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Brouwer de Koning IM, van Heusden HC, Mol SJJ, Rots ML, Draaisma WA, Bosscha K. A rapidly growing fibroadenoma in a pregnant woman: A case report. Breast Dis 2023; 42:325-330. [PMID: 37899052 DOI: 10.3233/bd-230030] [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: 10/31/2023]
Abstract
BACKGROUND Fibroadenomas are the most common benign breast lesions in women. They present as a unilateral mass and can rapidly enlarge in size through hormonal changes. Fibroadenomas could be classified as small or giant, and as simple or complex. They are classified as 'giant' when the size exceeds 5 cm and/or weight 500 gram; and as 'complex' if one of the following characteristics is present: cysts with a size >3 mm, epithelial calcifications, sclerosing adenosis and papillary apocrine metaplasia. Giant fibroadenomas can cause compression of surrounding breast tissue or breast asymmetry, requiring surgical excision in order to preserve a normal breast shape. CASE A 26-year-old pregnant woman was referred with a palpable mass of her right breast. The mass rapidly increased in size to a diameter of 13 cm during the second trimester of her pregnancy. A tru-cut biopsy confirmed a fibroadenoma. The rapid growth and compression of normal breast tissues indicated a lumpectomy during her pregnancy. The mass was easily excised without any consequences for the pregnancy. Pathological examination showed a complex giant fibroadenoma. CONCLUSION A unique case of a pregnant woman with rapid progression of a fibroadenoma that met the criteria of a complex and giant fibroadenoma, was presented. This case emphasizes the importance of timely surgical intervention, even during pregnancy, to prevent permanent breast tissue damage.
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Affiliation(s)
| | - H C van Heusden
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - S J J Mol
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M L Rots
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY, Weissler JM, Rodriguez ED. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Gland Surg 2015; 4:312-21. [PMID: 26312217 DOI: 10.3978/j.issn.2227-684x.2015.06.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/28/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Currently, there is a lack of clear guidelines regarding evaluation and management of giant juvenile fibroadenomas. The purpose of this study was to conduct a systematic review of giant juvenile fibroadenomas and to evaluate the most common diagnostic and therapeutic modalities. METHODS A systematic literature search of PubMed and MEDLINE databases was conducted in February 2014 to identify articles related to giant juvenile fibroadenomas. Pooled outcomes are reported. RESULTS Fifty-two articles (153 patients) met inclusion criteria. Mean age was 16.7 years old, with a mean lesion size of 11.2 cm. Most patients (86%) presented with a single breast mass. Imaging modalities included ultrasound in 72.5% and mammography in 26.1% of cases. Tissue diagnosis was obtained using a core needle biopsy in 18.3% of cases, fine-needle aspiration (FNA) in 25.5%, and excisional biopsy in 11.1% of patients. Surgical treatment was implemented in 98.7% of patients (mean time to treatment of 9.5 months, range, 3 days to 7 years). Surgical intervention included excision in all cases, of which four were mastectomies. Breast reconstruction was completed in 17.6% of cases. There were no postoperative complications. CONCLUSIONS Diagnosis and treatment of giant juvenile fibroadenoma is heterogeneous. There is a paucity of data to support observation and non-operative treatment. The most common diagnostic modalities include core needle or excisional biopsy. The mainstay of treatment is complete excision with an emphasis on preserving the developing breast parenchyma and nipple areolar complex. Breast reconstruction is uncommon, but may be necessary in certain cases.
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Affiliation(s)
- Michael Sosin
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Marisa Pulcrano
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Elizabeth D Feldman
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Ketan M Patel
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Maurice Y Nahabedian
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Jason M Weissler
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Eduardo D Rodriguez
- 1 Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 2 Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, USA ; 3 Specialty Physicians of Northern Virginia, Reston Hospital Center, Reston, VA, USA ; 4 Department of Plastic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA ; 5 Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, USA ; 6 Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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