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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 16  |  Page : 54-58

A histopathological study of 752 female lesions of the breast with benign biological behavior


1 Department of Histopathology, Jos University Teaching Hospital, University of Jos, Jos, Nigeria
2 Department of Morbid Anatomy, Bingham University Teaching Hospital, Jos, Nigeria
3 Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria

Date of Submission17-Mar-2020
Date of Acceptance31-May-2020
Date of Web Publication26-Nov-2020

Correspondence Address:
Dr. Innocent Emmanuel
Department of Histopathology, Jos University Teaching Hospital, University of Jos, Jos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_3_20

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  Abstract 


Introduction: Lesions of the breast with benign biological behavior (LBBBB) are nonmalignant pathologies. They underlie the most common cause of symptomatic breast problems. It is estimated that 30% of women at sometimes in their lifetime are afflicted with LBBBB that requires treatment. The objective of this work is to study the histological pattern of LBBBB in females at the Jos University Teaching Hospital, Nigeria, between January 2010 and December 2020, relating this finding to age and site, and comparing this with reports in published literature. Methodology: This is a descriptive retrospective research of consecutive cases of LBBBBs diagnosed at the Jos University Teaching Hospital, Nigeria, between January 2010 and December 2020. The records at the department were used to obtain the lesions so diagnosed. Results: A total of 1122 female cases of breast lesions were diagnosed during the period of the study: 370 (32.98%) malignancies and 752 (67.02%) benign (malignancy-to-benignity ratio, 1:2.03). Of the 752 cases of female LBBBB, 382 (50.80%) were on the right, whereas 370 (49.20%) were on the left. The five most common LBBBB were fibroadenoma, 382 (50.79%); fibrocystic change, 126 (16.76%); acute mastitis/abscess, 38 (5.05%); intraductal papilloma, 29 (3.86%); and fat necrosis, 21 (2.79%). The age range was 4–85 years, with mean, median, and mode of 30.60 ± 12.0 years, 28 years, and 23 years, respectively. Conclusion: Two-third of breast lesions in the female breast in our environment are benign and slightly more common on the right. Fibroadenoma is the most common histological type constituting more than half of cases and together with fibrocystic change (the second most common lesion) makes up two-third of all cases. The reproductive age is overwhelmingly the commonly affected group. We recommend increasing research in this field to help predict the risk of subsequent malignancy in affected women with LBBB in our environment.

Keywords: Benign, breast, lesions


How to cite this article:
Emmanuel I, Abobarin O, Abaniwo S, Nzekwe P, Richard SK, Mandong BM. A histopathological study of 752 female lesions of the breast with benign biological behavior. N Niger J Clin Res 2020;9:54-8

How to cite this URL:
Emmanuel I, Abobarin O, Abaniwo S, Nzekwe P, Richard SK, Mandong BM. A histopathological study of 752 female lesions of the breast with benign biological behavior. N Niger J Clin Res [serial online] 2020 [cited 2021 Apr 18];9:54-8. Available from: https://www.mdcan-uath.org/text.asp?2020/9/16/54/301640




  Introduction Top


The breast is a hub of a wide range of disease processes. One of such is a heterogeneous group of diseases designated benign breast disease[1],[2],[3],[4],[5],[6],[7],[8] or benign breast lesions.[9],[10],[11],[12],[13],[14] These diseases are lesions of the breast with benign biological behavior (LBBBB)-nonmalignant pathologies.[8],[12] They underlie the most common cause of symptomatic breast problems.[9]

It is estimated that 30% of women at sometimes in their lifetime are affected with LBBBB that requires treatment.[15] Presenting symptoms of this disease include breast lump/mass, nipple discharge, and pain.[4],[5],[9],[15],[16] Although lesions are diagnosed with high accuracy using triple assessment that involves clinical examination, imaging, and pathologic examination,[9] the later involving histology of a tissue biopsy is necessary for a definitive diagnosis.[17]

The objective of this work is to study the histological pattern of LBBBB in females at the Jos University Teaching Hospital, Jos, Nigeria, between January 2010 and December 2020, relating this finding to age and site, and comparing this with reports in published literature.


