DOI: 10.4103/jmu.jmu_83_21] [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: 04/11/2021] [Revised: 09/02/2021] [Accepted: 12/27/2021] [Indexed: 05/16/2023] Open
Abstract
We describe the case of a 35-year-old woman who comes to our institute with a palpable lump on her left breast. Clinically the mass was mobile, nontender and with no nipple discharge. Sonography revealed a circumscribed, oval-shaped, and hypoechoic mass, suggestive of a benign lesion. We performed an ultrasound-guided core needle biopsy that demonstrated multiple foci of high-grade (G3) ductal carcinoma in situ arising on fibroadenoma (FA). Subsequently, the patient had surgical excision of the mass with a final diagnosis of triple-negative breast cancer arising on FA. After diagnosis, the patient performs a genetic test that detects the BRCA 1 gene mutation. A review of the literature demonstrated only two cases of triple-negative breast cancer on FA. In this report, we describe another such case.
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Affiliation(s)
- Nicole Brunetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Address for correspondence: Dr. Nicole Brunetti, Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore 1, Genoa, Italy. E-mail:
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7
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Liang M, Zhang Z, Zhang C, Chen R, Xiao Y, Li Z, Li T, Liu Y, Ling L, Xie H, Chen L, Liu X, Wang S, Xia T. Feasibility and efficacy of ultrasound-guided high-intensity focused ultrasound of breast fibroadenoma. Int J Hyperthermia 2023; 40:2240548. [PMID: 37544652 DOI: 10.1080/02656736.2023.2240548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This nonrandomized prospective clinical trial aimed to assess the efficacy, safety and follow-up outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) surgery in patients with breast fibroadenoma. METHODS With the approval of the institutional ethics committee and written informed consent, a total of 113 patients diagnosed with breast fibroadenoma by core-needle biopsy in our hospital were recruited. USgHIFU surgery was performed under local anesthesia. Contrast-enhanced ultrasound (CEUS) or contrast-enhanced MRI (CEMRI) was performed to evaluate the nonperfused volume (NPV). The patients were followed up with physical examination and ultrasound imaging. RESULTS The clinical outcome of 85 patients with 147 fibroadenomas with a follow-up time of more than 3 months was analyzed in this study. Fifty-two patients had one lesion, twenty-one patients had two lesions and twelve patients had more than two lesions. During USgHIFU, the median localization time for all fibroadenomas was 3 (interquartile range: 1, 5) min, and the median treatment time was 9 (interquartile range: 5, 15) min. Under local anesthesia, all the patients tolerated the treatment well. No serious epidermal burns were observed in any of the patients. Based on CEUS or CEMRI imaging evaluation, the median NPV ratio was 100% (interquartile range: 79.2%, 116.8%). The VRR were 26.77 ± 50.05%, 50.22 ± 42.01% and 72.74 ± 35.39% at 3-6 months, 6-12 months and >12 months, respectively, which showed significant statistical difference (p < .001). CONCLUSION Ultrasound-guided HIFU surgery is an effective and safe noninvasive alternative technique for the treatment of breast fibroadenoma.
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Affiliation(s)
- Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhizheng Zhang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Haifu Hospital, Chongqing, China
- National Engineering Research Center of Ultrasound Medicine, Chongqing, China
| | - Rui Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yao Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Tao Li
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yuelin Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lin Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Shui Wang
- 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
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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8
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Wang M, Leong MY, Tan QT. A case of fibroadenoma with lobular carcinoma in situ and microinvasion in a young woman. J Surg Case Rep 2022; 2022:rjac602. [PMID: 36601097 PMCID: PMC9803969 DOI: 10.1093/jscr/rjac602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023] Open
Abstract
Fibroadenomas are benign breast tumors with a rare incidence of malignant transformation. Carcinoma arising within fibroadenomas typically occurs in women above the age of 40. We present a case of a young patient with microinvasive carcinoma arising within a biopsy-proven fibroadenoma, highlighting the possibility of carcinoma arising within fibroadenomas in young patients and the importance of vigilant surveillance even after a benign biopsy. In younger patients, new suspicious changes in benign lesions should be investigated. If prior core needle biopsy was performed, excision biopsy should be considered as the malignancy may be small and may be missed on needle biopsy.
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Affiliation(s)
- Mingjia Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - May Ying Leong
- Pathology and Laboratory Medicine, Histopathology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Qing Ting Tan
- Correspondence address. Breast Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899 Singapore. Tel: +65-63941653; Fax: +65-63945817; E-mail:
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9
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Elnahas W, Metwally IH, Bonna K, Youssef M, AbdAllah S, Bonna M, Ali Faried M, Atef Tira M, Hamdy O. Fibroadenoma of the breast; incidence of malignancy and indicators for surgical intervention: An analysis of 1392 patients. Breast Dis 2022; 41:421-426. [PMID: 36565097 DOI: 10.3233/bd-210074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish. METHODS This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria. RESULTS The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕- 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients' age, marital status, and imaging criteria as measured by BIRADS score were significant (<0.001). CONCLUSION Approaching patients with the age above 35 or with BIRADS 4 provisionally diagnosed with fibroadenomas should be cautious with biopsy and short-term follow-ups The size of the tumor alone should not be used as an indication for surgical intervention.
