Al Hakkak Samer Makki Mohamed, Al Faham Firas Shaker Mahmoud, Awwady Ali Najeh, Al Hakkak Maryam Samer, Al Wadees Alaa Abood
College of Medicine, University of Alkafeel, Iraq.
Department of Surgery, College of Medicine, University of Kerbala, Iraq.
Int J Surg Case Rep. 2024 Aug;121:109954. doi: 10.1016/j.ijscr.2024.109954. Epub 2024 Jun 27.
Giant juvenile fibroadenomas occurring at a mean age of 13 may be multiple and bilateral, accounting for approximately 0.5 % of all fibroadenomas. The pathogenesis of these tumors is closely linked to hormonal changes during puberty, characterized by increased estrogen stimulation, heightened estrogen receptor sensitivity, and reduced estrogen antagonists. These hormonal factors are pivotal in the rapid growth and substantial size observed in giant juvenile fibroadenomas.
An adolescent girl presented at the outpatient clinic with significant bilateral breast enlargement, causing redness and discomfort when sitting, leading to difficulty wearing age-appropriate clothing and chest wall pressure. Despite previous consultations attributing the condition to genetic causes, further investigation via radiological ultrasound indicated a probable diagnosis of bilateral breast mass fibroadenoma, occupying a substantial portion of the breast tissue. Consequently, the decision was made to perform bilateral breast surgery to remove the giant masses for histopathological analysis.
The delayed diagnosis accentuated the case's complexity, highlighting the challenges in effectively identifying and managing giant fibroadenomas in adolescents. Despite the initial absence of alarming symptoms, these fibroadenomas' sheer size and impact underscored the importance of early detection and comprehensive evaluation in similar clinical presentations.
The surgeon must emphasize meticulous planning when deciding on the surgical approach for removing a giant juvenile fibroadenoma. This planning is crucial for preserving breast functionality, achieving a satisfactory cosmetic outcome, and addressing the psychological distress of young patients. Early detection and excision are imperative to safeguard breast tissue.
平均发病年龄为13岁的巨大青少年纤维腺瘤可能为多发和双侧性,约占所有纤维腺瘤的0.5%。这些肿瘤的发病机制与青春期的激素变化密切相关,其特征为雌激素刺激增加、雌激素受体敏感性增强以及雌激素拮抗剂减少。这些激素因素在巨大青少年纤维腺瘤的快速生长和较大体积中起关键作用。
一名青春期女孩到门诊就诊,双侧乳房明显增大,坐下时导致发红和不适,致使难以穿着适合其年龄的衣物并产生胸壁压迫感。尽管此前的会诊将该病症归因于遗传原因,但通过放射学超声进一步检查提示双侧乳腺肿块纤维腺瘤的可能诊断,该肿块占据了大部分乳腺组织。因此,决定进行双侧乳房手术以切除巨大肿块进行组织病理学分析。
诊断延迟加剧了该病例的复杂性,凸显了有效识别和处理青少年巨大纤维腺瘤的挑战。尽管最初没有警示症状,但这些纤维腺瘤的巨大尺寸和影响强调了在类似临床表现中早期检测和全面评估的重要性。
在决定切除巨大青少年纤维腺瘤的手术方法时,外科医生必须强调精心规划。这种规划对于保留乳房功能、实现满意的美容效果以及解决年轻患者的心理困扰至关重要。早期检测和切除对于保护乳腺组织至关重要。