Fig. 1: PIE Chart Showing Distribution of Neoplastic

 and Non-Neoplastic Lesions of Breast

Out of 95 neoplastic lesions, 46 cases were diagnosed as benign lesions and 49 cases as malignant lesions, which constituted 48% and 52% respectively (Table 2).

In the present study, fibrocystic disease is the predominant benign lesion comprising 39 cases (41%), followed by fibroadenoma 26 cases (28%), fibrocystic disease with columnar cell change 13 cases (14%), sclerosing adenosis 8 cases (8%), intraductal papilloma 5 cases (5%), apocrine adenoma 3 cases (3%), benign phyllodes 1 case (1%)  (Figure 2).

Fig. 2: Bar Diagram Showing Distribution

Pattern of Benign Lesions of Breast

Among malignant lesions, invasive ductal carcinoma-NST type was the most common type constituting 31 cases (61%), followed by infiltrating lobular carcinoma 11 cases (21%), invasive papillary carcinoma 3 cases (6%), medullary carcinoma 3 cases (6%) with mixed IDC and ILC, carcinoma with neuroendocrine differentiation, and metaplastic carcinoma 1 case (2%) each (Table 3).

Statistically, the test of proportion is used to obtain the frequency of all lesions. Chi-square test, which is used to find the association between the spectrum of lesions showed a p value of 0.0438 and hence the study was considered significant.

DISCUSSION

Our study conducted from June 2012 to June 2014, the clinical history, gross, and histopathological examination of breast specimens of all the 100 cases are collected and analysed. Out of 100 cases, 46 cases are found to be benign lesions, 49 cases are malignant lesions, and the remaining 5 cases are non-neoplastic or inflammatory lesions.

Fibrocystic disease and fibroadenoma were the most common benign lesions commonly occurring in the age range of 40-50 years and 20-30 years respectively.

Among the malignant lesions, invasive ductal carcinoma-no special type (IDC-NST) is the most common malignant lesion. It occurred in females of the age group 40-50 years. In the study of Parajuli S et al (2011), benign lesions constituted about 85% of lesion, malignant constituted about 12% and the remaining 3% of lesions were inflammatory.

The peak age incidence of benign lesion is in between 21-30 years and the malignant lesions in between 31-50 years. In his study, also fibroadenoma and fibrocystic disease were the most common benign lesions and infiltrating ductal carcinoma was the most common malignant lesion.

In Samir S et al (1995).³ study majority of cases are non-neoplastic lesions i.e. 56 cases (51.9%) and neoplastic lesions comprised 52 cases (48.1%). In the study conducted by M S Siddiqui et al (2003)⁴ out of 3279 cases, majority i.e., 2357 cases were diagnosed as neoplastic lesions and 922 cases (28.2%) were non-neoplastic lesions. In the study conducted by Naseer Ahmed Shaik et al (2012).⁵ out of 2693 cases, 2186 cases (81.1%) were neoplastic lesions and 507 cases (18.83%) were non-neoplastic lesions.

In our study, we have found neoplastic lesions as majority with 95 cases (95%) and only 5 cases (5%) of non-neoplastic or inflammatory lesions.

Our study was in concordance with the other two studies with majority being the neoplastic lesions when compared to non-neoplastic lesions. (Table 4)

In the study conducted by Khanna R et al (1998).⁶, which involved a study of 1315 cases, benign lesions comprised 807 (61.4%) and malignant lesions comprising 508 cases (39.6%).

Two more similar studies i.e. Tarek Tawfik et al (2009)⁷ had out of 969 cases majority were benign lesions comprising of 583 cases (60.2%) and malignant lesions comprising of 207 cases (21.3%). Other study by Parajuli S et al (2011).⁸ Which had out of 114 cases, 100 cases (87%) of benign lesions and 14 cases (13%) of malignant lesions.

In our study, among the 95 neoplastic lesions, benign lesions comprised about 46 cases i.e. 48.4% of neoplastic lesions and malignant lesions comprised of 49 cases (51.5%). When compared to all the above 3 studies in which the benign lesions form the majority, our study has predominantly malignant lesions (Table 5).

In Tarek Tawfik Amin et al (2009).⁷ study, fibrocystic disease was the commonest lesion to be associated with usual ductal hyperplasia comprising of about 73 cases (40.1%), followed by fibroadenoma with UDH of 46 cases (15.9%), sclerosing adenosis with UDH of 21 cases (13.3%), intraductal papilloma with UDH of about 6 cases (3.8%) and simple adenosis with usual lobular hyperplasia (ULH) of 10 cases (2.5%). In our study, the benign lesions were commonly associated with the epithelial proliferative lesions without atypia. Among the benign lesions, fibroadenoma the second commonest benign lesion in our study was most commonly associated with usual hyperplasia of ductal type or usual ductal hyperplasia (UDH) constituting about 14 cases (36.8%), followed by fibrocystic lesion with usual ductal hyperplasia comprising 13 cases (34.2%), fibrocystic disease with columnar cell change associated with usual ductal hyperplasia in 8 cases (21%), followed by sclerosing adenosis with UDH in 2 cases (5.2%), intraductal papilloma with UDH, and simple adenosis with usual lobular hyperplasia (ULH) comprised 1 case (2.6%) each (Table 6).

In Tarek Tawfik Amin et al (2009).⁷ study, fibrocystic disease was the commonest lesion to be associated with atypical ductal hyperplasia comprising of about 13 cases (30.2%), followed by fibroadenoma with ADH of 12 cases (27.9%), apocrine adenosis with ADH of 6 cases (14%), sclerosing adenosis and intraductal papilloma constituted about 4 cases (9.3%) each in association with ADH.

In our present study, the benign lesions are also seen in associated with the epithelial proliferative lesions with atypia, among the benign lesions the commonest benign lesion fibrocystic disease was mostly associated with atypical hyperplasia of ductal type or atypical ductal hyperplasia (ADH) constituting about 4 cases (28.5%), followed by fibrocystic disease with columnar cell change and intraductal papilloma associated with atypical ductal hyperplasia in 3 cases (21.4%)each, followed by sclerosing adenosis with ADH and fibroadenoma with ADH of 2 cases(14.2%) each, simple adenosis with atypical lobular hyperplasia (ALH) comprised 2 cases (14.2%) (Table 7).

The association of benign lesions with the epithelial proliferative lesions with and without atypia in comparison to other similar studies showed significant concordance.

ACKNOWLEDGEMENT

I would like to express my sincere gratitude to my guide and advisor Dr. Jayaprakash Shetty K, Dr. Chandrika Rao, our technical staff Mrs. Vinaya, Mr. Girish, my parents, and family for the continuous support for my study and research. Above all, I thank God for giving me the strength all along.

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