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Affiliation(s)
- Waleed Elnahas
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Khaled Bonna
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Marco Youssef
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Samar AbdAllah
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed Bonna
- Medical Students, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Mohamed Ali Faried
- Medical Students, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Mohamed Atef Tira
- Medical Students, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
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10
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Xiao Y, Liang M, Chen M, Li Z, Xia T, Yue X, Yin H, Yang H, Huang H, Wang Z, Zhang C. Evaluating the learning curve of high intensity focus ultrasound for breast fibroadenoma by CUSUM analysis: a multi-center study. Int J Hyperthermia 2022; 39:1238-1244. [PMID: 36123038 DOI: 10.1080/02656736.2022.2123566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To explore the learning curve of high intensity focus ultrasound (HIFU) treatment for breast fibroadenoma. METHODS A database of 110 patients with 255 breast fibroadenomas who underwent HIFU treatment at two different clinical centers (Center 1 and 2) were retrospectively analyzed. The learning curves of HIFU treatment for breast fibroadenoma were drawn by CUSUM analysis in two centers, respectively. According to the inflection point of the learning curves, the treatment was divided into two groups: initial phase and consolidation phase. HIFU treatment parameters were compared between two groups. The effectiveness and safety results were also evaluated. RESULTS The inflection points of the learning curves were the 60th treatment in Center 1 and the 65th treatment in Center 2. The screening time, treatment time, sonication time and hyperechoic scale change time were significantly shorter in consolidation phase than those in initial phase of the two centers (p < 0.05). There were no differences in non-perfused volume (NPV) ratio and energy effect factor (EEF) between the two groups in Center 1, while in Center 2, these above-mentioned results in consolidation phase led to a greater improvement than those in initial phase. There was no difference of Visual Analogue Scale (VAS) scores and no adverse event observed in both centers. CONCLUSION HIFU treatment for breast fibroadenoma was effective and safe. The learning curve of HIFU treatment for breast fibroadenoma can be completed after treating 60-65 tumors without increasing the safety risk.
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Affiliation(s)
- Yao Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, 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
| | - Maoshan Chen
- Department of Breast Surgery, Suining Central Hospital, Suining, China
| | - Zi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xuewen Yue
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Heng Yin
- Department of Breast Surgery, Suining Central Hospital, Suining, China
| | - Hongwei Yang
- Department of Breast Surgery, Suining Central Hospital, Suining, China
| | - Haoran Huang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Haifu Hospital, Chongqing, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Haifu Hospital, Chongqing, China
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Ece B, Aydın S. Imaging of fibroadenoma: Be careful with imaging follow-up. World J Clin Cases 2022; 10:9176-9179. [PMID: 36157665 PMCID: PMC9477063 DOI: 10.12998/wjcc.v10.i25.9176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/10/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
The present letter to the editor is related to the study titled, “Preoperational diagnosis and management of breast ductal carcinoma in situ arising within fibroadenoma: Two case reports.” Fibroadenoma is the most common benign mass lesion in young females. Based on this study showing that malignancy can develop on fibroadenomas, we want to emphasize that careful sonographic follow-up of fibroadenomas should be done and that each lesion should be followed carefully and separately in cases with multiple fibroadenomas. Additionally, we want to emphasize the critical role of sonographic examination in diagnosing fibroadenoma, the importance of correctly defining benign and malignant sonographic findings, and which lesions should be followed up sonographically and which lesions should be evaluated histopathologically.
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Affiliation(s)
- Bunyamin Ece
- Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey
| | - Sonay Aydın
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
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12
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Seow DY, Tay TK, Tan PH. FIBROEPITHELIAL LESIONS OF THE BREAST: A REVIEW OF RECURRING DIAGNOSTIC ISSUES. Semin Diagn Pathol 2022; 39:333-343. [DOI: 10.1053/j.semdp.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
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13
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Tee SW, Tan YH, Jeyabalan D, Selvam D. Fibroadenoma in axillary ectopic breast. BMJ Case Rep 2022; 15:e246838. [PMID: 35272989 PMCID: PMC8915268 DOI: 10.1136/bcr-2021-246838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/03/2022] Open
Abstract
Axillary lumps are common clinical presentations in surgery, which have various differential diagnoses. We encountered an unusual case of an isolated axillary mass. The patient was a young woman in her 20s with a 2 year history of right axillary swelling. Clinically, the lump measured 3 cm ×3 cm, mobile, non-tender, and there was no associated breast lump or skin changes. Our initial impression was an isolated lymphadenopathy, and further workup for tuberculosis lymphadenopathy returned negative. Ultrasound demonstrated a well circumscribed oval lesion, and fine needle aspiration could only identify a benign proliferative breast tissue. As it was increasing in size and causing discomfort, we decided for an excision biopsy for both diagnostic and therapeutic reasons. Intraoperatively, the lump was noted to have well defined, smooth surface along with whitish-grey appearance. The tissue surrounding it was also removed and sent for histopathological assessment. Results confirmed our diagnosis of fibroadenoma in an ectopic breast tissue.
