Breast fibroadenoma is called a benign tumor formation that occurs as a result of focal duct hyperplasia with fibrosis of the connective tissue. That is, when glandular and connective tissue grows during fibroadenoma.
This disease is referred to as dyshormonal dysplasia of the mammary glands.
Most often, this education is diagnosed in young women and girls (15-30 years).
Depending on the growth of the connective tissue component, there are:
- intra-canalicular fibroadenoma, in which connective tissue grows into the lumen of the ducts;
- prikanalikulyarnuyu fibroadenoma, when the connective tissue grows around the ducts;
- mixed fibroadenoma, with signs of both forms;
- phyloid or leaf fibroadenoma, which is characterized by rapid growth and every tenth woman develops into cancer (sarcoma) of the mammary gland. That is why it is called a borderline tumor.
In addition, mature, having a dense capsule and a densely elastic consistency, and immature soft-elastic fibroadenomas, prone to growth.
The reasons for the formation of fibroadenomas are not known for certain, but experts identify a number of predisposing factors:
- heredity (among relatives on the maternal line, tumor-like diseases of the mammary glands);
- neuroendocrine pathology (thyroid disease, diabetes , obesity );
- reproductive peculiarities (childbirth and pregnancy up to 20 and over 30 years old, large fetus, long lactation period, early menarche, late onset of menopause, cycle disorders);
- artificial termination of pregnancy (proliferation in the mammary glands and its abrupt termination);
- taking hormonal contraceptives;
- prolonged stress, dissatisfaction with life situations (problems in the family, position in society, dissatisfaction with sexual relationships);
- short breastfeeding period;
- inflammatory gynecological processes;
- diseases of the liver and biliary tract, hypertension, colitis;
- passion for smoking and alcohol, foods rich in methylxanthines (coffee, tea, chocolate).
If the fibroadenoma is large, then it can be defined visually as a subcutaneous formation of the breast. On palpation, the tumor is thick and painless, it is mobile and not soldered to the skin. The consistency of education is elastic (dense or soft).
Fibroadenoma is usually localized outside the nipple areola: usually in the upper outer quadrant of the breast.
The size of the tumor may be small, about 0.2-0.7 cm in diameter, and large, reaching 5-7 cm.
Capsule education smooth. Very rarely, nipple discharge may occur. Regional lymph nodes are not enlarged.
Fibroadenoma in no way affects the course of pregnancy, although gestation can cause growth, and even significant, tumor-like formation due to hormonal changes, therefore all women who are planning a pregnancy should be consulted with a breast specialist. The rapid growth of education during pregnancy serves as an indication for its removal, but only after giving birth.
Diagnosis of fibroadenoma, as well as any disease of the mammary glands, begins with the collection of history and complaints. Then the mammary glands are assessed visually and they are palpated (standing, lying on their backs and on their side). The doctor carefully probes each quadrant in order to determine whether or not there is a discharge from the nipple.
Women aged 35-40 years prescribed breast ultrasound . It is safe and helps to identify the formation and distinguish a cyst from a solid breast tumor.
Mammography , or X-ray examination of the mammary glands, is prescribed to women over 40 years of age (effectively with ultrasound) in the first half of the menstrual cycle (if there are no menstruations, the day of the examination does not matter). Radiographs are performed in two projections: in the straight and lateral. The method is valuable in that it allows to identify both primary and secondary signs of malignancy. These may be calcinates or other ultrasound signs. Fibroadenoma is defined as a tumor shadow with a smooth surface, not fused to surrounding tissues.
Magnetic resonance imaging reveals palpable or non- palpable formations, but does not differentiate them.
The newest technology is the microwave method or RTM-research – measuring the temperature of the breast tissue, followed by its digital image. The temperature of the mammary glands (on average) is 34-35 degrees, and the temperature difference between the individual quadrants is no higher than 0.5 degrees. The use of radiothermia allows to suspect not only fibroadenoma, but also breast cancer.
It is also necessary to conduct:
- targeted biopsy of the formation with further histological examination;
- Ultrasound of the pelvic organs and abdomen;
- determination of hormone levels ( prolactin, progesterone, estradiol ).
Conduct a differential diagnosis of fibroadenoma in order to distinguish it from cancer and breast cyst.
Breast cyst has a soft-elastic consistency, it is mobile and it is difficult to distinguish it from fibroadenomas by palpation . Diagnose a cyst on ultrasound and x-rays of the mammary glands.
Breast cancer has pronounced visual signs: dense, nodular, education, which is soldered to the skin, and does not move on palpation. Marked nipple retraction or deformation.
A woman with a tumor in the breast should contact a mammologist, oncologist-mammologist or surgeon.
All fibroadenomas are subject to surgical removal. Conservative therapy is not effective and not appropriate. Only patients with education in the mammary gland of no more than 1 cm should be observed if they have no suspicion of cancer. Such patients should undergo a mammogram and breast ultrasound twice a year.
Indications for surgery:
- size of fibroadenoma 1cm or more;
- breast cancer cannot be ruled out;
- at the stage of pregnancy planning;
- the rapid growth of education;
- leaf-shaped fibroadenoma (regardless of size).
Surgery may include sectoral resection of the gland or enucleation of the tumor (husking).
During the operation, the material obtained during the puncture of fibroadenomas is sent for urgent histology to exclude / confirm cancer.
Surgery is carried out under both local and general anesthesia. The postoperative period takes from 2 hours to 1 day.
The recurrence of the disease, that is, the emergence of a new tumor, is not excluded; this is due not to the technique of the operation, but to the preservation of the causes that led to the appearance of fibroadenoma. Newly formed fibroadenoma is localized elsewhere in the breast. The risk of recurrence is usually quite low, and does not exceed 1%.
According to some authors, the threat of malignancy of fibroadenoma (transformation into cancer) persists in 18-51% of cases, although their opponents deny the possibility of malignancy in general.
The point of view remains on leafy fibroadenoma, which in 10% of cases is transformed into cancer, and therefore must be removed immediately.
The prognosis after tumor removal is favorable.