{"paper_id":"5ea3fa21-04b3-4b40-a7fa-b245f8b5d4ff","body_text":"Int.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n \n \n472 \nOriginal Research Article     https://doi.org/10.20546/ijcmas.2019.801.050  \n \nDiagnosis and Treatment Procedures Involved for Young  \nFemale Patients having Fibroadenoma \n \nDebasmita Chatterjee*, Rathin Chakravarty, Bishaka Halder, Asutosh Kundu,  \nSuparna Mukherjee and Satadal Das \n \n \nDepartment of Immunogenetics, Dr. Bholanath Chakravarty Integrated Medical Research and \nTreatment Centre, Kolkata, India \n \n*Corresponding author \n \n   \n \n \n \n                           A B S T R A C T  \n \n  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nIntroduction \n \n„Fibroadenoma‟, a common benign breast \nmass often noticed among young female \npatients within 35 years of age. They are often \nfelt as smooth rubbery or hard  palpable mass \nsimilar to a structure of pea or grape (Begum \net al., 2017). The structure is not considered to \nbe true neoplasms, rather an eccentricity of \nnormal development of breast (Greenberg et \nal., 1998). As they are considered to be benign \nbreast lesions, therefore there are two mode of \nsuggestive treatment for the disease, i.e., \nconservative mode of treatment where it could \nbe assumed that surgical excision is not \nneeded and the structure could regress \neventually and the other method is surgical \nexcision method (Santhosh et al., 2018).  \nThere are mainly two issues to consider with \nthe enlargement of FAs: 1) probable \nInternational Journal of Current Microbiology and Applied Sciences \nISSN: 2319-7706 Volume 8 Number 01 (2019)   \nJournal homepage: http://www.ijcmas.com \n \n‘Fibroadenoma‟, is the most common benign tumors among most of the young female \npatients who are in their adolescent phase. They can be asympto matic or painful and \nsometimes develop as tumors which cause distortions of breast.  Here we have \nconducted a descriptive 6 months survey from April to September, 2018 at Dr. \nBholanath Chakravarty Integrated Medical Research and Treatment Centre. All the \nclinical records along with the consent of the patients were taken and recorded for \nfuture analysis. It was observed that among selected 113 patients attending the OPD, \n11 patients (9.73%) were found as confirmed cases of fibroadenoma via diagnostic \ntechniques ultrasonography and X -Ray Mammogram.  Fibroadenomas are more \nfrequent among married woman than unmarried woman.  The factors such as early \nmarriage and parity, age of menarche and age of menopause, hormonal therapy such \nas intake of oral contraceptives have no effect on these lesions. Our study revealed \nthat the incidence percentage of fibroadenoma out of 113 cases were 11 (9.73%). \nPatients who undergo conservative therapy involves combination of progesterone and \ndanazol as it is the most accepted theory for the treatment. \nK e y w o r d s \n \nFibroadenoma \n(FA), High \nResolution \nUltrasonography \n(HRUSG), X-Ray \nMammogram, \nHormonal \nregulation, \nTreatment options \n \n \n \nAccepted:  \n04 December 2018 \nAvailable Online:  \n10 January 2019 \nArticle Info \n \n\nInt.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n473 \n \ndevelopment of malignancy in the epithelial \ncomponent, 2) the possibility of progression of \nFA into phyllodes tumor (PT) (Sanders et al., \n2015). Histological examination revealed that \nFA resembles hyperplastic breast lobule and \nthey also respond to hormonal stimulation in \nthe same manner as normal breast tissue does \n(Begum et al., 2017). The biological nature of \nfibroadenoma is unpredictab le as they may \nremain static or grow rapidly (Begum et al., \n2017).  \n \nInitially surgical excision was considered to be \nthe only mode of treatment for FAs to avoid \nthe development of malignancy. Fortunately \nthis doctrine has been recently challenged \nbecause confident diagnosis with preoperative \ninvestigations excludes the need for surgical \nexcision (Begum et al., 2017). There are \nbasically three categories of FAs: 1) simple \nfibroadenoma, 2) giant juvenile fibroadenoma \nand multicentric fibroadenoma (Begum et al., \n2017).  \n \nFibrocystic disease \n \nPatients have lumpy breast rather than the \nclassical lump. Pain, nipple discharges are the \ntwo major clinical features observed among \nthese patients though exact pathogenesis is \nunknown. Hormone estrogen predominates \nover progesterone which plays the key role in \nthe development of the disease. Core biopsy is \nsuggested as the tool for confirmatory \ndiagnosis (Hartmann et al., 2005; Marshall et \nal., 1997; Kennedy et al., 2003; Patterson et \nal., 2004; Fasih et al., 2005; Rabban  et al., \n2004). \n \nPhyllodes tumor \n \nPT represents the most common benign tumor \nof the breast which enlarges rapidly. It \nrepresents a spectrum of diseases which \nranges from FA to benign, metastasising \nbenign and malignant PT. Large PT are \nexpected to become m alignant and may \nrepresent pain and according to the data \navailable from previous studies, 38% of PT \nturned out to be malignant and rest are all \nsarcomas (Vijayalakhmi et al., 2016). \n \nAdenomyoepithelioma \n \nIt is considered to be a rare benign tumor \ncondition of the breast and it is difficult to \nclinically differentiate from carcinoma. After \nsurgical excision the recurrence rates are also \nhigh, therefore mastectomy is the only choice \nleft for those patients. Fine Needle Aspiration \nCytology (FNAC) confirms the diagnosis with \n86% of specificity and 99% of sensitivity. \nCore biopsy acts as a confirmatory tool for \ndoubtful cases (Vijayalakhmi et al., 2016). \n \nMaterials and Methods \n \nA descriptive observational study was \nconducted for 6months, from April to \nSeptember, 2018. A total number of 113 cases \nwere selected for our study, investigated and \nconfirmed by physical examinations followed \nby ultrasonography and X -Ray mammogram \nstudy. The detailed history and clinical \nexamination of all patients were also recorded. \n \nInclusion criteria for the patients are \n \n1. Female patients showing breast lump. \n2. Ages of the patients were more than 12 \nyears. \n3. Patients admitted in between the study \nperiod. \n4. Cases confirmed by physical examinations \nand sonography. \n \nExclusion criteria for the patients are \n \n1. Male Patients. \n2. Ages of the patients were less than 12 years. \n3. Patients having any congenital \nabnormalities. \n\nInt.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n474 \n \n4. Patients having inflammatory condition of \nthe breast or having breast carcinoma. \n \nResults and Discussion \n \nAge distribution and its significance \n \nAccording to previous literatures, higher \nnumbers of cases of fibroadenomas (FAs) are \nobserved among the second and third decade \n(Table 1) (Frantz et al., 1951). Hormonal \nchange especially estrogen is considered to be \nthe ma jor reason behind fibroadenoma as it \nchanges their size during pregnancy, \nmenstruation and also during lactating phase \n(Soini et al., 1981; Ajitha et al., 2012) (Fig. 1 \nand 2).  \n \nTable.1 Age wise distribution of patients \n \nSl. No. Age Group No. Of Patients Percentage (%) \n1 10 - 20 2 20 \n2 21 - 30 5 45.45 \n3 31 - 40 4 40 \n \nTable.2 Clinical features observed for the confirmed cases by physical examination and \nultrasonography / Mammography \n \nPatient \nCode \nClinical Features \nBNC 006 Multiple benign fibroadenoma of left breasts \nBNCH \n010 \nSurgery was done, FA in both breasts. Important Features are \nfibroadenomas in both breasts (birads ii category). \nBNCH \n011 \nFibroadenoma, Benign FA - left breast, Right breast. \nBNCH \n016 \nBenign fibroadenoma