Fibroadenoma Flashcards
Define fibroadenoma.
Aberrations of normal breast development and involution (ANDI) that contain both stromal and epithelial elements.
Why are they not benign tumours?
ANDI because:
- Fibroadenomas develop from a whole lobule whereas neoplasms arise from a single cell
- Fibroadenomatoid changes in lobules are common findings in breasts of young women
- Fibroadenomas show the same hormonal dependence as the remainder of breast tissue, for example they may increase in size during pregnancy and involute during the perimenopausal period
What are the 3 types of fibroadenoma?
- Common fibroadenoma
- Juvenile fibroadenoma
- Giant fibroadenoma
Juvenile fibroadenomas occur in adolescence and sometimes undergo rapid growth. They are managed in the same way as a common fibroadenoma. Giant fibroadenomas are those which measure over 5cm. Fibroadenomas usually present as a palpable breast lump, although they may be detected by screening.
What is the pathophysiology of adenomas?
Fibroadenomas develop from a whole lobule rather than from a single cell, and show hormonal dependence similar to that of normal breast tissue, lactating during pregnancy and involuting in the perimenopausal period.
They are composed of fibrous and epithelial tissue
How common are fibroadenomas? Who is usually affected?
- Usually develop short after breast growth
- <30yrs - 60%
- Sometimes >35yrs as the glanduar component of breast is lost
- They are the most common type of breast lesion - account for 13% of all lumps
- As much as 7-13% will have a fibroadenoma at some point in their life
How do fibroadenomas present?
- Firm, tender, highly mobile palpable lump
- Well circumscribed
- Slowly growing
- Hx of HRT
- Most stop growing at 2-3cm
No other symptoms
- Surface - smooth
- Borders - distinct
- Consistency - rubbery
- Mobility - yes
- Fixity - no
- Lymphadenopathy - no
How does fibroadenoma appear on US?
Characteristic appearance with easily visualised margins
In contrast to cyst, fibroadenoma may show some internal echoes (not as hypoechoic)
May be multiple and bilateral
What investigations woudld you do for a suspected fibroadenoma?
US (if <40yrs) - enough to diagnose fibroadenoma in young women
Core biopsy not always necessary if aged <25yrs but necessary if older.
What is the management of fibroadenomas?
Non urgent referral if <30yrs
Reassurance
May disappear or get smaller within 2 years (rarely increase in size) and so no follow up may be necessary
Excisional biopsy - patient preference or increasing in size/ >2-4cm and to ensure a phyllodes tumour is not missed. Carcinoma in a fibroadenoma is extremely rare.
What are the complications of fibroadenomas?/ What is the prognosis w?
- Large or giant fibroadenomas (> 5 cm) are uncommon but are seen more often in women from certain African and Asian countries.
- Usually shrink or disappear within 2 years
- Carcinoma arising in a fibroadenoma is extremely rare.
- Patients with simple fibroadenomas are not at increased risk of developing breast cancer.
- Hormone dependant
How do fibroadenomas change over time?
Approximately 5% of fibroadenomas increase in size, a number (approximately 20%) will disappear and the remainder will stay the same size but become clinically less distinct with time
Which tumour can be mistaken for fibroadenomas?
Phyllodes tumours are distinct pathological entities and cannot always be clinically differentiated from fibroadenomas
So clinical examination is not a reliable test on its own as 5% of benign masses thought to be fibroadenomas on examination turn out to be carcinomas.
Which group are new fibroaenomas uncommon in?
Post menopausal
