Fibroadenoma is a benign breast tumor formed:
- Of the mammary glandular tissue,
- Of the stromal tissue (connective tissue).
This tumor is benign, therefore:
- It is not vascularized and proliferative,
- There are no cancerous cells in the axillary sentinel lymph nodes .
It is more common in women between 20 and 30 years of age, but it can develop in women of any age. The fibroadenoma that occurs during adolescence is called juvenile fibroadenoma.
Taking the contraceptive pill may reduce the risk of fibroadenoma, but may increase the risk of breast cancer , especially in women at high risk (eg in the case of cancer in the family).
Normal breast tissue is present in both men and women of all ages.
This tissue responds to hormonal changes and as a result, some lumps may shrink or increase in volume during the phases of the menstrual cycle and during pregnancy.
Among female cancers, myoma and leiomyoma of the uterus are more frequent, fibroadenoma is rarer.
Breast fibroadenoma is a juvenile disease in fact is observed especially in adolescents, usually in the 20 years after puberty.
- 1 How to recognize a fibroadenoma
- 2 How big is fibroadenoma?
- 3 Types of fibroadenoma
- 4 Can fibroadenoma increase the risk of cancer?
- 5 Causes of fibroadenoma
- 6 Symptoms of fibroadenoma
- 7 Diagnosis of fibroadenoma
- 8 What is the best treatment for a fibroadenoma?
- 9 Non-surgical treatments for fibroadenoma
- 10 When to remove fibroadenoma?
- 11 Prognosis of fibroadenoma
How to recognize a fibroadenoma
Some fibroadenomas are so small that they can not be felt with breast self-examination and do not cause symptoms.
When you are able to feel a fibroadenoma, it is very different from the surrounding tissue.
- The breast is swollen at a precise point,
- The edges of the fibroadenoma are well defined,
- The tumor has a rounded shape.
- It moves under the skin,
- It is usually not painful.
Often, these tumors occur as solid nodules of hard or elastic consistency.
Can be found anywhere, even near the nipple
How big is fibroadenoma?
The fibroadenomas range in size from 1 to 5 cm.
The giant fibroadenoma may be the size of a lemon, about 10-15 cm.
Types of fibroadenoma
There are several types of fibroadenoma:
- Single or multiple fibroadenoma – may present as a nodule (single) or multiple nodules (multiple).
- Unilateral or bilateral fibroadenoma – may be present in both breasts (20% of cases)
- Simple Fibroadenoma – Simple tumors do not increase the risk of carcinoma in the breast (cancer).
- Fibroadenoma complex – Contains other components such as:
Complex tumors may slightly increase the risk of breast cancer. The American Cancer Society says women with fibroadenoma have a risk of approximately 1-1.5 times greater risk of developing breast cancer than women who do not have nodules.
- Phyloid Tumor
It is a rare type of breast tumor (2-3%).
This tumor is slightly different from a common fibroadenoma because:
- It has no homogeneous consistency,
- It is not very mobile,
- Grows faster and has larger dimensions and volume
The phylloid tumor may be benign or malignant (phyloid cystosarcoma), but less aggressive than a carcinoma.
For this reason, it should always be removed surgically.
Can fibroadenoma increase the risk of cancer?
Some types of benign tumor may increase the risk of breast cancer, especially:
- The atypical hyperplasia in which the abnormal cells but not cancer, multiply.
- Phyloid tumor – is a mass composed of fibrous and epithelial tissue – the average size of the tumor is 4 cm, but may grow even more.
It is unusual for a ductal (or lobular) carcinoma of the breast to coexist with a filoid tumor.
Fibroadenoma and breast carcinoma
Within a fibroadenoma, a carcinoma may develop, but they are rare cases.
Lobular carcinoma is the most frequent type observed in fibroadenoma.
The prognosis is favorable; usually neoplastic formations are diagnosed earlier.
What increases the risk of benign breast tumors?
Some factors may increase the risk of benign breast tumors, including:
- Menopausal hormone replacement therapy (use of postmenopausal hormones);
- Family history of cancer or benign breast tumor.
There are some lifestyle factors that may be important for the risk of benign breast tumors.
For example, alcohol abuse in adulthood and adolescence may increase the risk.
Causes of fibroadenoma
The cause of fibroadenoma is unknown.
However, the development of fibroadenoma is probably related to reproductive hormones.
- They form above all during the reproductive years,
- They may increase in size during pregnancy or by treatment with estrogen,
- If they reduce or remain stable after menopause , when it decreases the stimulation of estrogen.
Symptoms of fibroadenoma
Fibroadenomas are usually individual nodules, but about 10-15% of women have several lumps that can affect both breasts.
The node can be:
- Easily mobile under the skin, unlike breast cancer that is fixed;
- The nodules have well defined and smooth borders. They can grow in size especially during pregnancy.
As you can see, the symptoms of breast cancer are different from fibroadenoma.
A fibroadenoma is felt as a marble within the breast during self-examination.
