Fib Road en Om A

8/8/2019 Fib Road en Om A

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Eunice Athena A. Manuel


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To discuss a case of Fibr oaden om a withfibr ocystic changes


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Discuss the typical symptoms andfindings on physical examination of apatient with Fibroadenoma

Discuss the treatment and plan of management of a patient withFibroadenoma


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S.P.39/Fe maleSingleFilipin oBaptistBorn: R osari o, Cavite

Live: Tanza , CaviteAdm itted , first ti me , August 30 , 2010 , 5:39pm


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Bilateral breast mass and tenderness


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3 years P TA

Bilateral breast pain (6/10 , pricking) and fullness of both breastSympt om s are present during menstruati on, res olves sp ontane ouslyno medicati on taken , no noted palpable breast massSought c onsult - underwent ultras ound of both breast which revealedmultiple n odules on bilateral breastWas advised t o repeat ultras ound 2x a year fo r mo nit oring

1 year P TA

Succeeding breast ultras ound revealed increase in nu mber of breastmassNo further w ork-up d one

2 mo nthsPTA

Persistence of bilateral breast pain and fullness of breast even in theabsence of menstruati on.Noted palpable s mall multiple masses on right breast , mo veable


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1 mo nthPTA

Patient s ought c onsult(+) persistence of sympt om s(-) nipple discharge and retracti on, no skin

changesRepeat Ultras ound revealed:

fibr ocystic changes , both breastSolid breast n odule with s onographycallybenign features , le ft , which may c orrelatewith fibr oaden om aFocal ductal dilatati on with s mallech ogenic fo cus within , right breast , consider ductal pappil om aPatient was advised and schedule fo rbreast mass excisi on hence subsequentlyad mitted


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(-) HPN(-) DM(-) Asth ma(-) Allergies


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(-) HPN(-) DM(-) Allergies(+) Astha ma -sibling(+) Breast mass -sibling


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(-) s mo ker(-) alc oholic beverage drinker


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O B score: G0P0(0-0-0)LNMP: 3rd week of JulyRegular menstrual cycle , 3-4 days , no dys men orrheaMenarche: 12 y/ o


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(-) weight l oss(-) weakness(-) pall or

(-) hyper-pig mentati on(-) hyp o-pig mentati on(-) dizziness(-) headache

(-) dyspnea(-) angina(-) palpitati ons(-) nipple discharge

(-) c onstipati on(-) diarrhea(-) abd om inal pain(-) v om iting(-) an orexia(-) p olyuria

(-) dysuria(-) bleeding(-) nu mbness


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Vital signsBP: 110/80 mm Hg; HR: 72 BPM; RR: 20cp m; T: 36.9 oC

GeneralSurvey

awake , coherent , ambulant , oriented t o ti me place and pers on, not incardi o-respirat ory distress , end omo rph , appears t o be in herchr onological age of 39 years old

Integu ment

No pall or, no jaundice , no cyan osis , good skin turg or, no hyp o/hyperpig mentati on, no signi ficant pri mary or sec ondary lesi ons

HEENT

Normo cephalic , no peri orbital ede ma, pink palpebral c onjunctiva , anicteric sclerae , no ear/nasal discharge , no septal deviati on, no CLAD, no palpable mass on neck , trachea at the midline


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Chest andLungs

No retracti ons , symm etrical lung expansi on, res onant on all lungfields , clear breath s ounds , no crackles , no wheezes

CVS

No pre c ordial bulge , no heaves , no thrills , APB and PMI @ 5 th ICS, LMCL, normal heart rate , regular rhyth m, no mur murs

BreastExam

(+) tenderness at the upper quadrants of both breast(+) multiple palpable masses on right breast firm, moveablemeasuring approx. 1x1cm, located near the nipple, right upperquadrant(-) palpable mass on le ft breast(-) nipple discharge/retracti ons; (-) skin changes(-) palpable axillary n ode


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Abdom en

l bb , no visible ls ti on, inverted mbili s, ( ) stri e , ABS bs min, t mpa niti , (-) tenderness

Extre mities

ll and eq al peri pher a l pu lses , no limit a ti on of mo ve ments , no ede ma

NEURO LO GIC

AL EXAM

CRANIALNERVES: essenti a ll norma l


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Fibr oaden om a with fibr ocystic changesbilateral breast


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Ultras onography:y Fibr ocystic changes , both breasty Solid breast n odule with s onographically benign

features , le ft which may c orrelate withfibr oaden om as

y Focal ductal dilatati on with s mall ech ogenic focuswithin , consider ductalpappil om a.


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O ther i maging techniques:Mammo graphy use t o evaluate w om en withabn ormal findings such as breast mass or nipple

dischargeDuct ography pri mary indicati on is nippledischarge , particularly when fluid c ontains bl ood.Breast Biopsy i mage guided breast bi opsies arefrequently required t o diagn ose n on palpablelesi ons


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Lumpect om y, bilateral breast


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Right breast:0.5c m x 0.5c m doughy mass n oted at 8 o clockpositi on, ab out 1.6c m depth

Left breastMultiple s olid d oughy n odular masses at 2-3o clock p ositi on ab out 1.9 c m depth


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A. Fibr ocystic and fibr oaden om at ouschanges , breast mass , RightB. Fibr ocystic changes , breast mass , Le ft


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Fibr oaden om a: l obular str om a


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Fibr oaden om aMost c ommo n benign tu mo rs of the fe male breastO ccurring at any age within the repr oductive

peri od of lifeAre s om ewhat mo re c ommo n be fore age 30Usually present with palpable mass , frequentlymultiple and bilateralO n mammo gra m presence of mammo graphicdensity or mammo graphic calci ficati ons


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Fibr oaden om a:Remo val of all fibr oaden om as has been adv ocateirrespective of patient age or other

considerati ons and s olitary fibr oaden om as inyoung w om en are frequently re mo ve t o alleviatepatient c oncernMost fibr oaden om as are sel f limiting and may g o undiagn osed s o a mo re c onservative appr oach is

reas onableCare ful ultras ound exa minati on with c ore needlebiopsy will pr ovide fo r an accurate diagn osis


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Fibr ocystic disease/ fibr ocystic changes:The ter m fibr ocystic disease is n on speci fic andused as a diagn ostic ter m t o describe sy mpt om s, t o rati onalize the need for breast bi opsy.It re fers t o a spectru m of hist opath ologic changesthat are best diagn osed and treated speci fically.These changes are ter med n on pr oliferative t o distinguish the m from the pr oliferativechanges ass ociated with increase risk of breastcancer.These lesi ons might c om e t o clinical attenti onwhen they mimic carcin om a pr oducing palpablelumps , mammo graphic densities or calci ficati onsor nipple discharge.


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