Fibroadenoma of the breast is the most common benign tumor of the breast and can occur at any age after puberty, mostly between 20 and 30 years of age. Its occurrence is related to estrogen stimulation, so it rarely occurs in women before menarche or after menopause. It is usually solitary, but can be multiple in 15% to 20% of cases. It can occur unilaterally or bilaterally. They are usually round, oval, or lobulated in large cases.
What are the causes of fibroadenoma of the breast?
The cause and pathogenesis of mammary fibroadenoma is not well understood, but most experts believe that it may be related to the following factors.
1. Imbalance of estrogen level: If the estrogen level is relatively or absolutely elevated, the over-stimulation of estrogen level may lead to abnormal proliferation of epithelial and mesenchymal components of breast ducts to form tumors.
Local breast tissues are overly sensitive to estrogen: The sensitivity of normal breast tissues to estrogen varies, and tissues with high sensitivity are prone to disease. The sensitivity of breast tissues to estrogen stimulation is different among different women, and the chance of disease is greatly increased for women sensitive to estrogen stimulation.
3. Dietary and physical factors: High-fat and high-energy diet, obesity and liver dysfunction can increase estrogen in the body, which in turn stimulates the proliferation of epithelial and interstitial fibrous tissues in the ducts of the breast.
4.Hereditary tendency.
What are the clinical manifestations of mammary fibroadenoma?
The main clinical manifestation of breast fibroadenoma is breast lumps, and in most cases, breast lumps are the only symptom. In most cases, breast lumps are the only symptom. Most breast lumps are unintentionally felt or detected during physical examination and are not usually painful and do not change with the menstrual cycle. In a small number of cases, the lump is accompanied by breast enlargement, in which case there may be symptoms such as premenstrual breast swelling and discomfort.
Fibroadenomas can occur in all quadrants of the breast, but are particularly common in the upper outer quadrant of the breast. Adenomas are often single or multiple. The tumor is round or ovoid in shape, with a diameter of 1 to 3 cm being the most common, and occasionally a large one. The surface of the mass is smooth, tough, with clear borders, no adhesions to the skin and surrounding tissues, and large mobility. The axillary lymph nodes are not enlarged. The masses are mostly painless and non-tender. The size and nature of the mass does not usually change with the menstrual cycle. It usually grows slowly and can remain unchanged for several years, and because there is no obvious discomfort, it is rarely noticed by the patient at first. The lump grows unconsciously and often people are reluctant to go to the doctor for examination because they are afraid of shyness, until the lump grows larger and then they have to go to the hospital for treatment, which delays the condition.
There are two types of fibroadenoma seen clinically, one is a simple fibroadenoma and the other is a fibroadenoma accompanied by mastopexy. The former has a smooth surface, clear edges, medium quality, and high mobility, and can slip away under the fingers of the palpating finger; the latter can only be found partially outside the hyperplastic breast tissue with smooth tumors and unclear edges, and has a certain self-limitation, and its mobility is active with the activities of the hyperplastic tissue.
Can fibroadenoma of the breast become malignant?
Fibroadenoma is not related to breast cancer and has little chance of malignant transformation.
How many types of mammary fibroadenoma can be classified?
There are 3 types according to clinical manifestations.
1. Common type: The most common type, the diameter of the tumor is usually 1 to 3 cm, and the growth is slow.
2, Youthful type: rare, occurring before the first menstruation, tumor growth is fast, the tumor body is large, which can cause skin tension thinning and skin vein anger.
3.Megalofibroadenoma: Also called lobulated fibroadenoma, mostly seen in adolescent women aged 15 to 18 and premenopausal women aged 40 or above. The tumor often exceeds 5 cm, or even up to 20 cm, and is often lobulated in shape.
How to diagnose fibroadenoma of the breast?
Diagnosis is based on medical history and physical examination. Color ultrasound and mammography are the main diagnostic aids, while hollow needle aspiration pathology or surgical excision pathology is required to confirm the diagnosis.
What diseases can be confused with fibroadenoma of the breast? How to differentiate?
