Study of Benign Breast Lumps in Females

Original Research Article

Study of benign breast lumps in females

Kanchan Waikole1*, Mahendra Wante2

1,2Assistant Professor Department of General Surgery, Yashwantrao Chavan Memorial Hospital Pimpri Pune, Maharashtra, INDIA. Email: [email protected] , [email protected]

Abstract Background: The need for study is to analyze the spectrum of benign breast disease with respect to age, sex, mode of presentation, clinical features and management. Methods: The study was conducted among 100 patients who were diagnosed to have various forms of Breast Diseases that are found to be benign in nature and admitted at YCMH, Pimpri from April 2017 to march 2019. Diagnosis was made by doing careful clinical assessment, ultrasonography and/or mammography, FNAC and specimen biopsy. Surgery was done as per indications. The conservative treatment was advocated based on clinical acumen, symptoms and supportive histology. The incidence of variable benign breast diseases and clinical features were compared and evaluated. Results: Out of the 100 patients who presented with breast lumps, fibroadenoma, accounted for 62 % of the cases, which was the highest number of patients. Fibroadenosis accounted 26 % of the cases. Inflammatory lesions like Fibrocystic changes, chronic abscess and granulomatous mastitis accounted 12%. Most patients presented with complaints of lump in the breast, pain or a combination of both. 45 patients had a right sided lesion and 35 had left side lesion. Bilateral disease was present in 20 patients. The upper outer quadrant was more involved and lower medial quadrants were least commonly affected. Of 62 cases of fibroadenoma, all were operated upon by excision.14 patients with Fibroadenosis had undergone excision where the diagnosis was doubtful.5 out of 8 patients with gralunamatous mastitis were subjected for wide local excision. Rest were managed by conservative treatment. Conclusion: Benign breast diseases are common in female patients and fibroadenoma is the commonest of them all. Clinical, radiological and pathological assessment gives a firm diagnosis and it eliminates unnecessary anxiety or fear of every lump in breast being malignant. Keywords: Breast lump,Fibroadenoma, Fibroadenosis, granulomatous mastitis, Fibrocystic disease, Breast abscess, FNAC.

*Address for Correspondence: Dr Kanchan Waikole, Assistant Professor Department of General Surgery, Yashwantrao Chavan Memorial Hospital Pimpri, Pune Maharashtra, INDIA. Email: [email protected] Received Date: 22/11/2019 Revised Date: 03/01/2020 Accepted Date: 29/01/2020 DOI: https://doi.org/10.26611/1061415

malignant even though majority of the breast lumps are Access this article online part benign breast disease.3 Early diagnosis and prompt Quick Response Code: treatment with indicated surgery or conservative treatment Website: will relieve patient’s anxiety of having breast lump as

www.medpulse.in carcinoma. Assessments which includes clinical examination, imaging ,FNAC and tissue histopathology examination is now considered a gold standard approach to the diagnosis of breast lump.4 The more common age Accessed Date: group for benign breast lesion is between teenage to fifth 12 April 2020 5 decade of women’s life unlike malignant breast lesion which is more seen in post menopausal age group of 6 females. There are many types of benign breast diseases INTRODUCTION which can be classified according to predominant Any non-malignant breast condition with clinical and symptoms like lump, mastalgia. We had 8 cases of pathological evidences are defined as benign breast granulomatous mastitis which seems like emerging as new Disease1 It is one of the most common diseases in the variant of BBD. The leading symptom is a painful mass, females of any society. The statistical data of previous erythema and swelling as symptoms of inflammation of the study shows 30% of women suffer from benign breast involved breast. Other symptoms are hyperemia, areolar lesions once in their lifetime making them compulsory to retraction, fistula, and ulceration. Around 37% present take treatment. 2 Most of our female population is always with signs of an abscess 7. The lesion may occur in any worried about increasing numbers of carcinoma of breast. quadrant of the breast but is mostly present in the So every small or large lump is considered as malignant retroareolar region from where it extends radially. Most and creates high level of stress in their family. Its very lesions occur unilaterally. The mass may clinically mimic difficult to convince them about every lump not being a bacterial abscess and/or breast cancer by inducing skin or

How to cite this article: Kanchan Waikole, Mahendra Wante. Study of benign breast lumps in females. MedPulse International Journal of Surgery. April 2020; 14(1): 21-23. https://www.medpulse.in/Surgery/ MedPulse International Journal of Surgery, Print ISSN: 2550-7591, Online ISSN: 2636-4751, Volume 14, Issue 1, April 2020 pp 21-23 nipple retraction. Lymphadenopathy is present in up to 15% of patients.8 some cases of GM simulate inflammatory carcinoma9 so needs to be evaluated carefully. So our purpose of the study is to analyse the spectrum of BBD with respect to age, mode of presentation, clinical features and managements. This data