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Affiliation(s)
- Sui Wu Tee
- Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Yi Han Tan
- Department of General Surgery, Serdang Hospital, Kajang, Selangor, Malaysia
| | - Dhinisya Jeyabalan
- Department of General Surgery, Serdang Hospital, Kajang, Selangor, Malaysia
| | - Devanraj Selvam
- Department of General Surgery, Serdang Hospital, Kajang, Selangor, Malaysia
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14
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Fujimoto A, Matsuura K, Kawasaki T, Ichinose Y, Nukui A, Hiratsuka M, Asano A, Shimada H, Osaki A, Saeki T. Early HER2-positive breast cancer arising from a fibroadenoma: a case report. Oxf Med Case Reports 2021; 2021:omab083. [PMID: 34527256 PMCID: PMC8436269 DOI: 10.1093/omcr/omab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/11/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
Breast cancer arising from fibroadenoma (FA) is rare, in which almost all reported cases are human epidermal growth factor receptor 2 (HER2)-negative. This is the first report to describe a case of HER2-positive breast cancer arising from FA that was treated with chemotherapy plus anti-HER2 therapy. In this early case, upfront surgery outcomes guided the selection of appropriate systemic therapy. A 31-year-old woman previously diagnosed with FA experienced tumor growth. Core needle biopsy and imaging studies confirmed a diagnosis of stage IIA HER2-positive invasive ductal carcinoma (IDC) with no evidence of lymph node metastasis (cT2N0M0). Breast-conserving surgery was performed. Pathological diagnosis revealed stage IA IDC with a predominant intraductal component (pT1aN0M0), arising from FA. In conclusion, we encountered an extremely rare case of HER2-positive breast cancer arising from FA in which pathological infiltration was difficult to predict based on preoperative imaging.
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Affiliation(s)
- Akihiro Fujimoto
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuo Matsuura
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuki Ichinose
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Asami Nukui
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Miyuki Hiratsuka
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Aya Asano
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroko Shimada
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Akihiko Osaki
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Toshiaki Saeki
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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15
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Tagliati C, Lanni G, Cerimele F, Di Martino A, Calamita V, Lucidi Pressanti G, Mingliang Y, Giuseppetti GM, Argalia G, Giovagnoni A. Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report. Breast Dis 2021; 40:283-286. [PMID: 34092581 DOI: 10.3233/bd-201080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a case of ductal carcinoma in situ within a fibroadenoma. Breast cancer arising within fibroadenoma incidence ranges from 0.125% to 0.02%, and ductal carcinoma in situ is not the most frequent malignancy that can be found within a fibroadenoma. Dynamic contrast-enhanced magnetic resonance imaging showed an oval mass with circumscribed margins and dark internal septations, suspicious for fibroadenoma. According to European Society of Breast Radiology diffusion-weighted imaging consensus, mean apparent diffusion coefficient value obtained by drawing a small region of interest on the lesion apparent diffusion coefficient map showed a low diffusion level. Therefore, ductal carcinoma in situ within a fibroadenoma was diagnosed at final pathology after surgical excision.
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Affiliation(s)
- Corrado Tagliati
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Giuseppe Lanni
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Federico Cerimele
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Antonietta Di Martino
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Valentina Calamita
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Gabriella Lucidi Pressanti
- U.O.S.D. Radiologia Ospedale "San Liberatore" Atri - Dipartimento dei Servizi - ASL Teramo, Teramo, Italy
| | - Ying Mingliang
- Department of Radiology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
| | - Gian Marco Giuseppetti
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Giulio Argalia
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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16
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Feliciano YZ, Freire R, Net J, Yepes M. Ductal and lobular carcinoma in situ arising within an enlarging biopsy proven fibroadenoma. BMJ Case Rep 2021; 14:e237017. [PMID: 33468635 PMCID: PMC7817826 DOI: 10.1136/bcr-2020-237017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/21/2023] Open
Abstract
The diagnosis via core needle biopsy of concurrent ductal carcinoma in situ and lobular carcinoma in situ within an enlarging previously biopsied benign fibroadenoma in women in their 40s is rare. Several case reports have described the occurrence of malignant changes within fibroadenomas, usually as an incidental finding following excision, and few reports have documented the transition of a fibroadenoma to malignancy. The current case report emphasises the importance of re-biopsying enlarging fibroadenomas, even with otherwise maintained benign appearing features on imaging, in women in their 40s, in order to exclude the possibility of malignancy.
