|Year : 2014 | Volume
| Issue : 1 | Page : 28-31
Benign breast diseases in Warri Southern Nigeria: A spectrum of histopathological analysis
Gerald Dafe Forae1, Francis Nkadi Nwachokor2, Alex Payim Igbe3, Emmanuel Igho Odokuma4, Eseroghene Arthur Ijomone2
1 Department of Pathology, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Pathology, Delta State University, Abraka, Nigeria
3 Department of Pathology, Ambrose Ali University, Ekpoma, Nigeria
4 Department of Anatomy, Delta State University, Abraka, Nigeria
|Date of Web Publication||18-Sep-2014|
Gerald Dafe Forae
Department of Pathology, University of Benin Teaching Hospital, P.M.B. 1111, Benin City
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Benign breast diseases (BBDs) constitute a source of morbidity and mortality among women globally. Most of these lesions are common in women of reproductive age and are associated with hormonal influences. However, studies have reported an increasing incidence of these lesions in children and adolescents.
Aims: The aim was to highlight the spectrum and histological patterns of BBDs among women in Delta State and other Southern states of Nigeria as seen at central hospital, Warri.
Materials and Methods: This study was a 7-year retrospective analysis of all histologically diagnosed breast diseases in women. Request forms were scrutinized for clinical bio-data, diagnosis. Hematoxylin and eosin stained-slides of breast biopsies carried out at the central hospital, Warri were archived and studied.
Results: A total of 905 breast lesions were received during this 7 years period in the Pathology Department. Of these, 644 cases accounting for (71.2%) were benign lesions, while 261 cases (28.8%) were malignant giving a ratio of 2.5:1. A total of 638 cases occurred in female while only 6 cases occurred in males. The mean age was 31.2 ± 8.4 years, and the peak age incidence was 20-29 years constituting 49.8% cases of BBDs. Fibroadenoma was the most common BBD accounting for 302 cases (46.9%). Fibrocystic disease was the second majority and constituted 126 cases (19.6%).
Conclusion: Fibroadenoma constituted the most common histopathological patterns of BBDs in children and adolescents in our environment.
Keywords: Adolescents, benign, breast tumors, childhood, fibroadenoma
|How to cite this article:|
Forae GD, Nwachokor FN, Igbe AP, Odokuma EI, Ijomone EA. Benign breast diseases in Warri Southern Nigeria: A spectrum of histopathological analysis. Ann Nigerian Med 2014;8:28-31
|How to cite this URL:|
Forae GD, Nwachokor FN, Igbe AP, Odokuma EI, Ijomone EA. Benign breast diseases in Warri Southern Nigeria: A spectrum of histopathological analysis. Ann Nigerian Med [serial online] 2014 [cited 2021 Apr 18];8:28-31. Available from: https://www.anmjournal.com/text.asp?2014/8/1/28/141026
| Introduction|| |
Currently, the female breast is one of the most commonly biopsied tissues today because of the myriads of diseases and lesions that arise from it. These lesions constitute a source of morbidity and mortality among women globally.  Among these lesions, benign breast diseases (BBDs) constitute the majority accounting for 90% of breast lesions worldwide.  The BBDs spectrum range from developmental abnormalities, inflammatory, epithelial, fibro-epithelial, stromal proliferations and neoplastic tumors. , Most of these lesions are seen in women of reproductive age and are associated with hormonal influences. , However, studies have reported an increasing trend of these lesions in children and adolescents.  Most of these lesions present with features of palpable masses, nipple discharge, and pains. These features constitute anxiety among women and their relatives due to increase awareness of the incidence of breast cancer scourge worldwide. Studies have shown that there is a 5-fold increase risk of breast cancer in patients that have some of these benign breast lesions, especially atypical ductal and atypical lobular hyperplasia.  Although, several studies have been done on the histopathological patterns of BBDs in Africa, the exact prevalence rate of these lesions in Nigeria remains unknown due to dearth of information. This study is thus aimed at defining the frequency and morphological patterns of BBDs in our environment. This study is first of its kind in our center and data derived from this study would help in defining the burden of benign breast lesions and in the management of patients with these lesions; and moreover serve as baseline data for further research.
| Materials and Methods|| |
Data of all 905 breast specimens of the surgical day books of the Department of Pathology, Central Hospital, Warri over a 7-year period (January 2005-December 2011) were the materials scrutinized for this research. These specimens were sent from the Department of Surgery of this hospital, and other hospitals in the Warri metropolis and Southern Nigeria. The original pathology request cards of the different cases were retrieved to obtain sociodemographic data on age, sex, and clinical information.
