FIBROADENOMA

Fibroadenoma is common among 15-25 age group though it may present late in older woman. It is a benign tumour arising from lobules of the breast. Their normal growth phase is followed by static phase in 80%,regression in 15% and progression in 5-10%. If more than 5 fibroadenomas are present then they are said to have multiple fibroadenomas.

Etiology:
It develops from lobules. It is considered to be benign tumour by the majority of pathologists and hence behave like any benign tumour. However some regard them as aberration of normal development resulting from unusual responsiveness of breast tissue to oestrogen.

Clinical Presentation:
Patients often accidentally notice the lump during self-examination or some times diagnosed during ultrasound examination of the breast for some other symptoms. It is also not uncommon to find more lumps in imaging which are not felt by hand initially. Patient also some times notices change in size of the lumps during menstrual periods which only accounts for the hormonal influence on the breast tissue.

Investigations:
After careful history and examination patient will undergo ultrasound examination of the breast. Mammogram will also be performed if the patient is above 35 years of age. If any lump is visualised in ultrasound examination then they will undergo biopsy to confirm the diagnosis.
Patients below 25 will not usually undergo biopsy unless the image is not typical of Fibroadenoma or a patient is a high-risk category. This is because cancer in this age group is extremely rare and imaging is taken as sufficient evidence for fibroadenoma.

Management:
Once the diagnosis of simple fibroadenoma is made then patients are simply reassured explaining its benign nature. They can be safely left alone, as they are not premalignant conditions.
Excision of fibroadenoma can be offered to the patients if:
a. Patient wants the lump to be removed
b. It is symptomatic
c. It is complex in pathology rather than simple
d. Cosmetic reasons
e. It is big

Most patients are happy to leave the fibroadenoma if proper explanation is given. Patients should also be explained about the scar and possibility of new fibroadenomas and multiple surgeries in case they opt for removal.

Fibroadenoma and cancer:
Fibroadenoma is not a premalignant condition per se nor it increases the risk of cancer in the rest of the breast tissue. Rare occurrences of cancer in fibroadenoma have been reported in the literature, which represent the sporadic nature rather than any association.

Follow up:
The patients are usually discharged from the breast clinic once full explanation is given and the patient has decided against surgery. They are advised to do regular self-examination to look for change in size and sensation of the lump, occurrence of any new lumps and presence of any symptoms. In any case if the patient decides to get the lump removed at a later date then it can be considered.
The patients are followed up in breast clinic if
a. they have any other risk factors for breast cancer
b. they have complex fibroadenoma on histology
c. have multiple fibroadenoma

Once the patient is in the screening age group they can be discharged to have regular screening mammogram and advised to come back if any there is any future problems.

Giant Fibroadenaoma:
It is same as the fibroadenoma and called when the size is more than 5 cm. They are more common in Africans and are generally treated by excision after histopathological diagnosis.

Phylloides Tumour

Classically it is a huge fleshy tumour hence it was erroneously called cystosarcoma phylloides in the past. They are often diagnosed by pathologists rather than clinically. They are considered as locally recurring benign tumours
Clinical features
Like many tumours the aetiology is not known. They are rare before the age of 20 and can attain very large size and the overlying skin can sometimes ulcerate merely due to the pressure. They are usually soft as opposed to the cancer and sometimes can elicit fluctuation. They are often mobile though some malignant variety can be attached to the underlying muscle.

10% of these tumours are frankly malignant and are identified by their aggressive histology and clinical behaviour. These malignant tumours can recur locally as well as can cause distant metastasis. They do not metastasise to the lymphnodes.

Investigations and Management:
Ultrasound and mammogram are the primary investigations followed by biopsy of the lump. If the histology is one of phylloides tumour with aggressive histology patient may need further investigations to check if there is any metastasis.
If the tumour is small they can be excised with normal tissue margins with preservation of breast. However if the tumour is big mastectomy may be required. Further recurrences can be treated by repeat excisions.
Chemotherapy may be required in-patients who have metastasis.

Follow up:
Patients are usually followed up for detection of any recurrences. The phylloides tumour is separate from breast cancer and they do not predispose to breast cancer.

If you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020 8565 5885