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MESH Headings
- Biopsy, Large-Core Needle
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Female
- Fibroadenoma/pathology
- Humans
- Mammography
- Middle Aged
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Affiliation(s)
- Yara Z Feliciano
- Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rochelle Freire
- Pathology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jose Net
- Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Monica Yepes
- Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
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SEÇİNTİ İE, GÜRSOY D. Comparative study of the histopathologic changes within and around fibroadenomas. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.837941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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18
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Tan PH. Fibroepithelial lesions revisited: implications for diagnosis and management. Mod Pathol 2021; 34:15-37. [PMID: 32461622 DOI: 10.1038/s41379-020-0583-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
Fibroepithelial lesions of the breast, comprising the fibroadenoma and phyllodes tumour, are a unique group of neoplasms that share histological characteristics but possess different clinical behaviour. The fibroadenoma is the commonest benign breast tumour in women, while the phyllodes tumour is rare and may be associated with recurrences, grade progression and even metastasis. The diagnosis of fibroadenoma is usually straightforward, with recognised histological variants such as the cellular, complex, juvenile and myxoid forms. The phyllodes tumour comprises benign, borderline and malignant varieties, graded using a constellation of histological parameters based on stromal characteristics of hypercellularity, atypia, mitoses, overgrowth and the nature of tumour borders. While phyllodes tumour grade correlates with clinical behaviour, interobserver variability in assessing multiple parameters that are potentially of different biological weightage leads to significant challenges in accurate grade determination and consequently therapy. Differential diagnostic considerations along the spectrum of fibroepithelial tumours can be problematic in routine practice. Recent discoveries of the molecular underpinnings of these tumours may have diagnostic, prognostic and therapeutic implications.
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Affiliation(s)
- Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Academia, Diagnostics Tower Level 7, 20 College Road, Singapore, 169856, Singapore.
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19
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Abstract
<br><b>Introduction:</b> Fibroadenomas are one of the most common benign tumors of the breast in the adolescent females accounting for about 2/3<sup>rd</sup> of all the breast lumps and more than half of all the biopsied breast lesions. They come into being due to overgrowth of glandular tissue under the influence of hormonal changes that the girls undergo at the time of puberty. Due to the wide prevalence of fibroadenomas and the psychosocial morbidity associated with the finding of a breast mass, it is imperative for physicians treating adolescent patients to be thoroughly familiar and updated with this disease. <br><b>Aim:</b> The article aims at providing a brief review of the classification, presentation, diagnosis, and update on the management of breast fibroadenomas on the basis of recent literature.
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20
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Grouthier V, Chakhtoura Z, Tejedor I, Badachi Y, Goffin V, Touraine P. Positive association between progestins and the evolution of multiple fibroadenomas in 72 women. Endocr Connect 2020; 9:570-577. [PMID: 32485673 PMCID: PMC7354733 DOI: 10.1530/ec-20-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Multiple fibroadenomas (MFA) of the breast is a rare benign disease, thus its natural history is poorly understood. The aim of our study was to describe the radiological evolution of MFA and to evaluate the influence of different factors on this evolution. METHODS This was a longitudinal cohort study. All patients included had two clinical and radiological assessments (breast ultrasound (US) and/or MRI) at least 5 years apart. RESULTS Seventy-two women were followed for 7.6 ± 2.1 years. The radiological evolution showed a decrease or stability in the number of fibroadenomas (FA) in 26/44 cases on the MRI and in 38/64 cases on the US. There was a decrease of size in 35/44 cases on the MRI and in 53/64 cases on the US. An increase in the number of FAs was found in 18/44 cases in the MRI and 26/64 cases in the US with, for the majority, a decrease of size (19/26 by MRI and 16/18 by MRI). Older age at the first FA (P < 0.0001) and at the diagnosis of MFA (P < 0.0001), pregnancy (P = 0.003) and progestin use (P < 0.001), particularly lynestrenol (P < 0.0001), had a beneficial effect on the evolution of MFA. CONCLUSION This is the first longitudinal study describing women with MFA. The radiological evolution of MFA seamed favorable and similar to that expected for a single FA. We identified factors influencing the evolution of the disease, including progestin treatments such as lynestrenol, which could have a beneficial effect. Our cohort should be followed further in order to expand our knowledge of MFA, especially concerning the risk of breast cancer.
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Affiliation(s)
- Virginie Grouthier
- Department of Endocrinology and Reproductive Medicine, GH La Pitié-Salpêtrière Charles-Foix, Center for Rare Gynecological Diseases, Paris, France
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Bordeaux, Bordeaux, France
| | - Zeina Chakhtoura
- Department of Endocrinology and Reproductive Medicine, GH La Pitié-Salpêtrière Charles-Foix, Center for Rare Gynecological Diseases, Paris, France
| | - Isabelle Tejedor
- Department of Endocrinology and Reproductive Medicine, GH La Pitié-Salpêtrière Charles-Foix, Center for Rare Gynecological Diseases, Paris, France
| | - Yasmina Badachi
- Department of General Radiology, GH La Pitié-Salpêtrière Charles-Foix, Paris, France
| | - Vincent Goffin
- Inserm U1151 – CNRS UMR 8253, Institut Necker Enfants Malades (INEM), Faculté de Médecine Paris Descartes, Paris, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, GH La Pitié-Salpêtrière Charles-Foix, Center for Rare Gynecological Diseases, Paris, France
- Sorbonne Université, F-75013, Paris, France
- Correspondence should be addressed to P Touraine E-mail:
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21
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El-Essawy M, AL Haidary A, Khan AL. Ductal carcinoma in situ (DCIS) in breast fibroadenoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00191-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Fibroadenoma is the most common benign tumor; although malignant, changes are rare. Any changes or increase in size should be evaluated thoroughly to exclude any malignant formation.
