Giant juvenile fibroadenoma of the mammary gland (analytical review of the literature and personal observation)
DOI:
https://doi.org/10.15574/SP.2025.1(145).119125Keywords:
giant juvenile fibroadenoma, tumor, mammary gland, girls, surgical treatment, cosmetic consequences, quality of life, rehabilitationAbstract
Fibroadenoma refers to widespread tumors of the mammary gland in childhood, while their nature is very different from pathology in adults. Giant juvenile fibroadenoma of the mammary gland belongs to the benign formations of the mammary gland, the structure of which consists of estrogen-sensitive epithelial and stromal tissues, the frequency of which reaches up to 27.9% in the pre- and 72.1% in the postmenarchal periods.
Aim is to highlight the experience of diagnosing and treating giant juvenile fibroadenoma of the breast on an analytical review of literature and clinical case example.
The article presents a clinical case that demonstrates the clinical course of a giant fibroadenoma of the mammary gland, as well as the method of surgical treatment of this pathology using mastopexy after tumor removal, which leads to a good cosmetic effect in the postoperative period. The diagnostic algorithm for giant juvenile fibroadenoma of the mammary gland consists of determining the visual and palpable changes of the mammary gland and involving certain additional examinations with the help of ultrasound, mammography, MRI and biopsy, which also help in differential diagnosis. Doppler ultrasound in 80% of cases reveals hypervascularization of the mammary gland. Differential diagnosis of giant juvenile fibroadenoma of the mammary gland is carried out with phylloid tumors, pseudoangiomatous stromal hyperplasia, virginal hypertrophy, hamartoma, lipoma, breast abscess, macrocyst, adenocarcinoma. Undisputed indications for surgical treatment of giant juvenile fibroadenoma of the mammary gland are suspicious characteristics during its visualization, including during ultrasound (increase in the density of intra-tissue vascularization) and rapid growth of the tumor formation. The need to remove a giant juvenile fibroadenoma of the mammary gland at a young age is also due to the preservation of the ability to lactate, minimizing injury to the mammary gland, supporting the development of its parenchyma by reducing the hypoxic effect of compression on normal tissue and good cosmetic results, which is also of great importance.
Conclusions. Giant juvenile fibroadenoma of the mammary gland refers to rare tumors in girls during puberty, which are characterized by rapid growth and deformation of the mammary gland. The final diagnosis is possible only through morphological verification. After the diagnosis, a satisfactory oncological and cosmetic result is possible with timely surgical intervention and appropriate rehabilitation.
The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
References
Abidin Z. (2024). Giant juvenile fibroadenoma mammae case report. Science Midwifery. 12(3): 1082-1090.
Arora BK. (2017). Giant axillary fibroadenoma: a rare case report. MOJ Clin Med Case Rep. 7(2): 00196. https://doi.org/10.15406/mojcr.2017.07.00196
Baral S, Gyawali M, Thapa N, Chhetri RK, Dahal P. (2020). Giant juvenile fibroadenoma in an adolescent female: A case report. Clinical Case Reports. 8(12): 3488-3492. https://doi.org/10.1002/ccr3.3466; PMid:33363957 PMCid:PMC7752576
Bardisi ES, Smeets A, Floris G, Ongeval CV, Keupers MA. (2021). Giant juvenile fibroadenoma in a 12-year-old girl: Case report and brief literature review. J Clin Images Med Case Rep. 2(4): 1235. https://doi.org/10.52768/2766-7820/1235
Çelik MF, Dural AC, Ünsal MG, Akarsu C, Alim ER, Kapan S et al. (2015). Giant juvenile fibroadenoma. Turkish Journal of Surgery/Ulusal Cerrahi Dergisi. 31(2): 96-98. https://doi.org/10.5152/UCD.2014.2574; PMid:26170749 PMCid:PMC4485822
