Stromal fragments meaning6/18/2023 ![]() Few stromal fragments along with spindle shaped cells having elongated nuclei and adipocytes were also evident. In the background numerous single bare bipolar nuclei were seen ( Figure 2A & 2B). The cytology smears showed tightly cohesive monolayered sheets and aggregates of benign ductal epithelial cells with myoepithelial cells scattered in between these epithelial fragments. Smears were drawn and stained with May-Grunwald-Giemsa (MGG) stain. Fine-needle aspiration cytology (FNAC) of the breast lump was performed. Based on these radiological findings, a differential diagnosis of phyllodes tumor and giant fibrodenoma were made. The skin thickness and the nipple as well as subareolar tissue was normal. The retro mammary region consisting of fat, ribs and muscle was normal. There was no evidence of enlarged intra mammary or axillary lymph nodes. A hyperechoic nodule of 2.1x2cm was noted within this lesion and there was minimal increase in its vascularity. Ultrasonography of the right breast showed a well-circumscribed hypoechoic lesion of 12x7.5cm size in inner half of the right breast with smooth margins and broad base. Her routine hematological, biochemical and microbiological parameters were within normal limits.ġa) Asymmetrical breasts and deviation of nipple-areola complex of the right breast on clinical inspection.ġb) Distended tortuous veins on the overlying skin of the right breast lump.Ĭhest X- ray was normal. Based on the patient’s age, history and the breast examination, a clinical diagnosis of phyllodes tumor was made. Her systemic examination, the left breast and bilateral axilla were within normal limits. There was no skin ulceration or any nipple discharge. The overlying skin was tense and shiny with prominent distended superficial veins ( Figure 1B). It was firm in consistency, non-tender, freely mobile within the breast tissue and free from the chest wall. On palpation, there was a lump in the right breast which measured 12圆cm in size and was located in the right upper and lower inner quadrant. On physical examination, the right breast was slightly bigger than the left breast and the right nipple-areola complex was displaced laterally ( Figure 1A). Her menstrual cycles were regular and she did not take any hormonal therapy. ![]() Her past, medical and family history was non-contributory. There was no history of breast trauma, fever, anorexia or weight loss. ![]() She also complained of associated dragging non-radiating type of pain in the right breast since last 15 days. She gave a history that the lump was first noticed around 10 years back in the form of small nodule, which increased progressively in size with a rapid enlargement over a period of last 6 months. ![]() Case presentationĪ 35-year-old woman came to the surgical outpatient department of our hospital with the chief complaints of asymmetrical breasts and a large lump in the right breast. We herein report one such unusual case of giant fibroadenoma of the right breast in a 35-year-old woman creating a diagnostic dilemma as it mimicked a phyllodes tumor. 2, 8 This rare entity is of great importance as this may not only cause asymmetrical breasts, stretching and displacement of the nipple-areola complex, congestion and ulceration of skin by centrifugal pressure but also it has to be differentiated from other giant breast masses as all these have a different therapeutic approach and prognosis. 7 Increased estrogen stimulus and receptor sensitivity and a decrease in estrogen antagonist levels during puberty are thought to be the basis of its etiology. 6 Most commonly it is seen in females of Afro-Caribbean or East Asian descent and have a bimodal age distribution with occurrence typically either in adolescent or premenopausal women. 5 This subtype has been also been defined as fibroadenoma with size larger than 5cm and/or weight of more than 500 grams. 3 Giant (juvenile or cellular) fibroadenoma is a rare variant of fibroadenoma accounting for 0.5-2per cent of all cases of fibroadenomas 4 and is characterized by its large size and rapid growth. 1 It is encountered in women usually before the age of 30 (commonly between 10-18 years of age), 2 although its occurrence in postmenopausal women, especially those receiving estrogen replacement therapy has been documented. Fibroadenoma is the commonest solid benign lesion that can exist as a solitary mass or multiple masses in the breasts.
0 Comments
Leave a Reply. |