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Fibroadenomas

  • Fibroadenomas are derived from the breast lobule
  • They have both epithelial and connective tissue elements
  • Their pathogenesis is unclear
  • They are not true neoplasms being polyclonal rather than monclonal
  • Should be considered as an 'Aberration of Normal Development and Involution'

Histology of fibroadenoma

Simple fibroadenoma

  • Most are smooth or slightly lobulated
  • Usually 2-3 cm in diameter
  • Usually present between 16 and 24 yrs of age
  • Decrease incidence approaching the menopause
  • May present has 'hard' calcified mass in the elderly
  • Approximately 10% of fibroadenomas are multiple
  • Diagnosed by triple assessment
    • Clinical examination
    • Mammography or ultrasound
    • Fine needle aspiration cytology or core biopsy

Fibroadenoma on ultrasound

  • Recent improvement in understanding of natural history
  • Over a 5 year period
    • 50% increase in size
    • 25% remain stable
    • 25% decrease in size
  • Risk of malignant transformation is approximately 1 in 1,000
  • Resulting carcinoma is often a lobular carcinoma

Treatment

  • Less than 25 years - observe
  • 25 - 35 years - offer conservative treatment
  • More than 35 years - excision biopsy
  • Excise at any age if patient requests

Giant fibroadenoma

  • Bimodal age presentation - teens & premenopausal
  • More common in women of Afro-Caribbean or Far East Asian origin
  • Rapidly grow to a large size
  • Present with pain, breast enlargement, nipple displacement
  • Characteristic shiny skin changes with dilated veins
  • Enucleate through cosmetically sited scar
  • Resulting breast distortion is usually self correcting
  • No evidence that these tumours recur

Phyllodes tumour

  • Occur in premenopausal women
  • Wide spectrum of activity
  • Vary from benign to locally aggressive
  • Have cellular fibrous element

Histology of phyllodes tumour

  • Excise with 1 cm margin of normal tissue
  • Re-excise or mastectomy for local recurrence

Clinical picture of a phyllodes tumour

Bibliography

Alle K M,  Moss J,  Venegas R J,  Khalkhali I, Klein S R. Conservative management of fibroadenoma of the breast. Br J Surg 1996; 82: 992 - 993.

August D A,  Kearney T.  Cystosarcoma phyllodes:  Mastectomy, lumpectomy or lumpectomy plus irradiation.  Surg Oncol 2000;  9:  49-52.

Carty N J, Carter C, Rubin C, Ravichandran D, Royle G T, Taylor I. Management of fibroadenoma of the breast. Ann R Coll Surg Eng 1995; 77: 127-130.

Dixon J M, Dobie V, Lamb J, Walsh J S, Chetty U. Assessment of the acceptability of conservative management of fibroadenoma of the breast. Br J Surg 1996; 83: 264-265.

Hindle W H,  Alonzo L J.  Conservative management of breast fibroadenomas.  Am J Obstet Gynecol 1991;  6:  1647-1651.

Houssami N,  Cheung M N,  Dixon J M.  Fibroadenoma of the breast.  Med J Aust 2001;  174:  185-188.

Parker S J,  Harries S A.  Phyllodes Tumour.  Postgrad Med J 2001;  77:  428-438.

 

 
 

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