Breast fibroadenoma

Any neoplasm in the breast causes natural anxiety, but not all of them are associated with malignant tumors. So, breast fibroadenoma is a benign tumor. At its core, fibroadenoma is a nodular form of the pathology of breast tissue, and results from the abnormal development of glandular tissue cells (parenchyma) and connective tissue (stroma) of the breast. 

[1],

Causes of the breast fibroadenomas

To date, the true causes of breast fibroadenomas remain the subject of scientific research and are not fully established. However, no one doubts the fact that dense moving "balls" are formed in the breasts of women due to various hormonal disorders. As the doctors say, the mammary gland is a "target" for hormones.

During life - from puberty until menopause, including the menstrual cycle and periods of pregnancy - cyclical changes occur in the mammary glands caused by fluctuations in the level of sex hormones. The epithelial and muscular tissue cells of the breast are particularly sensitive to the action of hormones, as a result of which the structure of these tissues is constantly changing. This leads either to an increase in the number of their structural elements (hyperplasia) or to abnormal development (dysplasia). So, the etiology of the pathological process of development of the mammary gland fibroadenoma is associated just with tissue tissues, which is manifested by an increase in the mass of fibrous tissue.

Disorders of hormonal levels, in particular, excessive estrogen levels and progesterone deficiency, play a major role in the pathogenesis of breast fibroadenomas. Among the factors that provoke the occurrence of this pathology, experts also include diseases of the ovaries, thyroid, adrenal glands and pituitary; diabetes, liver disease, obesity, and gynecological diseases and menstrual disorders.

According to British and American physicians, the use of hormonal birth control pills by girls under the age of 20 years is also associated with the risk of fibroadenoma.

[2], [3]

Symptoms of the breast fibroadenomas

It is believed that breast fibroadenoma is a disease without clinical manifestations. Practically the only symptom of the fibroadenoma of the mammary gland is a dense enough knot of a round or oval shape with clear borders.

This “ball” or “pea” can be from several millimeters to three or more centimeters in diameter. If the size of the formation in diameter exceeds 6 cm, then such fibroadenoma is classified as “giant”. The formation is mobile and is not connected with the surrounding tissues or skin. The typical localization of the tumor is in the upper part of the outer side of the mammary gland.

In most cases, women discover a tumor in the mammary gland by chance - in the process of palpation of the breast. Visually, only a large tumor can be detected. And with palpation, it is painless. In general, the pains in the breast fibroadenoma are absent. The exception is phylloid fibroadenoma of the mammary gland.

When a woman complains that she has a breast fibroadenoma, this may mean that she has this type of tumor. Or she has a different formation in the chest, for example, a cyst, in which during the menstruation pain in the mammary gland can be felt.

As a rule, during the examination a single formation is detected - left breast fibroadenoma or right breast fibroadenoma. But, as doctors-mammologists emphasize, at least 15% of cases occur in multiple breast fibroadenomas, which can affect both breasts at once.

The growth of fibroadenoma occurs spontaneously and stops at some stage. In women of childbearing age during menstruation, breast fibroadenoma may slightly increase in size and then decrease again.

[4]

Forms

According to the WHO International Classification of Diseases of the 10th revision (ISD 10), which is used by physicians for coding diagnoses, ICD-10 breast fibroadenoma is classified as Class D 24 - Benign neoplasm of breast, that is, noncancerous fibroepithelial tumors in the breast that occur in the result of neoplasia (neoplasm). Breast fibroadenoma is about 7% of these tumors, and cancer - 10%.

[5], [6]

Breast fibroadenoma during pregnancy

Speaking about the hormonal factors of the occurrence of this type of benign tumors, it is necessary to highlight such an important issue as breast fibroadenoma and pregnancy.

During the carrying of the child - against the background of a general hormonal adjustment of the woman's body - the acceleration of the growth of the existing benign tumor is noted. The growth of the glandular tissue of the mammary glands is stimulated by estrogen, and the development of the mammary glands and preparation for lactation - by the hormone prolactin. Thus, during pregnancy, physiologically caused intensive proliferation of parenchyma cells occurs in the breast. Therefore, during pregnancy, breast fibroadenomas almost in a quarter of cases increase in size. And although, according to doctors, this disease does not adversely affect the course of pregnancy and fetal development, they strongly recommend removing fibroadenomas when planning pregnancy.

Similarly, the opinion of gynecologists and about the solution of the problem - breast fibroadenoma and IVF. Both in preparation for in vitro fertilization, and directly during its implementation, a woman’s ovaries are stimulated, so a high content of estrogen in the blood (estradiol) can lead to increased fibroadenoma growth.