Case presentation
A 25-year-old female presenting to our department complaining of enlargement of the previously stable mass underwent imaging assessment and biopsy which revealed ductal carcinoma in situ changes developed in a fibroadenoma.
Conclusion
Although malignant changes in a fibroadenoma are rare, biopsy of increasing size fibroadenoma is advised to avoid missing any malignant changes; the incidence is more in the complex fibroadenoma.
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22
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Brock CM, Harper C, Tyler T. Fibroadenoma containing lobular carcinoma in situ, an unusual finding in a normally benign mass. J Surg Case Rep 2020; 2020:rjaa059. [PMID: 32280442 PMCID: PMC7136718 DOI: 10.1093/jscr/rjaa059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
This is the case of a 27-year-old female who underwent breast lumpectomy for fibroadenoma of the left breast. Pathologic evaluation of the specimen revealed lobular carcinoma in situ (LCIS) entirely confined to a large fibroadenoma without LCIS in the surrounding breast tissue.
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Affiliation(s)
- Christie M Brock
- Advanced Surgical Associates, 3460 NE Ralph Powell Rd. Lee’s Summit, MO 64064, USA
| | - Charles Harper
- Advanced Surgical Associates, 3460 NE Ralph Powell Rd. Lee’s Summit, MO 64064, USA
| | - Troy Tyler
- Advanced Surgical Associates, 3460 NE Ralph Powell Rd. Lee’s Summit, MO 64064, USA
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Shiino S, Yoshida M, Tokura M, Watase C, Murata T, Jimbo K, Takayama S, Suto A, Satomi K, Miyagi Maeshima A, Kikuchi M, Uchiyama N, Kinoshita T. Locally advanced triple negative breast cancer arising from fibroadenoma with complete response to neoadjuvant chemotherapy: A case report. Int J Surg Case Rep 2020; 68:234-238. [PMID: 32193143 PMCID: PMC7078443 DOI: 10.1016/j.ijscr.2020.02.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Breast cancer arising from benign fibroadenoma (FA) is rare. The histological type of the former was either carcinoma in situ or early-stage invasive breast carcinoma with hormone receptor positive/HER2 (human epidermal growth factor receptor-2)-negative phenotype. Meanwhile, advanced breast cancer of triple negative (TN) phenotype such as our case is extremely uncommon and clinically challenging. PRESENTATION OF CASE We experienced a case of a 53-year-old woman that had invasive ductal carcinoma of TN phenotype in FA with multiple lymph node metastases. After receiving neoadjuvant chemotherapy (NAC), she underwent breast mastectomy and axillary dissection. The pathological examination on postoperative specimens revealed the dense fibrous stroma in the FA without any residual viable tumor cells and was considered as pathological complete response (pCR). DISCUSSION This is the first report presenting a case of NAC treatment for invasive ductal carcinoma (IDC) in FA. Furthermore, the patient achieved pCR even if IDC was located within FA. Diagnosing breast cancer in FA may be challenging as the carcinoma component may be hidden by the FA component. If imaging of FA became larger or abnormal changes during follow-up examinations, needle biopsy should be recommended for assessment of the lesion positively. CONCLUSION This is the first report presenting a case of advanced breast cancer in FA of TN phenotype with multiple lymph node metastases who achieved pCR even if IDC was located within FA.
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Affiliation(s)
- Sho Shiino
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
| | - Momoko Tokura
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Chikashi Watase
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takeshi Murata
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Kenjiro Jimbo
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Shin Takayama
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Akihiko Suto
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Kaishi Satomi
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Akiko Miyagi Maeshima
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Mari Kikuchi
- Diagnostic Imaging Department, Cancer Institute Hospital, Tokyo 135-8550, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Nachiko Uchiyama
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan; National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
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Dória MT, Jales RM, Conz L, Derchain SFM, Sarian LOZ. Diagnostic accuracy of shear wave elastography – Virtual touch™ imaging quantification in the evaluation of breast masses: Impact on ultrasonography’s specificity and its ultimate clinical benefit. Eur J Radiol 2019; 113:74-80. [DOI: 10.1016/j.ejrad.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 12/18/2022]
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Marumoto A, Steinemann S, Furumoto N, Woodruff S. An Uncommon Pairing of common Tumors: Case Report of Ductal Carcinoma in situ Within Fibroadenoma. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:39-43. [PMID: 30766763 PMCID: PMC6369888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fibroadenomas are common benign tumors of the female breast. In the appropriate clinical setting, they are often managed expectantly without excision. Rarely, cancer may arise within a fibroadenoma, and this diagnosis mandates prompt treatment for malignancy. We present the case of a 70-year-old Samoan woman with ductal carcinoma in situ (DCIS) arising within a fibroadenoma. Health care practitioners should be aware of the possibility, particularly in older women, of finding carcinoma within a fibroadenoma, which informs the rationale for prompt surgical evaluation and follow up of all breast masses.
