Mammology

Fibroadenoma of the breast

Marina Virko
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Oleg Gluz

Among the problems related to the mammary glands, mastopathy is the most common. The disease comes in a number of types. In young girls until the age of 35, fibroadenoma of the mammary gland is common. The condition may not be disturbing for an extended period. In some cases, pain occurs in the latter half of the menstrual cycle under the influence of altered hormonal levels.

What is breast fibroadenoma?

It is a benign tumor consisting of glandular tissue. It refers to a nodular mastopathy subtype. The peak incidence of fibroadenoma occurs among 20-year-olds. In the majority of cases, nodes are formed in one gland, and only in 10% both sides are affected.

As a rule, the size of mass does not exceed 2-3 cm. Rarely, giant fibroadenomas up to 6 cm in size are encountered. Every fifth woman has multiple lumps. In the rest of the cases there are single ones.

Why do fibroadenomas grow?

The exact cause of fibroadenoma of the breast is not known. Experts can only mention some provoking factors which increase the risk of lump growth. First of all, it is an increase in the level of estrogen in the blood and a pronounced lack of progesterone. Hyperestrogenism can be relative or absolute. In the former case, the estrogen level remains normal, but its ratio to progesterone is abnormal.

Other factors that may be considered to provoke fibroadenoma include:

  • early menarche;
  • breastfeeding for less than a month;
  • frequent abortions;
  • overweight;
  • concomitant gynecological diseases;
  • consumption of oral contraceptives before the age of 20;
  • congenital conditions such as multiple cartilage tumors, benign uterine neoplasms, growth disorders, and so on;
  • permanent stress;
  • breast injuries.

It should be noted that patients with liver disorders have a significantly increased fibroadenoma risk in, which is associated with impaired production of steroid hormones. The same applies to thyroid and adrenal gland conditions.

The beginning of puberty is a provoking factor in itself due to the improper function of the hypothalamic-pituitary system.

The chances to develop fibroadenoma in women who were previously diagnosed with uterine myoma or endometriosis increase significantly. This is explained by the fact that such conditions disrupt neuroendocrine regulation, which causes changes in the menstrual cycle and, consequently, hormone imbalance.

A similar situation is observed with polycystic ovarian syndrome, when there is no ovulation. As a result, fibroadenomas grow in the mammary glands due to progesterone deficiency.

Fibroadenoma types

There are several mammary fibroadenoma types depending on their localization. This is directly related to the treatment tactics and prognosis of the disease.

In the duct - intracanalicular

The characteristic feature is overgrowth of connective tissue inside the ducts or between them. Single lumps are palpable, but no clear border can be defined. It can only be treated by surgery, since this variation of fibroadenomas practically does not respond to drug therapy. The lumps are not malignant.

Around the duct - pericanalicular

The abnormal process is characterized by overgrowth of connective tissue around the ducts. It is distinguished by the fact that the neoplasm can grow into a malignant one. At the same time, it can very well be cured with medications.

Leaf-shaped, phyllodes

This is a particularly aggressive form of fibroadenoma, capable of reaching gigantic sizes. The mass is most often detected during the menopause. The follicular structure indicates a high risk of degeneration into cancer. This complication is noted in 10% of cases. If this form is diagnosed, removal of the fibroadenoma is indicated.

Mature

Lumps of the mature type have a dense structure, and a pronounced capsule. This indicates that the mass has stopped growing.

Immature

Soft and elastic lumps revealed at palpation. Without appropriate treatment such lesions continue to grow.

Symptoms

Lumps can be identified by breast palpation. The neoplasm is felt as a rounded, dense, mobile, painless mass. When it is small, it does not cause any discomfort.

As a rule, women go to the doctor with a complaint of a lump in the breast. It is not fused with the surrounding tissues, so it easily rolls over under the fingers when palpating. Such masses rarely develop into cancer, but such transformation is not impossible.

The condition does not cause external changes. The mammary gland gets larger only with really huge masses. Such forms have a higher risk of malignization (turning into cancer).

Diagnosis

To make a diagnosis, the doctor first palpates the breast tissue. Should the initial testing reveal abnormalities, radiology exams are conducted:

  • Mammary gland ultrasound allows to determine the localization of the lump, its structure, shape and size. If necessary, a biopsy is performed under ultrasound monitoring.
  • Mammography. Fibroadenoma may be shown as a dense rounded mass with clearly defined borders. If the lump has existed for a long time, it may accumulate calcium salts, resulting in a higher contrast.
  • Tissue sample analysis. The material obtained during biopsy is subjected to cytological examination to determine its cell type.

