Heng Sophia Si Ling, Yahya Maya Mazuwin, Sulaiman Wan Azman Wan, Saad Arman Zaharil Mat
Reconstructive Sciences Unit, University of Sciences Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia; Plastic, Reconstructive and Aesthetic Unit, Department of Surgery, University Malaysia Sabah, Sabah, Malaysia.
Department of Surgery, University of Sciences Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia.
Int J Surg Case Rep. 2021 Mar;80:105202. doi: 10.1016/j.ijscr.2020.10.096. Epub 2020 Nov 28.
Juvenile giant fibroadenoma is a rare type of fibroadenoma characterized by rapid growth of a breast tumor in an adolescent. Benign in nature, they rarely present as fungating and ulcerating tumors. Benign tumors masquerading as malignancies are surgical conundrums. No co nsensus exists yet on the management of these cases. We aim to discuss the dilemma in managing a bleeding, fungating giant fibroadenoma in an adolescent female and highlight risks of alternative therapies.
A 19-year-old lady presented with a bleeding, fungating breast mass worsened with topical herbal concoction. Examination revealed a 10 × 15 cm fungating breast mass that obliterated her nipple- areolar complex (NAC). Computed Tomography (CT) scan reported a huge heterogeneously enhancing mass 10.6 × 14.5 × 15.1 cm with loss of normal fat plane with the overlying skin but a clear fat plane with the pectoralis muscle posteriorly.
Giant breast masses that fungate and ulcerate usually indicate a sinister pathology. Traditional remedies have been reported to exacerbate growth. In cases where most of the breast parenchyma and NAC has been destroyed, it is no longer possible to proceed with breast conserving techniques. Breast reconstruction is crucial in adolescents and should be tailored to the patient's existing breast size as well as body habitus.
In juvenile giant fibroadenomas where breast parenchyma and NAC has been destroyed, breast reconstruction is the goal. The lack of consensus in both diagnosis and management further compounds the difficulty in dealing with this sensitive population. Awareness needs to be raised regarding negative effects related to traditional medicine.
青少年巨大纤维腺瘤是一种罕见的纤维腺瘤类型，其特征是青少年乳腺肿瘤快速生长。本质上为良性，它们很少表现为呈蕈状和溃疡状的肿瘤。伪装成恶性肿瘤的良性肿瘤是外科难题。目前对于这些病例的管理尚无共识。我们旨在讨论一名青春期女性出血性、呈蕈状巨大纤维腺瘤的管理困境，并强调替代疗法的风险。
一名19岁女性因出血性、呈蕈状的乳腺肿块就诊，外用草药制剂后病情加重。检查发现一个10×15厘米的呈蕈状乳腺肿块，乳头乳晕复合体消失。计算机断层扫描（CT）报告显示一个巨大的、不均匀强化的肿块，大小为10.6×14.5×15.1厘米，与上方皮肤的正常脂肪平面消失，但与后方胸大肌之间有清晰的脂肪平面。
呈蕈状和溃疡状的巨大乳腺肿块通常提示严重病变。据报道，传统疗法会加剧其生长。在大部分乳腺实质和乳头乳晕复合体已被破坏的情况下，不再可能进行保乳技术。乳房重建对青少年至关重要，应根据患者现有的乳房大小以及身体形态进行定制。
在乳腺实质和乳头乳晕复合体已被破坏的青少年巨大纤维腺瘤病例中，乳房重建是目标。在诊断和管理方面缺乏共识进一步加剧了处理这一敏感人群的难度。需要提高对传统医学相关负面影响的认识。
