Fibroadenoma of the breast

Any new growth in the breast causes natural concern, but not all of them are associated with malignant tumors. Thus, fibroadenoma of the mammary gland is a benign tumor. In essence, fibroadenoma is a nodular form of pathology of the tissues of the mammary gland, and occurs as a result of the abnormal development of cells of the glandular tissue (parenchyma) and connective tissue (stroma) of the breast.

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Causes mammary fibroadenomas

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

Throughout life - from puberty to menopause, including the menstrual cycle and pregnancy periods - the mammary glands undergo cyclical changes caused by fluctuations in the level of sex hormones. The cells of the epithelial and muscle tissue of the breast are especially 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 fibroadenoma development of the mammary gland is associated precisely with tissue tissue, which is manifested by an increase in the mass of fibrous tissue.

Hormonal imbalances, in particular, excess estrogen levels and progesterone deficiency, play a major role in the pathogenesis of fibroadenoma of the mammary gland. Among the factors that provoke the occurrence of this pathology, specialists also include diseases of the ovaries, thyroid gland, adrenal glands and pituitary gland; diabetes mellitus, liver disease, obesity, as well as gynecological diseases and menstrual cycle disorders.

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

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Symptoms mammary fibroadenomas

It is believed that fibroadenoma of the mammary gland is a disease without clinical manifestations. Almost the only symptom of fibroadenoma of the mammary gland is a palpable, fairly dense, round or oval-shaped node with clear boundaries in the thickness of the soft tissues of the breast.

This "ball" or "pea" can be from a few millimeters to three or more centimeters in diameter. If the size of the formation in diameter exceeds 6 cm, then such a 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, a tumor in a woman's mammary gland is discovered by chance - during palpation of the breast. Only a large tumor can be detected visually. Moreover, it is painless upon palpation. And in general, there is no pain with fibroadenoma of the mammary gland. An exception is phylloid fibroadenoma of the mammary gland.

When a woman complains that she has pain in her breast fibroadenoma, it may mean that she has this type of tumor. Or she may have another breast formation, such as a cyst, which can cause pain in the breast during menstruation.

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

Fibroadenoma growth occurs spontaneously and stops at some point. In women of childbearing age, fibroadenoma of the mammary gland may slightly increase in size during menstruation and then decrease again.

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Forms

According to the International Classification of Diseases, 10th revision (ISD 10) developed by WHO, which is used by doctors to code diagnoses, fibroadenoma of the mammary gland ICD-10 is classified as class D 24 - Benign neoplasm of breast, that is, non-cancerous fibroepithelial tumors in the breast that arise as a result of neoplasia (new growth). Fibroadenoma of the mammary gland accounts for about 7% of these new growths, and cancerous tumors - 10%.

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Fibroadenoma of the mammary gland during pregnancy

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

During pregnancy - against the background of general hormonal changes in the woman's body - an acceleration of the growth of the existing benign tumor is observed. The growth of 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, there is a physiologically conditioned intensive proliferation of parenchyma cells in the breast. Therefore, during pregnancy, fibroadenomas of the mammary gland increase in size in almost a quarter of cases. And although, as doctors assure, this disease does not negatively affect the course of pregnancy and the development of the fetus, they strongly recommend removing fibroadenoma when planning a pregnancy.

Gynecologists have a similar opinion regarding the solution to the problem - fibroadenoma of the mammary gland and IVF. Both during preparation for in vitro fertilization and directly during its implementation, the work of the woman's ovaries is stimulated, so that a high content of estrogens (estradiol) in the blood can lead to increased growth of fibroadenoma.

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

Pericanalicular fibroadenoma of the mammary gland

With this type of tumor, proliferation of connective tissue cells in the lobules of the gland is observed. A tumor of dense consistency is formed, precisely delimited from other tissues, localized around the milk ducts of the mammary gland. The structure of the formation is dense, and calcium salts (calcifications) are deposited in it quite often - especially in elderly patients. 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 mammary gland

Intracanalicular fibroadenoma differs from pericanalicular fibroadenoma by its lobular structure and looser consistency, as well as the absence of clear contours. The stroma (connective tissue) grows into the lumens of the mammary gland ducts, tightly adjoining their walls.

Mixed fibroadenoma has features of both types of breast fibroadenoma.

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Phyllodes fibroadenoma of the mammary gland

The least common type of this pathology, leaf-shaped fibroadenoma of the mammary gland, also known as phylloid fibroadenoma of the mammary gland, reaches especially large sizes (5-10 cm and even more). This tumor is a marker of an increased risk of developing breast cancer.

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

With significant tumor sizes, it can capture a significant volume of the mammary gland or even the entire one, the skin of the chest becomes thinner and becomes bluish-purple (due to the expansion of subcutaneous blood vessels). As mentioned above, pain with fibroadenoma of the mammary gland is noted precisely with 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 nodular fibroadenoma of the mammary gland, it is obviously implied that fibroadenoma of the mammary gland is a nodular form of mastopathy (almost all benign pathological growths of breast tissue are classified as mastopathies). And the definition of "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 fibroadenoma of the mammary gland is that with fibroadenosis, not only epithelial and fibrous tissues are involved in the process of tumor formation, but also adipose tissue.