Specimen sampling and laboratory procedure
All specimens sent for histology were fixed in 10% formalin solution, processed with Histokinette automated tissue processor, paraffin-embedded, and sectioned at 3-5 μ using the microtome machine; before staining with hematoxylin and eosin (H and E). The corresponding slides were retrieved, and where such slides could not be recovered, the stored paraffin-embedded tissue blocks in the archives were recovered and new slides prepared with routine standard H and E stain. Special stains including reticulin and periodic acid-Schiff were used where necessary.
All cases where both the H and E stained slides, and the paraffin-embedded tissue blocks were missing, and all previously diagnosed cases in which breast lesions could not be substantiated on microscopic review were excluded from the study. All cases in which the actual age of the patient was not specified were also excluded from the study.
Data obtained were coded and entered into Microsoft Excel, 2010. Categorical variables where expressed as percentages and continuous variables as mean ± standard deviation, using the Statistical Packaging for Social Sciences (SPSS) version 17 (SPSS Inc., Chicago, Illinois, USA).
| Results|| |
A total of 905 breast lesions were received during this 7 years period in the Pathology Department. Of these, 644 cases accounting for (71.2%) were benign lesions, while 261 cases (28.8%) were malignant giving a ratio of 2.5:1 for benign to malignant breast diseases. Among 611 recorded anatomic biopsy sites, left breast, right breast, and bilateral breast biopsies accounted for 250 (40.9%), 275 (45.0%) and 86 (14.1%) cases, respectively. A total of 638 cases occurred in females with only six cases occurring in males. The age range incidence was 10-86 years. The mean age was 31.2 ± 8.4 years. The peak age of incidence was 20-29 years constituting 49.8% cases of BBDs as seen in [Table 1]. Sixty-nine percent of patients were 30 years and below. The most recurring presentation was a painless breast lump. Others were nipple discharge, breast pains, nipple deformity, and skin changes.
Among the groups of BBDs, fibro-epithelial breast lesions were the most common accounting for 315 thereby constituting 48.9% of BBDs grouping. This is followed by epithelial breast lesions constituting 257 (39.9%). Inflammatory breast lesions and stromal tumors were relatively rare as seen in [Table 2]. Among the BBDs, the most common lesion was fibroadenoma accounting for 302 cases (46.9%). The second and third majority were fibrocystic disease and tubular adenoma constituting 126 cases (19.6%) and 34 cases (5.3%) respectively. Pseudoangiomatous stromal hyperplasia was the most common stromal tumor recorded accounting for 15 cases of stromal tumors. The other lesions are outlined in [Table 2].
|Table 2: The histological classifi cation and types of benign breast diseases|
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Other less frequently histologically diagnosed BBDs include the hamartomas.
| Discussion|| |
In our study, most cases of BBDs were seen in female. This is consistent with findings by other researchers worldwide. The reason is that females are far more anatomically adapted with greater breast volume and more complex structural architecture, while men have rudimentary breast due to lack of response to hormonal changes. In this study, we found that benign breast lesions were more common than malignant lesions. This finding is in tandem with previous reports from Ilesa,  Kano,  Benin,  Enugu  and Makurdi  where BBDs accounted for 87%, 73%, 72.4%, 69%, and 67% of all breast diseases, respectively. Similar studies have been documented in other parts of Africa and the rest of the world. , In this study, the peak age range for BBDs is seen between 20 and 29 years followed by 10-19 years. This trend is becoming alarming in our locale as most of the lesions biopsied now-a-days are seen in teenage and young girls. This is corroborated by other researchers where its peak incidence was reported in the third decades of life.  This finding is also strengthened by Olu-Eddo and Ugiagbe  reports where childhood and adolescent breast lesions constituted majority of BBDs. The reasons attributed to this trend is partly due to changes in physiological and pathological hormonal influences on the young female breast as well as infections among young lactating mothers due to poor hygiene.  Besides there is an increase in the level of awareness of breast diseases morbidity and mortality globally. In view of this situation, a lot of anxiety has been expressed by young girls and adolescent school females who present to health care facilities with even the smallest lump in their breast. This again justify the increasing trends of BBDs seen in young adolescent girls. 
