Fibroadenoma gigante juvenil y cirugía de reconstrucción: reporte de un caso y revisión de la bibliografía / Giant juvenile fibroadenoma and reconstruction surgery: A case report and literature review

El fibroadenoma es la lesión mamaria benigna más frecuente en la mujer joven, siendo el fibroadenoma gigante juvenil una entidad que aparece principalmente en menores de 25 años. Con una etiología actualmente no bien establecida, se caracteriza por ser una lesión tipo masa mayor de 5cm que puede ocupar más del 80% de la mama y que presenta un importante crecimiento con las consecuencias físicas y psicológicas que ello conlleva. A pesar de ser una lesión benigna, su evolución progresiva con un rápido crecimiento obliga a descartar malignidad, lo cual ocurre en menos del 0,2% de los casos. El diagnóstico se basa en una correcta anamnesis, exploración física y pruebas complementarias, siendo preferible la ecografía. El estudio anatomopatológico mediante biopsia permite confirmar el diagnóstico clínico de benignidad o descartar malignidad ante una evolución sospechosa. El tratamiento es quirúrgico y consiste en la escisión completa de la lesión variando la técnica quirúrgica realizada (desde cirugía conservadora hasta mastectomía con reconstrucción) según el tamaño de la lesión, las características de la mama y la edad de la paciente. (AU)

Fibroadenoma is the most common benign breast lesion in young women, being the giant juvenile fibroadenoma an entity that appears mainly in those under 25 years. With an etiology currently not well established, it is described as a mass type lesion greater than 5cm or that occupies more than 80% of the breast and presents significant growth, with the physical and psychological consequences that this entails. Despite being a benign lesion, its fast evolution and growth makes it necessary to rule out malignancy, which occurs in less than 0.2% of the cases. The diagnosis is based on a correct anamnesis, physical examination and complementary tests, preferable with ultrasound. The anatomopathological study by biopsy allows to confirm the clinical diagnosis of benignity or to rule out malignancy in the event of a suspicious evolution. Its management is surgical and consists of complete excision of the lesion, varying the surgical technique performed (from conservative surgery to mastectomy with reconstruction) according to the size of the lesion, the characteristics of the breast, and the age of the patient. (AU)

Ultrasound Imaging Characteristics of Breast Lesions Diagnosed During Pregnancy and Lactation.

Background and Objectives: The breast undergoes extensive physiologic changes during pregnancy/lactation. We aimed to review the ultrasound (US) imaging characteristics of breast lesions during pregnancy/lactation and to demonstrate ultrasonography as an excellent imaging modality in this patient population. Materials and Methods: We performed a retrospective study involving 195 patients with 206 pathologically confirmed breast lesions during pregnancy/lactation over the period of January 2010 to December 2018; 51 were diagnosed with breast cancer, including 50 invasive ductal carcinomas and 1 low malignant potential phyllodes tumor, whereas 144 were diagnosed with 155 benign lesions, including 103 mastitis/abscesses, 45 fibroadenomas, 2 intraductal papillomas, 2 sclerosing lesions, and 3 benign phyllodes tumors. The patients' age, lesion diameter, and US characteristics were analyzed. Results: The breast lesions of patients during pregnancy/lactation were compared with those during nonpregnancy/lactation. Patients with breast cancer or fibroadenomas during pregnancy/lactation were younger than those during nonpregnancy/lactation. The average lesion diameter was significantly higher among pregnant/lactating patients compared with controls of childbearing age for fibroadenomas, but not for malignant lesions. The fibroadenomas and mastitis/abscesses during pregnancy/lactation usually have higher BI-RADS categories than those during nonpregnancy/lactation. Conclusions: The imaging features of breast cancer during pregnancy/lactation did not differ much from those of nonpregnancy/lactation; however, some benign lesions had suspicious sonographic features, and US-guided core biopsies were necessary for differentiating benign from malignant lesions.

Fibroadenoma in adolescent females after living donor liver transplantation.

