Patología mamaria en niñas y adolescentes: a propósito de un caso / Breast pathology in adolescents: case report

La patología mamaria en el grupo de niñas y adolescentes es poco frecuente, correspondiendo generalmente a lesiones benignas, sin embargo, crea gran ansiedad en la paciente y su grupo familiar .El propósito del presente artículo es en base a un caso clínico larevisión de la patología mamaria benigna más frecuente en este grupo etario, las imágenes y su tratamiento...

Pediatric and adolescents breast masses are relatively rare, and most are benign, nevertheless, is very disconcerting in the patient and her family. The purpose of this article is based on a case review the benign breast conditions, the imaging findings and treatmentstrategies in this population...

Evolución inusual de fibroadenomas mamarios múltiples en adolescente con metrorragia disfuncional / Unusual evolution of multiple breast fibroadenomas in adolescent with dysfunctional uterine bleeding

Se describe la inusual evolución de fibroadenomas (FA) mamarios múltiples en una adolescente de 11 años en tratamiento con progestinas cíclicas por metrorragia disfuncional. Inicialmente la ecografía mamaria mostró más de 10 lesiones sólidas en cada mama de hasta 2,6 cm, compatibles con fibroadenomas. Al cabo de 13 meses las lesiones se redujeron en número y tamaño. Se discute la historia natural de los FA, la influencia hormonal en la etiología de los FA y finalmente el diagnóstico ecográfico y manejo de este cuadro en la adolescencia. Se plantea, a modo de hipótesis, que existe un desbalance estrógeno-progesterona (E-P) dado por ciclos anovulatorios en el periodo posmenárquico, que se manifestó con metrorragia disfuncional y la presencia de FA. Al administrar progesterona cíclica se reequilibra la relación E-P explicando el control del ciclo y la involución de las lesiones mamarias.

We describe the unusual evolution of multiple fibroadenomas (FA) in a 11-years old adolescent during treatment of an abnormal uterine bleeding with cyclic progestins. Inicially ultrasound demonstrated more than 10 masses in each breast, up to 2,6 cm diameter, compatible with fibroadenomas. After 13 month follow up lesions decreased in number and size. We discuss the natural history of FA, the hormonal influence in FA etiology, the ultrasound diagnosis and the managment of this pathology in adolescents. We hypothesized that there is an estrogen/progestin imbalance, due to the anovulatory cycles of the post menarche period that caused the AUB and FA. Cyclic progesterone balanced the E/P relation, thus managing both AUB and causing regression of the breast masses.

Importancia de la información en el control de los síntomas de la displasia mamaria / Importance of information in the control of the symptoms of breast dysplasia

INTRODUCCIÓN. La displasia mamaria es un problema de salud de gran repercusión social, por el estrés y la ansiedad que suelen acompañarla. El presente trabajo tuvo el objetivo de valorar diferentes variantes de conducta ante esta afección. MÉTODOS. Se realizó un estudio retrospectivo-prospectivo con 3668 pacientes diagnosticadas de displasia mamaria, y atendidas por esta razón entre enero de 1991 y diciembre de 2004 en el Hospital Universitario Comandante «Manuel Fajardo¼. RESULTADOS. La incidencia de displasia mamaria (enfermedad fibroquística) en la consulta de patología mamaria fue del 50 por ciento, seguida en frecuencia por el fibroadenoma y las enfermedades inflamatorias. Se realizó el estudio en dos etapas: una con carácter retrospectivo (1991-1996) y otra con carácter prospectivo (1997-2004). La evolución de los casos que solo recibieron información fue similar a la de los pacientes que fueron sometidos a otros esquemas de tratamiento médico, en ambas etapas. Se necesitó exéresis quirúrgica en el 16,21 por ciento y 13,42 por ciento de los pacientes, respectivamente, a causa de dudas en relación con un carcinoma. CONCLUSIONES. La información médica es una opción que puede utilizarse en más del 70 por ciento de las mujeres que presentan displasia mamaria (enfermedad fibroquística). Tiene la ventaja de que los resultados son más duraderos que los del tratamiento médico, y de que disminuye el consumo innecesario de medicamentos. El tratamiento quirúrgico de la enfermedad fibroquística está solo justificado ante la duda de cáncer y en lesiones que no se modifican ni duelen durante el ciclo menstrual, sobre todo en el caso de mujeres mayores de 35 años(AU)

