A 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.
The overall diagnostic efficacy of these three modalities—namely, A) manual
breast examination, B) imaging and
C) 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. If you have a lump that can be felt (palpable), it
will be wise to 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
?
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 hyperplasic processes, rather
than true neoplasms.
How
to examine Breasts at Exam Hall / or your private clinic?? 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 surgical removal:-Although removal of these lesions is a definitive solution,
But 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.,
Which 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 . Hyperplasic lobules are common at that time,
and may be regarded as a normal phase of breast development. Hyperplasic 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 hyperplasic 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 interlobular 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.
How a woman present with
Fibroadenoma??
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, contender, 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.
How useful Breast 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..
Treatment: A) Follow up:-In many cases, fibroadenomas require no treatment.
However, some women choose surgical removal for their peace of mind. If
physician is reasonable certain that breast lump is a fibroadenoma — based on the
results of the A) clinical breast exam & Axillary gland palpitation,
B) imaging test and C) FNAC:-biopsy — then
follow up may be advised without lumpectomy..
Points
against surgery?? Because:
·
Surgery can distort the shape and
texture of the breast
·
Fibroadenomas sometimes shrink or
disappear on their own
·
The breast has multiple
fibroadenomas that appear to be stable — no changes in size on an ultrasound
compared to an earlier ultrasound
If one is advised not to have
surgery, it's important to monitor the fibroadenoma under regular follow-up visits preferably under the
supervision of a dedicated breast clinic
if available nearby .
Rpt breast ultrasounds to detect
changes in the appearance or size of the lump may be necessary .
Surgery: What kind??
It may be necessary to remove the
fibroadenoma if lump is big; the fibroadenoma is extremely large, gets bigger
or causes symptoms.
&
consultant after reviewing all the three reports, taken together —1) the clinical breast exam, 2) an imaging test
or 3) FNAC is abnormal or if Procedures to remove a fibroadenoma include:
Can left out Fibroadenoma turn out to be cancer??
This
is an imp topic that every woman & surgeon would like to know about it??
The associations of fibroadenomas with breast cancer must address two main
questions: whether or not a fibroadenoma is a marker for increased risk of
breast cancer, and whether or not breast cancer can evolve from the epithelial
component of a fibroadenoma. The first issue was originally assessed in several
retrospective studies, which demonstrated a 1.3 to 2.1 increased risk of
breast cancer in women with fibroadenomas compared with the general population.
The elevated risk was persistent, and did not decrease with time. A more recent
study designed to delineate the possible correlation between the histologic features of the
fibroadenomas and the risk for subsequent breast cancer used the term “complex
fibroadenoma.”
Malignant transformations in the epithelial components of
fibroadenomas are generally considered rare. The incidence of a carcinoma
evolving within a fibroadenoma was reported to be 0.002% to 0.0125%.,, About 50%
of these tumors were lobular carcinoma in situ (LCIS), 20% were infiltrating
lobular carcinoma, 20% were ductal carcinoma in situ (DCIS), and the remaining
10% were infiltrating ductal carcinoma. The clinical, sonographic and
mammographic findings are usually similar to those of benign fibroadenomas, and
the malignant changes are often noted only when the fibroadenoma is excised.
Who
are more prone to Ca ?? Fibroadenomas having the histologic characteristic of
being A) more than 3 mm in diameter, or B) with elements of sclerosing
adenosis, epithelial calcifications, or C) papillary apocrine metaplasia, which
were associated with a 3.1 elevated risk of breast cancer. D) Proliferative
changes in the parenchyma adjacent to the fibroadenoma were related to a
further increase of the risk to 3.88. E) The relative risk for women with a
familial history of breast cancer and complex fibroadenoma was 3.72, compared
with control women with a family history of breast cancer without fibroadenoma.
In
these studies, women with noncomplex fibroadenomas and no family history of
breast cancer were not at a greater risk of breast cancer.
