Surgical management of a giant fibroadenoma during lactation.

Fibroadenomas are the most common breast lesion in women of reproductive age. During pregnancy and lactation, fibroadenomas can undergo rapid growth in response to hormonal stimulus. These changes may prompt further investigation and/or intervention due to the risk of an underlying phyllodes tumour. We present a case of a female patient who underwent surgical excision of a giant fibroepithelial lesion at 4 months post partum while continuing to breastfeed. The lesion was successfully excised while maintaining lactation. A postoperative milk fistula resolved with non-operative management. There is limited literature on the surgical management of breast lesions in lactating women. This case illuminates the surgical management of breast lesions in an often well informed group of patients who may choose to have surgery while lactating in spite of the increased risk of complications. This case also highlights the need for a holistic approach to maintain the overall health of mother and child.

The use of Au@SiO2 shell-isolated nanoparticle-enhanced Raman spectroscopy for human breast cancer detection.

This study uses the powerful fingerprint features of Raman spectroscopy to distinguish different types of breast tissues including normal breast tissues (NB), fibroadenoma (FD), atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS), and invasive ductal carcinoma (IDC). Thin frozen tissue sections of fresh breast tissues were measured by Raman spectroscopy. Due to the inherent low sensitivity of Raman spectra, Au@SiO2 shell-isolated nanoparticle-enhanced Raman spectroscopy (SHINERS) technique was utilized to provide supplementary and more informative spectral features. A total of 619 Raman spectra were acquired and compared to 654 SHINERS spectra. The maximum enhancement effect of distinct and specific bands was characterized for different tissue types. When applying the new criteria, excellent separation of FD, DCIS, and IDC was obtained for all tissue types. Most importantly, we were able to distinguish ADH from DCIS. Although only a preliminary distinction was characterized between ADH and NB, the results provided a good foundation of criteria to further discriminate ADH from NB and shed more light toward a better understanding of the mechanism of ADH formation. This is the first report to detect the premalignant (ADH and DCIS) breast tissue frozen sections and also the first report exploiting SHINERS to detect and distinguish breast tissues. The results presented in this study show that SHINERS can be applied to accurately and efficiently identify breast lesions. Further, the spectra can be acquired in a minimally invasive procedure and analyzed rapidly facilitating early and accurate diagnosis in vivo/in situ.

Selenium levels in neoplastic breast lesions.

AIMS AND OBJECTIVES: The aim of this prospective case controlled study was to evaluate the tissue levels of selenium in patients with cases of fibroadenoma, cancer of the breast and in the controls in order to relate them to the occurrence of breast diseases. SUBJECTS AND METHODS: Consecutive consenting patients who had histologically confirmed breast cancer and fibroadenoma attending the General surgical outpatients departments of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, were recruited for the study. One gram of core disease breast tissues was taken for Selenium level estimation. RESULTS: There were 127 female subjects;. 95 (74.8%) cases of fibroadenoma and 32 (25.2%) of breast cancer. While breast cancer was common on the left, fibroadenoma was more common on the right breast (? = 8.994; p=0.011). The median tissue level of selenium in patients with fibroadenoma was 0.0272 mg/g with a range of 0.0124 to 0.0576 mg/g and that of the cancer patients was 0.0178 mg/g with a range 0.0072 to 0.0436 mg/g. These were statistically significantly different ( p=0.001). Factors affecting tissue selenium level include age (p<0.001), overall stage of breast cancer (p<0.001), maximum length of breast mass (p=0.023), previous delivery (p=0.004), age at last confinement (p=0.007), parity (p<0.001), oestrogen receptor (ER) status (p<0.001) and progesterone receptor (PR) status (p=0.021). CONCLUSION: Tissue selenium was lower in breast cancer than in fibroadenoma; Tissue selenium inhibits carcinogenesis; low tissue level of selenium therefore may be a factor in the development of breast cancer.

4-Vinylcyclohexene diepoxide (VCD) inhibits mammary epithelial differentiation and induces fibroadenoma formation in female Sprague Dawley rats.

4-Vinylcyclohexene diepoxide (VCD), an occupational chemical that targets ovarian follicles and accelerates ovarian failure in rodents, was used to test the effect of early-onset reproductive senescence on mammary fibroadenoma formation. One-month female Sprague Dawley rats were dosed with VCD (80 mg/kg or 160 mg/kg) and monitored for 22 months for persistent estrus and tumor development. Only high-dose VCD treatment accelerated the onset of persistent estrus relative to controls. However, both doses of VCD accelerated mammary tumor onset by 5 months, increasing incidence to 84% (vs. 38% in controls). Tumor development was independent of time in persistent estrus, 17 ß-estradiol, androstenedione and prolactin. Delay in VCD administration until after completion of mammary epithelial differentiation (3 months) did not alter tumor formation despite acceleration of ovarian senescence. VCD administration to 1-month rats acutely decreased mammary alveolar bud number and expression of ß-casein, suggesting that VCD's tumorigenic effect requires exposure during mammary epithelial differentiation.

A new predictive and prognostic marker (ATP bioluminescence and positron emission tomography) in vivo and in vitro for delivering adjuvant treatment plan to invasive breast tumor patients.

