|March 26, 2016|
Fibroadenomas of the breast are small, solid, rubbery, noncancerous, harmless lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors usually recommend a tissue sample ( biopsy) to rule out cancer. Unlike typical lumps from breast cancer, fibroadenomas are easy to move, with clearly defined edges.
The typical case is the presence of a painless, firm, solitary, mobile, slowly growing lump in the breast of a woman of childbearing years.
In the male breast, fibroepithelial tumors are very rare, and are mostly Phyllodes tumors. Exceptionally rare case reports exist of fibroadenomas in the male breast, however these cases may be associated with antiandrogen treatment.
A fibroadenoma is usually diagnosed through clinical examination, ultrasound or mammography, and often a needle biopsy sample of the lump .
Fibroadenomas arise in the terminal duct lobular unit of the breast. They are the most common breast tumor in adolescent women. They also occur in a small number of post-menopausal women. Their incidence declines with increasing age, and they generally appear before the age of thirty years, probably partly as a result of normal estrogenic hormonal fluctuation. Although fibroadenoma is considered a neoplasm, some authors believe fibroadenoma arises from hyperplasia of normal breast lobule components.Rosen, PP. Rosen's Breast Pathology . Third Edition. ISBN 978-0-7817-7137-5 .
The diagnostic findings on needle biopsy consist of abundant stromal cells, which appear as bare bipolar nuclei, throughout the aspirate; sheets of fairly uniform sized epithelial cells which are typically arranged in either an antler-like pattern, or a honeycomb pattern. These epithelial sheets tend to show typical metachromatic blue staining on DiffQuick staining. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. The gallery images below demonstrate these features.
Approximately ninety percent of fibroadenomas are less than three centimetres in diameter. The vast majority of the remaining ten percent that are four centimetres or larger occur mostly in women under twenty years of age. The tumor is round or ovoid, elastic, nodular, and has a smooth surface. The cut surface usually appears homogenous and firm, and is grey-white or tan in colour.
The proliferation forms duct-like spaces. These are surrounded by fibroblastic stroma. The proliferating epithelium is of normal appearance. Fibroadenomas may be sub-classified into two types, intracanalicular and pericanalicular, depending on the relative amounts of epithelial and stromal tissue present. There is also a mixed type, in which both forms coexist simultaneously. Intracanalicular fibroadenomas show predominant stromal proliferation that compresses the ducts, which are irregular and reduced to slits. Pericanalicular fibroadenomas show fibrous stromal proliferation around the ductal spaces that allows the duct spaces remain round or oval. The gallery image below demonstrates both morphological subtypes.
Most fibroadenomas are left in situ and monitored by a doctor, or the patient in question. Some are treated by surgical excision. They are removed with a small margin of normal breast tissue if the preoperative clinical investigations are suggestive of the diagnosis. A small amount of normal tissue must be removed in case the lesion turns out to be a phyllodes tumour on microscopic examination.Rosai, J. 2004. Rosai and Ackerman's Surgical Pathology 9th Edition. ISBN 0-323-01342-2
Because needle biopsy is often a reliable diagnostic investigation, some doctors may decide not to operate to remove the lesion, and instead opt for clinical follow-up to serially observe the lesion over time using clinical examination and mammography to determine the rate of growth, if any, of the lesion. A growth rate of less than sixteen percent per month in women under fifty years of age, and a growth rate of less than thirteen percent per month in women over fifty years of age have been published as safe growth rates for continued non-operative treatment and clinical observation.
Gordon PB, Gagnon FA, Lanzkowsky L. Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up.
Radiology. 2003 Oct;229(1):233-8.
There are also natural treatments being touted to diminish fibroadenomas, such as Fibrosolve, but no definite studies have been made as to prove their effectiveness.
The FDA has approved cryoablation (the use of extreme cold to destroy tissue) of a fibroadenoma as a safe, effective and minimally-invasive alternative to open surgical removal. and over time the cells are reabsorbed into the body. The procedure can be performed in an office setting with local anesthesia only and leaves substantially less scarring than open surgical procedures.
The American Society of Breast Surgeons recommends the following criteria to establish a patient as a candidate for cryoablation of a fibroadenoma:
Image:Breast_fibradenoma_(2).jpg|Fibroadenoma Histology (H&E). The image demonstrates intracanalicular morphology (top right) and pericanalicular morphology (bottom left)
Image:Breast_fibroadenoma_by_fine_needle_aspiration_(1)_DG_stain.jpg|Fibroadenoma, Fine Needle Aspiration Biopsy (Giemsa or DiffQuickTM stain). The image shows abundant bare bipolar stromal nuclei surrounding sheets of metachromatic epithelial cells.
Image:Breast_fibroadenoma_by_fine_needle_aspiration_(2)_PAP_stain.jpg|Fibroadenoma, Fine Needle Aspiration Biopsy (Papanicolou stain). The image shows a sheet of epithelial cells in the typical antler pattern.
Image:Breast fibradenoma (1).jpg|Histopathologic image of breast fibroadenoma. Core needle biopsy. Hematoxylin & eosin stain.
GNU Free Documentation License. It uses material from the Wikipedia article "fibroadenoma".
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