fibroadenoma Flashcards
definition of fibroadenoma
It is a benign overgrowth of collagenous mesenchyme of one breast lobule
firm, smooth, mobile lump
may be multiple
A benign estrogen-dependent breast tumor composed of fibrous and glandular tissue that is usually found in premenopausal women - hormone dependent, likely to get bigger during period
types of adenoma
common
juvenile - in adolescence and sometimes undergo rapid growth
giant >5cm
aetiology of fibroadenoma
unknown
hormonal relationship has been established - increased oestrogen eg during pregnancy or before menstruation may stimulate growth
hypertrophy of a breast lobule containing epithelial and connective tissue elements
may also be apocrine hyperplasia
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.
may be less common in people on OCP
epidemiology of fibroadenoma
usually presents when pt is <35 but can occur up to menopause from menarche (peak incidence 15-35yrs)
o Fibroadenomas account for 13% of all palpable symptomatic masses. They are common lumps in young women accounting for 60% of palpable lumps in women under the age of 30.
sx of fibroadenoma
non-tender and rubbery, smooth, mobile mass
asymptomatic - found incidentally
signs of fobroadenoma
solitary and well defined mass
smooth, well circumscribed and mobile lumps (breast mouse)
ix for fibroadenoma
observation and reassurance
if in doubt refer for US - usually conclusive
fine needle aspiration
surgical excision if >4cm because could be malignant
mammogram:- well defined mass, oval or round, circumscribed, may have coarse calcifications
breast ultrasound:- well defined mass, homogenous, solid, oval or round, circumscribed, lobulated, width greater than height
breast fine needle aspiration
epithelial and stromal elements, fibrous and glandular tissue
a core biopsy is usually taken under US guidance. This aims to remove a small core of tissue from the mass using a cutting needle technique. A local anaesthetic is used to numb the area and a small incision is made to allow the needle placement. The needle is introduced through the skin until it abuts the lesion. The fully mechanised biopsy gun is fired and a core of tissue is obtained. Several cores are taken and are sent for histology.
Fine needle aspiration cytology can differentiate between a cystic and solid lesion, but is less specific and can only differentiate between benign and malignant cells
A 21 gauge needle is attached to a syringe and the needle is inserted into the palpable lump. Suction is applied. If the lump is cystic fluid will be drawn into the syringe. If the lump is solid several passes should be made to obtain cells which should be sent for cytology. If the cytology is inadequate or equivocal a core biopsy should be performed.
Excision biopsy should only be performed if a definitive diagnosis cannot be made by imaging and core biopsy or there is a suspicion that this is a phyllodes tumour.
mx of fibroadenoma
regular check-ups, if more than 4cm or changing quickly - excise because could be malignant tumour - when over 4cm likely to be phyllodes tumour
If the lump is > 2cm and visible then it may be appropriate to excise it if the patient requests excision. If there is evidence that the lump is increasing in size then it would be appropriate to excise it.
symptomatic treatment
surgery
- removal/excision biopsy of breast lump
- WLE if any suspicion not benign - excised with a margin to make a definitive diagnosis, as phyllodes tumours may recur.
complications of fibroadenoma
pain, recurrence
fibroadenoma is rubbery and mobile mass - moves when you feel it
if you take a core biopsy of a small mass - likely to be representative if you’re told benign ie B2
if take core biopsy of large mass - nothing to say that it is representative if B2 could be sampling error and the rest of the mass could be malignant. So you have to enucleate (ie excise the mass) then look under microscope to determine whether or not it is malignant.
If it is >4cm, or grows quickly could be phyllodes tumour which can be malignant and life threatening, look similar to fibroadenoma histopathologically - do you have to go back and excise more?
px of fibroadenoma
1/3 regress, 1/3 stay the same 1/3 get bigger
mass is not in the tissue, so when you remove it the breast stays the same size