Celik SU, Celik DB, Yetiskin E, Ergun E, Percinel S, Demirer S. (2017). Giant juvenile fibroadenoma of the breast: a clinical case. Arch Argent Pediatr. 115(6): e428-e431. https://doi.org/10.5546/aap.2017.eng.e428; PMCid:PMC6250071
Chao TC, Lo YF, Chen SC, Chen MF. (2002). Sonographic features of phyllodes tumors of the breast. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 20(1): 64-71. https://doi.org/10.1046/j.1469-0705.2002.00736.x; PMid:12100421
Çitgez B, Baran E, Yiğit B, Baş S, Tufan AE, Özşahin H. (2020). Breast conservation with batwing mastopexy for the management of giant juvenile fibroadenoma: A case report of a 12-year-old girl. Archives of Clinical and Experimental Medicine. 5(3): 119-122. https://doi.org/10.25000/acem.799406
Çitgez B, Yiğit B, Uçak R, Yetkin SG. (2020). Giant fibroadenoma of the breast: A case report of a 37-year-old woman during the second trimester of pregnancy. Journal of Surgery and Medicine. 4(7): 613-615. https://doi.org/10.28982/josam.707606
Corredor Andrés B, Márquez Rivera M, Lobo Bailón F, González Meli B, Azorín Cuadrillero D et al. (2018). Fibroadenoma gigante de mama en adolescentes: procedimientos diagnóstico-terapéuticos. An. pediatr.(2003. Ed. impr.): 383-385. https://doi.org/10.1016/j.anpedi.2018.01.006; PMid:29802049
Darido J, El Daou S, El Assaad R, Fakih A, Dagher M, Safa A et al. (2019). Unusual Presentation of a Rare Giant Fibroadenoma of the Breast. Journal of Cancer Therapy. 10(9): 717-721. https://doi.org/10.4236/jct.2019.109059
Dasgupta R, Rajak TK, Kaushal S, Ritolia N. (2022). Giant Juvenile Fibroadenoma of the Breast in a 12-Year-Old Girl. African Journal of Paediatric Surgery. 19(4): 271-273. https://doi.org/10.4103/ajps.ajps_75_21; PMid:36018214 PMCid:PMC9615957
Dayal S, Shukla KM, Singh A. (2017). Giant Juvenile Fibroadenoma of the Breast in a Preadolescent Girl. Pediatric Oncall Journal. 14(1): 21-22. https://doi.org/10.7199/ped.oncall.2017.1
Du F, Dong R, Zeng A, Liu Z, Yu N, Wang X, Zhu L. (2020). Surgical management of giant juvenile fibroadenoma with skin reducing tumor resection and immediate breast reconstruction: A single‐center experience. Journal of Surgical Oncology. 121(3): 441-446. https://doi.org/10.1002/jso.25828; PMid:31907948
El Graini S, El Hassouni F, Rouas L, Fathi K, Chat L, El Haddad S. (2024). Giant juvenile fibroadenoma: A case report. International Journal of Surgery Case Reports. 121: 109897. https://doi.org/10.1016/j.ijscr.2024.109897; PMid:38906040 PMCid:PMC11252914
Eleftheriades A, Tsarna E, Toutoudaki K, Paschalidou E, Christopoulos N, Georgopoulos I et al. (2023). Giant juvenile fibroadenoma: Case report and review of the literature. Journal of Clinical Medicine. 12(5): 1855. https://doi.org/10.3390/jcm12051855; PMid:36902642 PMCid:PMC10003210
Firdaus CM, Norjazliney AJ, Rashid NFA. (2017). A case report of juvenile giant fibroadenoma of the breast: How common?. Tzu Chi Medical Journal. 29(3): 177-179. https://doi.org/10.4103/tcmj.tcmj_64_17; PMid:28974914 PMCid:PMC5616000
Giannos A, Stavrou S, Gkali C, Chra E, Marinopoulos S, Chalazonitis A et al. (2017). A prepubertal giant juvenile fibroadenoma in a 12-year-old girl: Case report and brief literature review. International journal of surgery case reports. 41: 427-430. https://doi.org/10.1016/j.ijscr.2017.11.026; PMid:29546008 PMCid:PMC5702868
Golatta M, Harcos A, Pavlista D, Danes J, Klein R, Simovich P et al. (2015). Ultrasound-guided cryoablation of breast fibroadenoma: a pilot trial. Archives of Gynecology and Obstetrics. 291: 1355-1360. https://doi.org/10.1007/s00404-014-3553-5; PMid:25408274
Greenberg R, Skornick Y, Kaplan O. (1998). Management of breast fibroadenomas. Journal of general internal medicine. 13: 640-645. https://doi.org/10.1046/j.1525-1497.1998.cr188.x; PMid:9754521 PMCid:PMC1497021