The cell proliferation rate has been used to assess the biological aggressiveness and the metastatic potential of breast carcinoma. Different methods (flow cytometric S phase and proliferation associated antigens) have been used to assess the rate of proliferation previously. In this preliminary study, the cell proliferation rate of normal (N=45), benign (N=29) and invasive breast tumor tissue (N=70) has been quantified in vitro by ATP bioluminescence assay. Next, individual prognostic factor (tumor grades, lymph node involvement, estrogen and progesterone receptor and HER-2 status) has been correlated with the level of metabolic rate (ATP). The results showed that invasive tumor had the highest level of ATP bioluminescence compared with that of benign tumor (mean difference=1.97) and the normal breast tissue (mean difference=2.75). In addition, ATP level positively correlated with the number of axillary lymph node involvement (r(spearman)=0.433, P=0.021). These findings suggested that the measurement of ATP level may serve as a mean for the detection of cell proliferation and hence a surrogate marker for disease prognosis.

Cryotherapy for breast fibroadenomas.

PURPOSE: To assess freezing protocols, imaging, and clinical outcomes of percutaneous ultrasonographically (US)-guided cryotherapy for breast fibroadenomas. MATERIALS AND METHODS: Institutional review board approval and patient consent were obtained. Forty-two biopsy-confirmed fibroadenomas were treated in 29 patients (mean age, 27 years) by using a 2.4-mm cryoprobe inserted into the fibroadenoma with US guidance. The first seven patients underwent conscious sedation, but the other 22 patients required only local anesthesia. US and thermocouple monitoring of the procedure were performed to evaluate freeze protocols based on tumor size. Saline injections protected the skin and/or chest wall. US follow-up was performed at 1 week and at 1, 3, 6, and 12 months. Pre- and 12-month postcryotherapy mammograms were available for seven patients who were over 30 years old. chi(2) and Student t tests were used to assess frequency and mean differences, respectively. RESULTS: The 22 patients who underwent local anesthesia reported minimal discomfort. No significant complications were noted, and patients were very pleased with the resolution of palpable mass effect and cosmetic results. The average pretreatment fibroadenoma volume of 4.2 cm(3)+/- 4.7 (standard deviation) was reduced to 0.7 cm(3)+/- 0.8 at 12-month follow-up (73% reduction, P < .001). US produced excellent ice visualization beyond tumor margins, while thermocouples confirmed cytotoxic temperatures approximately 5 mm behind the visible leading edge. Two patients elected to undergo either removal or biopsy of a residual mass, which revealed a shrunken hyaline matrix with preserved collagenous architecture. Mammograms showed comparable resolution of mass effects with mild surrounding parenchymal reaction. CONCLUSION: Cryotherapy of fibroadenomas is a safe, effective, and virtually painless clinic-based (ie, outpatient) treatment option with good cosmesis.

Office-based ultrasound-guided cryoablation of breast fibroadenomas.

BACKGROUND: Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas. METHODS: A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation. RESULTS: Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent. CONCLUSIONS: With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.

Interstitial laser hyperthermia, a new method in the management of fibroadenoma of the breast: A pilot study.

BACKGROUND AND OBJECTIVE: This study attempts to evaluate the effect of interstitial laser hyperthermia in breast fibroadenomas as an outpatient procedure. STUDY DESIGN/MATERIALS AND METHODS: In an uncontrolled prospective study, 27 patients younger than 35 years were subjected to laser phototherapy of their breast fibroadenomas. Under real-time ultrasound monitoring, Nd:YAG laser (1,064 nm wavelength) was used at 2 W for 300 sec (600 J) in a continuous wave mode to produce interstitial hyperthermia. Follow-ups were done at 2, 4, and 8 weeks. Subsequently, excision biopsy of residual lumps was performed. RESULTS: There was significant decrease in clinical and sonographic sizes (P < 0.001). Follow-up ultrasound showed a progressive change of hyperechoic texture, from a heterogeneous to a nearly homogeneous one. There were minimal scars (2-3 mm) and no keloid or abscess formation. CONCLUSION: Interstitial laser hyperthermia is a safe, precise, and minimally invasive outpatient procedure for in situ destruction of breast fibroadenomas.

Tea, or tea and milk, inhibit mammary gland and colon carcinogenesis in rats.

Research was performed on the effect of tea, or tea and milk, instead of drinking water, in rat models of cancer in the mammary gland or colon. Solutions of 1.25% (w/v) black tea, or 1.85% (v/v) milk in tea were prepared three times per week. SD rats were given tea beginning at 42 days of age; one group was gavaged 5 mg 7,12-dimethylbenz[a]anthracene (DMBA) at 49 days of age; another group received 8.4 mg 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) twice per week beginning at age 49, then 14 mg twice a week for 4 weeks more. The groups on DMBA were killed 33 weeks later, and those on IQ 39 weeks later. Tea decreased the mammary gland tumor multiplicity and volume, and milk and tea had a greater protective action. Male F344 rats were given two doses of 15 mg/kg azoxymethane (AOM) on weeks 6 and 7, and some groups started on tea, or tea and milk at 5 weeks; one group started on tea 2 days after AOM. Foci of aberrant crypts in the colon were decreased, after 9 weeks, in the groups on tea, or tea and milk during AOM administration, but not after AOM. Thus, tea decreases mammary tumor induction, and the production of foci of aberrant crypts in the colon. Milk potentiates these inhibiting effects.