  Methodology Top


This is a descriptive retrospective research of consecutive cases of LBBBB diagnosed at the Jos University Teaching Hospital, Nigeria, between January 2010 and December 2020. The records at the department were used to obtain the lesions so diagnosed. The diagnosis of each case was confirmed by reviewing the archival slides. Cases of missing, broken, or faded slides were resolved by selecting corresponding archival tissue blocks, and sectioning same into 5 μm slides, staining with hematoxylin and eosin stain, and reviewed microscopically to confirm the diagnosis of the disease. Histologically confirmed cases were included in the study, whereas cases with inadequate records were excluded from the study. The data were analyzed using Epi info statistical software of the Center of Disease Control and Prevention (CDC), Atlanta, Georgia, USA and are presented in tables in terms of simple frequencies and percentages.


  Results Top


General

A total of 1178 breast samples were received at the laboratory during the period of the study. Out of these, 1129 (95.84%) got a histological diagnosis, whereas 49 (4.16%) were unsatisfactory biopsies and as such did not get a histopathologic diagnosis. Of the samples that were diagnosed, 7 (0.62%) were male and cases of gynecomastia, whereas 1122 (99.38%) were female cases. The total cases of benign disease for both gender were 759 and 370 for malignant disease.

Female lesions of the breast with benign biological behavior

The 1122 female cases had 370 (32.98%) malignancies and 752 (67.02%) benign (malignancy-to-benignity ratio, 1:2.03). Of the 752 cases of female LBBBB, 382 (50.80%) were on the right, whereas 370 (49.20%) were on the left. The LBBBB were categorized into: fibroepithelial, 525 (69.8%); epithelial, 112 (14.9%); stromal, 19 (2.5%); and inflammatory, 96 (12.8%) [Table 1]. The five most common LBBBB were fibroadenoma, 382 (50.79%); fibrocystic change, 126 (16.76%); acute mastitis/abscess, 38 (5.05%); intraductal papilloma, 29 (3.86%); and fat necrosis, 21 (2.79%) [Table 1].
Table 1: Distribution of female lesions of the breast with benign biological behavior according to age, site and frequency of occurrence

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The age range was 4–85 years, with mean, median, and mode of 30.60 ± 12.0 years, 28 years, and 23 years, respectively. The age ranges and measures of central tendency for individual histological types of LBBBB are presented in [Table 2].
Table 2: Distribution of female lesions of the breast with benign biological behavior according to age range and measures of central tendency

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  Discussion Top


The ultimate significance of a diagnosis of LBBBB is to rule out breast cancer as these pathologies are mimics of the malignancy.[18] This frees the patient from anxiety[5] and the ensuing therapeutic burden that accompanies cancer of this gland. This study found that approximately, there is a 1 in 3 chance (32.98%) that a breast lesion in females is malignant in our environment. This finding of a similar or higher ratio of benign-to-malignant lesions as in this study was corroborated by other researchers.[2],[10],[11],[12],[13] The diagnosis of many histological types of LBBBB has been associated with an increasing lifetime risk of the development of subsequent breast cancer.[18],[19] This risk is higher with hyperplasia that has features of atypia.[18],[20],[21],[22],[23] This has led to the classification of LBBBB into nonproliferative disease, nonatypical proliferative disease, and atypical proliferative disease, with a relative lifetime risk of development of carcinoma of 1%, 1.5%–2.0%, and 4.0%–5.0%, respectively.[6],[18] In this study, atypical LBBB constituted only 2.39% of the disease in females. Since breast cancer recorded as high as 32.98% of all female lesions, it follows that only a few lesions with higher chances of progression to cancer are identified in our environment. Zeng et al. have demonstrated that LBBBB tissue is a rich source of clues for breast oncogenesis, having discovered shared/similar mutations in benign and malignant cases of breast lesions in a case–control study.[1]

Although all categories of the disease as classified were seen in this work, we choose, owing to convenience, to classify LBBBB largely according to the histology of the constituent cells of the lesion: fibroepithelial, epithelial, stromal, and inflammatory. This histological approach to classification was employed by Forae et al.[2] The most common histological type of LBBB in this study is fibroadenoma, accounting for more than half (50.79%) of all cases seen. Similar to this study, fibroadenoma was widely reported by researchers as the most common LBBBB.[2],[8],[9],[10],[11],[13],[14],[15],[24],[25],[26] Fibroadenoma without complex features and that with complex features carries a relative lifetime risk of development of cancer of 1.0% and 1.5%–2.0%, respectively.[18] It follows, therefore, that the risk in this regard for 50.79% of patients so studied herein is low.

