EXCISION OF GIANT FIBROADENOMA UNDER LOCAL ANAESTHESIA AS A DAY-CARE SURGICAL PROCEDURE: A CASE REPORT

Background: Fibroadenoma is one of the most common benign fibroepithelial lesions of the breast, particularly among young women. Although most fibroadenomas are small and asymptomatic, occasionally they may attain a large size and produce breast asymmetry, discomfort and cosmetic concerns. Lesions measuring more than 5 cm are generally described as giant fibroadenomas. Large breast fibroepithelial lesions may present a diagnostic challenge because giant fibroadenoma and phyllodes tumour can have similar clinical and radiological characteristics. Definitive diagnosis may therefore only become apparent after complete surgical excision and histopathological examination. Case Presentation: A 38-year-old female presented with a large breast lump. Clinical assessment and preoperative evaluation were suggestive of a giant fibroadenoma. The patient was planned for surgical excision. Considering the location and accessibility of the lesion, excision was performed under local anaesthesia as a day-care surgical procedure. The excised specimen measured 9 × 7 × 4.5 cm. The specimen was sent for histopathological examination. Surprisingly, histopathology demonstrated a biphasic fibroepithelial tumour with increased stromal cellularity, mild to moderate stromal atypia and focal permeative growth. The final histopathological impression was a borderline phyllodes tumour. Surgical Intervention: The tumour was completely excised through a planned breast incision under local anaesthesia. The mass was mobilised from the surrounding breast tissue, removed in toto, and sent for histopathological examination. Haemostasis was achieved and the wound was closed primarily. Outcome: The patient tolerated the procedure under local anaesthesia and was managed as a day-care surgical case. The final histopathological examination changed the diagnosis from the clinically suspected giant fibroadenoma to a borderline phyllodes tumour. Conclusion: Excision of a clinically suspected giant fibroadenoma under local anaesthesia may be feasible in carefully selected patients and may permit day-care management. However, large breast fibroepithelial lesions require histopathological examination because fibroadenoma and phyllodes tumour may overlap clinically and radiologically.