The cyst in the breast and fibroadenoma can be painful.
In the case of breast cancer, the pain is rare, but this does not exclude the possibility that it is a breast cancer.
- Redness ,
- Secretion of the nipple (secretions may also indicate breast cancer or benign tumor).
It should be remembered that pain in the sinus that does not originate in the breast can be caused by:
- Tietze syndrome ( intercostal pain under the breast that may be related to excessive muscle tension),
- Fracture of the ribs ,
- Mondor’s disease (pain in the lower part of the breast caused by an inflammation of a vein within the breast tissue),
Diagnosis of fibroadenoma
Generally, a triple assessment is performed which includes:
- Clinical examination: palpation of the breast and armpit.
- The mammography ie radiography of the breast. This may show the microcalcifications that may indicate cancer when it develops in areas of proliferation (where anomalous growth is seen) in the cell.
10-15% of tumors are not localized with mammography.
- The ultrasound uses sound waves of high frequency to examine breast tissue. The echo sound wave is converted into an image. Breast ultrasound can distinguish between solid and liquid nodules.
- Puncture fine needle aspiration and biopsy:
If a suspicious area is examined with mammography or ultrasound, but is not palpable, the radiologist makes aspiration biopsy or fine needle guided by ultrasound / mammography.
Fine needle aspiration
The fine needle aspiration is the aspiration of the suspected area or the contents of the nodule.
If the syringe is filled with fluid and decreases the prominence is a cyst.
A solid nodule can be:
- A benign tumor such as a fibroadenoma,
- A breast cancer.
Results of cytology (cell) examination
The pathologist collects a sample of cells from the aspiration, places it on a glass slide and classifies the cells as follows:
-C1 = cells unsuitable for diagnosis;
-C2 = benign tumor;
-C3 = unclear, anomalous, but with a higher probability of being a benign tumor;
C4 = suspected cancer;
C5 = malignancy.
Biopsy or needle biopsy, this exam consists of collecting and analyzing a small piece of breast tissue and provides histological information (in tissue type).
The extraction is performed with a special needle.
Procedure – the doctor:
- Perform anesthesia (local) on the affected chest region,
- It affects the skin,
- Insert the needle and collect the tissue sample.
This procedure takes about 20 minutes and can be guided by a computerized instrument called a mammotome.
Results of histological examination (of tissue)
The results are reported as:
-B1 = normal breast tissue;
-B2 = benign breast tissue;
-B3 = uncertain, an injury with possible malignant potential;
-B4 = suspected cancer;
-B5 = malignancy.
Excisional biopsy : may be performed under local anesthesia and consists of removal:
- Of the lump.
- From a part of the surrounding tissue.
It is performed especially in the case of a suspected injury.
What is the best treatment for a fibroadenoma?
In many cases, no therapy is required for fibroadenoma, it may be sufficient to do a periodic check, usually every six months.
However, most women choose to surgically remove the fibroadenoma for added safety.
Non-surgical treatments for fibroadenoma
Surgery is not indicated if the doctor thinks the breast lump is a fibroadenoma and not a breast cancer based on the results:
- From clinical examination,
- From breast imaging,
- From the biopsy.
You can choose to avoid surgery because:
- Surgery may change the shape and texture of the breast;
- Fibroadenoma can diminish or disappear by itself;
- The breast has several fibroadenomas that appear to be stable.
If you choose not to remove fibroadenoma, constant monitoring is important to ensure that the benign tumor does not become larger.
When to remove fibroadenoma?
Your doctor may recommend surgery to remove fibroadenoma when:
- An examination (clinical breast examination, instrumental examination, or biopsy) is abnormal,
- The fibroadenoma is greater than 4 cm,
The procedure to remove a fibroadenoma is called nodulectomy or excisional biopsy.
The tissue is examined in a pathology laboratory.
After removing a fibroadenoma, it is possible to have relapses.
The new lumps should be evaluated with mammography, ultrasonography, and biopsy to determine if the lump is a fibroadenoma or a malignant tumor.
According to a study Bernardes JR Jr et al. (The effect of tamoxifen on PCNA expression in fibroadenomas) Fibroadenoma is a hormone-dependent tumor that contains a number of estrogen receptors larger than the breast lobes, this tumor can be treated with anti-estrogen drugs such as tamoxifen or raloxifene to reduce the risk of breast cancer in high-risk patients.
These medications have side effects in the uterus (increasing the risk of cancer) that should be considered.
Women who have fibroadenoma should undergo periodic exams to check for nodules.
Women who maintain a healthy body weight and regular physical activity have a lower risk for various diseases like breast cancer.
Prognosis of fibroadenoma
Life expectancy is excellent compared to the prognosis of breast cancer .
Women with fibroadenoma have a slightly higher risk of developing breast cancer later in life.
If the core is not removed and checked carefully, it may need to be removed at a later time if:
- Grown up.
In very rare cases, the lump is cancer and other treatments are needed.