The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty for over 14 years. (2015).
Breast fibroadenoma called benign tumor formation, which arises as a result of focal ductal hyperplasia with connective tissue fibrosis. That is, when there is overgrowth of fibroadenoma and glandular and connective tissue.
This disease is referred to as dishormonal mammary dysplasia.
this education is most often diagnosed in young women and girls (15-30 years).
Kinds
Depending on the proliferation of connective tissue components are distinguished:
- intrakanalikulyarnuyu fibroadenoma, at which the connecting tissue grows into the lumen of the ducts;
- prikanalikulyarnuyu fibroadenoma when the connective tissue grows around the ducts;
- mixed fibroadenoma, features and having one and the other forms;
- filloidnuyu or leaf-fibroadenoma, which is characterized by rapid growth and one in ten women develops into cancer (sarcoma) of the breast. That is why it is called borderline tumors.
In addition, the release of mature, with a dense capsule and tightly-elastic consistency, and immature soft-elastic fibroadenomas are prone to growth.
Causes
Causes of fibroadenomas is not known, but experts allocate a number of predisposing factors:
- Heredity (with relatives on the maternal line tumorous breast diseases);
- neuroendocrine pathology (thyroid disease, diabetes, obesity);
- reproductive characteristics (childbirth and pregnancy to 20 and older than 30 years, large fruit, a long period of lactation, early menarche, late menopause, cycle disorders);
- abortion (Proliferation in the mammary gland and its abrupt ending);
- hormonal contraceptives;
- Prolonged stress, dissatisfaction with life situations (problems in the family, social status, dissatisfaction with sexual relations);
- a short period of breastfeeding;
- gynecological inflammatory processes;
- liver and biliary tract, arterial hypertension, colitis;
- fascination with smoking and alcohol, foods rich methylxanthines (coffee, tea, chocolate).
Symptoms breast fibroadenoma
If the fibroadenoma is large-sized, it can be determined visually as subcutaneous formation of breasts. On palpation of tumor dense and painless, it is agile and is not soldered to the skin. Consistency elastic formation (dense or soft).
Fibroadenoma is usually localized areola: usually in the upper-outer quadrant of the breast.
The dimensions of the tumor can be as small, about 0,2-0,7sm in diameter, as well as significant, reaching 5-7cm.
Capsule formation is smooth. Very rarely, you may receive the discharge from the nipple. Regional lymph nodes were not enlarged.
Fibroadenoma does not affect the course of pregnancy, although the gestation may cause an increase, and even significant, of tumor Education as a result of hormonal adjustment, so that all women planning a pregnancy, you should consult a mammalogy. Rapid growth of education during pregnancy is an indication to remove it, but only after giving birth.
Diagnostics
Diagnosis of fibroadenoma, as well as any breast disease, begins with the collection of medical history and complaints. Then the mammary gland is carried out visually and evaluated their palpation (standing, lying on the back and side). The doctor carefully probes each quadrant in order to identify whether or not there discharge from the nipple.
Women aged 35-40 years are designated Breast ultrasound. It is safe and helps to identify the education and distinguish a cyst from a solid tumor of breast.
mammogramsOr x-ray of the breast, is prescribed to women older than 40 years (effectively together with the US) in the first half of the menstrual cycle (monthly if not daily survey values are not It has). Radiographs operate in two projections: and lateral. The method is valuable because it reveals both primary and secondary signs of malignancy. It can be calcifications or other ultrasound signs. Fibroadenoma defined as a tumor shadow with a smooth surface not soldered to surrounding tissues.
Magnetic resonance imaging reveals palpable or nonpalpable formation, but does not differentiate them.
The newest technology acts microwave method, or RTM-study - measuring tissue temperature mammary gland, with subsequent digital image. The temperature of the mammary glands (average) is 34-35 degrees, and the temperature difference between the individual quadrants of not greater than 0.5 degrees. Using radiotermiii allows not only suspected fibroadenoma, but also breast cancer.
It is also necessary to carry out:
- biopsy formation with subsequent histological examination;
- Pelvic ultrasound and abdomen;
- determining the level of hormones (prolactin, progesterone, estradiol).
Differential diagnosis of fibroadenoma with a view to distinguish it from cancer and Breast cyst.
Lactocele has soft-elastic consistency, it is mobile and palpable to distinguish it from fibroadenoma difficult. Diagnosed with a cyst on ultrasound and x-rays of the mammary glands.
Breast cancer has pronounced visual signs: dense, nodular, soldered with the skin formation, is not displaced by palpation. It is noted nipple retraction or deformation.
Treatment of breast fibroadenoma
Woman with tumor formation in the breast should appeal to mamologist, oncologist or surgeon-mammologist.
removal of fibroadenoma
All fibroadenomas be removed surgically. Conservative therapy is not effective or appropriate. Monitoring a patient subject to the formation in the mammary gland is not more than 1 cm, if the suspicion of cancer have absent. Such patients twice a year must undergo a mammogram and breast ultrasound.
Indications for surgery:
- fibroadenoma size of 1cm or more;
- we can not exclude breast cancer;
- at the stage of planning of pregnancy;
- the rapid growth of education;
- leaf-fibroadenoma (regardless of size).
Surgical intervention may include sectoral resection the prostate or the enucleation tumors (husking).
During operation the material produced by the puncture fibroadenoma, is sent to the urgent histology to exclude / confirm cancer.
Operative intervention is carried out both under local or general anesthesia. The postoperative period lasts from 2 hours to 1 day.
Consequences and outlook
Not ruled out recurrence of the disease, that is, the emergence of a new tumor, it is not associated with the technique of the operation, and on the preservation of the reasons that led to the emergence of a fibroadenoma. Newly formed fibroadenoma localized elsewhere breast. The risk of recurrence is usually quite low and does not exceed 1%.
According to some authors, the threat of fibroadenoma malignancy (degeneration into cancer) is stored in 18-51% of cases, although their opponents deny the possibility of malignancy in general.
It remains the undisputed view of the leaf-fibroadenoma, which is 10% of the degenerating into cancer and, therefore, is subject to immediate removal.
The prognosis after tumor removal is favorable.
