Recurrent Multiple Fibroadenomas: History of a Case Presented in MDT Meeting With Clinical Discussion and Decision Making

Abstract

Background: Fibroadenoma is a common benign breast disorder in young women which has a low risk of malignant transformation. Most fibroadenomas present as a single mass, but the presence of multiple fibroadenomas can be seen in 15–20% of patients, with average number of 3–4 masses in one breast. In different studies and reports, various treatment modalities-including observation and follow up, surgery, radiofrequency ablation, etc- have been proposed, though the best management for these patients are not determined yet.
 Case presentation: We present the case of 33-year-old female with history of multiple bilateral benign breast lesions with a presumptive diagnosis of fibroadenomas. She had three previous surgical excisions in the past 14 years. Her case was presented to a breast MDT meeting to obtain a recommendation on appropriate management.
 Question: The proposed a question in MDT concerned the best and most appropriate management plan for the patient; Does she require further surgical excisions? And if not, how should she be followed?
 Conclusion: After reviewing past medical history, physical examination, and all documents regarding the patient, MDT members recommended that the patient should be managed with close follow up with physical examination and ultrasound every 6 months. The necessity of further surgical intervention would be determined according to any new findings.

Evaluating the Effect of Ormeloxifene on Multiple Fibroadenomas and Mastalgia

“…Although unknown,the possible hormonal aetiology may be hypersensitivity of breast tissue to oestrogen by risk factors such as oral contraceptive pills, dietary factors and hereditary predisposition. [ 2 3 ] Usually in multiple fibroadenoma, average number of masses in a single breast is 3-5 but more numbers have been reported in various studies including this study. [ 3 ] Increased body mass index and oral contraceptives could not be established as a risk factor in this study as in other studies.…”

“…The most common benign breast masses in adolescents include fibroadenomas, they are mostly found in patients under 30 years of age and appear as a single mass but in about 20% of the cases there may be multiple mass in one breast. [ 2 ] Women with multiple fibroadenomas mostly have familial history. [ 3 ] The exact etiology of multiple fibroadenomas is not known it is believed that the possible etiology may include the use of oral contraceptive pills (OCP's), estrogen and prolactin level disproportion in the body, local breast tissue reaction to estrogen, and dietary or inherited predisposition.…”

“…[ 3 ] The exact etiology of multiple fibroadenomas is not known it is believed that the possible etiology may include the use of oral contraceptive pills (OCP's), estrogen and prolactin level disproportion in the body, local breast tissue reaction to estrogen, and dietary or inherited predisposition. [ 2 3 ]…”

“…Multiple fibroadenoma is defined by the unilateral or bilateral existence of at least three fibroadenomas in one breast of women of child bearing age. [ 2 ] Surgical treatment is usually required for symptomatic, more than 4cm size rapidly, enlarging, and the ones causing cosmetic breast deformity. [ 4 ] The management and treatment of multiple fibroadenomas can be challenging due to the rare occurrence and scarcity of original research on these conditions.…”

Effects of oral N-acetyl cysteine on pain and plasma biochemical parameters in fibrocystic breast disorder: A randomized controlled trial

“…Pathologically, excessive estrogen and imbalance in estrogen to progesterone ratio following sex hormone releasing cycles are paramount points for FCC development. Diagnosis of FCC is confirmed by history taking, physical examination, and breast imaging [ 7 ]. Benign characteristic in physical examination including palpable, nontender, mobile, and round-shaped lesion is highly suggestive for FCC, although evidence of firmness, pain, and tenderness does not absolutely exclude FCC [ 8 ].…”