at lower lateral part of right breast. \nBNCH \n019 \nSmall benign hypoechogenic is visible in lower lateral area of right breast. \nMay be benign fibroadenoma in right lower lateral part of the breast. \nBNCH \n050 \nFinding more suggestive of fibroadenoma of both breast. \nBNCH \n056 \nFinding more suggestive of fibroadenoma of left breast. \nBNCH \n080 \nInflammatory breast lesion. Suggestive of fibroadenoma of breast via \nHRUSG \nBNCH \n082 \nUSG finding shows bilateral fibroadenoma with X - Ray mammogram and \nHRUSG \nBNCH \n097 \nFibroadenoma in right breast. Clinical correlation using X-Ray \nmammography and HRUSG are suggested for patients for further \nevaluation. \nBNCH \n112 \nFibroadenoma in right breast. Clinical correlation using X-Ray, \nmammogram and HRUSG are suggested for patients for further evaluation. \nFA: Fibroadenoma \nHRUSG: High Resolution Ultrasonography \n\nInt.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n475 \n \nFig.1 Mode of treatment employed for fibroadenoma cases (FA) among female patients within \n35 years of age (Greenberg et al., 1998) \n \nMode of Treatment for patients having Fibroadenoma: \n \n \nFig.2 The picture represent the simplified anatomy of the female breast explaining the major \nstructural components of the breast which includes the anatomic location of various lesions along \nwith their histology indicating the potential lesion ((Kotepui et al., 2014) \n \n              \n     \n\nInt.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n476 \n \nFig.3 The graph describes the location and percentage of fibroadenoma patients among the \nconfirmed cases \n \n \n \nFig.4 The visualized sonographic image region reveals a focal bulge of homogeneous soft tissue \ndensity of size approximately 20.39mm x 12.93mm, suggestive benign SOL with smooth \nmargins \n \n \n \nThey also undergo autotrophic changes during \nmenopause and have receptors which respond \nto growth hormone and epidermal growth \nfactor. Menopause is considered to be a \nprobable contribution to lump  formation and \nevolution (Ajitha et al., 2012). According to \nthe data mentioned in previous literatures \n72% of positive cases are reported from urban \n\nInt.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n477 \n \nareas and very few cases are reported from \nrural background (Soini et al., 1981). The \nmajor reasons behind  this kind of differential \ncase reporting are sedentary life style of urban \npopulation, unhealthy food habits especially \njunk foods.  The other reasons that can be \nconsidered for higher reporting of cases from \nurban population are due to high literacy rate \nand availability of facilities for the screening \nof breast cancer (Santhosh et al., 2018).  \n \nConfirmation of cases by ultrasonography \n \nThis technique has often been used as \nconfirmatory diagnosis of fibroadenoma as \nthe observation reveals round solid mass \nhaving smooth contour and weak internal \nechoes which supports the diagnosis (Table 2) \n(Fig. 4). This technique may also help us to \ndifferentiate between solid and cystic lesions. \nPrevious literature revealed that 25% of the \nFAs, showed irregularity indicat ing \nmalignancy. The sonography data confirmed \nwith biopsy depicted that 82% of the cases are \nfibroadenomas. We have also described our \ndata based on the location along with its \npercentage of the benign mass (Fig. 3). On the \nother hand the role of mammograp hy for the \ndetection of fibroadenoma among young \nwomen is very limited (Greenberg et al., \n1998).  \n \nFibroadenoma and association with \ndevelopment of breast cancer \n \nLiterature studies reported that 0.002% to \n0.0125% cases of developing fibroadenoma \nare found to be carcinomas (Greenberg et al., \n1998). The patients having a history of non \ncomplex fibroadenoma and having no history \nof breast cancer are reported to be at lower \nrisk. Previous literature revealed that 50% of \nthe tumors are lobular carcinoma in situ  \n(LCIS), 20% were considered to be ductal \ncarcinoma in situ (DCIS) and the remaining \n10% are infiltrating ductal carcinoma (Ajitha \net al., 2012).  \nAccording to epidemiological survey data \nmentioned in other literatures FAs are more \nfrequent among married w oman than \nunmarried woman. The factors such as early \nmarriage and parity, age of menarche and age \nof menopause, hormonal therapy such as \nintake of oral contraceptives have no effect on \nthese lesions. Therefore, no definitive \nassociations could be achieved.  Patients \nundergoing conservative therapy involve \ncombination of progesterone and danazol \nsince it is the most accepted theory for the \ntreatment of FA, which occurs due to \nexcessive influence of hormone estrogen. \nAnti-estrogen medications could not show \nany effect upon FAs.  Therefore, conservative \ntreatment follows clinical examination, \nradiology and biopsy (Ajitha et al., 2012).  \n \nTreatment options \n \nPatients who don‟t want to undergo surgery, \nUSG guided cryoablation are advi sed for \nthem (Lee et al., 2015).  \n \nVacuum assisted percutaneous biopsy \n \nThis process removes tumor through core \nbiopsies and depending on radiographic \nguidance, the whole procedure gets completed \nwhen the mass is completely removed via \nradiographic means (Lee et al., 2015). \n \nAblative procedure \n \nIt involves cryotherapy where FA gets \nremoved with a probe which gets \nsubsequently cooled by argon gas to – 160 ˚ \nC. The cell membrane gets disrupted which \nresults thrombosis of capillaries and results in \neventual destruction of FA (Lee et al., 2015). \n \nSurgical excission \n \nGiant FAs can be removed surgically without \ncausing iatrogenic deformity to the breast \n(Lee et al., 2015). \n\nInt.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n478 \n \nIn conclusion, f ibroadenomas are more \nfrequent among married woman than \nunmarried woman. It was observed that \namong selected 113 patients attending the \nOPD, 11 patients (9.73%) were found as \nconfirmed cases of fibroadenoma via \ndiagnostic the applied diagnostic technique \nultrasonography and X -Ray mammogram.  \nPatients who undergo conservative therapy \ninvolves combination of progesterone and \ndanazol, as it is the most accepted theory for \nthe treatment (Ajitha et al., 2012). \n \nAcknowledgement \n \nThe authors would like to acknowledge the \nInstitution, for providing all the facilities for \nperforming the study. \n \nAuthor’s contribution \n \nAll the authors have analysed the data and \nhave gone through the final draft of the \nmanuscript. \n \nReferences \n \nBegum R, Thomus R, Babu N. 2017. Chances \nof breast cancer with fibroadenoma – \nReview. J of Sci and Innov Res. 6: 84 – \n86. \nGreenberg R, Skornic k Y, Kaplan O. 1998. \nManagement of breast fibroadenomas. 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IOSR J of Dental and Med \nSci. 15: 32 -36. \nKotepui M., Piwkham D., Chupeerach C., \nSongsri A., Charoenkijkajorn L . 2014. \nEpidemiology and histopathology of \nbenign breast diseases and breast cancer \nin Southern Thailand. Eur J of Gynaecol \nOncol. 35: 670-5. \n\nInt.J.Curr.Microbiol.App.Sci (2019) 8(1): 472-479 \n479 \n \nLee M., Soltanian HT. 2015. Breast \nfibroadenomas in adolescents: current \nperspectives. Adolesc Health Med Ther. \n6: 159 – 169. \n \nHow to cite this article:  \n \nDebasmita Chatterjee, Rathin Chakravarty, Bishaka Halder, Asutosh Kundu, Suparna \nMukherjee and Satadal Das. 2019. Diagnosis and Treatment Procedures Involved for Young \nFemale Patients having Fibroadenoma. Int.J.Curr.Microbiol.App.Sci. 8(01): 472-479.  \ndoi: https://doi.org/10.20546/ijcmas.2019.801.050","source_license":"CC0","license_restricted":false}