Fibroadenoma is a very common benign breast condition. The most common symptom
is a lump in the breast which during a clinical breast exam, you
or doctor will check both breasts for
lumps and other problems. Some fibroadenomas are too small to feel, so they can
only be discovered in imaging tests.
If you have a lump that can
be felt (palpable), it will be wise t go ahead with some tests and those tets
depends /or procedures, will depend on her age and the characteristics of the
lump.
What is etiology ? OBJECTIVE
To identify from the literature and
clinical experience a rational approach to management of fibroadenomas of the
breast.
METHOD
Recent literature on detection,
diagnosis, and natural history of fibroadenomas was reviewed. Experience with
over 4,000 women evaluated in the breast clinic at the Tel- Aviv Medical Center
contributed to the management strategies suggested by review of the literature.
RESULTS
Fibroadenomas of the breast are common,
accounting for 50% of all breast biopsies performed. Physical examination,
sonography, and fine needle aspiration are effective in distinguishing
fibroadenomas from breast cancer. Transformation from fibroadenoma to cancer is
rare; regression or resolution is frequent, supporting conservative approaches
to follow-up and management.
CONCLUSION
Age-based algorithms that allow for
conservative management and that limit excision to patients whose fibroadenomas
fail to regress are presented.
Keywords: fibroadenoma, breast neoplasms, women
Fibroadenomas are common benign lesions of the
breast that usually present as a single breast mass in young women. They are
assumed to be aberrations of normal breast development or
the product of hyperplastic processes, rather than true neoplasms.
How to examine Breasts at Exam Hall ?? If male
candidate ask ward Nurse to be present and be polite,& courteous to woman
concerned,Show & practice as U practice how best to palpate thyroid, Axillary glands!!
Dilemma & Dilemma; To
do or not to do:After a clinical diag
of Fibroadenoma you now have two options like Breast sonography & FNAC,I
leave it to members,-The clinician often faces the dilemma whether to remove the mass or to monitor it by means of periodic follow-up examinations.
Adv of removal:-Although removal of these lesions is a
definitive solution,
Disadvantages of surgery: surgery may involve 1) unnecessary excisions of benign lesions
and2) unbecoming cosmesis. Moreover, a policy of conducting surgery on all
patients with fibroadenomas would place an 3) enormous burden on health care
systems.
Then whom to vote for ?? What is in your back of mind?? Thinking:1:- Cancer probality in near future. Or no cancer??
That lurks in one’s mind,. A balanced and rational approach to the management
of a fibroadenoma of the breast needs to address
the crucial questions about its
association with breast cancer,
especially whether or not it is a marker of increased risk of breast
malignancy. Another consideration to be weighed is that a Thinking: 2
:-A substantial percentage of
these lesions undergo spontaneous regression. Herein, based on our review of
the current data on fibroadenomas of the breast and our experience, we propose
practical algorithms for their management.
What is the prevalence. More common in young women. Fibroadenomas usually form during menarche (15
–25 years of age), a time at which lobular structures are added to the ductal
system of the breast There are no clear-cut data on the incidence of fibroadenomas in
the general population. In one study, the rate of occurrence of fibroadenomas
in women who were examined in breast clinics was 7% to 13% while
it was 9% in another study of
autopsies. Fibroadenomas comprise about A) 50% of all breast biopsies, and this rate
rises to B) 75% for biopsies in women
under the age of 20
years. Fibroadenomas are more frequent among women in C) higher socioeconomic classes and in dark-skinned
populations.
Can I take OCP:_Yes, no restrictions in presence Fibroadenoma. The age of
menarche, the age of menopause, and hormonal therapy, including oral
contraceptives, were shown not to alter the risk of these lesions.,
Whoch factors
discourages development of fibroadenoma?? body mass index and the number of full-term pregnancies were
found to have a negative correlation with the risk of fibroadenomas., Moreover,
consumption of large quantities of vitamin C and surprisingly cigarette smoking were found to
be associated with reduced risk of a fibroadenoma.
No genetics factors are known to alter the risk of fibroadenoma.
However, a family history of breast cancer in first-degree relatives was
reported by some investigators to be related with increased risk of developing
these tumors.
At What age this initiates?? Fibroadenomas
usually form during menarche (a time at which lobular structures are added to
the ductal system of the breast . Hyperplastic lobules are common at that time,
and may be regarded as a normal phase of breast development. Hyperplastic lobules were shown to be
histologically identical with fibroadenomas. .Analyses of the cellular components of
fibroadenomas by means of polymerase chain reaction demonstrated that both the
stromal and the epithelial cells are polyclonal supporting the theory that
fibroadenomas are hyperplastic lesions associated with aberration of the normal
maturation of the breast, rather than true neoplasms.
