|Year : 2018 | Volume
| Issue : 1 | Page : 46-52
Individualized homoeopathic treatment of breast fibroadenoma: A case report
Research Officer (Homoeopathy)*, Dr. Anjali Chatterjee Regional Research Institute (H), Kolkata, West Bengal, India
|Date of Web Publication||3-Apr-2018|
Dr. Suraia Parveen
Dr. Anjali Chatterjee Regional Research Institute (H), 50, Rajendra Chatterjee Road, Kolkata - 700 035, West Bengal
Source of Support: None, Conflict of Interest: None
Fibroadenoma is the commonest benign breast tumor in adolescent and young women. Conservative management with regular observation is the rule for newly diagnosed patients. For progressive growth in young patients or failure of regression in patients above 35 years surgical intervention is contemplated. But there may be recurrence after surgery and patients are often apprehensive of surgery. Here, a 18-year-old girl presented with a palpable, non-tender, movable lump in the left breast at upper outer quadrant progressively increasing in size over last 2 years and was advised for surgery. Sonomammography and FNAC confirmed it as simple fibroadenoma (3.48 × 2.38 centimeter). She was successfully treated by individualized homoeopathic treatment with single medicine Pulsatilla nigricans over 15 months. Serial Sonomammography reports revealed progressive regression of Fibroadenoma to non palpable state. Possible causal attribution of changes was explicitly depicted by Naranjo Criteria. It shows positive role of Homoeopathic treatment in regression of fibroadenoma in a young woman.
Keywords: Fibroadenoma-Breast, Homoeopathy, Naranjo criteria, Pulsatilla nigricans, Single-medicine
|How to cite this article:|
Parveen S. Individualized homoeopathic treatment of breast fibroadenoma: A case report. Indian J Res Homoeopathy 2018;12:46-52
|How to cite this URL:|
Parveen S. Individualized homoeopathic treatment of breast fibroadenoma: A case report. Indian J Res Homoeopathy [serial online] 2018 [cited 2019 Sep 17];12:46-52. Available from: http://www.ijrh.org/text.asp?2018/12/1/46/229065
| Introduction|| |
Fibroadenoma (FA) is a benign breast lesion, usually found in adolescent and young women but may be discovered at any age. FA is assumed to be aberrations of normal breast development or the product of hyperplasic processes, rather than true neoplasm. FAs are usually smooth, clearly demarcated, firm, mobile, nontender, and rubbery in consistency. Usually, they exist as unilateral, solitary mass; however, in 10%–25% of cases, there may be multiple masses and occur bilaterally. FA can be located anywhere in the breast, but the majority are situated in the upper outer quadrant. Their size may vary from 1 to 10 cm, but mostly 2–3 cm., There may be subcategories of FAs including simple FA, giant juvenile FA, and multicenter FA. The most common type (70%–90%) of FA is simple solitary FA; however, in multicenter FAs, they appear as multiple masses in different quadrant. Giant juvenile FAs are defined as any rapidly enlarging encapsulated FA with a diameter >5 cm. They may also be associated with skin changes and venous engorgement. The multicenter, bilateral FA (complex FA) may have familial preponderance.
Simple FAs are most often detected incidentally during a medical examination or during self-examination. They are more frequent among young women with obesity, in higher socioeconomic classes and dark-skinned populations. The age of menarche and any hormonal therapy including oral contraceptives do not alter the risk of these lesions. No genetic factors are found to alter the risk of simple FA.
Several other breast lesions may have similar clinicopathological characteristics of FA. Studies showed that physical examinations failed to provide an accurate diagnosis in one-third to one-half of cases. Thus, sonomammography and fine-needle aspiration cytology (FNAC) are required in distinguishing FAs from other breast masses including breast cancer. There are some overlaps in the sonographic criteria for FAs and breast cancer as both of them are solid masses. Approximately 25% of FAs appear with irregular margins, which may raise the suspicion of malignancy. The yield of X-ray mammography in young women is low, and its role in the diagnosis of FA is limited as there is no calcification. Thus, FNAC is essential for confirmatory diagnosis of FA.
The natural history of FA varies from individual to individual. Some FAs may remain dormant without any change in size. In most of the patients, there may be slowly waxing and waning of sizes without associated pain or skin changes. Usually, FAs show spontaneous regression in 10%–40% of population during observation. The risk of transformation from FA to cancer is rare unless the tumor or the surrounding breast parenchyma shows proliferative changes in serial investigation or the patient has a family history of breast cancer. However, this risk rises above the age of 35 years. Regular follow-up with sonomammographic evaluation at least every 6 months interval is the rule until there is complete regression. Apart from risk of carcinoma, increase in size or failure of regression of FA during observation causes psychological distress with discomfort and esthetic distortion. Usually, other than regular observation, there is no role for allopathic medication under conservative treatment. Surgical excision is considered for patients <35 years when there is progressive increase in size of the mass or failure of regression in patients above 35 years of age. Surgical excision under local anesthesia is done in those cases. However, in spite of successful percutaneous excision, FAs have been reported to recur. In young unmarried females, postoperative scar mark in the breast is a matter of great concern to many of them. Thus, definitive treatment with sustained recovery is still elusive for FA.,
Literature review on use of homoeopathic treatment on FA had revealed a double-blinded randomized trial of Phytolacca showing decrease in size in 69% of FAs in the experimental group whereas only 36% did so in the placebo group. In another study on 135 patients of various benign breast lesions, constitutional homoeopathic treatment showed positive response in 73 (54.08%) patients. Out of them, complete resolution of lesions in 24 (17.78%) and significant reduction in 49 patients (36.30%). Thirty patients (22.22%) maintained status quo and 32 patients (23.70%) did not improve. Out of the total 135 patients, 98 (72.59%) were of FA. The period of treatment varied from case to case depending on size, type, and number of breast lesions.