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Complications and consequences

The consequences of fibroadenoma of the mammary gland in the form of malignant transformations in epithelial components are considered a rare phenomenon or practically impossible. According to recent studies conducted in Israeli clinics, the incidence of breast carcinoma that developed from fibroadenoma is in the range of 0.002-0.0125%. At the same time, specialists do not hide the fact that clinical analysis data and mammography results often show the presence of benign fibroadenomas, and during surgical removal of neoplasms, their malignant nature was revealed.

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

So women who have been diagnosed with phyllodes fibroadenoma of the mammary gland may face such a problem as fibroadenoma and breast cancer. Moreover, women with a family history of breast cancer have a 3.7% higher risk of oncology compared to women with a family history of breast cancer.

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Consequences of removal of fibroadenoma of the mammary gland

There are two pieces of information - good and bad. Let's start with the good: the consequences of fibroadenoma removal in the form of a scar on your chest become almost invisible several years after the operation.

Now about the sad part. Removal of fibroadenoma of the mammary gland is not the same as recovery. The reason for the tumor's appearance in the breast is related to hormonal imbalance. The tumor was cut out, but the imbalance remained.

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

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Diagnostics mammary fibroadenomas

Most often, this disease is diagnosed in women aged 20 to 35 years, but it can also be first detected in teenage girls during puberty and in mature women after 45-50 years.

Currently, the arsenal of methods for diagnosing fibroadenoma of the mammary gland (in addition to examining patients with palpation and collecting anamnesis) includes a biochemical blood test for sex hormones, mammography (X-ray of the mammary gland), ultrasound examination (ultrasound), biopsy and cytological examination of tumor tissue.

Ultrasound signs

Ultrasound examination of fibroadenoma of the mammary gland makes it possible to obtain a clear picture of even those areas of the organ that are “impenetrable” to X-rays and are located directly near the chest wall.

Ultrasound can also differentiate fibroadenoma and breast cysts. However, ultrasound cannot determine whether fibroadenoma is benign or malignant.

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Biopsy

To determine the nature of the tumor, a biopsy of the fibroadenoma of the mammary gland must be performed. This diagnostic manipulation is carried out by a non-surgical method of aspiration biopsy, that is, a puncture of the fibroadenoma of the mammary gland is taken.

A needle on a syringe penetrates the tumor and “pumps out” a certain volume of tissue from it. Despite the minimally invasive nature of this method, the reliability of the puncture results is considered insufficiently high. 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.

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Histology

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

During the cytological (cellular) examination of neoplasm samples, the nature and intensity of proliferation of parenchyma and stromal cells included in the “body” of the fibroadenoma of the mammary gland are determined.

Cytology of fibroadenoma of the mammary gland is also important for differential diagnostics of other benign tumors of this organ. Cytological examination allows to be sure of the most important thing with a high degree of reliability - the absence or presence of cancer cells, as well as to determine the histogenesis of the tumor - the tissue structure from which it developed.

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Nutrition for fibroadenoma of the mammary gland

There is no special diet for fibroadenoma of the mammary gland, but you need to eat right with this disease. It is recommended to eat more fruits and vegetables, especially cabbage and kelp; use coriander and nutmeg as seasonings; drink green tea and freshly squeezed juices.

It is better to avoid: eating fatty foods (fatty foods cause increased secretion of bile, and bile is a source of steroid hormones); eating legumes (beans, peas, beans) and natural coffee.

A categorical “no” to tobacco and alcohol.

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Treatment mammary fibroadenomas

Currently, oncologists believe that fibroadenomas of the mammary gland, except for phylloid, are not capable of degenerating into cancer. The strongly recommended treatment for the phylloid type is exclusively surgical.

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

Removal of fibroadenoma of the mammary gland is recommended for those over forty, as well as pregnant women - to deprive the tumor of the chance to degenerate into breast cancer. In addition, a growing fibroadenoma can interfere with normal breastfeeding of a child.

What treatment for fibroadenoma of the mammary gland is used in all other cases? Doctors say: no medications are effective against this disease. And all other patients need to live quietly, register with a dispensary, and regularly visit their attending physician.

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Surgical treatment

Surgery for fibroadenoma of the breast has such available options as lumpectomy and nucleation.

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

Enucleation of fibroadenoma of the mammary gland (nucleation) is the removal of the tumor itself (without surrounding tissues). This operation lasts no more than 60 minutes, is performed under local (or general) anesthesia. During the surgical intervention, an emergency histological examination of the removed formation is mandatory.

Postoperative period for fibroadenoma of the mammary gland: in hospital - maximum 24 hours and another 10 days at home (with mandatory antiseptic treatment of the wound), removal of stitches - 8-9 days after the operation. Doctors warn that the scar site may hurt for several months.

