Journal of Applied Molecular Cell Biology


ISSN: 2412-2580
Short Key Title: J App Mol Cell Bio
DOI: http://dx.doi.org/10.21065/24122580
Start Year: 2014

CLINICAL STUDY OF A FIBROCYSTIC BREAST PATIENT PRESENTED IN DHQ HOSPITAL SIALKOT, PAKISTAN.
Muhammad Usman, Arshad Awan.
Faculty of Pharmacy, University of Sargodha, (40100) Sargodha, Pakistan.
Keywords: Fibrocystic changes, Adenosis, Epithelial Hyperplasia, Tamoxifen, Ciprofloxacin.
Abstract

This case report was designed to report an incident of benign breast tissue with fibrocystic change in a 50 years old woman brought to Gujranwala Institute of Nuclear Medicine and Radiotherapy (GINUM) and having 2-3 months of disease history with serious symptoms. With mammography she was diagnosed fibrocystic breast changes and later on fine needle aspiration cytology (FNAC) of the breast was performed. Hence, surgical removal of benign mass was recommended by the consultant oncologist . In DHQ Hospital Sialkot, she undergone a successful surgery. Chemotherapy was suggested for two weeks and she was cured.The effective care of fibrocystic breast change may potentially needs comprehensive assessment for appropriate differential diagnosis. However, the rational therapy and scientific drug monitoring can help to control the fibrocystic breast change. Moreover, consultant oncologists should be careful to detect the exact neoplasm and initiate the treatment to avoid morbidities and mortalitiesss

Article Information

Identifiers and Pagination:
Year:2015
Volume:2
First Page:1
Last Page:4
Publisher Id:JAppMolCellBio (2015 ). 2. 1-4
Article History:
Received:November 5, 2014
Accepted:December 23, 2014
Collection year:2014
First Published:January 1, 2015

Introduction

The designation fibrocystic is applied to a miscellany of changes in the female breast that consist predominantly of cyst formation and fibrosis. In the past, these lesions were called fibrocystic disease. However, since most of these changes have little clinical significance beyond the need to distinguish them from cancer, the term fibrocystic change is preferred. [1] Benign mass or mass-like areas occur far more frequently than cancer, at a rate of almost 10:1. [2] 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.[3-12] Proliferative breast conditions are not cancerous, but they increase the risk of breast cancer. [6][13][14] The most common type of proliferative breast condition is hyperplasia. There are two types of hyperplasia: usual hyperplasia (more common) and atypical hyperplasia (less common). In usual hyperplasia (the most common form of hyperplasia) the proliferating (dividing) cells look normal under a microscope. In atypical hyperplasia, the proliferating (dividing) cells look abnormal. Atypical hyperplasia is less common than usual hyperplasia. [6][13][14] It is characterized by noncancerous breast lumps which can sometimes cause discomfort, often periodically related to hormonal influences from the menstrual cycle. [15] When ovarian function stops at menopause, small but significant levels of estrogens are synthesized by the conversion of adrenal precursors to estrone and estradiol. This is accomplished by aromatase enzyme in body fat. Higher levels of body fat are correlated with higher circulating levels of estrogens. [2] There is preliminary evidence that iodine deficiency contributes to fibrocystic breast changes by enhancing the sensitivity of breast tissue to estrogen. [16-17] Intraductalpapillomas of the breast are benign lesions with an incidence of approximately 2-3% in humans. [18] It is the most common cause of bloody nipple discharge. Excision is sometimes performed. Microdochectomy/microdochotomy (removal of a breast duct) is the treatment of choice. [19] Tamoxifen is approved by the FDA for the prevention of breast cancer in women at high risk of developing the disease. [20]Tamoxifen produced 49% reduction in the incidence of breast cancer. The preventive effect was noted in pre- and postmenopausal women for invasive and noninvasive breast cancer. [2]

 

Case Report

A 50 years old woman was sufferring from fibrocystic breast disease, presented in DHQ Hospital Sialkot, Pakistan. She experienced bloody nipple discharge; and diagnostic tests were made to evaluate situation severity. The mammography showed a low density opacity on retroareolar region. However, no dominant mass, suspicious microcalcifications or areas of architectural distortion seen. Correlative ultrasound showed localized branching dilated ducts (7mm) in retroareolar region. Some of them appeared to contain intraductal lesion measuring about 11x6mm.Fine needle aspiration cytology ( FNAC) of breast was performed by using 21G needle and aspirates taken from dilated duct seen in retroareolar region of right breast. Histopathological investigation showed sections contain benign breast parenchymal tissue consisting of lobules and ducts lined by benign double layer of epithelial and myo-epithelial cells. There was focal adenosis, epithelial hyperplasia of usual type and focal cystic change. The stroma revealed fibrosis and focal chronic inflammatory cell infiltrate. No granulomas were seen and there was no evidence of insitu or of invasive malignancy in any of the sections examined. Surgical removal of the benign mass of right breast was held in DHQ Hospital Sialkot, Pakistan.

