Fibroadenoma
- Benign encapsulated tumour
- Most common in females 15-25 years old
- Hyperplasia of a single lobule of the breast
- Juvenile fibroadenoma – in adolescent girls
- Even though it has rapid growth with epithelial hyperplasia, it does not show any cellular atypia
- No potential to turn into phyllodes or carcinoma
- Complex fibroadenoma – condition with typical fibroadenoma with fibrocystic changes
- Apocrine metaplasia, cyst formation, sclerosing adenosis
- Occurs in older females
- Can occasionally turn into malignancy
Types
- Intracanalicular – large, soft; distorted duct
- Pericanalicular – small, hard; normal duct
Clinical features
- Typical presents in a woman of reproductive age with a mobile palpable breast lump
- Commonly enlarge during pregnancy and involute at menopause
- Painless swelling in one quadrant
- Smooth, firm, non-tender, well-localised, moves freely within breast tissue
- Axillary lymph nodes not enlarged
Investigations
- Mammography – well localised smooth regular shadow
- FNAC
- US
Treatment
- Indications for surgery
- Size >3cm, multiple, giant type, recurrence, complex type
- Excision through circumareloar (Webster’s) or submammary (Galliard Thomas incision) under general anaesthesia
Fibrocystic disease of the breast
- Oestrogen dependent condition – oestrogen predominance over progesterone
- exaggerated response of breast stroma and epithelium to hormones and growth factors
- Nontender, tensely cystic swelling with thin bluish capsule – blue dome cyst of Bloodgood
- Schimmelbusch disease – diffuse small, multiple cysts
Classification
- Non proliferative – moderate hyperplasia of ductal luminal cells. No risk of cancer
- Proliferative without atypia – severe hyperplasia
- Proliferative with atypia (atypical ductal/lobular hyperplasia) – risk factor for breast cancer. Often mimics CIS
Stages
- I – Stromal proliferation or hyperplasia
- II – Adenosis (increased glands)
- III – Cyst formation
Clinical features
- Presents during menstruating age group – bilateral, painful, diffuse, granular, tender swelling
- Most common in upper quadrant
- Pain and tenderness are more just prior to menstruation – cyclic mastalgia
- Subsides during pregnancy, lactation and after menopause
- Discharge from nipple – serous, occasionally greenish
- Not fixed to skin, muscle or chest wall
Investigations
- FNAC
- US
- Mammography
Treatment
- Conservative treatment is preferred
- Avoid caffeine, chocolate, salt
- Drugs – relieve pain, reverse changes, softens breast issue
- Primrose oil, gamolenic acid (120mg/d), danazol (interferes with FSH+LH), tamoxifen (antioestrogenic)
- Surgery
- Indications – intractable pain, Bloodgood cyst, persistent bloody discharge
- Subcutaneous mastectomy with prosthesis placement
- Excision of cyst
Sclerosing adenosis
- Most common in 30-50 year olds
- Can present as breast lump or mastalgia
- Palpation – smooth, relatively mobile mass
- Can mimic carcinoma clinically, radiologically and histologically
- Complex type – with papilloma and epithelial hyperplasia
- No risk of malignancy
Histology
- Lobular enlargement and distortion
- Proliferative terminal ductules and acini
- Fibrous stromal proliferation – with deposition of calcium
Phyllodes tumour
- Wide spectrum of activity – benign (85%), malignant (15%)
- Depends on mitotic index and degree of pleomorphism
- Malignant (sarcoma) – spreads to lungs or bones
- Gross – large capsulated area with cystic spaces
- Microscopic – contains cystic spaces with leaf like projections. . Cells show hypercellularity and pleomorphism
Clinical features
- Most common in premenopausal women – 30-50 year olds
- Unilateral, grows rapidly to attain large size, with bosselated surface
- Swelling – smooth, nontender, soft, fluctuant with necrosis of skin due to pressure
- Skin over breast – stretched, red, dilated veins
- Differential diagnosis from carcinoma
- Tumour is not fixed to skin/muscles/chest wall
- Nipple retraction is absent
- Lymph nodes are not involved
Investigations
- FNAC
- US
- Mammography, CXR
- CT
Treatment
- Excision or subcutaneous mastectomy is done
- If malignant (sarcoma) – total mastectomy