Breast FA is the most common breast tumor diagnosed in young women. Female renal transplant recipients on CsA have an increased risk of developing FA. However, reports of FA after LDLT have not been described. Our objectives were to determine the incidence of FA, analyze risk factors for FA, and evaluate treatment strategies in adolescent females after LDLT. A total of 18 female patients aged 10-19 years who underwent LDLT and survived at least one year after transplantation were enrolled in our study. The incidence of FA was 11.1%. To determine pre- or post-transplant conditions that are associated with FA after transplantation, the patients were divided into two groups according to the presence or absence of FA: FA group (n=2) and non-FA group (n=16). There were no differences in mean age at LDLT, mean age at breast evaluation, and mean duration between transplantation and breast evaluation between the two groups. However, there was a difference in the immunosuppressive regimen between the two groups. The FA group was maintained on CsA, whereas the non-FA group was maintained on tacrolimus. CsA might be implicated in FA development in adolescent females after LDLT.

Diagnostic dilemmas and pitfalls in ThinPrep® cytology of breast fine needle aspiration biopsy:: Report of Six Cases with Histological Correlates.

Fine needle aspirations (FNA) of the breast for primary diagnoses have become less popular in the USA and are usually performed for lesions with low or extremely high clinical suspicion. They are also performed for lesions in close proximity to a breast implant. Liquid-based cytological preparations, such as ThinPrep® (TP), provide a practical alternative to clinicians who are performing FNA. Using a selection of cases that represent challenging diagnoses, we describe common diagnostic pitfalls of breast FNA that are specifically associated with this preparation. Well known breast cytology pitfalls, such as fibroadenoma, when solely examined using a TP slide can be even more challenging since the usual stripped bipolar cells seen in the background of smeared slides, can appear singly dispersed with preserved cytoplasm, resembling carcinoma. We describe that large fragments of solid papillary carcinoma are represented by mostly singly dispersed cells with plasmacytoid features that mimic those of a lobular carcinoma. Since nuclear features are more pronounced in TP, prominent nucleoli and cytological atypia can potentially be overcalled. TP processing might also lead to clumping of epithelioid histiocytes that appear atypical, which increases the suspicion of malignancy. The presence of atypical cells in a TP slide of a peri implant seroma should always undergo additional testing, especially in patients with a prior history of breast carcinoma, to determine if it represents recurrent carcinoma or an implant associated anaplastic large cell lymphoma. Familiarity with the aforementioned artifacts associated with TP is essential to avoid diagnostic misinterpretations. Diagn. Cytopathol. 2017;45:655-661. © 2017 Wiley Periodicals, Inc.

Fibroadenoma in Axillary Supernumerary Breast in a 17-Year-Old Girl: Case Report.

BACKGROUND: Supernumerary breast or polymastia is a well documented anomaly of the breast, and commonly presents along the embryonic milk line extending between the axilla and groin. However, cases of polymastia have been recorded in the face, vulva, and perineum. The clinical significance of these anomalies include their susceptibility to inflammatory and malignant changes, and their association with other congenital anomalies of the urinary and cardiovascular systems. CASE: In this article we report a case of fibroadenoma that developed in the supernumerary breast of the right axilla in a 17-year-old girl. It is uncommon to find such palpable masses in young patients. Clinical and sonographic examination of both breasts revealed no abnormalities and no lymph nodes were detected in the axillae or the neck. No associated urologic or cardiovascular abnormalities were found, and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated intracanalicular type of fibroadenoma similar to that of eutopic mammary tissue. SUMMARY AND CONCLUSION: In this report, we describe a rare case of fibroadenoma in an accessory breast in a young woman. There are a fewer than 40 reports in the world about this subject, of which differential diagnoses include: cancer in axillary supernumerary breast, hidradenitis, axillary lymphadenomegaly, lipomas, anexial cutaneous neoplasia, cysts, and phylloides tumor. The combination of clinical examination, ultrasound, and cytology leads to adequate treatment, especially surgical. The diagnosis could be confused because of findings from cytology. In this case, because of the clinical and sonographic findings and multiple differential diagnosis, only the histopathological study was used to confirm the diagnosis. Despite its high sensitivity, cytology has low specificity and could create false positive results. However, atypical lesions can be seen in fibroadenomas, especially in younger patients, pregnant patients, and in patients who use hormonal contraception. Although there are a few reports, our case report is similar to current medical registers and, after surgical treatment, our patient had an excellent prognosis.