Ha N, Yun J, Shin HC, Myung Y. (2024). Bilateral giant juvenile multilobulated fibroadenomas of the breast: a case report. Archives of Aesthetic Plastic Surgery. 30(2): 69-73. https://doi.org/10.14730/aaps.2023.01074
Islam S, Saroop S, Bheem V, Naraynsingh V. (2019). Largest giant juvenile fibroadenoma of the breast. BMJ Case Reports CP. 12(1): e227277. https://doi.org/10.1136/bcr-2018-227277; PMid:30696639 PMCid:PMC6350733
Juarez AM, Juarez CAS, Martinez IMA, Mondragon ER. (2021). Breast-conserving surgery in giant juvenile fibroadenoma: A case report. AME Surgical Journal. 1. https://doi.org/10.21037/asj-21-10
Kabuyaya MK, Mutombo FL, Moseka FM, Kihemba K, Wetzig N, Lussy JP. (2021). A giant fibroadenoma in a mature woman: diagnosis and treatment in a limited resource environment (a case report). Pan African Medical Journal. 38(1). https://doi.org/10.11604/pamj.2021.38.19.26200; PMid:34650650 PMCid:PMC8488286
Kafadar MT, Kırşan MA, Çal S, Okur MH, Girgin S. (2020). Giant Juvenile Fibroadenoma of the Breast: Clinical Manifestation in Two Cases. JAREM. Journal of Academic Research in Medicine. 10(3): 303. https://doi.org/10.4274/jarem.galenos.2020.3729
Kataria A, Aden D, Jairajpuri ZS, Jetley S. (2024). Pseudoangiomatous stromal hyperplasia (PASH) in a young female diagnosed on core needle biopsy. Journal of Medicine, Surgery, and Public Health. 2: 100055. https://doi.org/10.1016/j.glmedi.2024.100055
Kaur N, Saini S, Somasekhar S, Gupta A. (2015). Bilateral florid juvenile fibroadenomas of the breast in an adolescent: a rare indication for subcutaneous mastectomy. Journal of pediatric and adolescent gynecology. 28(5): e135-e137. https://doi.org/10.1016/j.jpag.2014.10.009; PMid:26049942
Khanal S, Singh N, Paudel A, Singh Y. (2023). Modified Lateral Oncoplastic Surgery for Giant Breast Fibroadenoma with Flat Epithelial Atypia: A Case Report. Eurasian journal of medical advances. 3(3): 144-148. https://doi.org/10.14744/ejma.2023.85057
Kim H, Shim J, Kim I. (2017). Surgical excision of the breast giant fibroadenoma under regional anesthesia by Pecs II and internal intercostal plane block: a case report and brief technical description: a case report. Korean Journal of Anesthesiology. 70(1): 77-80. https://doi.org/10.4097/kjae.2017.70.1.77; PMid:28184271 PMCid:PMC5296392
King KS, Harrington MA, Kassira N. (2017). Recurrent giant juvenile fibroadenoma. Journal of Pediatric Surgery Case Reports. 26: 42-45. https://doi.org/10.1016/j.epsc.2017.08.016
Kitazawa M, Futamura M, Tokumaru Y, Kohyama K, Nakakami A, Yoshida K. (2022). Breast reconstruction using a tissue expander after enucleation of a giant fibroadenoma: A case report. International Journal of Surgery Case Reports. 90: 106723. https://doi.org/10.1016/j.ijscr.2021.106723; PMid:34991047 PMCid:PMC8741496
Kopkash K, Yao K. (2020). The surgeon's guide to fibroadenomas. Annals of Breast Surgery. 4(25). https://doi.org/10.1016/j.ijscr.2021.106723; PMid:34991047 PMCid:PMC8741496
Lee EJ, Chang YW, Oh JH, Hwang J, Hong SS, Kim HJ. (2018). Breast lesions in children and adolescents: diagnosis and management. Korean Journal of Radiology. 19(5): 978-991. https://doi.org/10.3348/kjr.2018.19.5.978; PMid:30174488 PMCid:PMC6082765
Lee M, Soltanian HT. (2015). Breast fibroadenomas in adolescents: current perspectives. Adolescent health, medicine and therapeutics. 6: 159-163. https://doi.org/10.2147/AHMT.S55833; PMid:26366109 PMCid:PMC4562655
Mounir M, Jaouad K, El Mehdi EHM, Rachid AB, Driss MR, Mohammed D. (2022). Giant Fibroadenoma of the Breast: A Case Report. Journal of Obstetrics, Gynecology and Cancer Research. 2(3). https://doi.org/10.5812/jogcr.57935
Naraynsingh V, Maharaj D, Rampaul R. (2002). "Swiss‐Roll" Operation for Giant Fibroadenomas. The breast journal. 8(1): 45-46. https://doi.org/10.1046/j.1524-4741.2002.08009.x; PMid:11856161
Nelson L, Horattas I, Horattas M. (2023). Excision of Giant Juvenile Fibroadenoma through Circumareolar Incision. Clin Surg. 8: 3637.