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Affiliation(s)
- Ashley Marumoto
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AM, SS, NF, SW)
- Department of Surgery, Pali Momi Medical Center, Aiea, HI (SW)
| | - Susan Steinemann
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AM, SS, NF, SW)
- Department of Surgery, Pali Momi Medical Center, Aiea, HI (SW)
| | - Nancy Furumoto
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AM, SS, NF, SW)
- Department of Surgery, Pali Momi Medical Center, Aiea, HI (SW)
| | - Stacey Woodruff
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (AM, SS, NF, SW)
- Department of Surgery, Pali Momi Medical Center, Aiea, HI (SW)
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Krishnamurthy K, Alghamdi S, Gyapong S, Kaplan S, Poppiti RJ. A clinicopathological study of fibroadenomas with epithelial proliferation including lobular carcinoma in-situ, atypical ductal hyperplasia, DCIS and invasive carcinoma. Breast Dis 2019; 38:97-101. [PMID: 30909180 DOI: 10.3233/bd-180368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Fibroadenoma is a benign mixed tumor composed of epithelial and non-epithelial components. The epithelial component of a fibroadenoma may exhibit proliferation, including lobular carcinoma in-situ, atypical ductal hyperplasia, DCIS and rarely, invasive breast carcinoma. OBJECTIVE In this series of 30 cases of fibroadenoma with epithelial proliferation, we assessed the radiological and histopathological findings of each entity. METHOD A retrospective review was performed to identify all fibroadenomas diagnosed at our institution between January 2012 and May 2018. RESULTS In a total of 1523 consecutive cases of fibroadenomas, thirty cases had epithelial proliferations with an overall prevalence of 1.97%. Eight cases had fibroadenoma with lobular carcinoma in-situ, six cases had atypical ductal hyperplasia, ten cases had DCIS and six cases had invasive carcinoma. In cases of fibroadenomas with lobular carcinoma in-situ, 62.5% of the cases the neoplasia was confined to the fibroadenoma whereas only 10% of the cases with DCIS showed confinement to the fibroadenoma (p = 0.036). The most common radiological finding was the presence of a mass. The BI-RADS scores were 4 and above in all cases (p > 0.05). CONCLUSION In our study population, the most common type of carcinoma arising in fibroadenomas was DCIS, followed by lobular carcinoma in-situ. Lobular carcinoma in-situ was more likely to be confined to the fibroadenoma while most DCIS involved surrounding breast tissue.
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Affiliation(s)
- Kritika Krishnamurthy
- Arkadi Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami, FL, USA
| | - Sarah Alghamdi
- Arkadi Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami, FL, USA
| | | | - Stuart Kaplan
- Radiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Robert J Poppiti
- Arkadi Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami, FL, USA
- FIU Herbert Wertheim College of Medicine, Miami, FL, USA
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27
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Hot S, Coşkun ZÜ, Akçakaya A, Bender Ö, Türkmen ÜA, Nayır PÖ, Sarı A, Hot AB. The breast lesion excision system procedure: An optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety. Saudi Med J 2018; 39:891-896. [PMID: 30251732 PMCID: PMC6201004 DOI: 10.15537/smj.2018.9.22573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the efficacy of the Breast lesion excision system (BLES) procedure as a primary excisional biopsy for the management of breast imaging-reporting and data system (BI-RADS) category 3, small, and solid breast lesions in women having severe breast cancer anxiety. Methods: A retospective study was conducted on 68 patients who underwent a BLES procedure. The study protocol was approved by the local ethical committee of Yeni Yuzyıl University in Istanbul, Turkey. The study was carried out according to the principles of the Helsinki Declaration. Small breast lesions removed using a (12, 15 or 20 mm) wand from September 2011 to November 2014. These were category 3 lesions as determined by ultrasound (US) imaging according to BI-RADS. The radiological and pathological sizes of these lesions, the complete excision rates, the procedure durations, the pathological diagnosis, the complications, and the imaging findings before and after the procedure were all recorded. Results: All the patients had a benign pathology. The mean duration of procedure was 12 (range=8-22) minutes. There was no major complication during the procedure and in the following period. Only some small hematomas were determined in 3 (4.2%) patients, and no additional surgical intervention was performed. Conclusion: The BLES procedure is an optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.