As a rule, these tests are enough to make a diagnosis. However, in some situations an MRI is necessary, for example, if the patient has already undergone breast surgery, has silicone implants, or has a history of breast cancer. Also MRI has a higher sensitivity for high density gland tissue.

Fibroadenoma treatment

In most cases, doctors recommend removal of the fibroadenoma. Sometimes, if the lump is 5-8 mm in size, conservative therapy may be given, including analgesics, vitamins, hormones, and iodine-based medications. The course continues for 4-6 months with regular ultrasound follow-ups. Such therapy may reduce the tumor size, but its complete resorption occurs in rare cases.

In the absence of effect from drug therapy, and in the presence of larger lumps, surgery is indicated. Breast fibroadenomas can be resected using one of the following procedures:

  • Sectoral resection. The method is chosen if cancer is suspected.
  • Tumor enucleation. The procedure consists in lump excision under local anesthesia, followed by histological examination of the removed tissue.

Recovery after surgery is fast. On the 8th-10th day the stitches are removed. To achieve an aesthetically appealing result, the doctor tries to carry out the excision as gently as possible using internal cosmetic sutures.

Fibroadenoma vs breast cancer

Fibroadenoma is not a malignancy. It has quite different characteristic symptoms. All that a woman feels with fibroadenoma is the presence of a lump in the breast. There are no visual changes. Of course, it is possible for the tumor to transform into cancer, so the following signs should be the warning signals:

  • Skin changes (flakes).
  • Redness.
  • Retraction of the nipple.
  • "Orange peel" skin texture.
  • Change in the shape or size of the breast.

The above symptoms may indicate the development of a malignant tumor, which requires a comprehensive examination and therapeutic action.

Fibroadenoma during pregnancy

A lump in the mammary glands can be found both before conception, and during pregnancy. In the former case, it is recommended to immediately perform an operation to remove the mass, and only then plan to conceive a child.

Should the mass be detected during pregnancy, the risk of its transformation into malignancy increases. This is attributed to hormone imbalance.

Fibroadenomas do not affect the development and growth of the fetus. But pregnancy itself can make an impact on the lump. Most often its size increases under the influence of hormones.

The treatment strategy depends on the size of the mass. If the volume of the lesion does not exceed certain limits, mere observation is possible. If, however, there is an evident growth and signs of transformation, surgery is indicated. The pregnancy prognosis in this case depends only on the peculiarities of the malignant process.

Fibroadenoma prevention

Measures to prevent fibroadenoma include the creation of conditions in which the hypothalamus-pituitary system develops normally. This includes the elimination of stress, a healthy meal plan and lifestyle, giving up starvation and dieting. The choice of birth control and pregnancy planning should be very careful.

Second opinion

Second opinion makes it possible for every patient to get a consultation with doctors from European clinics without overseas trips. Each particular issue is considered by an expert with the appropriate sub-specialty. This gives an opportunity to get advice from a healthcare professional extensive experience in the diagnosis and treatment of a particular disorder. Regarding fibroadenoma, when the condition is suspected, a second opinion may be required both at diagnosis and in the course of therapy.

In the former case, the doctor will assess if the diagnostic procedures were chosen correctly. After receiving the findings, the breast care specialist will review the data and make a diagnosis based on the current complaints. European specialists apply the latest methods of fibroadenoma treatment. A second opinion will help to find out which options are the most effective in each particular case.

After drug treatment or surgery, a second opinion may also be advisable. The reason is that fibroadenomas tend to relapse, so it is important to make a plan of action to prevent the lump from forming again.

Consultations with European experts are available both as online discussions with interpreter support, and in written form.

Fibroadenoma of the breast is a fairly common disease in women. In most cases, doctors recommend only monitoring or conservative therapy. But it should always be kept in mind that some conditions tend to transform into breast cancer. Therefore, regular check-up examinations are obligatory for all patients.

References

  1. Fibroadenoma of the breast, N Houssami, 2001
  2. Phyllodes tumours of the breast: a consensus review, Benjamin Y Tan, 2016
  3. Fibroepithelial tumours of the breast-a review, Melinda F Lerwill, 2022
  4. Breast fibroadenomas: a review in the light of current literature, Sajad Ahmad Salati, 2020
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