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