Where to remove fibroadenoma of the mammary gland? Such operations are performed by oncosurgeons - only in specialized oncology clinics. Information about the cost of surgery for fibroadenoma of the mammary gland is provided directly to patients of a specific medical institution and depends on the complexity of the operation.

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Laser removal of fibroadenoma of the mammary gland

Fibroadenomas of the mammary glands can be removed with a laser – a method of laser-induced thermotherapy. The laser device, precisely aimed at the tumor using ultrasound control, destroys the pathological formation in the mammary gland (under local anesthesia). After two months, new connective tissue forms in place 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 specialists, after removing fibroadenoma of the mammary gland with a laser, patients recover very quickly.

In large Western clinics, fibroadenoma of the mammary gland is removed using cryoablation (cryodestruction), that is, using extremely low temperatures of liquid nitrogen to destroy tumor tissue. Cryoablation has long established itself as a safe and highly effective method for treating cancerous tumors of the prostate, kidney, and liver. As noted by 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 the breast fibroadenoma tissue 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 heals quickly.

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Conservative treatment

Fibroadenoma is not amenable to conservative treatment, say some doctors. Others assure: some of them are still amenable to treatment... The second statement looks more optimistic. So, according to this statement, conservative treatment of fibroadenoma of the mammary gland consists of the following:

• taking vitamin E,
• getting rid of excess weight;
• correction of hormonal background;
• microdoses of iodine;

Regarding the use of hormonal drugs, you must consult with your doctor. Remember: the mammary gland is a "target" for hormones.

Although there are positive opinions about the advisability of hormonal therapy in the treatment of fibroadenoma of the mammary gland, since, in principle, taking some hormones for the sake of suppressing others should balance the hormonal background in order to “fight back” new tumors.

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Treatment with Duphaston

The drug duphaston belongs to the pharmacological group of gestagens, its active substance is an analogue of the natural hormone progesterone - dydrogesterone. When taken orally, the synthetic hormone affects the mucous membrane of the uterus (endometrium) and prevents its growth and thickening, which are provoked by excessive production of estrogens in the body.

This medicine is used in case of endogenous progesterone deficiency in: endometriosis, PMS, menstrual cycle disorders, amenorrhea and dysmenorrhea. Moreover, taking duphaston does not suppress ovulation, i.e. it has no contraceptive effect.

In hormone replacement therapy for hysterectomy and menopause syndrome, Duphaston is used when it is necessary to neutralize the proliferative effect of estrogens on the mucous membrane of the uterine cavity. The drug can cause breakthrough bleeding. Duphaston is contraindicated in liver disease and individual intolerance to the drug.

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Treatment with folk remedies

The list of remedies for treating fibroadenoma of the mammary gland with folk remedies begins with walnut partitions. Or rather, an alcohol tincture on them, which is used for many diseases, for example, for thyroid pathology, gastrointestinal tract, joint diseases.

Walnut partitions are a source of iodine, the deficiency of which causes mastopathy, myoma and adenoma. You need to take a bottle of dark glass with a capacity of 0.5 liters, fill it with partitions by 1/3, pour vodka to the top, close it tightly and leave it to infuse for 20-25 days. The finished tincture should be taken one tablespoon before meals - once a day.

Herbal treatment

Herbs such as licorice, clover and sweet clover are natural sources of estrogens, so they should not be used for fibroadeomas. And take note of the following recipes.

Three teaspoons of wormwood herb should be poured with 200 ml of boiling water, cover the container with a lid and leave for 2 hours. Take twice a day (after meals) - one teaspoon. The duration of the health course is a week. After a week's break, repeat the same.

For a glass of hot water you will need equal parts of corn silk, yarrow herb, and juniper berries. Pour the raw materials with water, boil for 10 minutes and leave to infuse for 35-40 minutes (covered with a lid). Drink the infusion three times a day after meals - a quarter of a glass for 10 days.

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Prevention

Prevention of fibroadenoma of the mammary gland consists of avoiding sunbathing, solariums and taking hot baths (only showers), and no warming compresses on the chest. Get into the healthy habit of regularly self-examining your mammary glands. After all, timely detection of a mammary gland tumor contributes to early diagnosis.

If fibroadenoma is diagnosed, it is necessary to visit a mammologist for examination once every three months. And after stabilization - twice a year.

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Forecast

After surgery, the occurrence of repeated benign fibroepithelial tumors occurs in almost 15% of cases. Recurrence of the most cancer-dangerous phyllodes (leaf-shaped) fibroadenoma can occur in 8% of patients.

During pregnancy, it is impossible to predict the behavior of fibroadenoma of the mammary gland.

Benign tumors in women on the threshold of menopause and in its midst usually do not increase in size. And according to British mammologists, about 10% of fibroadenomas of the mammary gland disappear annually. As a rule, they regress after menopause.

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