Histologic
section of a fibroadenoma (hematoxylin-eosin staining, × 40). The cellular
fibroblastic stroma, which resembles intralobular stroma, encloses glandular
and cystic spaces lined by epithelium. Round and oval gland spaces, lined by
either single or multiple cell layers, are present in other areas. The stroma
in the connective tissue appears to have undergone a more active proliferation
with compression on the gland spaces.
The pattern of stromal growth in a fibroadenoma depends on its
epithelial component: stromal mitotic activity was found to be higher near this
component.1 Fibroadenomas are stimulated by estrogen and
progesterone, and by lactation during pregnancy, and they undergo atrophic
changes in menopause. Some fibroadenomas have receptors and respond to growth
hormone and epidermal growth factor.
Clinical presentation of
a classical fibroadenoa
A fibroadenoma is most often detected incidentally during a
medical examination or during self examination, usually as a discrete solitary
breast mass of 1 to 2 cm.Although they can be located anywhere in the breast,
the majority are situated in the upper outer quadrant.A fibroadenoma is usually
smooth, mobile, nontender, and rubbery in consistency Several other breast
lesions have similar characteristics, and physical examinations provided an
accurate diagnosis in only one half to two thirds of cases studied.However,
most of the masses that are erroneously diagnosed by palpation as fibroadenomas
are found on histologic examination to be another benign form of breast disease
such as cystic fibrosis.
Macroscopic appearance
of a fibroadenoma. The spherical mass is sharply circumscribed, and could be
easily separated from the surrounding breast tissue. The section margins have a
green-white color, and contain slit-like spaces.
Multiple Fibroadenomas
From 10% to 16% of patients with multiple fibroadenomas have two
to four in a single breast, which may present initially or be discovered over
several years. Unlike women with a single fibroadenoma, most of the
patients with multiple fibroadenomas have a strong family history of these
tumors. A possible connection between multiple fibroadenomas and oral
contraceptives was proposed but has not yet been substantiated.
Fibroadenomas larger than 5 cm (about 4% of the total) are
commonly defined as being giant fibroadenomas; however, this terminology
is not universally accepted. Giant fibroadenomas are usually encountered in
pregnant or lactating women. When found in an adolescent girl, the term
juvenile fibroadenoma is more appropriate. These lesions in young women
constitute 0.5% to 2% of all fibroadenomas, and are rapidly growing masses that
cause asymmetry of the breast, distortion of the overlying skin, and stretching
of the nipple. Histologically, they appear to be more cellular and have less
lobular components than do simple fibroadenomas. However, giant fibroadenomas
are benign lesions that do not undergo transformation into malignancy.Sonography
Breast sonography is often used for the diagnosis of
fibroadenomas. The sonographic criteria that support the diagnosis of a
fibroadenoma are a round or oval solid mass with a smooth contour and weak
internal echoes in a uniform distribution and intermediate acoustic attenuation .
This imaging technique is very useful for differentiating between solid and
cystic lesions. However, attempts to correlate between the sonographic features
of solid masses compatible with fibroadenomas and pathologic findings were
disappointing. There is some overlap in the sonographic criteria for
fibroadenomas and for breast cancer, and approximately 25% of
fibroadenomas appear with irregular margins, which may imply that the lesions
are malignant. Also, only 82% of biopsy-proven fibroadenomas were
visualized by sonography in one study.
Sonographic appearance
of a fibroadenoma. The mass is homogenous, with sharp and smooth margins.
Slight posterior and edge enhancements are visible. Neither compression effects
nor internal echoes are present.
Mammography
The yield of mammography in young women is low, and its role in
the diagnosis of fibroadenomas is limited. However, it may disclose features of
infiltrative lesions in older women. In the mammographic image, fibroadenomas
appear as soft, homogenous, and well-circumscribed nodules, and inner coarse
calcifications are often observed.
Fine needle aspiration (FNA) has become a popular method in the
evaluation of breast masses. The characteristic cytologic features of
fibroadenomas are: clusters of spindle cells without inflammatory or fat cells,
found in 96% of all fibroadenomas; aggregates of cells with a papillary
configuration resembling elk antler (antler horn clusters), found in 93% of all
cases; and uniform cells with well-defined cytoplasm lying in rows and columns
(honeycomb sheets), found in 95% of all fibroadenomas.32 Taken together with the clinical diagnosis of fibroadenoma,
FNA can improve the sensitivity of the diagnosis to 86% with a specificity of
76%, while for breast cancer FNA is 96% sensitive and 98% specific. Thus,
while aspiration cytology may confuse fibroadenomas with other benign breast
lesions, incorrect diagnosis of a malignant process is rare.
The overall diagnostic efficacy of these three modalities—namely,
manual breast examination, imaging and cytology is approximately 70% to 80%,
but they provide a 95% (±2% SD) accurate differentiation between a benign and a
malignant lesion. A follow-up period of 1 to 3 years after fibroadenoma is diagnosed
and breast cancer is excluded using the three modalities can enhance the
accuracy of the diagnosis.