In this study, fibroadenoma was the most common lesion among the BBDs. This accounted for 46.9% of BBDs biopsies. This finding is similar to previous reports from other parts of Nigeria. Furthermore similar studies done in Benin,  Enugu  and Makurdi  showed that the fibroadenoma constituted 43%, 44%, and 45%, respectively. However, this finding is slightly lower than what was found in Maiduguri,  where it ccounted for 32.1% of all BBDs. This is further corroborated by other researches carried out globally. ,, Oluwole and Freeman noted that there is a racial predilection of blacks to fibroadenoma.  This may partly be attributed to genetic, diet, and geo-ethnic variations.
In our study, fibrocystic disease of the breast was the second most common BBDs. It is found most commonly in women of premenopausal age group. This again is similar to previous reports from other Africa researchers. The study has shown that fibrocystic disease was the second majority in several studies across Nigeria. However, this finding is contrary to reports from Caucasians and Asian series where fibrocystic disease of the breast was the most common BBDs.  In spite of this variation, fibrocystic disease is indeed a very common breast diagnosis locally and globally. The reason adducible to this may partly be related to early menarche, early marriage, and multiparty. 
Other BBDs encountered including benign phyllodes tumor, which are relatively uncommon. Benign phyllodes tumor constituted 2% of BBDs and is found commonly after the third decade of life. Similar studies by Olu-Eddo et al. reported that benign phyllodes tumor constituted 1.8% of BBDs and most commonly encountered between the third and fifth decades of life. This is further supported by studies from Caucasian series.  However, this is in contrast with reports by some researchers  where it is found to be more common in younger age group. The reason for this variation cannot be explained.
In this study, gynecomastia was the most prevalent male BBDs encountered. This accounted for 0.9% and 83.3% of overall BBDs and male BBDs, respectively. This is consistent with reports from Caucasian series where it constituted 1% of overall BBDs. Nevertheless, other Nigeria studies show slightly higher figures of 2.1% and 4% of overall BBDs. , Data of relatively very high frequency of gynecomastia, constituting 12% of overall BBDs also was documented in Uganda. 
In this study, all inflammatory breast diseases constituted 6.4% of BBDs. This is congruous with reports from other Africa series where it constituted 6% and 4.6%, respectively. , This suggests that most of the young lactating mothers due to improper breastfeeding habits and poor hygiene may contract infections from bites of the nipples by their sucklings. In addition, this figure is not the true reflection of these inflammatory BBDs, because most of the such cases are treated with fine-needle aspiration, incision and drainage of abscess coupled with the use of antibiotics. Hence, biopsies may not be sent for histology except for the very critical cases that mimic carcinomas.
In our study, BBDs with premalignant characteristics are atypical ductal hyperplasia and atypical lobular hyperplasia. Both constituted 3% of BBDs. This again is in keeping with reports from Benin where they constituted 2.7% of BBDs.  Studies from European series have shown that it constitute about 4- to 10-fold increase risk of malignant transformation in the general population and first-degree relatives.  Notwithstanding, this may not be a true reflection of these lesions in our locality. In this respect, adequate mammographic screening and follow-up biopsy may help in detecting early premalignant lesions and possible surgical treatment. , This would go a long way in reducing the progression of the lesion to cancer of the breast, and in turn reduce the burden associated with breast cancer in our locality in particular and around the world.
| Conclusion|| |
Considering the patterns of BBDs in our locale, fibroadenoma was the most common BBDs with majority occurring in teenage and young adolescents. Notwithstanding, BBDs constitute a source of morbidity and mortality for women of all age groups. Again among the BBDs, the atypical proliferative lesions may transform to malignant breast diseases. Therefore, adequate health campaign awareness, screening and follow-up of all BBDs may help to reduce the burden of these lesions in our environment.
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[Table 1], [Table 2]