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Fibroadenoma

fibroadenoma, fibroadenomas masses
Fibroadenomas of the breast are benign tumors characterized by an admixture of stromal and epithelial tissue Breasts are made of lobules milk producing glands and ducts tubes that carry the milk to the nipple These are surrounded by glandular, fibrous and fatty tissues Fibroadenomas develop from the lobules The glandular tissue and ducts grow over the lobule to form a solid lump

Since both fibroadenomas and breast cancer can appear as similar lumps, it is currently recommended to perform ultrasound analyses and possibly tissue sampling with subsequent histopathologic analysis in order to perform diagnosis Unlike typical lumps from breast cancer, fibroadenomas are easy to move, with clearly defined edges12

Fibroadenomas are sometimes called breast mice or a breast mouse owing to their high mobility in the breast3

Contents

  • 1 Signs and symptoms
  • 2 Cause
  • 3 Pathology
    • 31 Cytology
    • 32 Macroscopic
    • 33 Microscopic
  • 4 Molecular pathology
  • 5 Diagnosis
  • 6 Treatment
    • 61 Cryoablation
    • 62 Ultrasound
  • 7 Epidemiology
  • 8 References
  • 9 Further reading
  • 10 External links

Signs and symptomsedit

The typical case is the presence of a painless, firm, solitary, mobile, slowly growing lump in the breast of a woman of child-bearing years245

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 treatment6

Causeedit

Fibroadenomas are partially hormone-related and frequently regress after menopause

Higher intake of fruits and vegetables, higher number of live births, lower use of oral contraceptives and moderate exercise are associated with lower frequency of fibroadenomas7

Pathologyedit

Macroscopic view of fibroadenoma of the breast Closeup of a fibroadenoma of the breast

Cytologyedit

The diagnostic findings on needle biopsy consist of abundant stromal cells, which appear as bare bipolar nuclei, throughout the aspirate; sheets of fairly uniform-size epithelial cells that 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 features48 The gallery images below demonstrate these features

Cellular fibroadenoma, also known as juvenile fibroadenoma, is a variant type of fibroadenoma with increased stromal cellularity910

Macroscopicedit

Approximately 90% of fibroadenomas are less than 3 cm in diameter However, these tumors have the potential to grow reaching a remarkable size, particularly in young individuals The tumor is round or ovoid, elastic, and nodular, and has a smooth surface The cut surface usually appears homogenous and firm, and is grey-white or tan in colour The pericanalicular type hard has a whorly appearance with a complete capsule, while the intracanalicular type soft has an incomplete capsule8

Microscopicedit

Fibroadenoma of the breast is a benign tumor composed of a biphasic proliferation of both stromal and epithelial components that can be arranged in two growth patterns: pericanalicular stromal proliferation around epithelial structures and intracanalicular stromal proliferation compressing the epithelial structures into clefts

These tumors characteristically display hypovascular stroma compared to malignant neoplasms258 Furthermore, the epithelial proliferation appears in a single terminal ductal unit and describes duct-like spaces surrounded by a fibroblastic stroma The basement membrane is intact11

Molecular pathologyedit

Up to 66% of fibroadenomas harbor somatic mutations in the exon 2 of the mediator complex subunit 12 MED12 gene In particular, these mutations are restricted to the stromal component1213

Diagnosisedit

A fibroadenoma is usually diagnosed through clinical examination, ultrasound or mammography, and often a needle biopsy sample of the lump4

Treatmentedit

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 necessity of this procedure A small amount of normal tissue must be removed in case the lesion turns out to be a phyllodes tumour on microscopic examination814

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 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 observation15

Some fibroadenomas respond to treatment with ormeloxifene16

Fibroadenomas have not been shown to recur following complete excision or transform into phyllodes tumours following partial or incomplete excision8

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

Cryoablationedit

The FDA has approved cryoablation of a fibroadenoma as a safe, effective and minimally-invasive alternative to open surgical removal in 200117 In the procedure, ultrasound imaging is used to guide a probe into the mass of breast tissue Extremely cold temperatures are then used to destroy the abnormal cells,18 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 and no breast tissue deformation18

The American Society of Breast Surgeons recommends the following criteria to establish a patient as a candidate for cryoablation of a fibroadenoma:17

  1. The lesion must be sonographically visible
  2. The diagnosis of fibroadenoma must be confirmed histologically
  3. Lesions should be less than 4 cm in diameter

Ultrasoundedit

An alternative using high intensity focused ultrasound or HIFU has recently proved its efficacy in treating fibroadenoma This method is noninvasive, without general anesthesia and is performed in an ambulatory setting Ultrasound waves are focused and produce heat enabling to destroy fibroadenomasThis method is non-invasive and relies on tissue heating to destroy fibroadenoma cells19

Focused ultrasounds have been used to treat other benign tumors, such as fibroid disease in the uterus20

Epidemiologyedit

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, in general, they appear before the age of thirty yearscitation needed