Popli V, Popli MB. (2019). Juvenile Fibroadenoma at Menarche: A Case Series. Journal of Diagnostic Medical Sonography. 35(3): 225-228. https://doi.org/10.1177/8756479318824301.
https://doi.org/10.1177/8756479318824301
Santos DC, Cardoso A, Martins JM, da Luz Barroso M, Costa H. (2016). Suspensory ligament of the mammary gland: a case report. Aesthetic plastic surgery. 40: 98-101. https://doi.org/10.1007/s00266-015-0589-2; PMid:26695951
Schnitt SJ. (2000). Pathology of benign breast disorders. Breast diseases. 90.
Shi L, Chang L, Wang J, Zhang Y, Li S. (2023). Juvenile fibroadenoma of breast: A case report. International Journal of Radiation Research. 21(4): 841-843. https://doi.org/10.61186/ijrr.21.4.841
Sliusariev MI, Susak YM. (2007). Quality of life of the women with breast asymmetry, influence of personified augmentation mamoplastics. Journal of Endodontics. 33(11): 1278-1282. https://doi.org/10.1016/j.joen.2007.07.018; PMid:17963946
Smith GC, Burrows P. (2008). Ultrasound diagnosis of fibroadenoma - is biopsy always necessary?. Clinical radiology. 63(5): 511-515. https://doi.org/10.1016/j.crad.2007.10.015; PMid:18374713
Song BS, Kim EK, Seol H, Seo JH, Lee JA, Kim DH, Lim JS. (2014). Giant juvenile fibroadenoma of the breast: a case report and brief literature review. Annals of Pediatric Endocrinology & Metabolism. 19(1): 45. https://doi.org/10.6065/apem.2014.19.1.45; PMid:24926464 PMCid:PMC4049547
Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY et al. D. (2015). Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Gland surgery. 4(4): 312-321.
Sukmawati E, Rantauni DA, Khomsah YSB, Fatonah U, Nurhasanah N. (2023). Pelatihan Pijat Oketani Untuk Melancarkan ASI Ibu Menyusui Pada Kader Kesehatan. Jurnal Abdimas Bina Bangsa. 4(1): 506-514.
Tea MKM, Asseryanis E, Kroiss R, Kubista E, Wagner T. (2009). Surgical breast lesions in adolescent females. Pediatric surgery international. 25: 73-75. https://doi.org/10.1007/s00383-008-2285-7; PMid:18985359
Templeman C, Hertweck SP. (2000). Breast disorders in the pediatric and adolescent patient. Obstetrics and gynecology clinics of North America. 27(1): 19-34. https://doi.org/10.1016/S0889-8545(00)80004-2; PMid:10693180
Urban C, Rietjens M, El-Tamer M, Sacchini VS. (Eds.). (2013). Oncoplastic and reconstructive breast surgery. Milano: Springer: 325-330. https://doi.org/10.1007/978-88-470-2652-0
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