will help us to relieve stress of the patients and their family who has fear of cancer in every lump in the breast. DISCUSSION Benign Breast diseases are at least 10 times more common METHODS than breast cancer in hospital clinics. 11 Currently This prospective study was done for 100 patients malignant to benign ratios of 1:10 are seen in breast presenting in the Surgery OPD of YCM Hospital, PCMC clinics.12 In a case study of benign breast diseases in Maharashtra India from April 2017 to March 2019. All Greater Boston in 1968 fibroadenoma was commonest and breast related complaints and lesions of the breast in found during the second decade of life commonly in female patients were included in this comprehensive study. married nullipara.13 Presenting complaints of the patients The age group ranges between 15 to 60 years.Exclusion were mostly of the lump alone followed by lump and pain, criteria: males with breast lesions, patients with any with a minimal number complaining of pain alone.With obvious cancer or biopsy proven malignant diseases which respect to investigations FNAC was the initial procedure had been treated for malignancy earlier or operated were of choice and was carried out on all patients on OPD basis. excluded from this study. A detailed history was taken and Every specimen which was removed surgically was sent to diagnosis was done by detail clinical examination, imaging HPE. Our study shows more cases of fibro adenoma(62%). like USG, FNAC, core needle or excision biopsy. Our We had more unmarried young girls and nullipara womens institute does not have facility for mammography, so it was with fibroadenomas. which is consistent with Greater not advised to each and every patient. Those patients in Bostan study13.Fibroadenosis was the next common which indication of mammography was evident only those lesion(26 cases) found in our study in the married patients were referred out side for mammography. Surgery multipara womens in the age of 25 to 40 years. The was done in each case of fibroadenoma, 3 young girls had Rangabashya study established over 5-years also multiple fibroadenamas ranging from 2 to 4 in numbers. demonstrated fibroadenomas to be the commonest Out of 26 patients of fibroadenosis sector mastectomy was followed by fibroadenosis and inflammatory disease.14 As done in 18 cases, 5 patients of granulomatous mastitis were far as inflammatory conditions were concerned, the present subjected to wide excision. 3 patients had under gone true study involved 12 patients, 8 granulomatous mastitis, 2 cut needle biopsy and were given treatment based on cases of fibrocystic disease and 1 case antibioma. In our pathological findings. Antibioma was drained and study we had remarkable numbers of granulomatous reassurance with conservative treatment was given to those mastitis (8%). So we searched for previous data on the patients with cystic fibrosis and mastalgia due to same topic but found few studies and felt need for more fibroadenosis as per guidelines and as suggested by studies. The majority of cases reported in the literature previous studies.10 indicate that the disease primarily occurs in women of childbearing age, mostly with a history of breastfeeding. Table 1 The disease usually occurs around 2 years after breast Age group Numbers feeding at a median age of 30 years.15 Our data too is 15 to 30 56 having the same prevalence ,as most womens in our study 30 to 60 46 belonged to 26 to 32 years of age having GM. A possible Total 100 reason for GM is an inflammatory autoimmune response to epithelial damage, although the trigger for this damage Table 2 is still unknown. A correlation with breastfeeding and Diagnosis Total childbirth has also been discussed. An inflammatory Fibroadenoma 62 reaction might occur in response to extravasated secretions Fibroadenosis 26 from the lobules 12. Due to the fact that the clinical Granulomatous mastitits 8 Cystic fibrosis 3 presentation of the disease is typical for mastitis, most Chronic abscess(antibioma) 1 patients get antibiotics in the beginning of their therapy Total 100 cascade in the form of a blind antibiotic therapy without any microbiological proof of a bacterial infection. GM is per definition a sterile inflammatory disease; therefore,

MedPulse International Journal of Surgery, Print ISSN: 2550-7591, Online ISSN: 2636-4751, Volume 14, Issue 1, April 2020 Page 22 Kanchan Waikole, Mahendra Wante antibiotic therapy usually fails.17,18 When GM is 3. Srivatsava A, Dhar A. Benign breast disease: a neglected diagnosed, 2 treatment options are discussed in the entity. Recent Adv Surg. 2006;10:175- 201. literature: a conservative strategy involving medical 4. Hughes LE, Mansel RE, Webster DJT. The approach to diagnosis and assessment of benign breast lumps benign therapy with corticosteroids versus a surgical approach. In disorders and diseases of the breast concepts and clinical 19 1980, DeHerthogh et al. first recommended a high-dose management, 2nd edition. London: WB Saunders; 2005:35. corticosteroid therapy with prednisolone 30 mg/day for at 5. Kelsey JL, Gammon MD. Epidemiology of breast cancer. least 2 months. In general, this leads to a decrease in the Epidemiol Rev. 1990;12:228-40. diameter of the lesion but also to a variety of side effects 6. GM 12 Vecchia C Parzzini F, Franceschi S. Risk factors for such as weight gain, hyperglycemia, and the risk of benign breast disease and their relation with breast cancer risk. Pooled information from epidemiologic studies, Cushing’s syndrome. Despite these side effects, this Tumori;1985;17;167-178. 16 approach became standard of care. Freeman et al. 7. GM16 Freeman CM, Xia BT, Lewis JD, et al.: Idiopathic proposed a lower-dose regimen of 16 mg prednisolone granulomatous mastitis: a diagnostic and therapeutic twice a day for 2 weeks and slow tapering over 2 months. challenge. Am J of Surg 2017;214:701–706. In our study 5 GM patients had undergone wide local 8. GM17 Calis H, Karabeyoglu SM: Follow-up of granulomatous excision and three were managed on low dose mastitis with monitoring versus surgery. Breast Dis 2017;37:69–72. corticosteroids with monthly OPD followup. The decision 9. GM[1] . References 1 Kessler E, Wolloch Y: Granulomatous at what stage of the disease surgery is performed depends mastitis: a lesion clinically simulating carcinoma. AM J Clin on the individual clinical appraisal of the patient as does Pathol 1972;58:642–646. the choice of surgical technique which varies from wide 10. 1/13. Mansel RE. European multicentre trial of Bromocriptine excision to mastectomy. 17,18, 20 in cyclic mastalgia. Lancet. 1990;335:190-92. 11. 2/ 13.S.Selvakumaran, Mimamsychet B.Sangma, Study of CONCLUSION various benign breast diseases. International surgery journal Benign breast diseases are common in female patients and January 2017;vol 4(1)339-343. fibroadenoma is the commonest of them all. The age of the 12. 12 2/9. Beyer T, Moonka R. 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