Fibroadenoma gigante juvenil de mama: presentación de un caso clínico / Juvenile giant fibroadenoma of the breast: presentation of a clinical case

RESUMEN El fibroadenoma gigante juvenil es un tumor de mama benigno y una variante rara de los fibroadenomas. La presentación clínica suele ser una masa tumoral unilateral, de crecimiento rápido e indolora. En este artículo presentamos el caso de un fibroadenoma gigante juvenil de 12 cm de diámetro en la mama de una niña de 13 años. Se realiza estudio radiológico e histológico de la lesión siendo categorizada como un fibroadenoma gigante juvenil por lo que se realiza tumorectomía completa con remodelación mamaria posterior. A los dos meses de seguimiento, la paciente se encuentra sin signos de recidiva, con buena situación general y a la espera de cirugía de remodelación mamaria.

ABSTRACT Juvenile giant fibroadenoma is a benign breast tumor and a rare variant of fibroadenomas. The clinical presentation is usually a painless, fast growing, unilateral tumor mass. In this article we present the case of a giant juvenile fibroadenoma of 12 cm in diameter in the breast of a 13-year-old girl. A radiological and histological study of the lesion was carried out and it was categorized as a juvenile giant fibroadenoma, so a complete lumpectomy with posterior breast remodeling was performed. After two months of follow-up, the patient is without signs of recurrence, in good general condition and waiting for the breast remodeling surgery.

Adenomioepitelioma de mama. Presentación de un caso / Adenomyoepithelioma of the breast. A case presentation

RESUMEN El adenomioepitelioma es un tumor de la mama poco frecuente, generalmente de comportamiento benigno, de histología variable, que puede simular otras lesiones epiteliales, mioepiteliales y bifásicas de la mama. Patológicamente es un desorden raro caracterizado por la proliferación simultánea de las células del epitelio ductal y células mioepiteliales. Es más común en las glándulas salivales o en la piel, raras veces es encontrado en el tejido mamario. Afecta fundamentalmente al sexo femenino, alrededor de los 50 años de edad. Clínicamente se presenta por una pequeña masa palpable que ocupa cuadrantes centrales de la mama. El tratamiento de elección es la exéresis amplia de la lesión. Es frecuente la recidiva local y en algunas ocasiones puede tener degeneración maligna. Se presentó una paciente 13 años de edad, que acudió al Servicio de Cirugía del Hospital "Dr. Mario Muñoz Monroy" , municipio Colón, provincia de Matanzas con un tumor de consistencia dura; pero no pétreo, de 8-10 cm de diámetro, en cuadrantes inferiores y región retroareolar de la mama derecha. El estudio sonográfico informó la presencia de una imagen hipoecoica, de forma oval. Se realizó exéresis de la lesión. El estudio patológico e inmunohistoquímico aportó un adenomioepitelioma de la mama. La paciente no presentó complicaciones postoperatorias. Actualmente se sigue por consulta a 7 años de la cirugía.

ABSTRACT Adenomyoepithelioma is a very rare and generally benign tumor of varying histology that can simulate other epithelial, myoepithelial and biphasic lesions of the breast. Pathologically it is rare disorder characterized by the simultaneous proliferation of ductal epithelium and myoepithelial cells. It is more common in salivary glands and in skin. Rarely found in mammal tissue, it mainly affects women, aged around 50 years, and clinically presents like a palpable mass occupying central breast quadrants. The treatment of choice is the extensive excision of the lesion. Local recidivisms is very frequent, and sometimes they could have malignant degeneration. The authors present the case of a female patient, aged 13 years, who assisted the service of Surgery of the Hospital "Dr. Mario Muñoz Monroy", municipality of Colon, province of Matanzas with a tumor of hard consistence, of 8-10 cm diameter, in lower quadrants and retro alveolar region of the right mamma. The sonographic study informed the presence of a hypoechoic, oval image. The lesion was excised. The pathological and immunohistochemical study showed a breast adenomyoepithelioma. The patient did not have post-surgery complications. Currently she is followed in consultation after seven years of the surgery.