The second most common LBBBB seen in this study was fibrocystic change consisting of 16.76%. Fibrocystic change was similarly the most common LBBBB in some other reports.[2],[10],[11],[24] Fibrocystic change was the most common LBBBB in a study by Ochicha et al. and Benard et al.[12],[27] This research thereby showed that as much as two-third (67.55) of LBBBB in our environment were either fibroadenoma or fibrocystic change.

LBBBB are more common in young women.[10],[24] Forae et al., Nahar et al., and Jayavarmaa et al. found a mean age of 31.2 years, 32.9 years, and 35.0 years, respectively, for LBBBB.[2],[9],[15] This was similar to the 30.6 years seen in this study, but higher than the 24.49 years reported by Rajkumar and Ranjan.[14] The pathogenesis of fibroadenoma and fibrocystic change had been explained by the action of female reproductive hormones on affected breast tissues.[28],[29] These hormones are abundantly produced at a younger age. As fibroadenoma and fibrocystic change constituted two-third (67.55) of all LBBBB in this study, this could explain the mean (30.6 years), median (28 years), and modal (28 years) age, all occurring in the young. This is without prejudice to the fact that other benign epithelial proliferations of the breast (e.g., atypical and nonatypical hyperplasia, lactating and tubular adenoma, sclerosing adenosis, adenoma, and papilloma) are also dependent on reproductive hormones, thereby increasing the population of affected individuals in the reproductive age group with LBBBB.[18] In Nigeria, the average age at menarche is approximately 13 years,[30] while that of menopause is approximated as 48 years.[31] This period represents the time in a woman's life where reproductive hormones are actively produced. In this study, 681 (90.6%) of females were within the age of 10 years and 49 years, giving credence to the possible dominant role of reproductive hormones on the pathogenesis of LBBBB.

The right breast in this study has a slightly higher frequency of LBBBB than the left (50.0% to 49.0%). The preponderance of this pathology on the right over the left was similarly reported, respectively, by Patil et al., Jayavarmaa et al., and Kumar et al.[13],[15],[26] The significance of this predilection to the right has not been fully elucidated in the available literature.


  Conclusion Top


Two-third of breast lesions in the female breast in our environment are benign and slightly more common on the right. Fibroadenoma is the most common histological type constituting more than half of cases and together with fibrocystic change (the second most common lesion) makes up two-third of cases. The reproductive age is overwhelmingly the commonly affected group. We recommend increasing research in this field to help predict the risk of subsequent malignancy in affected women with LBBBB in our environment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Zeng Z, Vo A, Li X, Shidfar A, Saldana P, Xuei X, et al. Somatic Genetic Aberrations in Benign Breast Disease and the Risk of Subsequent Breast Cancer. bioRxiv; 2019.  Back to cited text no. 1
    
2.
Forae DG, Nwachokor NF, Igbe PA, Odokuma IE, Ijomone AE. Benign breast diseases in Warri Southern Nigeria: A spectrum of histopathological analysis. Ann Niger Med 2014;8:28-31.  Back to cited text no. 2
    
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Nahar N, Iqbal M, Rahman KM, Razzaque S, Yeasmin F, Alam U, et al. Age and gender distribution of benign breast lesions of women at port city of Bangladesh. J Sci Found 2018;16:27-31.  Back to cited text no. 9
    
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Patil V, Khandelwal A, Ghorpade GK. Histopathological spectrum of benign breast lesions. J Res Med Dent Sci 2017;5:9-14.  Back to cited text no. 13
    
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Rajkumar, Ranjan A. Clinico – Pathological study and management of benign breast lesions. Int J Contemp Med Res 2017;4:1-4.  Back to cited text no. 14
    
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Jayavarmaa R, Kabalimurthy J, Mohan CP. A clinical study on benign breast diseases. J Med Sci Clin Res 2018;6:761-5.  Back to cited text no. 15
    
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London S, Connolly J, Schnitt S, Colditz GA. Prospective study of benign breast disease and the risk of breast cancer. J Am Med Assoc 1992;267:941-4.  Back to cited text no. 22
    
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