In clinical practice, the fibroadenomas of the mammary gland in accordance with the histological features are divided into the following types: pericanalicular, intracanalicular, mixed and phylloid (or leaf-shaped).

Perikalikulyarnaya mammary fibroadenoma

With this type of tumor, proliferation of connective tissue cells in the lobules of the gland is observed. A dense consistency tumor with a localization around the mammary ducts of the mammary gland is precisely limited from other tissues. The structure of the formation is dense, and in it quite often - especially in elderly patients - calcium salts (calcinates) are deposited. Then, according to the results of mammography, the so-called calcified fibroadenoma of the mammary gland or calcified fibroadenoma of the mammary gland can be diagnosed.

Intracanalicular fibroadenoma of the breast

Intracanalicular fibroadenoma differs from the pericanalicular lobular structure and looser consistency, as well as the lack of clear contours. The stroma (connective tissue) grows into the lumen of the mammary gland, tightly adjacent to their walls.

Mixed fibroadenoma has signs of both types of breast fibroadenomas.

[7], [8], [9], [10]

Phyloid fibroadenoma of the breast

Particularly large (5-10 cm and even more) reaches the least common form of this pathology - leaf-shaped breast fibroadenoma, it is phylloid breast fibroadenoma. This tumor is a marker of increased risk of developing breast cancer.

Phyloid fibroadenoma of the mammary gland at first develops very slowly, and for many years it may not show itself. And then suddenly begins to grow rapidly.

With a significant size of the tumor can capture a significant amount of the mammary gland or even the whole, the skin of the breast becomes thinner and bluish-purple (due to the expansion of the subcutaneous blood vessels). As mentioned above, the pains in the fibroadenoma of the mammary gland are observed precisely in this type of pathology. In addition, the appearance of discharge from the nipple of the affected breast is very likely.

By the way, when patients say that they have a nodal breast fibroadenoma, it is obviously implied that breast fibroadenoma is a nodular form of mastitis (almost all benign pathological growths of the breast tissue belong to mastopathy). And the term “diffuse fibroadenoma of the mammary gland” most likely refers to the diffuse form of mastopathy, one of the varieties of which is fibroadenosis. Its difference from the mammary gland fibroadenoma lies in the fact that in fibroadenosis, not only epithelial and fibrous tissue are involved in the process of tumor formation, but fatty tissue.

[11], [12], [13], [14], [15]

Complications and consequences

The effects of breast fibroadenomas in the form of malignant transformations in epithelial components are considered rare or almost impossible. According to recent studies in clinics in Israel, the incidence of breast carcinoma, which developed from fibroadenoma, is in the range of 0.002-0.0125%. At the same time, experts do not hide the fact that data from clinical tests and mammography results often show the presence of benign fibroadenomas, and during the surgical removal of tumors, their malignant nature was found out.

Despite the fact that cases of phylloid fibroadenoma diagnosis do not exceed 2% of all fibroepithelial breast tumors, the level of its malignancy, that is, degeneration into a malignant form, is, according to one data, 3-5%, according to others - 10%.

So women who have found leafy fibroadenoma of the mammary gland may face such a problem as fibroadenoma and breast cancer. Moreover, in women with a family history of breast cancer, the risk of oncology is 3.7% higher than in women with a family history of breast cancer.

[16], [17], [18], [19]

Consequences of the removal of breast fibroadenoma

There are two informations - bad and good. Let's start with the good: the effects of removing the fibroadenoma of the mammary gland in the form of a scar on your chest become almost invisible a few years after the operation.

And now about the sad. Removal of breast fibroadenomas is not identical to recovery. The cause of the tumor in the chest is associated with hormonal imbalances. The tumor was cut out, in the imbalance remained.

Therefore, no one can guarantee that the tumor will not recur.

[20],

Diagnostics of the breast fibroadenomas

Most often, this disease is diagnosed in women from 20 to 35 years old, but it can be detected for the first time in adolescent girls during puberty, and in mature women after 45-50 years of age.

Now, the arsenal of breast fibroadenoma diagnostics methods (except for examination of patients with palpation and history taking) includes a biochemical blood test for sex hormones, mammography (breast X-ray), ultrasound examination (ultrasound), biopsy and cytological examination of tumor tissues.

Ultrasound signs

Examination of the fibroadenoma of the mammary gland on ultrasound provides an opportunity to get a clear picture of even those organ-impenetrable X-ray areas of the organ that are located directly near the chest wall.

Ultrasound also allows differentiation of fibroadenoma and breast cyst. But to determine whether benign fibroadenoma or malignant, ultrasound is not able to.

[21],

Biopsy

To determine the nature of the tumor must necessarily be a biopsy of the fibroadenoma of the breast. This diagnostic manipulation is carried out by a non-operative aspiration biopsy method, that is, breast fibroadenoma puncture is taken.

A needle on the syringe penetrates the tumor and "pumps" out a certain amount of tissue from it. Despite the minimally invasiveness of this method, the accuracy of the puncture results is considered not high enough. And the doctor can and should resort to an incisional biopsy, in which a small fragment of tumor tissue is excised under local anesthesia. The resulting sample is sent for histological examination.

[22], [23], [24], [25]

Histology

To determine the correct diagnosis, histology of the fibroadenoma of the mammary gland is the cornerstone method. Only histological examination makes it possible to determine the peculiarity and extent of damage to the breast tissue by the pathological process.

During the cytological (cell) study of neoplasm samples, the nature and intensity of the proliferation of parenchyma cells and stroma cells belonging to the breast "fibroadenoma" body is determined.

Cytology of the mammary gland fibroadenoma is also important for the differential diagnosis of other benign tumors of this organ. Cytological examination allows one to be convinced in a high degree of confidence in the most important thing - the absence or presence of cancer cells, and also to determine the histogenesis of the tumor - the tissue structure from which it developed.

[26], [27], [28], [29], [30], [31], [32]

Nutrition for breast fibroadenoma

A special diet for breast fibroadenoma is not developed, but it is necessary to eat properly with this disease. It is recommended to eat more fruits and vegetables, especially cabbage and kelp; use as a seasoning coriander and nutmeg; drink green tea and fresh juices.

It is better to refuse: the use of fat (fatty foods cause increased secretion of bile, and bile - a source of steroid hormones); use of legumes (beans, peas, beans) and natural coffee.

Tobacco and alcohol - a definite "no."

[33], [34], [35]

Treatment of the breast fibroadenomas

At present, oncologists believe that breast fibroadenomas, except phylloid, cannot be reborn into cancer. The highly recommended treatment for phylloid species is exclusively surgical.

In addition, the operation is performed if the tumor length exceeds 30 mm or increases rapidly (doubled in 4-5 months). And also in the case when it is necessary to remove a cosmetic defect of the mammary gland which reduces the quality of life of a woman.

Recommended removal of fibroadenoma of the mammary gland for those over forty, as well as pregnant women - to deprive the tumor a chance to be reborn in breast cancer. In addition, growing fibroadenoma can interfere with normal breastfeeding.

What treatment of breast fibroadenoma is used in all other cases? Doctors say: against this disease, all drugs are powerless. And all the rest of the patients need to live in peace, get on the dispensary account, regularly visiting his doctor.

[36],

Surgical treatment

The operation for breast fibroadenoma has such options as lumpectomy and nucleation.

By lumpectomy or partial resection, the removal of breast fibroadenomas is performed (under general anesthesia) with the capture of a portion of healthy breast tissue. As a rule, this operation is performed if there is reason to suspect the malignant nature of the pathology, in particular, in case of leaf-shaped fibroadenoma of the mammary gland.

Husking of the fibroadenoma of the breast (nucleation) is the removal of the tumor itself (without surrounding tissues). This operation lasts no more than 60 minutes, is done under local (or general) anesthesia. In the course of surgical intervention, an emergency histological examination of a distant education is mandatory.

The postoperative period for breast fibroadenoma: in the hospital - a maximum of 24 hours and another 10 days at home (with mandatory antiseptic treatment of the wound), removal of sutures - after 8-9 days from the day of surgery. Doctors warn that the site of the scar may ache a few months.

Where to remove breast fibroadenoma? Such operations are performed by oncologic surgeons - only in specialized oncological clinics. Information about the cost of the operation for breast fibroadenoma is reported directly to the patients of a particular medical institution and depends on the degree of complexity of the operation.

[37], [38]

Removal of breast fibroadenoma by laser

Fibroadenomas of the mammary glands can be removed with a laser - a method of laser-induced thermotherapy. The laser apparatus, precisely induced on the tumor with the help of ultrasound control, destroys the pathological formation in the mammary gland (under local anesthesia). Two months later, a new connective tissue forms at the site of the destroyed tumor. After this outpatient treatment, which lasts no more than an hour, a miniature scar remains on the chest, and the shape of the breast does not change. According to experts, after removal of the fibroadenoma of the mammary gland by the laser, the patient recovers very quickly.

In large Western clinics, breast fibroadenoma removal is performed by cryoablation (cryodestruction), that is, using extremely low temperatures of liquid nitrogen to destroy the tumor tissue. Cryoablation has long established itself as a safe and highly effective method of treating cancers of the prostate, kidney and liver. According to leading experts

The American Society of Breast Surgeons (American Society of Breast Surgeons), this technique (officially approved by the FDA for the treatment of fibroadenoma) is an alternative to open surgery. Freezing of the fibroadenoma tissue of the mammary gland kills its cells, which are metabolized over time. The cryoablation procedure is performed on an outpatient basis - under ultrasound guidance and local anesthesia. The scar from the puncture of the skin on the chest is only 3 mm and it grows quickly.

[39], [40]

Conservative treatment

Fibroadenoma is not amenable to conservative treatment, some doctors say. Others assure: some of them are still treatable... The second statement looks more optimistic. So, according to this statement, conservative treatment of breast fibroadenomas is as follows:

• taking vitamin E,
• weight loss;
• hormonal correction;
• iodine microdose;

Regarding the use of hormonal preparations, it is necessary to consult a doctor. Remember: the mammary gland is a “target” for hormones.

Although there are positive opinions about the feasibility of hormone therapy in the treatment of breast fibroadenomas, because, in principle, taking some hormones for the sake of, suppressing others should balance the hormones in order to “fight back” new tumors.

[41], [42], [43]

Duphaston treatment

The drug duphaston belongs to the pharmacological group of gestagens, its active substance is an analogue of the natural hormone progesterone - didrogesterone. When ingested, the synthetic hormone acts on the uterine mucosa (endometrium) and prevents its growth and thickening, which are provoked by excessive production of estrogen in the body.

This drug is used in case of endogenous progesterone deficiency in: endometriosis, PMS, menstrual disorders, amenorrhea and dysmenorrhea. Moreover, the reception duphaston does not suppress ovulation, that is, it has no contraceptive effect.

In hormone replacement therapy for removal of the uterus and menopause syndrome, duphaston is used when it is necessary to neutralize the proliferative effect of estrogen on the mucous membrane of the uterus. The drug can cause breakthrough bleeding. Duphaston is contraindicated in liver diseases and individual intolerance to the drug.

[44]

Treatment with alternative means

A list of funds for the treatment of breast fibroadenomas alternative means begin walnut partitions. Rather, alcohol tincture on them, which is used for many diseases, for example, in the pathology of the thyroid gland, gastrointestinal tract, diseases of the joints.

Walnut partitions are a source of iodine, with a deficiency of which mastopathy, myoma and adenoma develop. It is necessary to take a bottle of dark glass with a capacity of 0.5 liters, fill the walls with 1/3, fill with vodka to the top, close tightly and put to insist for 20-25 days. Finished tincture should be taken on a tablespoon before meals - once a day.

Herbal medicine

Medicinal herbs such as licorice, clover and sweet clover are natural sources of estrogens, so they cannot be used in fibroadomes. And the following recipes take note.

Three teaspoons of wormwood herb need to pour 200 ml of boiling water, close the container with a lid and insist 2 hours. Take twice a day (after meals) - one teaspoon. The duration of the wellness course is a week. After a week break, repeat the same.

A glass of hot water will need fifty-fifty corn stigmas, yarrow herbs, and juniper fruits. Raw water pour, boil for 10 minutes and 35-40 minutes to insist (closing the lid). Drink the infusion three times a day after meals - a quarter cup for 10 days.

[45], [46], [47]

Prevention

Prevention of breast fibroadenomas is to avoid tanning, tanning beds and taking hot baths (shower only), and no warming compresses on the chest. Get a good habit: regular self-examination of the mammary glands. Indeed, the timely detection of breast tumors contributes to early diagnosis.

If a fibroadenoma is diagnosed, it is necessary to go for a checkup to a breast doctor every three months. And after stabilization - twice a year.

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Forecast

After surgery, the occurrence of recurrent benign fibroepithelial tumors occurs in almost 15% of cases. Recurrence of the most cancerous phylloid (leaf) fibroadenoma can occur in 8% of patients.

During childbirth, the behavior of the fibroadenoma of the mammary gland cannot be foreseen.

Benign education in women on the threshold of menopause and in its midst usually do not increase. And according to British breast doctors, every year about 10% of the mammary gland fibroadenomas disappear. As a rule, they regress after menopause.

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