Largest giant juvenile fibroadenoma of the breast.

Juvenile giant fibroadenoma is a rare benign tumour of the breast accounting for 0.5% of all fibroadenomas. The presentation can be very dramatic and may result in breast deformity and may mimic a rare malignant tumour. It is indeed a great challenge to provide the best treatment for these patients in terms of clinical and psychological care. Meticulous surgical planning is required to ensure a fine balance between adequate resection and the best cosmetic outcome for a developing breast. Every effort should be made to preserve the developing breast irrespective of the size of the tumour as it is in this case. We report the world's largest juvenile fibroadenoma of the breast in a 16-year-old girl who presented to our hospital with a 28×25 cm mass on her left breast in which breast conservation was done. A detailed literature search and management of these lesions are discussed.

Dimethyl-2-[(acridin-9-yl)methylidene]-malonate as fluorescent probe for histochemical analysis.

Fluorescent compounds have been widely used for biomolecule labeling in cytochemistry and histochemistry analysis. Here, it is described the optical properties of dimethyl 2-[(acridin-9-yl)methylidene]-malonate (LPSF/IP-81), an acridine derivative. This compound was conjugated to Concanavalin A (Con A) lectin and applied as sugar probe in lectin histochemistry. Evaluation of luminescent properties showed that LPSF/IP-81 is photoluminescent with excitation at 360 nm and emission at 428 nm. Con A hemagglutinating activity and LPSF/IP81 photoluminescence were unaltered after conjugation. Circular dichroism of Con A-LPSF/IP81 conjugate showed the maintenance of the Con A structure. Lectin histochemistry with Con A-LPSF/IP81 conjugate demonstrated different pattern recognition studying normal, fibroadenoma, and invasive ductal carcinoma of human breast. These findings indicate that LPSF/IP-81 can be proposed as an alternative probe for histochemical analysis.

Appearance of breast masses on sonoelastography with special focus on the diagnosis of fibroadenomas.

The aim of this study was to show and correlate the imaging features of breast masses, especially fibroadenomas, using sonoelastography. Two hundred thirty-five patients with 302 breast lesions referred for core needle biopsy participated in the study. All lesions appearing as solid masses on conventional US were included. Out of the included lesions (270), 115 (42.6%) corresponded to histologically confirmed fibroadenomas and 155 (57.4%) to lesions with histologically confirmed diagnoses other than fibroadenomas. These were further subdivided into fibrocystic changes, lesions with low malignancy potential, and malignant lesions. Fibroadenomas were also divided according to histological presentation into three subgroups to allow comparative study based on elastographic scores. All lesions were classified using a four-point scoring system based on ultrasound elastography imaging characteristics. Different presentations were observed for elastographic scores according to histological presentation of fibroadenomas, whereby fibroadenomas with benign characteristics tended to have elastographic classification similar to fibrocystic changes, and complex and hypercellular fibroadenomas had classifications similar to harder lesions. Fibroadenomas are generally classified as category 3 in the BI-RADS lexicon and are the most commonly found lesions in breast biopsies. Sonoelastography can provide additional information to conventional studies and be used as an auxiliary tool in assessing these masses in clinical practice.

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.

Melanoma metastasis to the breast masquerading as fibroadenoma.

BACKGROUND: Although primary malignant breast lesions are common, tumor metastasis to the breast is rare. Melanoma metastasis to the breast occurs even more rarely. CASE: In the present case report, we describe an adolescent girl with malignant melanoma metastasis to the breast masquerading as fibroadenoma, in which it was impossible to perform differential diagnosis based only on the physical examination and ultrasonographic evaluation. The definitive diagnosis both of the primary and of the metastatic lesion was reached by immunohistochemistry, which revealed positivity to Mart-1 antibody. CONCLUSION: Melanoma metastasizing to the breast is occasionally indistinguishable from a benign lesion at ultrasonographic evaluation. Emphasis should be made on the importance of a correct diagnosis prior to therapeutic management.