Referencesedit

  1. ^ 22-251cFibroadenomas at Merck Manual of Diagnosis and Therapy Home Edition
  2. ^ a b c Tavassoli, FA; Devilee, P, eds 2003 World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs Lyon: IARC Press ISBN 92-832-2412-4 page needed
  3. ^ Dirbas, Fredrick M; Scott-Conner, Carol EH, eds 2010 Breast surgery office management and surgical techniques New York: Springer p 71 ISBN 978-1-4419-6075-7 
  4. ^ a b c DeMay, M Practical Principles of Cytopathology Revised ed ASCP Press p 2007 ISBN 0-89189-549-3 page needed
  5. ^ a b Pathology Outlines Website 1 Accessed 12 February 2009
  6. ^ Shin SJ, Rosen PP July 2007 "Bilateral presentation of fibroadenoma with digital fibroma-like inclusions in the male breast" Archives of Pathology & Laboratory Medicine 131 7: 1126–9 PMID 17617003 doi:101043/1543-216520071311126:BPOFWD20CO;2 
  7. ^ Nelson ZC, Ray RM, Wu C, Stalsberg H, Porter P, Lampe JW, Shannon J, Horner N, Li W, Wang W, Hu Y, Gao D, Thomas DB July 2010 "Fruit and vegetable intakes are associated with lower risk of breast fibroadenomas in Chinese women" The Journal of Nutrition 140 7: 1294–301 PMC 2884330  PMID 20484549 doi:103945/jn109119719 
  8. ^ a b c d e Rosen, PP Rosen's Breast Pathology 3rd ed ISBN 978-0-7817-7137-5 page needed
  9. ^ Fekete P, Petrek J, Majmudar B, Someren A, Sandberg W May 1987 "Fibroadenomas with stromal cellularity A clinicopathologic study of 21 patients" Archives of Pathology & Laboratory Medicine 111 5: 427–32 PMID 3032124 
  10. ^ Nassar, Hind "Cellular fibroadenoma of breast" Retrieved 14 January 2013 
  11. ^ "Fibroadenoma of the breast" Retrieved 2007-12-15 
  12. ^ Lim WK, Ong CK, Tan J, Thike AA, Ng CC, Rajasegaran V, Myint SS, Nagarajan S, Nasir ND, McPherson JR, Cutcutache I, Poore G, Tay ST, Ooi WS, Tan VK, Hartman M, Ong KW, Tan BK, Rozen SG, Tan PH, Tan P, Teh BT August 2014 "Exome sequencing identifies highly recurrent MED12 somatic mutations in breast fibroadenoma" Nature Genetics 46 8: 877–80 PMID 25038752 doi:101038/ng3037 
  13. ^ Piscuoglio S, Murray M, Fusco N, Marchiò C, Loo FL, Martelotto LG, Schultheis AM, Akram M, Weigelt B, Brogi E, Reis-Filho JS November 2015 "MED12 somatic mutations in fibroadenomas and phyllodes tumours of the breast" Histopathology 67 5: 719–29 PMC 4996373  PMID 25855048 doi:101111/his12712 
  14. ^ Rosai, J 2004 Rosai and Ackerman's Surgical Pathology 9th ed ISBN 0-323-01342-2 page needed
  15. ^ Gordon PB, Gagnon FA, Lanzkowsky L October 2003 "Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up" Radiology 229 1: 233–8 PMID 14519878 doi:101148/radiol2291010282 
  16. ^ Dhar A, Srivastava A June 2007 "Role of centchroman in regression of mastalgia and fibroadenoma" World Journal of Surgery 31 6: 1178–84 PMID 17431715 doi:101007/s00268-007-9040-4 
  17. ^ a b Management of Fibroadenomas of the Breast
  18. ^ a b WebMD — Cryotherapy Shrinks Benign Breast Lumps
  19. ^ "Echotherapy: Fibroadenomas" 
  20. ^ Jolesz FA, Hynynen K, McDannold N, Tempany C August 2005 "MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery" Magnetic Resonance Imaging Clinics of North America 13 3: 545–60 PMID 16084419 doi:101016/jmric200504008 

Further readingedit

  • Jolesz FA, Hynynen K, McDannold N, Tempany C August 2005 "MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery" Magnetic Resonance Imaging Clinics of North America 13 3: 545–60 PMID 16084419 doi:101016/jmric200504008 
  • Gombos EC, Kacher DF, Furusawa H, Namba K June 2006 "Breast focused ultrasound surgery with magnetic resonance guidance" Topics in Magnetic Resonance Imaging 17 3: 181–8 PMID 17414075 doi:101097/rmr0b013e318033789f 
  • Hynynen K, Pomeroy O, Smith DN, Huber PE, McDannold NJ, Kettenbach J, Baum J, Singer S, Jolesz FA April 2001 "MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study" Radiology 219 1: 176–85 PMID 11274554 doi:101148/radiology2191r01ap02176 
  • Marret H, Bleuzen A, Guérin A, Lauvin-Gaillard MA, Herbreteau D, Patat F, Tranquart F January 2011 "French first results using magnetic resonance-guided focused ultrasound for myoma treatment" French first results using magnetic resonance-guided focused ultrasound for myoma treatment Gynecologie, Obstetrique & Fertilite in French 39 1: 12–20 PMID 21185759 doi:101016/jgyobfe201008038 

External linksedit

  • Cryoablation in the News
  • http://wwwmedgadgetcom/2012/12/theraclion-echopulse-ultrasound-therapy-for-breast-fibroadenomas-cleared-in-euhtmlfull citation needed

fibroadenoma, fibroadenoma breast cancer, fibroadenoma histology, fibroadenoma pain, fibroadenoma removal, fibroadenoma surgery, fibroadenoma symptoms, fibroadenoma treatment, fibroadenoma ultrasound, fibroadenomas masses


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