Fibroadenoma

00:01 Welcome.

00:02 In this talk, we're going to discuss a very common entity fibroadenoma.

00:06 It's one where if you and your patient can recognize what it is, can often put your patient at ease by telling them this is a very common very benign lesion of the breast.

00:18 So fibroadenoma is a benign breast tumor.

00:21 So it is a tumor. It's a neoplasm.

00:23 There is increased cellular proliferation, but it's composed mainly of fibrous tissue with a little bit of glandular element, but completely benign.

00:33 The epidemiology of this.

00:34 It is the most common breast tumor in premenopausal women and again, tumor doesn't mean cancer just means a growth.

00:42 The peak incidence is in the early menstrual years, 15 to 35.

00:49 There's an exceptionally low risk of developing breast cancer from an adenoma exceptionally low, vanishingly small, so tell your patient not to worry.

00:59 The pathophysiology.

01:01 It's actually unknown.

01:03 It is unlikely to be hereditary.

01:05 There doesn't seem to be a genetic component.

01:08 There is no association with smoking and in fact, tobacco smoking is negatively correlated.

01:14 So if you smoke, you tend to get fewer fibroadenoma, unclear reasons.

01:20 These tumors are responsive to estrogen, so they can increase in size during pregnancy, or lactation, or cyclically with normal menstruation or with the use of oral contraception, depending on whether they're an estrogen or progesterone based oral contraception, and they typically regress spontaneously on their own after menopause when there aren’t levels of estrogen to maintain them.

01:43 The clinical presentation.

01:45 They are usually asymptomatic.

01:47 They're found on a breast exam, or may be found on mammogram.

01:52 They are usually solitary lesions and about four fifths of the cases.

01:56 They are well defined rubbery, mobile, solitary, most commonly, masses.

02:03 Making the diagnosis.

02:04 An ultrasound will often be more than sufficient.

02:08 It will demonstrate a well circumscribed mass, often with a little bit of a fibrous rim.

02:13 It will be smooth, ovoid, without any heterogeneity within it.

02:19 Mammography will show many of the same changes, there may be calcifications, that's fine.

02:26 That doesn't infer that there's going to be any sort of malignant potential, and um, biopsy if we do that, most of the time, we won't, unless these are large, in which case we may do an excisional biopsy, but on biopsy they are cellular showing a lot of myxoid stroma.

02:43 And the epithelial tissue’s actually compressed, so this is not an epithelial tumor.

02:48 This is a stromal tumor.

02:51 The treatment? Usually leave ‘em alone.

02:55 Put your patient at ease and tell her that it's not cancer.

03:00 It's often unnecessary to do anything.

03:02 They will typically regress with menopause as we've already said.

03:05 You can observe them make sure they're not getting bigger and then they're you know that very rare risk of developing malignancy may mean that you want to follow them.

03:16 If they are large, you may do cryoablation or excisional surgery.

03:22 Fiber adenoma is really common entity or really benign.

03:26 And you know everything that I know.