| Patient Information|| |
An 18-year-old Hindu unmarried college girl from lower socioeconomic status family presented at Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy (DACRRIH), Kolkata, in August 2014 with a progressively increasing palpable painless lump in her left breast since 2 years.
She had nil contributory ongoing medical present and past history. Her menstrual cycle was regular (28–30 days), moderate flow, and lasting for 2–3 days. There was history of severe pain in the first 2 days of menstruation (dysmenorrhea), ameliorating on rest. There were no other associated symptoms and no history of intake of oral contraceptive pill.
Her childhood history was uneventful. She was pursuing graduation studies. Her father was a security guard of lower-middle socioeconomic status. In her family, there was a history of FA of the right breast in her paternal aunt who was operated for the lump but had recurrence. Subsequently, she was maintained on Homoeopathy for more than 5 years, details of which are not known. In others, paternal grandfather had diabetes and maternal grandmother was hypertensive. However, there was no history of malignancy.
Before coming to DACRRIH, Kolkata, she was under observation of a surgeon, evaluated by sonomammography, and waited for spontaneous resolution for 1 year. However, rather than regression, there was increase in size during observation. The lesion became 2.9 cm × 2.1 cm (sonomammography) on June 23, 2014, causing discomfort and psychological distress to the client. At this point, she was advised to undergo resection of the lump by surgeon. However, she was apprehensive of surgery for scarring of the breast and chances of recurrence. Thus, she decided for taking homoeopathic treatment as alternative method and came to DACRRIH outpatient department.
| Clinical Findings|| |
On clinical examination, it was revealed a nontender, mobile, firm, smooth, well-circumscribed mass with smooth margin in the upper and outer quadrant of the left breast. There was no asymmetry of both breast, no changes in skin, areola, and nipple, with no history of nipple discharges. The lump was movable with no adherence with skin and internal structure. There were no palpable axillary and clavicular lymph nodes. The patient had height 148 cm, weight 38 kg, body mass index 17.35, and fair complexion.
Along with this chief complaint, there were also complaints of unexplained anxiety, especially in crowd and public places with intermittent fear of death. There was painful menstruation (dysmenorrhea), vertigo with nausea/vomiting during car riding (motion sickness), and recurrent throbbing headache worse after exposure to the sun or exertion and relief from rest.
Other homoeopathic generalities
She was very gentle and polite in nature but fearful and anxious and always looking for company of known persons.
Thermal reaction: hot +++ (prefers winter); desire: rice ++, vegetables ++, salty things +; aversion: meat +++, sweets +; stool: normal, once/daily, bowel clear habit; urine: normal; perspiration: profuse especially upper part of the body, nonoffensive, nonstained on clothes; sleep: good.
On detailed case taking and analysis, the symptoms were evaluated to construct the totality. After evaluation of symptoms, repertorization was done. The following characteristic mental general symptoms, as well as physical general and particular symptoms, were considered for repertorization:
- Mild, gentle, polite in nature
- Fear of death
- Fear in crowd
- Desire for company
- Hot patient
- Vertigo, nausea/vomiting during riding in a car
- Aversion to meat
- Painful menstruation
- Profuse perspiration in the upper part of body
- Tumor in the left breast
- Headache from sun exposure.
This case was repertorized by Hompath Classic M.D. Version 8 software, Mind Technologies Pvt. Ltd., 2002, Mumbai, Maharashtra, India. using Kent's Repertory. The reportorial results [Table 1] were analyzed giving more importance on the mental as well as physical general symptoms than particular symptoms for selection of medicine.
|Table 1: Repertorization Software Chart: Hompath Classic M.D.version 8.0|
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| Timeline|| |
Milestones related to the diagnosis and management of the case has been depicted in [Figure 1]a and [Figure 1]b and [Table 2], respectively. Clinically, regular follow-up was done in every month and sonological evaluation was done at an interval of about 6 months. Sonomammography was done three times during the period of follow-up on January 10, 2015; May 09, 2015; and November 19, 2015.
|Figure 1: (a) Ultrasonography report of the left breast on August 28, 2014 (baseline), (b) fine-needle aspiration cytology report|
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| Diagnostic Assessment|| |
On investigation, sonomammography on August 28, 2014, (baseline) showed solitary large oval-shaped hypoechoic and sharply defined mass with smooth and regular margin measuring 3.48 cm × 2.38 cm [Figure 1]a. In FNAC, there was no evidence of malignancy and impression was FA [Figure 1]b. Hence, the final diagnosis was simple FA.
| Therapeutic Intervention|| |
Considering the reportorial totality, miasmatic analysis, and consultation with Materia Medica, Pulsatilla nigricans was selected as an individualized single constitutional remedy.,,
It was prescribed as a first prescription in 30C potency with four doses. A single dose consisted of four globules of size forty of the indicated medicine. Each dose is taken in the morning and evening before meal over 2 days. Medicine was dispensed to the patient from DACRRIH dispensary. Medicine was collected from Hahnemann Publishing Company Pvt. Ltd., which was a GMP certified ISO.9001:2008 unit.
| Follow-Up and Outcome|| |
Treatment was done periodically with single medicine Puls. nigricans with increasing higher potencies (30, 200, 1M, 10M) according to response over the 15th month. Potency changes and repetition were done, following the homoeopathic principles and the second prescription of Kentian philosophy.,
Clinical follow-up was done in every month, and sonological evaluation was done at an interval of about 6 months. Sonomammography was done three times during the period of follow-up, which showed progressive reduction of FA size from baseline 3.48 cm × 2.38 cm on August 28, 2014; 2.06 cm × 1.4 cm on January 10, 2015 [Figure 2]; 1.77 cm × 0.82 cm on May 09, 2015 [Figure 3]; and finally 0.94 cm × 0.67 cm on November 19, 2015 [Figure 4].
|Figure 2: Ultrasonography report of the left breast on January 10, 2015 (during treatment)|
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|Figure 3: Ultrasonography report of the left breast on May 09, 2015 (during treatment)|
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|Figure 4: Ultrasonography report of the left breast on November 19, 2015 (longitudinal sections and transverse sections), after treatment|
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In the initial 9 months of treatment from September 03, 2014, to May 15, 2015, FA was reduced to half in size (3.48 cm × 2.38 cm to 1.77 cm × 0.82 cm) which was assessed sonologically [Figure 3]. Then, over next 3 months, the case was followed up by placebo. However, there was no further reduction of size and improvement of other symptoms became standstill. In expectation of further reduction of size of FA, the next higher potency of same medicine, Puls. nigricans 10M, was prescribed on August 25, 2015, and October 23, 2015. Then, improvement was found in regression of FA, as well as in other symptoms such as anxiety in crowd with fear of death, dysmenorrhea, and motion sickness. Finally, there was nearly 75% regression in size (3.48 cm × 2.38 cm to 0.94 cm × 0.67 cm) of FA becoming almost nonpalpable [Figure 2], [Figure 3], [Figure 4] and [Table 2].
The final outcome and possible causal attribution of the changes in this case were assessed using the “Modified Naranjo Criteria” as proposed by HPUS Clinical data Working Group (December 2015) [Table 3].
The total score of outcome in this case was ten which was close to the maximum score of 13 as per Modified Naranjo Criteria.
| Discussion|| |
In this report, it was a confirmed case of simple FA in adolescence with no family history of malignancy. Thus, conservative management was appropriately considered and kept under observation for more than 12 months by the treating surgeon. However, this case does not fall under those categories of FA showing spontaneous regression and had progressive increase in size and thus had been advised to get operated by surgery before coming to homoeopathic treatment. Patient's choice for homoeopathic treatment was guided by the factors such as fear of surgery, scar mark over the breast, and family history of FA which showed recurrence after surgery and finally positive response on homoeopathic treatment.
In this case, Puls. nigricans was selected as a Similimum on the totality of characteristics symptoms assessed on mental and physical aspects, which was given more priority than the pathological diagnosis of soft tissue tumor. P. nigricans with subsequent higher potencies from 30C to 10M was prescribed according to the response of the medicine, which follows the principles of Homoeopathy and second prescription of Kentian philosophy. Finally, the treatment outcome of 75% regression in size of FA making it clinically almost nonpalpable was highly satisfactory. The total score of outcome as per Modified Naranjo Criteria was 10 in this case, which was close to the maximum score of 13. This explicitly shows the causal attribution of the single medicine homoeopathic treatment Puls. nigricans toward regression of the FA in this case.
Thus, the outcome of this case of FA in an adolescent girl indicates the usefulness of the homoeopathic treatment.
In previous study, homoeopathic treatment had shown positive results on breast lesions and the three homoeopathic medicines Calcarea carbonica, Natrum muriaticum, and Pulsatilla nigricans were found to be most effective in the treatment of breast lesions. This has been corroborated in this case.
Significant regression in the size of FA along with improvement in other mental symptoms (anxiety in crowd with fear of death) and physical symptoms (dysmenorrhea, headache, motion sickness, vomiting) on an individualized single homoeopathic medicine reestablishes the holistic concept of Homoeopathy.
| Conclusion|| |
- This case shows the positive role of homoeopathic treatment in simple FA which failed to show spontaneous regression
- It reconfirms the importance of individualized homoeopathic treatment based on holistic basis, rather than particular pathological diagnosis
- It may also suggest that the constitutional homoeopathic treatment may be given preference over surgical intervention as the first-line of treatment in spontaneously nonregressing FA cases in young women.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]