Incidence:
Fibroadenoma is the commonest cause of breast mass in young females
(The usual age is 15-30 years)
Pathology :
Fibroadenoma
is a benign neoplasm of the breast that affects both fibrous
&glandular tissues but fibrous element predominates.
Clinical Picture:
l- Hard fibroadenoma
-Type of patient : 20 - 30 years aged female.
-Symptoms: Painless lump that is discovered accidental
-Type of patient : 20 - 30 years aged female.
-Symptoms: Painless lump that is discovered accidental
-Signs: Breast swelling:
- Usually small, non tender, firm, well-circumscribed with smooth surface & with high mobility in breast tissue (breast mouse) with no LN enlargment.
- Usually small, non tender, firm, well-circumscribed with smooth surface & with high mobility in breast tissue (breast mouse) with no LN enlargment.
ll- Soft fibroadenoma
-Type of patient : 30-50 years old female
-Symptoms: painful rapidly growing lump
-Sign: Breast swelling
- May reach huge size, soft, mobile swelling in breast with no LN enlargment.
- May reach huge size, soft, mobile swelling in breast with no LN enlargment.
DD:
-Breast carcinoma.
-Duct ectasia.
-Localized fibroadenosis.
-Duct ectasia.
-Localized fibroadenosis.
Investigation:
Clinical picture is usually enough for diagnosis
-Mammography ..... reveals well-circumscribed lesion.
-U/S.... may be needed.
Clinical picture is usually enough for diagnosis
-Mammography ..... reveals well-circumscribed lesion.
-U/S.... may be needed.
Trestment:
1. For peri-canalicular:
- lt is enucleated through circum-areolar incision.
2. For intra-canalicular:
1. For peri-canalicular:
- lt is enucleated through circum-areolar incision.
2. For intra-canalicular:
- lf small, excision is better with a part of the normal breast tissue as a safety margin.
- lf large (Cystosarcoma phylloides) .... wide local excision (to prevent recurrence)
or if the tumor is the whole breast .....simple mastectomy.
- lf large (Cystosarcoma phylloides) .... wide local excision (to prevent recurrence)
or if the tumor is the whole breast .....simple mastectomy.
Cystosarcoma Phylloides (serocystic disease of Brodie)
characterized bv:
1- Highly cellular.
2- Rapidly growing, painful and reaching a large size (20 - 30 cm).
3- lt might ulcerate through skin but not attached to it.
The name cystosarcoma phylloids (is a wrong name):
- Cyst: may be cystic degeneration if hugely enlarged due to insufficient blood supply (but usually it is not cystic)
- Sarcoma: it is rarely malignant.
- Phylloids: the cut surface resembles leaf.
- So, it is better named "Phylloides Tumor"
Spectrum of activity:
- Variable from almost benign to locally aggressive & sometimes metastatic tumors.
Differential Diagnosis: carcinoma by probe test passing a probe of glass between the
tumor & skin:
- lf the probe can pass ) benign.
- lf the probe cannot pass ) malignant.
Treatment: wide local excision to prevent recurrence or simple mastectomy if occupying
the whole breast.
1- Highly cellular.
2- Rapidly growing, painful and reaching a large size (20 - 30 cm).
3- lt might ulcerate through skin but not attached to it.
The name cystosarcoma phylloids (is a wrong name):
- Cyst: may be cystic degeneration if hugely enlarged due to insufficient blood supply (but usually it is not cystic)
- Sarcoma: it is rarely malignant.
- Phylloids: the cut surface resembles leaf.
- So, it is better named "Phylloides Tumor"
Spectrum of activity:
- Variable from almost benign to locally aggressive & sometimes metastatic tumors.
Differential Diagnosis: carcinoma by probe test passing a probe of glass between the
tumor & skin:
- lf the probe can pass ) benign.
- lf the probe cannot pass ) malignant.
Treatment: wide local excision to prevent recurrence or simple mastectomy if occupying
the whole breast.
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