INTRODUCTION. Breast dysplasia is a health problem of great social impact due to the stress and anxiety accompanying it. The present paper was aimed at assessing different variants of behavior before this affection. METHODS. A retrospective prospective study was conducted among 3 688 patients that were diagnosed breast dysplasia and received attention from January 1991 to December 2004 in «Comandante Manuel Fajardo¼ Teaching Hospital. RESULTS. The incidence of breast dysplasia (fibrocystic disease) at the breast pathology office was 50 percent, followed in frequency by fibroadenoma and inflammatory diseases. A two-stage study was undertaken: one with retrospective character (1991-1996) and the other with prospective character (1997-2004). The evolution of the cases that received only information was similar to that of those that underwent other medical treatment schemes, in both stages. Surgical exeresis was necessary in 16.21 percent and 13.42 percent of the patients, respectively, due to suspicion of carcinoma. CONCLUSIONS. Medical information is an option that may be used in more than 70 percent of females with breast dysplasia (fibrocystic disease). Some of its advantages are that the results last more than those of medical treatment and that it reduces the unnecessary administration of drugs. The surgical treatment of the fibrocystic disease is only justified when cancer is suspected and in lesions that neither modify nor hurt during the menstrual cycle, mainly in females over 35(AU)

Effect of oral contraceptive with and without associated estriol on ultrasound measurements of breast fibroadenoma: randomized clinical trial

CONTEXT AND OBJECTIVE: Fibroadenomas are the most common benign tumors of the female breast. The aim of this study was to evaluate the proliferative activity of breast fibroadenoma as shown by ultrasound measurements, following administration of oral contraceptives with and without associated estriol. DESIGN AND SETTING: This was a randomized, double-blind, placebo-controlled clinical trial carried out in the Mastology Sector, Department of Gynecology, Universidade Federal de São Paulo. METHODS: We studied 33 women with fibroadenomas. Ten were placed in group 1 and took an oral contraceptive consisting of levonorgestrel and ethinyl estradiol together with placebo material in the same capsule, for four consecutive cycles with a seven-day interval between them. The other 23 patients constituted group 2 and took the oral contraceptive as above together with estriol in the same capsule, in the same way as done by the group 1 patients. We took ultrasound measurements of their tumors (in three dimensions) before and after the intake of medication. At the end of the study, all the patients had their tumors removed by surgery. RESULTS: We observed decreased fibroadenoma width among the users of oral contraceptives with placebo, and this decrease was statistically significant. In the other group, we did not observe any changes (in width, length or height). CONCLUSION: The results confirm that estriol may block the protective effect of oral contraceptives on fibroadenomas, since we observed decreased fibroadenoma width among the group 1 patients but not the group 2 patients.

CONTEXTO E OBJETIVO: Fibroadenomas são os tumores benignos mais comuns na mama feminina. Avaliamos a atividade proliferativa do fibroadenoma mamário por medidas ultra-sonográficas após a administração de anticoncepcional hormonal combinado oral, associado ou não ao estriol. TIPO DE ESTUDO E LOCAL: Ensaio clínico randomizado, duplo-cego, placebo-controlado, realizado na Universidade Federal de São Paulo. MÉTODOS: Foram estudadas 33 pacientes portadoras de fibroadenoma, do setor de Mastologia da Disciplina de Ginecologia da Universidade Federal de São Paulo, sendo que 10 mulheres constituíram o grupo 1 e utilizaram anticoncepcional oral composto de levonorgestrel e etinilestradiol, associados a um comprimido de placebo, na mesma cápsula, por quatro ciclos consecutivos, com intervalo de sete dias entre os mesmos. As restantes 23 pacientes alocaram-se no grupo 2 e ingeriram, além do anticoncepcional oral descrito acima, um comprimido de estriol, que foi manufaturado conjuntamente ao anticoncepcional, em uma mesma cápsula, sendo utilizado da mesma forma que nas pacientes do grupo 1. Realizamos medidas ultra-sonográficas dos tumores (três dimensões) antes e após a ingestão da medicação. Ao término do estudo, as pacientes sofreram exérese de suas tumorações. RESULTADOS: Obtivemos diminuição da largura nos fibroadenomas de pacientes usuárias apenas de anticoncepcional oral e esse resultado foi estatisticamente significante. Não houve alteração de nenhuma dimensão (largura, altura ou comprimento) no outro grupo. CONCLUSÕES: Os resultados corroboraram que o estriol bloquearia o efeito protetor do anticoncepcional hormonal combinado oral sobre os fibroadenomas, já que observamos diminuição na largura dos fibroadenomas das pacientes do grupo 1 e não do grupo 2.