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Affiliation(s)
- Semih Hot
- Department of Surgery, Okmeydanı Education Research Hospital, University of Health Science, Istanbul, Turkey. E-mail.
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Neville G, Neill CO, Murphy R, Corrigan M, Redmond PH, Feeley L, Bennett MW, O'Connell F, Browne TJ. Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J 2018; 24:981-985. [DOI: 10.1111/tbj.13069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Grace Neville
- Department of Pathology; Cork University Hospital Group; Cork Ireland
| | | | - Rosemary Murphy
- Department of Radiology; Cork University Hospital Group; Cork Ireland
| | - Mark Corrigan
- Department of Surgery; Cork University Hospital Group; Cork Ireland
| | - Paul H. Redmond
- Department of Surgery; Cork University Hospital Group; Cork Ireland
| | - Linda Feeley
- Department of Pathology; Cork University Hospital Group; Cork Ireland
| | | | | | - Tara Jane Browne
- Department of Pathology; Cork University Hospital Group; Cork Ireland
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Abstract
RATIONALE Most breast masses are benign and are rare in adolescent girls. The most frequent tumor is fibroadenoma. Juvenile fibroadenoma is a rare variant of fibroadenoma and is characterized by rapidly enlarging, painless, and unilateral masses occurring at ages between 10 and 18 years. PATIENT CONCERNS A 17-year-old girl who first presented to a hospital due to a left breast tumor. DIAGNOSES Juvenile fibroadenoma of the left breast. INTERVENTIONS She underwent fibroadenoma excision, but she complained of a mass that presented in her left breast 3 months after surgery. After 2 years of observation, the mass became tender and enlarged. We conducted a wide excision of the tumor. Recurrent juvenile fibroadenoma with hypercellular fibromyxoid stroma of the breast was noted. OUTCOMES The patient is in good general condition without tumor relapses during the 4 months of follow-up. LESSONS Recurrent fibroadenomas, particularly those of a large size with a rapid growth rate, in the same breast suggest a high possibility of transformation. We recommend wide tumor resection.
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Affiliation(s)
| | - Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University
| | - Dah-Ching Ding
- School of Medicine, Tzu Chi University, Hualien
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, Republic of China
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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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Lim S, Shim MK, Cho EY, Cho SY. Secretory Carcinoma Arising in a Fibroadenoma: A Brief Case Report. J Pathol Transl Med 2017; 52:198-201. [PMID: 28994273 PMCID: PMC5964283 DOI: 10.4132/jptm.2017.08.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sharon Lim
- Department of Pathology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | | | - Eun Yoon Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Soo Youn Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
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32
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The role of malignant tissue on the thermal distribution of cancerous breast. J Theor Biol 2017; 426:152-161. [DOI: 10.1016/j.jtbi.2017.05.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/18/2017] [Accepted: 05/23/2017] [Indexed: 11/20/2022]
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Egejuru RO, Nnadi IG, Duru ON. Fibroadenoma in Blacks. Health (London) 2017. [DOI: 10.4236/health.2017.911108] [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]
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Travieso Aja MDM, Munoz P, Rodriguez Rodriguez M, Vega Benitez V, Luzardo OP. A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e32190. [PMID: 27853496 PMCID: PMC5107243 DOI: 10.5812/iranjradiol.32190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/16/2015] [Accepted: 12/26/2015] [Indexed: 11/16/2022]
Abstract
Up to 19% of breast malignancies may be missed by conventional imaging techniques, especially when they are concurrent or co-located with other benign lesions. However, more sensitive techniques, such as magnetic resonance imaging (MRI), are often too expensive for routine use in developing countries. Contrast-enhanced, dual-energy digital mammography (CESM) is a recently introduced imaging modality whose performance has been reported to be similar to that of MRI. Being much cheaper, CESM may constitute a good alternative for improving diagnostic sensitivity in these countries. In this paper, we present a challenging case of the concurrent and co-located presentation of a fibroadenoma and a triple negative invasive carcinoma of no special type (TNBC-NST). The malignancy was indistinguishable from the fibroadenoma by mammography. By ultrasound, a suspicious area was observed and biopsied, but the histopathology did not confirm a cancer diagnosis. As the suspicion was not confirmed, a second stage of the imaging diagnosis using CESM was recommended. This technique allowed clear visualization of the malignancy, which was finally excised by breast-conserving surgery. This case reveals the potential of CESM as an easy, rapid and inexpensive new technique for the diagnosis of malignancies that might easily remain occult to mammography plus breast ultrasound (BUS).
