Yasamin Ghazvini Kor, Mehdi Saeedan and Mohamed Sobhy Badr Sobei
Introduction: Fibroadenomas are the most common benign neoplastic lesion of the breast. These hormonesensitive tumors can grow rapidly under the influence of pregnancy hormones. Although rare, malignant transformation of these lesions has been reported. The risk of the standard treatment regimen on the fetus makes the PABC (Pregnancy-Associated Breast Cancer) a challenging task for clinicians. Overall treatment is based on guidelines for the general population with some variations to decrease the risk of fetal damage as much as possible.
Case report: A 37-year-old Indian female, presented with a palpable mass in her right breast in the first month of pregnancy. A preliminary diagnosis of fibroadenoma was made at the time. She came back at 39 weeks of gestation with severe vaginal bleeding and a huge painful mass in the right breast. Labor was induced upon diagnosis of intrauterine fetal death and ultrasonography of the breast revealed a lobulated soft tissue mass with multiple cystic areas and internal vascularity; measuring 16 cm in largest diameter. Excisional biopsy under GA (General Anesthesia) was performed upon request of the patient and microscopic HPE (Histopathological Examination) reported the presence of Grade 3 invasive ductal carcinoma.
Conclusion: Breast cancer arising within fibroadenoma during pregnancy is extremely rare but presents unique challenges in evaluation and management. An enlarging breast mass during pregnancy should never be neglected, and thorough investigation including biopsy is strongly advised to establish a definitive diagnosis.
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