Evaluation of the ultrasonographic volume of breast fibroadenomas in women treated with tamoxifen.

BACKGROUND: Fibroadenomas are the most frequent benign breast neoplasias. Although they are hormone-dependent, no hormonal treatment of proven effectiveness is available for these neoplasias. The objective of the present study was to evaluate the ultrasonographic volume of fibroadenomas in premenopausal women treated with tamoxifen at the doses of 5, 10, 20 mg/day or with placebo for 50 days, starting on the 1st day of the menstrual cycle. METHODS: A prospective and randomized study was conducted on 62 eumenorrheic women aged 15 to 45 years with no hormonal treatment or pregnancy during the last 12 months, with a clinical, cytologic and ultrasonographic diagnosis of fibroadenoma, later followed by a biopsy diagnosis. The patients were divided at random into 4 groups: A (n=15; placebo), B (n= 16; 5 mg/day tamoxifen), C (n=16; 10 mg/day tamoxifen), and D (n=15; 20 mg/day tamoxifen). Fibroadenoma volume was measured by ultrasound at 3 different times: on the 22nd day of the cycle that preceded the beginning of tamoxifen treatment, after 1 month of treatment, and on the day of the biopsy (50th day). The mean volume obtained for groups A, B, C and D was 3, 3.3, 1.9, and 2.3 cm3, respecti-vely. RESULTS: Statistical analysis revealed a significant reduction in nodule size only in group D (p=0.0024). CONCLUSIONS: We conclude that tamoxifen significantly reduced fibroadenoma volume when administered for 50 days at the dose of 20 mg/day. Further clinical studies are needed using the drug for a longer period of time, and in order to exclude the need for unnecessary treatment in some women.

Technetium-99m sestamibi in the diagnosis of breast cancer. The Mayagüez Medical Center experience.

The most successful screening procedures for breast cancer are breast physical examination and mammography. However, mammography has a positive predictive value of 15-30% for nonpalpable malignancy and of 22% for palpable carcinoma; this results in a large number of biopsies on patients with benign lesions. Furthermore, the benefit of mammography in woman with dense breast tissue (< 50 years old) has been questioned. Different studies have shown that Scintimammography with Tc-99m has a high sensitivity and specificity for detecting breast cancer (average of 85% and 89%, respectively), with higher positive predictive value for palpable lesions (89%). We reviewed retrospectively 35 records of patients that had Scintimammography in our institution, and the sensitivity, specificity, positive and negative predictive values were similar to other centers (100%, 76%, 62.5% and 100%, respectively). So, Scintimammography may be a complement for current diagnostic techniques for breast malignancy in our setting.

[Radiologic visibility of breast fibroadenomas]. / Visibilidad radiológica de los fibroadenomas mamarios.

From a clinical point of view, all mammary fibroadenomas are similar. However some of them are not visible in mammograms, phenomenon probably related to glandular density. Aiming to elucidate whether the lack of visibility is caused by the glandular density or by tumor itself, a three stage study was performed. In 201 cases the mammographic visibility of fibroadenomas was determined and correlated with patient's age, the presence of fibrocystic disease and tumor histological type; after surgical excision, 18 fibroadenomas were sliced into 5 mm thick samples and X rayed to determine their visibility; finally 2 visible and 2 non visible tumors were calcinated at 550 degrees C and their ashes subjected to X-ray diffraction analysis. Twenty two percent of fibroadenomas were not visible on mammography, this percentage was higher for intracanalicular tumors, in younger women and in the presence of fibrocystic disease. Sixteen percent of excised and sliced tumors were not visible on X rays. Also, differences were found in X-ray diffraction studies between visible and invisible tumors, probably related to NaCl and KCl tumor content.