Year: 2024
Type: review
Study design: Systematic Review
Abstract: Introduction Fibroadenoma is the most common benign breast lesion; however, it carries a potential risk of malignant transformation. This systematic review provides an overview of the presentation, management, and outcome of carcinomas arising within fibroadenomas. Methods A systematic search on Google Scholar was conducted for English-language studies on breast carcinoma within fibroadenomas. Studies on fibroadenomas with no malignant components, review articles, pre-prints, incomplete data, and those published in suspicious journals were excluded. Results On ultrasonography, 28 masses (36.8%) appeared benign, and 20 (26.3%) were suspicious, with ultrasonographic data unavailable for the remaining tumors (36.8%). Mammography data were available for 50 tumors, revealing 27 benign lesions (54%) and 23 suspicious lesions (46%). Among the 17 lesions with available magnetic resonance imaging data, five were benign lesions (29.4%), and 12 were suspicious (70.6%). Cytology evaluation among 46 tumors revealed that 20 (43.5%) were benign, 24 (52.2%) were malignant, and two (4.3%) were suspicious. The most commonly performed surgery was wide local excision (50.7%), followed by mastectomy (32.9%). On histopathology, 11 tumors exhibited more than one pathology. Ductal carcinoma in situ was the most frequent finding (40.8%), followed by invasive ductal carcinoma (28.9%) and lobular carcinoma in situ (28.4%). Recurrence was observed in one case (1.4%), and metastasis occurred in two cases (2.8%). Conclusion Although rare, carcinomas arising within fibroadenomas may present considerable challenges in preoperative diagnosis, whether through imaging or cytology. Therefore, clinicians may find it necessary to approach fibroadenomas with increased caution. Introduction Fibroadenoma is the most common benign breast lesion comprising epithelial and stromal components [1,2]. The tumor generally manifests as a hyperplastic breast lobule, presenting as a solitary mass during a woman’s early reproductive years, with the peak incidence occurring in the second and third decades of life [3,4]. Estrogen, progesterone, pregnancy, and lactation are believed to stimulate tumor growth, although it tends to shrink during menopause as estrogen levels decline [3]. Incidence rates range from 7% to 13% in the general population, with up to 20% of cases presenting with bilateral or multiple masses [3]. Clinically, fibroadenoma presents as a palpable, mobile, solid mass with a rubbery consistency and smooth, well-defined borders [5]. It is radiologically and histologically classified into simple and complex types [2]. The tumor may exceed 3 mm in size, be associated with sclerosing adenosis or epithelial calcifications, and potentially give rise to carcinomas that can invade the surrounding breast tissue. Although cases of fibroadenomas containing malignancies are rare, malignancy tends to occur more frequently in patients 10 to 20 years older than the typical age for simple fibroadenomas [2,6]. Carcinomas within fibroadenomas are most commonly carcinoma in situ (CIS) [7,8]. Invasive carcinomas, though less common, can occur, with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) being the primary forms [6]. Carcinomas in situ signal an increased risk of developing invasive cancer if left untreated, and neoplasms arising within fibroadenomas behave similarly to those occurring independently [9]. This systematic review provides an overview of the presentation, management, and outcome of carcinomas arising within fibroadenomas. Methods Study design This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources and search strategy A systematic search on Google Scholar was undertaken to identify relevant English-language studies on breast carcinoma within fibroadenoma. The search strategy employed a combination of keywords, including "fibroadenoma" with terms such as (carcinoma, cancer, malignancy, malignant, carcinoma in situ, lobular carcinoma in situ (LCIS), and ductal carcinoma in situ (DCIS). Eligibility criteria The inclusion criteria were limited to studies specifically addressing breast carcinoma within fibroadenoma. Studies on fibroadenomas with no malignant components, review articles, pre-prints, incomplete data, and those published in suspicious journals were excluded [10]. Study selection and data extraction Two authors independently reviewed the titles and abstracts of the identified publications. Following this, the same two authors assessed the full texts of the remaining studies based on predefined inclusion and exclusion criteria. The extracted data included the first author’s name, the country of publication, study design, patient demographics, clinical presentation, physical examination findings, imaging and cytology