Professional Documents
Culture Documents
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Fibroadenoma
- The most common tumor female breast.
- It is composed of both glandular and fibrous tissue
- etiology: unknown, It can be AND (aberration of normal development
- May be seen along with Fibroadenosis (ANI)
- Pathology:
• Increased sensitivity to estrogen or increased secretion unopposed by
progesterone for long time
• Mostly spherical; may be multinodular
• They typically stop growing after 2 to 3 cm size
• May harbor lobular carcinoma in situ
• It has 2 Types according to amount of fibrous tissue relative to
glandular tissue, both variants can co-exist
- Clinical features
• More common in blacks
• The peri-canalicular occurs in younger females (15 to 30 yrs), The
intracanalicular affects older age group (30 to 50 yrs)
• Painless, slow growing solitary lump (pain when associated fibro
adenosis or fibro cystic disease)
• Mostly seen in the lower part of the breast
• Multiple may be present; 10% cases
• Intracanalicular can grow large causing pain due to stretching skin &
more liable to malignant transformation esp.in older age
• No discharge per nipple
Hard fibroadenoma Soft fibroadenoma
Pathology -firmer -relatively less firm
-smaller -grows larger with
-moves well within the breast profuse connective
tissue so called “breast tissue “INTRADUCTAL
mouse” MYXOMA”
-two capsules & in between
there is a line of cleavage:
1.True: fibrous
2.False: formed by
compressed breast
tissue
Microscopic picture -small acini impeded in a large -few large amount acini
amount of fibrous tissue impeded in soft-firm
-Peri-canalicular, ducts are fibrous tissue
surrounded by fibrous tissue, -Intra-canalicular, ducts
rounded glands+ dense are compressed by
fibrous tissue fibrous tissue so
glands show multiple
small projections
Clinical picture can grow large causing
pain due to stretching
skin
More common
Age younger females (15 to 30 older age group (30 to
yrs.) 50 yrs.)
Malignancy Less liable More Liable
Excision It is well capsulated so Small projections may
enucleation is easy be not seen & remain
leading to recurrence
so it needs safety
margin
On examination:
• No visible swelling ( large intra-canalicular may be visible)
• Palpation: Freely mobile; more in young girls*
• Firm consistency
• No axillary lymph nodes, ( associated with axillary lymph nodes in cases of
accompanied mastalgia or inflammatory processes)
Treatment:
o Present trend: women under 25 yrs of age, routine excision is avoided
(the mass is small so Follow up & excision & biopsy if there is gradual
increase in size).
• The fibroadenoma grows up to 3 cm in 5 yrs
• Thereafter gradually become smaller
o In case of suspected pathology: excision & biopsy is the treatment of
choice
• Enucleation of the peri-canlicular variety : as it is well-capsulated
• Excision of the intra-canalicular variety : Small projections may be
not seen & remain leading to recurrence so it needs safety margin.
o Types of incisions:
• Circum-areolar/Peri-areolar or Sub mammary incision (Gaillard
Thomas’s incision) for cosmetic surgery
• If not possible then radial or curved incision over Langer’s lines.
Giant fibro adenoma
- Grows more than 5 cm in size
- Bimodal age of presentation (at puberty and peri-menopause)
- More common in blacks
- Epithelial hyperplasia and atypia, more liable for malignant
transformation
- Characterized by rapid growth
- Differentiate from phyllodes tumour, Benign virginal hypertrophy
On examination:
- Enlarged breast
- Displaced nipple position
- Stretched and shiny skin
- Dilated veins
- Skin necrosis may occur: if stretching existed for a long period + super
added infections or scratches or erosions
Treatment:
- Enucleation &biopsy
- In cases of older age or suspicious to malignancy: a fine needle
aspiration is obtained before surgery & assure the patient that there is
completion of surgery (mastectomy) in cases of malignancy or severe
atypia
Phyllodes Tumor
- Also called Cystosarcoma Phyllodes, Serocystic Disease Of Brodie or
Benign Cystosarcoma
- Mostly seen in premenopausal women (40yrs age)
- Show a wide range of histology
o From an almost benign condition resembling
fibroadenoma
o To the ones with high mitotic index
&premalignant condition
- Tumor has irregular projections: cause for
recurrences
Clinical features:
• Presents as massive tumour
• Unevenly bosselated surface
• Ulceration with long-term stretching
• Pressure necrosis of overlying skin
• Or warm, red, shiny skin with dilated veins
• Normal nipple
• Firm consistency
• Smooth margins
• Not fixed: the stretched skin can be picked up
• No axillary lymph node involvement
• Known for local recurrence due to prjections
N.B
Probe test:
- It is used to differentiate if necrosis occurring due to skin stretch or
infiltration
- A probe is inserted under the skin, if it passes smoothly then necrosis is
a result of skin stretching
Treatment:
• Younger women (Benign end of spectrum known by fine needle
aspiration): Simple enucleation
• Older patients (Malignant end of the spectrum): Wide excision with 1
cm margin or more
• Recurrences or malignancy: mastectomy with reconstruction
Duct papilloma
- Benign tumor, usually small
- Arising from their lining epithelium of lactiferous duct
- It may too small for clinical palpation, but may obstruct a duct for cyst
formation
- Not a pre-cancerous condition*
- Usually single and unilateral (60-70%)
- Papilloma has a stalk
- Papilloma vs papillomatosis (epithelial hyperplasia without a stalk)
Clinical features
- Age 30 to 50 yrs.
- Bloody discharge: commonest presentation & most annoying complain for
the patient
- In cases of obstruction & cystic formation: Small and soft lump palpable
beneath the areola or nipple; often difficult
- Discharge from the affected duct on pressing the lump
- May present with a cystic swelling; due to impalpable lump blocking the
duct
- No lymph nodes are affected, except in cases of superadded affection
Treatment
• Single duct is affected: Microdochectomy
• complete excision of the affected duct
• Wedge resection
• If not palpable then gently probe the affected duct
• Carry on the resection with 1mm distance from the probe
• Papilloma is mostly situated 4-5 cm away from the nipple