Breast fibroadenoma

Content

Introduction

Breast fibroadenoma is a benign breast tumor that develops, especially in young women, between the ages of 15 and 30.

Generally, it is composed of a single nodule (simple fibroadenoma) but there are also forms, although less frequent, consisting of several nodules affecting one or both breasts (multiple fibroadenomas).

Usually, fibroadenoma does not cause ailments (asymptomatic). In most cases it is discovered by chance, following a breast ultrasound or a mammogram. If its size and position in the breast allow it, it can be identified by the doctor during a visit to the breast or by the woman herself during a self-examination.

The ascertainment (diagnosis) of a fibroadenoma should not cause concern, since it is a benign tumor, which tends to be harmless. It is quite unlikely that it will develop into a malignant tumor, however, as a precaution, it must be monitored constantly to evaluate changes in shape, size and consistency.

Symptoms

Touching it with the fingers, the fibroadenoma appears as a rounded mass with a smooth surface, similar to a marble, which tends to move under the pressure of the hands. Usually painless, it can have a hard or rubbery texture and sharp, regular contours.

The size of the nodules can be extremely variable. The most common measure from 1 to 3 centimeters (cm) in diameter but, in some cases, the mass can reach 5-6 cm and, in the case of giant fibroadenoma typical of adolescence, even 10-15 cm in diameter.

Over time, fibroadenoma can increase in volume, especially during pregnancy. Sometimes, however, it spontaneously reduces until it disappears completely, as often happens after menopause.

Causes

The causes of fibroadenoma are still unknown. Its development is thought to be due to an abnormal response to estrogen, the female sex hormones. Fibroadenoma, in fact, is more common in women of childbearing age, or who use hormone replacement therapy, when the amount of estrogen circulating in the body is high. On the contrary, it is rarer in women in menopause, a period in which the estrogen level is significantly reduced.

Diagnosis

The assessment (diagnosis) of fibroadenoma involves, first of all, a visit to the doctor who will allow to evaluate, through the palpation of the breast, the appearance and size of the lump. Based on the characteristics found and the age of the woman, the doctor may ask for further information using a mammogram or breast ultrasound, tests that allow you to view the structure of the breast.

Breast ultrasound is normally recommended for women under the age of 40, indicated for the study of dense breasts, typical of youth, characterized by the prevalence of glandular tissue over adipose (fat) tissue.

Women over the age of 40 are generally required to have a mammogram which allows them to optimally investigate the prevailing adipose tissue, with advancing age, on the glandular tissue. Mammography is usually accompanied by an ultrasound examination to distinguish solid formations from those with liquid content. A mass of a solid nature is in all likelihood a fibroadenoma, while a mass containing fluid is typically a cyst.

If you are uncertain about the benign or malignant nature of the lump, your doctor may recommend a nuclear magnetic resonance (MRI), needle aspiration, or biopsy to take a small amount of the suspected mass and submit it for testing. laboratory.

Nuclear magnetic resonance is an exam that provides detailed images of the human body using magnetic fields and radio waves. It allows to ascertain the presence of many types of cancer, to verify their stage and response to treatment.

The needle aspiration consists in taking cells from the nodule, through a very fine needle, and in their observation under a microscope (cytological examination). The biopsy, carried out under local anesthesia with a needle of a higher caliber, involves the removal of a fragment of tissue from the nodule and the execution of the histological examination.

In the case of small, non-palpable cell masses, the biopsy is performed under ultrasound or mammography guidance, or with the aid of sophisticated tools that allow localization with millimeter precision.

Therapy

Faced with the "ascertainment (diagnosis) of a benign fibroadenoma, confirmed by a possible biopsy, it is generally preferred to adopt a so-called conservative rather than surgical removal. The woman with fibroadenoma, however, must undergo breast examinations and ultrasound and / or mammography examinations at regular intervals, to check the evolution of the nodule over time.

The choice conservative is based on the following considerations:

  • fibroadenoma surgery can alter the shape and texture of the breast
  • with advancing age, the fibroadenoma can shrink on its own until it disappears completely
  • there are multiple nodules (multiple fibroadenoma) that appear to be stable in size

Surgical removal of the fibroadenoma is, however, necessary in the following cases:

  • uncertainty about the benign nature of the lump
  • diagnosis of complex fibroadenoma
  • nodule size greater than 3 cm
  • rapid growth of fibroadenoma in women over 35 years of age
  • ache

Surgery can also be performed at the explicit request of the woman if the presence of the fibroadenoma causes aesthetic problems or psychological discomfort.

The operation, called a lumpectomy or excisional biopsy, involves the incision of the breast, subject to local or general anesthesia, and the total removal of the tumor mass which will then be analyzed in the laboratory to verify its nature.

An alternative procedure to surgery, still being studied in Italy, is cryoablation indicated for the treatment of small fibroadenomas. Through a probe equipped with microneedles, introduced under the skin of the breast with a light local anesthesia, cryoablation allows to freeze and subsequently thaw the fibroadenoma, causing the death of cancer cells by thermal shock, without damaging healthy cells. Very recently, the curative use of ultrasound has also been proposed, which consists in the application, using a special instrument, of high intensity waves to destroy potentially abnormal cells.

These are innovative techniques that offer the advantage of operating in the total absence of scars, without changing the aesthetics of the breast. However, the destruction of the fibroadenoma in place prevents subsequent analysis of the tumor tissue.

Complications

Fibroadenoma does not increase the likelihood of developing breast cancer. The risk is slightly higher in the presence of a complex fibroadenoma which may contain macrocysts, filled with fluid and / or dense and opaque tissue (calcifications).

The assessment (diagnosis) of complex fibroadenoma is carried out by the pathologist through the examination of a tissue sample taken from the nodule by means of a biopsy.

Bibliography

Humanitas Research Hospital. Fibroadenoma

Mayo Clinic. Fibroadenoma (English)

MedlinePlus. Fibroadenoma of the breast

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