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Fibroadenoma

Fibroadenomas are the most common benign tumor Tumor Inflammation of the female breast and the most common breast tumor Tumor Inflammation in adolescent and young women. The tumors are well-circumscribed, mobile, and unencapsulated, with a rubbery or firm consistency Consistency Dermatologic Examination. Fibroadenomas are hormonally responsive, so they may increase in size during pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care and usually regress after menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause. Histologically, fibroadenomas are composed of a biphasic proliferation of both glandular and stromal elements. Fibroadenomas are associated with a slightly increased risk of carcinoma, with a somewhat higher risk if so-called “complex” features are present. Diagnosis is based on physical findings and ultrasonography. Management is based on regular Regular Insulin checkups to monitor growth.

Last updated: Sep 29, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Definition, Epidemiology, and Etiology

Definition

Epidemiology

  • Most common in women < 35 years of age (peak incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency: 15–35 years)
  • Most common benign tumor Tumor Inflammation of the breast, and the most common tumor Tumor Inflammation in young women
  • Accounts for half of all breast biopsies
  • Only a slightly increased risk of developing malignant breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer, with a somewhat higher risk if “complex” features are present:
    • Cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change > 0.3 cm
    • Sclerosing adenosis Adenosis Fibrocystic Change
    • Epithelial calcifications
    • Papillary apocrine change

Etiology

  • Unknown
  • Unlikely to be hereditary
  • Negative correlation Correlation Determination of whether or not two variables are correlated. This means to study whether an increase or decrease in one variable corresponds to an increase or decrease in the other variable. Causality, Validity, and Reliability with tobacco smoking Smoking Willful or deliberate act of inhaling and exhaling smoke from burning substances or agents held by hand. Interstitial Lung Diseases
  • A relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship has been established with estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy:
    • Increases in size during pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care, lactation Lactation The processes of milk secretion by the maternal mammary glands after parturition. The proliferation of the mammary glandular tissue, milk synthesis, and milk expulsion or let down are regulated by the interactions of several hormones including estradiol; progesterone; prolactin; and oxytocin. Breastfeeding, cyclically with menstruation Menstruation The periodic shedding of the endometrium and associated menstrual bleeding in the menstrual cycle of humans and primates. Menstruation is due to the decline in circulating progesterone, and occurs at the late luteal phase when luteolysis of the corpus luteum takes place. Menstrual Cycle, and with the use of oral contraceptives
    • Regresses after menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause

Clinical Presentation

  • Generally asymptomatic
  • Solitary lesion in 80% of cases
  • 20% of cases consist of multiple fibroadenomas occurring in the same breast or bilaterally.
  • Small, spherical, well-defined, mobile mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast with a rubbery or firm consistency Consistency Dermatologic Examination
  • Diameter of 3–10 cm that causes breast asymmetry Asymmetry Examination of the Upper Limbs (usually < 3 cm)
  • Usually found in the upper outer quadrant of the breast Quadrant of The Breast Examination of the Breast
  • Cyclic changes in size related to the menstrual cycle Menstrual cycle The menstrual cycle is the cyclic pattern of hormonal and tissular activity that prepares a suitable uterine environment for the fertilization and implantation of an ovum. The menstrual cycle involves both an endometrial and ovarian cycle that are dependent on one another for proper functioning. There are 2 phases of the ovarian cycle and 3 phases of the endometrial cycle. Menstrual Cycle due to sensitivity to estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy 
  • Other types of fibroadenomas:
    • Juvenile fibroadenomas
      • Usually occur in African American patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship aged 10–18 years
      • Rapid increase in size 
      • May cause skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions ulceration Ulceration Corneal Abrasions, Erosion, and Ulcers
    • Giant fibroadenomas
      • Histologically typical fibroadenomas > 10 cm in size
      • Excision is recommended
    • Complex fibroadenomas
      • Proliferative pathologic changes
      • Associated with a slightly increased risk of cancer
      • Management is controversial

Diagnosis and Management

Diagnosis

Management

  • Regular Regular Insulin check-ups in cases confirmed to be benign (“wait-and-see” approach)
  • Cryoablation for small but symptomatic fibroadenomas 
  • Surgical resection for cases of juvenile and giant fibroadenomas, irregular boundaries, and patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with personal or family history Family History Adult Health Maintenance of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer

Differential Diagnosis

The following conditions are differential diagnoses of fibroadenomas:

  • Galactocele Galactocele Benign Breast Conditions: retention cyst within the mammary gland Mammary gland Glandular tissue in the breast of human that is under the influence of hormones such as estrogens; progestins; and prolactin. In women, after parturition, the mammary glands secrete milk for the nourishment of the young. Breasts: Anatomy containing milk, which presents as a palpable, firm mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast in the subareolar region.
  • Breast abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease: accumulation of pus within the mammary gland Mammary gland Glandular tissue in the breast of human that is under the influence of hormones such as estrogens; progestins; and prolactin. In women, after parturition, the mammary glands secrete milk for the nourishment of the young. Breasts: Anatomy. Usually associated with lactational mastitis Mastitis Mastitis is inflammation of the breast tissue with or without infection. The most common form of mastitis is associated with lactation in the first few weeks after birth. Non-lactational mastitis includes periductal mastitis and idiopathic granulomatous mastitis (IGM). Mastitis. Presents as a unilateral and fluctuant Fluctuant Dermatologic Examination mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast within a painful, erythematous, and edematous breast.
  • Intraductal papilloma Papilloma A circumscribed benign epithelial tumor projecting from the surrounding surface; more precisely, a benign epithelial neoplasm consisting of villous or arborescent outgrowths of fibrovascular stroma covered by neoplastic cells. Cowden Syndrome: benign mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast with a papillary configuration of breast stroma and epithelium Epithelium The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions. Surface Epithelium: Histology within a breast duct, which presents as a solitary mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast found close to or behind the nipple Nipple The conic organs which usually give outlet to milk from the mammary glands. Examination of the Breast, with bloody nipple discharge Nipple discharge Fluid that seeps out of one or both nipples of the breast. Examination of the Breast.
  • Phyllodes tumor Tumor Inflammation: uncommon fibroepithelial tumor Tumor Inflammation similar to a fibroadenoma but requiring complete surgical excision with clean borders because of its malignant potential. The tumors are categorized into benign, borderline, and malignant types. Histologically, these tumors have stromal overgrowth with increased mitotic activity, with the borderline and malignant tumors showing infiltrative borders. 
  • Fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast of the breast: refers to the common changes that happen to breast tissue as a woman ages, causing a “lumpy-bumpy” breast in the more pronounced expressions of the condition. These changes can be non-proliferative Non-Proliferative Fibrocystic Change ( cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change, fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans, adenosis Adenosis Fibrocystic Change) or proliferative (epithelial proliferation, sclerosing adenosis Adenosis Fibrocystic Change, papilloma Papilloma A circumscribed benign epithelial tumor projecting from the surrounding surface; more precisely, a benign epithelial neoplasm consisting of villous or arborescent outgrowths of fibrovascular stroma covered by neoplastic cells. Cowden Syndrome), with or without atypia Atypia Fibrocystic Change. Atypical hyperplasia Hyperplasia An increase in the number of cells in a tissue or organ without tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. Cellular Adaptation has a moderately increased risk of carcinoma.
  • Mastitis Mastitis Mastitis is inflammation of the breast tissue with or without infection. The most common form of mastitis is associated with lactation in the first few weeks after birth. Non-lactational mastitis includes periductal mastitis and idiopathic granulomatous mastitis (IGM). Mastitis: inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the mammary gland Mammary gland Glandular tissue in the breast of human that is under the influence of hormones such as estrogens; progestins; and prolactin. In women, after parturition, the mammary glands secrete milk for the nourishment of the young. Breasts: Anatomy tissue; can be lactational or non-lactational. Mastitis Mastitis Mastitis is inflammation of the breast tissue with or without infection. The most common form of mastitis is associated with lactation in the first few weeks after birth. Non-lactational mastitis includes periductal mastitis and idiopathic granulomatous mastitis (IGM). Mastitis is most common in women of childbearing age.
  • Fat necrosis Fat necrosis A condition in which the death of adipose tissue results in neutral fats being split into fatty acids and glycerol. Cell Injury and Death of the breast: usually due to breast injury, which often goes unnoticed. As the damaged breast tissue is repaired, it is replaced by scar Scar Dermatologic Examination tissue. However, some fat cells may have a different response and form what are known as oily cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change.
  • Breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer: malignant tumor Tumor Inflammation of the mammary gland Mammary gland Glandular tissue in the breast of human that is under the influence of hormones such as estrogens; progestins; and prolactin. In women, after parturition, the mammary glands secrete milk for the nourishment of the young. Breasts: Anatomy. The 2 most common histological types of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer are ductal carcinoma and lobular carcinoma.

References

  1. Vinay K, Abbas A, Aster J. Robbins & Cotran Pathologic Basis of Disease. 2020, 10th Edition, Elsevier.
  2. Sabel MS. Overview of benign breast disease. UpToDate. Retrieved on August 28, 2020, from https://www.uptodate.com/contents/overview-of-benign-breast-disease#H14
  3. Rohan, T. E., & Miller, A. B. (1999). A cohort study of cigarette smoking and risk of fibroadenoma. Journal of Epidemiology and Biostatistics, 4(4), 297–302.

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