Fibroadenoma in axilla: another manifestation of ectopic breast.

Fibroadenoma of an accessory breast is a rare disease. The clinical significance lies in the fact that a number of cystic, inflammatory, neoplastic diseases similar to those of a normal breast have been reported in accessory breasts as well. Vigilant self-assessment and complete clinical examination are always encouraged to detect earliest malignancy in the axilla. We report two cases of ectopic breast fibroadenoma with the relevant literature.

Fibroadenoma in Beckwith-Wiedemann syndrome with paternal uniparental disomy of chromosome 11p15.5.

Herein is described a case of breast fibroadenomas in a 16-year-old girl with Beckwith-Wiedemann syndrome (BWS) and uniparental disomy (UPD) of chromosome 11p15.5. She was clinically diagnosed with BWS and direct closure was performed for an omphalocele at birth. Subtotal and 90% pancreatectomy were performed for nesidioblastosis at the ages 2 months and 8 years, respectively. Bilateral multiple breast fibroadenomas were noted at the age of 16 and 17 years. In this case, paternal UPD of chromosome 11p15.5 was identified on microsatellite marker analysis. The relevant imprinted chromosomal region in BWS is 11p15.5, and UPD of chromosome 11p15 is a risk factor for BWS-associated tumorigenicity. Chromosome 11p15.5 consists of imprinting domains of IGF2, the expression of which is associated with the tumorigenesis of various breast cancers. This case suggests that fibroadenomas occurred in association with BWS.

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.

An atypical growth of a giant fibroadenoma after trauma.

BACKGROUND: Fibroadenomas are the most common benign breast lesion in female adolescents. However, it is important to recognize that a small percentage have been shown to progress to giant fibroadenomas. Giant fibroadenomas can spontaneously infarct leading to significant morbidity and are also difficult to distinguish from the more aggressive phyllodes tumors. CASE: We describe the first case, to the best of our knowledge, of a 12-year-old girl who presented with a giant fibroadenoma complicated by a central infarct and an intra-lesional hemorrhage from a trauma to the breast. SUMMARY AND CONCLUSION: The complicated giant fibroadenoma with an intra-lesional hemorrhage has characteristics of both benign and malignant lesions, and is difficult to distinguish by history and physical alone. Ultrasonography is a valuable tool yet the core needle biopsy remains the gold standard to confirm the diagnosis.

Role of exogenous and endogenous sources of estrogen on the incidence of breast fibroadenoma: case-control study in Iran.

Breast fibroadenoma (FAD) is the most common benign mammary condition among women but the environmental risk factors have not identified yet. As the role of long term estrogen exposure in the incidence of FAD has been remained controversial; we have decided to investigate the possible role of endogenous and exogenous sources of estrogens in present study. Women less than 45 years old who underwent surgery from June 2009 to June 2010 were matched with controls by age and hospital. From reproductive factors, lack of breast feeding (p< 0.001, 8.76 CI95% 3.79-20.24), Nulliparity (p=0.001, OR=8.09, CI95% 3.505-18.67), Lack of parity (p=0.001, OR=6.64, CI 95% 2.56-16.31) and Hormonal dysfunction (p=0.016, OR=4.66, CI 95% 1.26- 17.28) were considered as the most important ones. Adiposity and abnormal weight gain after 18 years were considered as major background factor which induce FAD and may be contributed to the level of endogenous estrogen. Out of evaluated exogenous sources of estrogen, lower age at first OCP consumption (20.76_+3.87 vs. 22.85_+3.88, p=0.046) and living near Polycyclic aromatic hydrocarbons (PAHs) producing factories (p< 0.001, OR=3.7, CI95%1.61-7.94), were considered as the main sources of exposure to xenestrogens in FAD patients but FAD showed inverse association with cigarette smoking because of antiestrogenic activities of cigarette smoking . This study concludes that the incidence and development of FAD could be associated with the reproductive history of women, activity of ovarian hormones as well as environmental factors.

Case of Bowen's disease accompanying syringofibroadenoma.

Syringofibroadenoma is an extremely rare benign lesion with distinct histopathological features and variable clinical presentations. Most cases of syringofibroadenoma are thought to be benign skin appendage tumor with eccrine ductal differentiation, however, some syringofibroadenomas are suspected to be a reactive process. Herein, we report the first case of Bowen's disease accompanying syringofibroadenoma, which is suspected to be a reactive process, in a 78-year-old Japanese man. The precise nature of syringofibroadenoma accompanying carcinoma is still controversial. Syringofibroadenoma is thought to be a pre-existing neoplastic condition in some cases. In contrast, syringofibroadenoma is also considered to occur in a reactive process involving several inflammatory dermatoses and skin tumors, and the term "reactive syringofibroadenomatous hyperplasia" has been proposed. In this report, we summarize the clinicopathological features of carcinoma accompanying syringofibroadenoma and discuss the nature of syringofibroadenoma.

Role of hormonal and environmental factors on early incidence of breast cancer in Iran.

Although the probability of having breast cancer increases with the age in general, this malignancy affects Iranian women at least one decade younger than their counterparts in other countries. However the underlying risk factors for the discrepancy have not been identified. The aryl hydrocarbon receptor (AhR) mediates the effects of many environmental endocrine disruptors and contributes to the loss of normal ovarian function in polluted environments. This study was aimed to compare the interactions between AhR and other fundamental genes (p53, K-Ras, ER, PgR) in a clinical setting. To conduct the immunohistochemical studies using appropriate monoclonal antibodies, 25 premenopausal invasive ductal carcinoma, 29 postmenopausal invasive ductal carcinoma and 30 breast fibroadenoma were selected retrospectively from 2004 to 2007 in the pathology department of Imam Khomeini hospital complex of Tehran University of Medical Sciences . Higher levels of AhR in epithelial cells of premenopausal patients and breast fibroadenoma emphasized the susceptibility of these cells to environmental-induced tumors. AhR overexpression contributed to ER-/PgR-immunophenotype in young/premenopausal patients but the same pattern was not observed in benign and postmenopausal malignant tumors. It seems that early incidence of breast cancer in Iran is the result of interactions between hormonal and environmental factors.

Management of mastitis and abscessation of mammary glands secondary to fibroadenomatous hyperplasia in a primiparturient cat.

CASE DESCRIPTION: A 1-year-old sexually intact female domestic shorthair cat was evaluated because of an 8-week history of pronounced mammary gland hyperplasia that had progressed to mastitis and abscessation of the mammary glands since parturition 7 days earlier. The cat was anorectic, was febrile, and had signs of discomfort. Its kittens were weak and appeared to have difficulty nursing. CLINICAL FINDINGS: Physical examination revealed pyrexia, mastitis with abscessation in the 6 caudal mammary glands, skin ulceration over the nipples, and areas of skin necrosis over the abscessed mammary glands. A CBC revealed nonregenerative anemia and leukocytosis with a left shift (2.160 x 10(9) band cells/L) and toxic changes. Mastitis and incipient septicemia were considered the most likely causes. The history of mammary gland hyperplasia since the second week of pregnancy suggested a diagnosis of fibroadenomatous hyperplasia that predisposed the cat to subsequent mastitis. TREATMENT AND OUTCOME: Surgical drainage of the abscessed mammary glands, debridement of necrotic skin, and placement of a Penrose drain resulted in rapid improvement in clinical status. Broad-spectrum antimicrobial treatment (amoxicillin-clavulanic acid) was prescribed, and the cat was discharged from the hospital. Mastitis and fibroadenomatous mammary gland hyperplasia resolved rapidly afterward. CLINICAL RELEVANCE: Management of abscessed mammary glands through surgical drainage and drain placement is an option for treatment of cats with complications of fibroadenomatous hyperplasia. In the cat of this report, the treatment approach resulted in rapid resolution of mastitis, was less invasive than mastectomy, and avoided the potential complications of treatment with a progesterone-receptor antagonist.