Table 1.Three days post-surgical treatment recommended by consultant oncologist.

Medication

Duration

Dosage form

Frequency

Levofloxacin

3 days

IV Infusion

Once daily

Diclofenac sodium

3 days

Capsule

Once daily

Povidone+iodine

3days

Topical solution

Once daily

After three days she was discharged from the hospital and chemotherapy was prescribed.

Table 2. Post-surgical chemotherapy recommended for next 2 weeks.

Medication

Duration

Dosage form

Frequency

Tamoxifen

2 weeks

Tablet

Once daily

Ciprofloxacin

2 weeks

Tablet

Once daily

Diclofenac sodium

2 weeks

Capsule

Once daily

Povidone+iodine

2 weeks

Topical solution

Once daily

 

Discussion

The investigation of fibrocystic breast change demands appropriate patient identification and factors that trigger to exacerbate benign tissue symptoms. The mortality benefit of screening is comparatively greater in women aged 55-70 years. [21-22] The mortality benefit of screening women aged between 40 and 55 is approximately 20%. Screening women under the age of 40 has not been shown to provide any mortality benefit. [21-22] Women with usual hyperplasia have about two times the breast cancer risk of women without a proliferative breast condition. [6][13][14] Women with atypical hyperplasia have about four to five times the breast cancer risk of women without a proliferative condition. [6][13][14] To avoid the decline in health, the patient must follow the therapy and proper monitoring under physician and clinical pharmacist. Home remedies and life style modifications may help the patient to recover efficiently.

 

Conclusion

The effective care of fibrocystic breast change may potentially needs comprehensive assessment for appropriate differential diagnosis. However, the rational therapy and scientific drug monitoring can help to control the fibrocystic breast change. Moreover, consultant oncologists should be careful to detect the exact neoplasm and initiate the treatment to avoid morbidities and mortalities.

 

Acknowledgement

The author wishes to acknowledge Dr. TahaNazir (B.Pharm, M.Phil, and PhD) Course Director: Microbiology & immunology. Faculty of Pharmacy, University of Sargodha, Sargodha, Pakistan.

References

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15-   University of Maryland Medical Center. "Fibrocystic Breast Disease - Overview". Retrieved 21 June 2012.

16-    Cann, Stephen A.; van Netten, Johannes P.; van Netten, Christiaan (2000). "Hypothesis: iodine, selenium and the development of breast cancer". Cancer Causes and Control (review) 11 (2): 121–127.

17-   Joseph E. Pizzorno; Michael T. Murray (14 September 2012). Textbook of Natural Medicine. Elsevier Health Sciences. p. 1371.

18-   Cilotti A, Bagnolesi P, Napoli V, Lencioni R, Bartolozzi C (November 1991). "[Solitary intraductal papilloma of the breast. An echographic study of 12 cases]". La RadiologiaMedica (in Italian) 82 (5): 617–20. PMID 1780459

19-   Ahmadiyeh N, Stoleru MA, Raza S, Lester SC, Golshan M (August 2009). "Management of intraductalpapillomas of the breast: an analysis of 129 cases and their outcome". Ann. Surg. Oncol. 16 (8): 2264–9. doi:10.1245/s10434-009-0534-1.PMID 19484312

20-    Center for Drug Evaluation and Research (July 7, 2005). "Tamoxifen Information: reducing the incidence of breast cancer in women at high risk". U.S. Food and Drug Administration. Archived from the original on June 19, 2007. Retrieved July 3, 2007.

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Dr. Bruno Perillo PhD is associated with Istituto di Scienze dell, Alimentazione, Consiglio Nazionale delle Ricerche, via Roma, 52, 83100 Avellino, Italy. He has contributed in book chapter entitled “Analysis of posttranslational modifications in the control of chromatin plasticity observed at estrogen-responsive sites in human breast cancer cells” Methods Mol. Biol. 1204, 59-69. 2014. Whereas, his research work is published in renowned credible journals.  

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