1. Breast fibroadenoma and mastopexy: Both can be felt as lumps in the breast, single or multiple, with a tough texture. The lumps of breast fibroadenoma are more common in unilateral solitary cases, mostly round or ovoid, with clear borders and large mobility, and are painless and painful to touch, and have no obvious relationship with the menstrual cycle, and are more common in those under 30 years of age; the lumps of breast hyperplasia are more common in bilateral multiple cases, and can be nodular, lumpy or beaded granular, with a slightly tough texture, and are often painful to touch, and can change with the menstrual cycle. The lumps are often painful to the touch and can change with the menstrual cycle. The entire breast is often distended before menstruation and can be relieved after menstruation, and the age of onset is more common in people over 30 years old. If necessary, the relevant auxiliary examinations can be performed to differentiate the lumps, such as mammography, and a circular or ovoid shadow with uniform density can be seen around the fibroadenoma, which can be differentiated from mastopathy.
2, breast fibroadenoma and breast cyst: both are painless breast lumps, mostly unilateral and solitary, with clear borders and smooth surfaces. However, the lump of breast fibroadenoma is slightly harder and tougher than cyst, and its mobility is greater than that of cyst, and it is most common at the age of 18 to 25 years old; the lump of breast cyst has a cystic feeling, and its mobility is not as great as that of adenoma, and it mostly occurs during pregnancy and lactation, while simple breast cyst has clinical features of breast hyperplasia in addition to cyst. Ultrasound examination can be performed. Ultrasound has a great advantage in differentiating cystic masses from solid masses.
3. Fibroadenoma and breast cancer: both of them can be seen as painless breast lumps, mostly solitary. The lump of breast fibroadenoma is round or oval in shape, with firm texture, smooth surface, clear boundary, and high mobility. The lump can grow rapidly and the ipsilateral axillary lymph nodes are often enlarged. On mammogram, fibroadenoma can be seen as a round or oval shadow with a circular transparent halo around it; while breast cancer can be seen as a lump shadow, small calcified spots, abnormal vascular shadow and burr, skin depression and nipple invagination. If necessary, biopsy can provide histological evidence for differentiation.
How to treat fibroadenoma of the breast?
(A) Observation and follow-up, no treatment required
Recent studies have concluded that most fibroadenomas do not require treatment, but rather observation and follow-up. This is especially true for patients with small masses (less than 1 cm) that grow slowly. Some breast fibroadenomas remain the same size for a long time, and a few may shrink or even disappear on their own.
(II) Surgery
If the tumor is relatively large (greater than 3 cm), grows faster in a short period of time or has some accompanying symptoms such as pain and tenderness, surgery should be performed as early as possible. When the tumor is between 1-3 cm, you can choose whether to operate for treatment or observe and follow up according to the patient’s will.
Surgical methods.
①Traditional open excision: The design of surgical incision should consider the aesthetic and functional needs. If the mass is close to the areola, a curved incision can be made along the edge of the areola, while if the mass is far from the areola, a radial incision can be made. In case of multiple tumors, an incision at the junction of the lower border of the breast and the chest wall or an incision along the areola can be made. It is better to remove the whole tumor and the surrounding normal breast tissue together, or to remove the affected part of the breast to avoid recurrence. One more recurrence is one more risk of malignancy. However, the recurrence of the same tumor in the breast other than the removed tumor or in the contralateral breast after surgery should not be considered as recurrence, but strictly speaking as multiple recurrence. The recurrence of such a tumor in the original location is considered a recurrence, and repeated recurrences should alert the possibility of lobar tumors. Disadvantage: This procedure will leave scars on the breast and affect the aesthetics.
Minimally invasive surgical excision: A hole (about 3mm) is poked under the armpit or areola, and the tumor is removed under ultrasound guidance with the application of a rotary needle, which is less painful and leaves only a mark of about 3mm after surgery. The technical advantages of minimally invasive rotary incision are that for lumps of unknown nature, biopsy and pathological examination can be performed under ultrasound positioning, and tumors as small as 3 mm can be precisely excised, which is undoubtedly a very good method for the early diagnosis and treatment of breast cancer. Disadvantages: high cost, cannot guarantee complete excision for larger masses, close to nipple, skin and breast edge, prone to residue and recurrence, etc. This method is not suitable for masses larger than 4 cm. Follow-up is required after excision.
(C) Radiofrequency ablation and cryoablation In recent years, radiofrequency ablation or cryoablation can also be applied to mammary fibroadenoma. The diagnosis of breast fibroadenoma should be confirmed pathologically by puncture biopsy before treatment. Follow-up is required after ablation treatment.