We hope youre having a FANTASTIC week! Here are your answers to Mondays Challenger: 1.) D. Ultrasound only 2.) A. Clinical breast exam annually; self breast exam monthly Rationale both questions: According to UpToDate “Overview of benign breast disease”, “Benign epithelial breast lesions can be classified histologically into three categories: nonproliferative, proliferative without atypia, and atypical hyperplasia. The categorization is based upon the degree of cellular proliferation and atypia”. Fibroadenomas fall into the proliferative without atypia category since those in this category are associated with a small increased risk of developing breast cancer. The article defines fibroadenomas as usually presenting as a well-defined, mobile mass on physical examination or on ultrasound as a well-defined solid mass. These are benign solid tumors containing glandular as well as fibrous tissue. They can increase in size during pregnancy or with estrogen therapy and maybe tender prior to menses. In this case study, the patient presented with a single, nontender, firm mass measuring approximately 3 cm in diameter. The mass is freely moveable, well delineated, and located in the right upper outer quadrant near the “tail of Spence”, typical of fibroadenomas. Another article from UpToDate, “Overview of breast masses in children and adolescents”, refers to fibroadenomas as juvenile fibroadenomas and as the most common breast lesions in adolescents. At this stage of the disease, an ultrasound would be the least invasive and most appropriate given that the ultrasound can be somewhat diagnostic. If the ultrasound reveals a well-defined solid mass, it would be classified as a fibroadenoma and can be managed with core needle biopsy or short-term (three to six months) follow-up with a repeat ultrasound and breast examination. The definitive diagnosis can only be determined with a core biopsy or excision. Due to the disadvantages of excisional surgery, it is not necessary to excise all biopsy proven fibroadenomas. If the fibroadenoma is asymptomatic, it can be left in place. If the fibroadenoma increases in size or becomes symptomatic, then to rule out malignant changes, excision is mandated. Therefore, palpating for changes in the mass monthly with self-breast exams and annually with clinical breast examination is the recommendation. References Banikarim, MD, Chantay, and De Silva, MD, Niruparma. (2013). “Overview of breast masses in children and adolescents”. UpToDate. Retrieved April 27, 2014 from uptodate Hollier, Amelie and Hensley, Rhonda. (2011). Clinical Guidelines in Primary Care: A Reference and Review Book. Lafayette, LA. Advanced Practice Education Association, Inc. Sabel, Michael. (2013). “Overview of benign breast disease”. UpToDate. Retrieved April 27, 2014 from uptodate
Posted on: Wed, 30 Apr 2014 18:38:11 +0000
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