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Affiliation(s)
- Maria Del Mar Travieso Aja
- Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain
- Corresponding author: Maria Del Mar Travieso Aja, Imaging Diagnostic Service, San Roque Hospital Group, Las Palmas, Spain. Tel: +34-928012600, Fax: +34-928451461, E-mail:
| | | | | | - Victor Vega Benitez
- Department of Surgery, Insular and Maternal and Child Hospitals (CHUIMI), Las Palmas, Spain
| | - Octavio P. Luzardo
- Research Group in Environment and Health, Research Institute of Biomedical and Health Sciences (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
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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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Bednarski P, Dobruch-Sobczak K, Chrapowicki E, Jakubowski W. Breast ultrasound scans - surgeons' expectations. J Ultrason 2015; 15:164-71. [PMID: 26675118 PMCID: PMC4579747 DOI: 10.15557/jou.2015.0014] [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: 02/12/2015] [Revised: 03/01/2015] [Accepted: 03/10/2015] [Indexed: 12/02/2022] Open
Abstract
Recent years have witnessed a dynamic development of mammary gland imaging techniques, particularly ultrasonography and magnetic resonance imaging. A challenge related to these studies is the increase in the precision of the anatomical assessment of breast, particularly for early detection of subclinical lesions, performance of ultrasound- guided biopsy procedures, and accurate preoperative location of pathological lesions so as to optimize the surgical treatment. Ultrasound imaging is a primary and baseline diagnostic procedure the patient with suspected pathological lesions within breast is referred to by the surgeon. Lesions visualized in ultrasound scans are classified according to the BI-RADS US assessment categories. The successive categories (2 through 6) encompass individual pathological lesions, estimating the risk of malignancy and provide guidelines for further diagnostic and therapeutic management. This article described the important aspects of ultrasonographic imaging of focal lesions within the breasts as significant from the standpoint of surgical treatment of patients falling within BI-RADS US categories 3, 4, 5, and 6. Attention is drawn to the importance of ultrasound scans in the assessment of axillary fossa lymph nodes before the decision regarding the surgical treatment.
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Affiliation(s)
| | - Katarzyna Dobruch-Sobczak
- Department of Radiodiagnostics, 2nd Ultrasonography Lab, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Eryk Chrapowicki
- Cancer Center and Institute of Oncology Maria Sklodowska-Curie Memorial, Warsaw, Poland
| | - Wiesław Jakubowski
- Medical University of Warsaw, 2nd Faculty of Medicine, Department of Diagnostic Imaging, Kondratowicza 8, Warsaw, Poland
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Kovatcheva R, Guglielmina JN, Abehsera M, Boulanger L, Laurent N, Poncelet E. Ultrasound-guided high-intensity focused ultrasound treatment of breast fibroadenoma-a multicenter experience. J Ther Ultrasound 2015; 3:1. [PMID: 25635224 PMCID: PMC4310188 DOI: 10.1186/s40349-014-0022-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/08/2014] [Indexed: 01/20/2023] Open
Abstract
Background The aim of our multicenter study was to assess the clinical outcome and safety of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) in patients with breast fibroadenoma (FA). Methods From May 2011 to February 2013, 42 women with 51 FA in one or both breasts were selected for treatment with US-guided HIFU. Eight of 51 FA were treated twice. Patients’ age ranged from 16 to 52 years (mean 32 years). All patients with FA underwent core needle biopsy with histological confirmation. HIFU treatment was performed as an outpatient procedure under conscious sedation. Exclusion criteria were pregnant or lactating women, microcalcifications within the lesion at mammogram, history of breast cancer, previous laser or radiation therapy, and breast implant in the same breast. All patients signed written informed consent. After the treatment, follow-up US with volume evaluation was performed at 2, 6, and 12 months. Results The FA mean baseline volume was 3.89 ml (0.34–19.66 ml). At 2-month follow-up, the mean volume reduction was 33.2% ± 19.1% and achieved significance at 6-month (59.2% ± 18.2%, p < 0.001) and 12-month (72.5% ± 16.7%, p < 0.001) follow-up. Related side effects as superficial skin burn with blister-like aspect in three patients and hyperpigmentation over the treated area in one patient were transient and resolved spontaneously. In one patient, asymptomatic subcutaneous induration persisted at the end of the study. Conclusions US-guided HIFU treatment is an effective noninvasive method for the treatment of breast FA and well tolerated by the patients. Preliminary results are encouraging and show that HIFU could be an alternative to surgery for breast FA.
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Affiliation(s)
- Roussanka Kovatcheva
- Department of Thyroid and Metabolic Bone Disorders, University Hospital of Endocrinology, Medical University of Sofia, 2 Zdrave Street, 1431 Sofia, Bulgaria
| | - Jean-Noël Guglielmina
- Department of Gynecological Surgery, American Hospital of Paris, 63 Bld Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Marc Abehsera
- Department of Medical Imaging, American Hospital of Paris, 63 Bld Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Loïc Boulanger
- Department of Gynecological and Breast Surgery, University Hospital of Lille, Ave Eugène Avinée, 59037 Lille, France
| | - Nicolas Laurent
- Department of Imaging, Regional Hospital of Valenciennes, Ave Désandrouin - BP 479, 59322 Valenciennes, France
| | - Edouard Poncelet
- Department of Imaging, Regional Hospital of Valenciennes, Ave Désandrouin - BP 479, 59322 Valenciennes, France
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