findings, treatment strategies, and disease prognosis. Data analysis Microsoft Excel (2019) was employed to collect and organize the extracted data, while data analysis (descriptive statistics) was performed using the Statistical Package for Social Sciences (SPSS), version 27.0. The results are presented as frequencies, percentages, ranges, mean with standard deviation, and medians with quartile ranges. Results Study selection and characteristics A total of 317 studies were identified from the search. Thirty-six studies were excluded due to duplication (n=5) and non-English language publications (n=31). This left 281 studies for title and abstract screening. At this stage, 202 studies were excluded due to irrelevancy. As a result, 79 studies advanced to the full-text screening stage. At this point, nine studies were excluded for being meta-analyses (n=2), reviews (n=2), publications with incomplete data (n=1), and pre-prints (n=4). Nine of the remaining 70 studies were excluded for failing to meet eligibility criteria as they were published in suspicious journals [10]. Ultimately, 61 studies [1-9,11-62], encompassing 72 cases, were included (Figure 1). Most of the studies were case reports (n=58), accompanied by three case series. Most were affiliated with Japan (19.7%) and the USA (14.7%) (Table 1). The raw data of the study has been presented in Tables 1-6. Table 1. The distribution of the reported cases among countries. Author /Year [reference] Study design No. of included case(s) Country Ni et al./2023 [14] Case report 1 China Brunetti et al./2023 [4] Case report 1 Italy Wang et al./2022 [5] Case report 1 Singapore Pang et al./2022 [2] Case report 1 Malaysia Hammood et al./2022 [3] Case report 1 Iraq Tagliati et al./2021 [1] Case report 1 Italy Shojaku et al./2021 [6] Case report 1 Japan Fujimoto et al./2021 [11] Case report 1 Japan Feijó et al./2021[8] Case report 1 Brazil Shiino et al./2020 [12] Case report 1 Japan Moreno et al./2020 [17] Case report 1 Brazil Gonthong et al./2020 [13] Case report 1 Thailand El-Essawy et al./2020 [18] Case report 1 KSA Brock et al./2020 [9] Case report 1 USA Marumoto et al./2019 [16] Case report 1 USA Zeeshan et al./2018 [19] Case report 1 Pakistan Tiwari et al./2018 [15] Case report 1 India Frisch et al./2018 [7] Case report 1 South Africa Lim et al./2017 [20] Case report 1 Korea You et al./2016 [21] Case report 1 Korea Zheng et al./2015 [22] Case report 1 China Hua et al./2015 [23] Case report 1 China Wu et al./2014 [24] Case series 6 Taiwan Mele et al./2014 [25] Case report 1 Denmark Limite et al./2014 [26] Case report 1 Italy Kwon et al./2014 [27] Case report 1 Korea Kılıç et al./2014 [28] Case report 1 Turkey Dandin et al./2014 [29] Case report 1 Turkey Buteau et al./2014 [30] Case report 1 USA Hayes et al./2013 [31] Case report 1 Ireland Jahan et al./2012 [32] Case report 1 Bangladesh Butler et al./2012 [33] Case report 1 USA Ooe et al./2011 [34] Case report 1 Japan Lin et al./2011 [35] Case report 1 Taiwan Kato et al./2011 [36] Case report 1 Japan Abu-Rahmeh et al./ 2012 [37] Case report 1 Israel Rao et al./ 2010 [38] Case report 1 India Petersson et al./2010 [39] Case report 1 Singapore Tajima et al./2009 [40] Case report 1 Japan Gashi-Luci et al./2009 [41] Case report 1 Kosova Borecky et al./2008 [42] Case series 3 Australia Tiu et al./2006 [43] Case report 1 Taiwan Shin et al./2006 [44] Case report 1 Korea Blanco et al./2005 [45] Case report 1 USA Abite et al./2005 [46] Case report 1 Nigeria Stafyla et al./2004 [47] Case report 1 Greece Abe et al./ 2004 [48] Case report 1 Japan Adelekan et al./2003 [49] Case report 1 UK Yano et al./2001 [50] Case report 1 Japan Gebrim et al./2000 [51] Case report 1 Brazil Psarianos et al./1998 [52] Case report 1 Australia Shah et al./ 1998 [53] Case report 1 USA Kurosum et al./1994 [54] Case report 1 Japan Morimoto et al./1993 [55] Case report 1 Japan Gupta et al./1992 [56] Case report 1 New Zealand Gupta et al./1991 [57] Case report 1 New Zealand Fukud et al./1989 [58] Case report 1 Japan Yoshida et al./1985 [59] Case report 1 Japan Fond et al./1979 [60] Case report 1 USA Konakry et a./1975 [61] Case series 5 USA Durso et al./1972 [62] Case report 1 USA Table 2. Patient demography, disease presentation, and medical history. First Author /Year Age (years) Gender Presentation Laterality Duration (months) PMH FHx of breast cancer Ni et al./2023 [14] 60 F Mass UL 12 NN Neg. Brunetti et
Source: Barw Medical Journal
Authors: Abdulwahid M. Salih, Lana R.A. Pshtiwan, Mohammed Gh. Hamasaeed, Sami S. Omar, Shaban Latif, Shadi H. Sidiq, Bushra O. Hussein, Hunar A. Hassan, Diyar A. Omar, Sarhang S. Abdalla, Hemn A. Hassan, Yousif M. Mahmood, Marwan N. Hassan, Dahat A. Hussein, Sasan M. Ahmed, Hiwa O. Abdullah, Berun A. Abdalla
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4406289922