Fibroadenoma and intraduct papilloma--a common pathogenesis?

This report describes two cases, each showing fibroepithelial proliferation, admixed with intraduct papillomas. Case 1 was from a 13-year-old female who presented with a breast mass, while case 2 was from a 60-year-old female who also had a breast lump. Case 1 showed proliferative breast disease with multiple small papillomas, some with leaf-like contours. Broad-based parenchymal proliferations protruding into ducts were also seen, and there were overlap features between the two ends of this spectrum. Case 2, similarly, demonstrated a mixed intraductal proliferation, with papillomas on narrow stalks together with low-grade phyllode areas extending into ducts from a wider base. That fibroadenoma and intraduct papilloma may have a common pathogenesis is discussed.

Morphologic changes in fibroadenoma of breast due to chickenpox: a case report with suspicious cytology in fine needle aspiration smears.

BACKGROUND: Fibroadenomas with stromal giant cell reaction have been described in the literature, but cytologic atypia including giant cell reaction due to chickenpox giving rise to suspicious cytology has not been reported. CASE REPORT: A 25-year-old woman, recovering from chickenpox, presented with a 1.5 x 1.5-cm mass in the lower outer quadrant of her right breast. Fine needle aspiration smears showed sheets of benign ductal cells with overlapping myoepithelial cells and many bipolar bare nuclei. Cells showing nuclear enlargement, prominent nucleoli and multilobated or multinucleated giant cell formation occurred in separate sheets or dispersed among groups of benign ductal cells. Cytodiagnosis was suspicion for malignancy; excision biopsy was advised. Histopathologic examination showed fibroadenoma with evidence of epithelial hyperplasia, nuclear enlargement and multilobated giant cell formation. Atypical ductal cells, including the giant cells, were immunohistochemically positive for epithelial membrane antigen, estrogen receptor and progesterone receptor and negative for smooth muscle actin, indicating epithelial origin. Both cytologic and histologic specimens showed focal positive reaction with HSV-1 and HSV-2 antibodies. Ultrastructural examination of aspirated material revealed cytoplasmic viral particles with characteristic surface projections. CONCLUSION: Herpes zoster virus can produce morphologic alteration mimicking a malignancy. Pathologists should be aware of these changes to avoid a false positive diagnosis.

Cooperative induction of rat mammary cancer by radiation and 1-methyl-1-nitrosourea via the oncogenic pathways involving c-Myc activation and H-ras mutation.

Humans are continually exposed to various environmental carcinogens. Cancers may arise as a result of exposure to carcinogenic chemicals, ionizing radiation or a combination thereof. However, the mechanism of combined carcinogenesis has been only deduced from oncogenic actions of individual agents. Here, we analyzed experimental mammary carcinogenesis caused by a combination of radiation and a chemical carcinogen, 1-methyl-1-nitrosourea (MNU). Seven-week-old female Sprague-Dawley rats were divided into 4 groups: control, g gamma-irradiated (2 Gy), MNU-treated (40 mg/kg, i.p.) and combined treatment of radiation with subsequent MNU after 3 days. Rats with palpable tumors were sacrificed at 50 weeks of age to collect tumors for histologic typing and mutational analysis of the H-ras gene codon 12. The combined treatment induced adenocarcinomas, but not fibroadenomas, more efficiently than radiation or MNU alone. The H-ras mutation was not seen in radiation-induced carcinomas and was specific to MNU-induced carcinomas in individually treated groups. In the combined treatment group, H-ras-mutated, but not nonmutated, tumors were more frequent and developed significantly earlier than in the MNU-treated group. Significantly higher numbers of cells were stained for activated c-Myc protein in g gamma-ray- and combined treatment-induced cancers than in MNU-induced cancers. These results indicate that combined exposure to the 2 carcinogens elicits an unexpected cooperativity in which pre-irradiation enhances mammary carcinogenesis predominantly through the oncogenic pathway involving H-ras, possibly by synergism with c-Myc activation.