Fibroadenoma – Symptoms And Causes

Fibroadenoma

It is a benign tumour in which the epithelial cells are arranged in a fibrous stroma. It is an AND (Aberration of Normal Development) of a single lobule.

Fibroadenoma Types:

1. Pericanalicular type in which fibrosis is more.
2. Intracanalicular type in which fibrosis is less.

Read And Learn More: General Surgery Notes

Fibroadenoma Clinical Features:

• Peak age of incidence is at 20 years.
• Patients present with painless lump in the breast.
• It is smooth, round bordered, firm to hard in consistency, and freely mobile within the breast.
• Due to its free movement within breast tissue, it is known as breast mouse.
• However, when fibroadenoma occurs in elderly patients, it may not have characteristic features because of fibrosis.

Fibroadenoma Treatment

Excision of the lump

1. In intracanalicular type, the lump is deeper and peripheral. It is removed by submammary incision.
2. In pericanalicular type (Figs 39.17 and 39.18), the lump is superficial. It is removed by periareolar incision

Fibroadenoma Complications

• Fibroadenoma and malignancy: Patients with simple fibroadenoma and no family history of breast cancer have no risk of cancer. Complex fibroadenomas which show cysts, sclerosing adenosis, calcification have increased risk (3 to 4 times) of cancer.
• Fibroadenoma and fibroadenosis are compared.

Fibroadenoma Recent Advances

• Minimally invasive techniques are becoming popular.
• Advantages being breast preservation, no scarring and cosmesis is better. Four types of treatment is followed.

1. Surveillance and no Treatment

Basis: 40% of fibroadenoma remain stable at the end of 2 years and 20% of fibroadenoma resolve without treatment. Hence women under 40 years of age, conservative treatment of reassurance, surveillance and observation. Automated breast volume scans are available to detect even a minute increase in fibroadenomas—useful specially in multiple fibroadenomas.

2. High Intensity Focused Ultrasound Non-invasive

treatment which ablates the tissues.

• It uses the piezoelectric transducer inside a ultrasound machine and generates a high frequency high intensity ultrasound beam.
• This beam is directed towards the specific target area of fibroadenoma.
• It results in increase in local temperature, denaturation of protein, cell death and results in tissue necrosis due to temperature.
• A few reports say about 50% reduction of the maximum diameter of the fibroadenoma and also with significant reduction in the discomfort or pain. However, takes about more than 2 hours.

3. Cryotherapy:

Localized Destruction of the target tissue happens in cryotherapy. Ultrasound-guided cryoprobe is introduced into the fibroadenoma after making a small skin incision. Cooling temperature is –170°C.

Different varieties of systems are available such as argon-gas-based system, using liquid nitrogen as cryogen. Irreversible damage to fibroadenoma occurs due to intracellular ice formation at the tip of the cryoprobe.
Complications include ecchymosis and swelling.

4. Vacuum-Assisted Excision:

• Small incision is made in the breast and 8 or 11 gauge probe is inserted through the lesion. Small amount of tissue is aspirated. Probe is inserted into different parts of the tissue and aspirated again.
• Procedure will take about 30 to 60 minutes. Compression is applied at the site of puncture. Haematoma, recurrence and postprocedure pain are complications.

Differences between fibroadenoma and fibroadenomas: