fibroadenoma of breast
Introduction
Introduction to breast fibroadenomas Breast fibroadenomas are mixed tumors that occur in fibrous tissue and glandular epithelium in the lobule of the breast and are the most common type of benign breast tumor. Breast fibroadenomas can occur in women of any age after puberty, but are more common in young women between the ages of 18 and 25. The occurrence of this disease is related to the imbalance of endocrine hormones, such as the relative or absolute increase of estrogen can cause this disease. basic knowledge The proportion of illness: 0.64% Susceptible people: more common in young women aged 18 to 25 Mode of infection: non-infectious Complications: galactorrhea
Cause
Cause of breast fibroadenoma
(1) Causes of the disease
The etiology and pathogenesis of breast fibroadenoma are not well understood, but are consistently believed to be related to the following factors.
1. Estrogen level imbalance: If the estrogen level is relatively or absolutely elevated, excessive stimulation of estrogen levels may lead to abnormal proliferation of mammary duct epithelial and mesenchymal components to form a tumor.
2. Local breast tissue is oversensitive to estrogen: the sensitivity of various tissues of normal breast to estrogen is different, so that local tissues with high sensitivity are susceptible to the disease, and due to differences in local anatomy and physiological characteristics, The sensitivity of different women's breast tissue to estrogen stimulation is different, and women who are sensitive to estrogen stimulation are sick, indicating that the above two causes are synergistic.
3. Dietary factors: High-fat diet can change the intestinal flora, so that the steroids from bile are converted into estrogen in the colon, which in turn stimulates the proliferation of breast ductal epithelium and interstitial fibrous tissue.
4. Genetic predisposition.
(two) pathogenesis
The pathological features of breast fibroadenomas are:
1. Gross shape: The tumor is generally spherical, elliptical, and lobulated, with clear boundary and complete envelope. The diameter is more than 3cm, the texture is firmer, and the texture of the cut surface is grayish red, slightly outward. There are many cracks and mucous-like luster of different sizes. A few visible cuts have cystic cavity and intracapsular papilloma formation, sometimes see calcified or ossified areas.
2. Tissue morphology: According to the relationship between fibrous tissue and glandular structure in tumor, it can be divided into the following five types.
(1) perivascular type (condomal type): the lesion is mainly the perivascular connective tissue hyperplasia outside the elastic fiber layer around the gland tube, and the elastic fiber is also involved in tumor formation, but no smooth muscle, no mucoid degeneration, hyperplastic fiber The tissue compresses the duct and acinus from the surrounding to make it a glandular tube. The fibrous tissue is dense, often with collagen degeneration or glassy change, even calcification, cartilage-like or ossification, normal or mild hyperplasia of glandular epithelial cells, occasionally Sexual expansion and papillary hyperplasia, but glandular epithelial hyperplasia is not as active as fibrous tissue.
(2) Intraductal type (toward tube type): mainly for subcutaneous epithelial connective tissue hyperplasia, subepithelial smooth muscle tissue is also involved in tumor formation, but no elastic fiber component, lesions can involve 1 to several milk duct systems, diffuse Sexual hyperplasia, early subepithelial connective tissue showed focal hyperplasia, the cells were star-shaped or fusiform, with varying degrees of mucous degeneration, and the proliferating fibrous tissue protruded from the wall of the tube to the luminal surface at a single or multiple points, and then gradually filled and squeezed. The lumen forms irregular cracks, and the glandular epithelium covering the glandular tube and the fibrous tissue is squeezed into two rows. In the cross section, the fibrous tissue is not cut into the part from the tube wall. If it grows in the tube, it is called intraductal fibroadenomas. In the larger cavity, sometimes many epithelial-like interstitial papillary structures can be seen. The glandular epithelium can also be squeezed and atrophied or completely disappeared. The fibrous tissue can undergo mucoid degeneration, the fibrous tissue becomes dense and dense and undergoes hyaline degeneration, and the interstitial can also undergo calcification and ossification.
(3) Mixed type: The above two types of lesions exist in one tumor at the same time.
(4) lobulated type (macrofibrous adenoma): more common in adolescents or women over 40 years old, the tumor is larger, its diameter is more than 7cm, spherical, the basic structure is similar to intraductal fibroadenomas, due to subepithelial The connective tissue protrudes from the multi-point into the highly dilated lumen, but it is not completely filled with the latter. Therefore, the specimen is obviously lobulated when it is visually observed and microscopically examined. Generally, the fibroblasts and glandular epithelial cells proliferate actively, but no abnormalities. The difference from the intraductal type is that the lobulated tumor is large and has obvious lobes. The difference from the phyllodes is that the latter often has no envelope, and the interstitial cells are abnormal, showing nuclear division.
(5) Cystic hyperplasia: It is derived from hyperplasia of mammary gland. The boundary between the tumor and the surrounding breast tissue is clear. It may have a capsule. The tumor is made up of adenocarcinoma of the glandular epithelium and subepithelial or elastic fibers. The lesions include cyst formation, different degrees of hyperplasia of the ductal epithelium, papillomatosis, ductal adenosis and apocrine adenoids. The difference between this disease and cystic hyperplasia is that the latter has a wide range of lesions and boundaries with surrounding tissues. Unclear, and often involve both breasts.
Prevention
Breast fibroadenoma prevention
1. Adequate nutrition, keeping the muscles of the breasts strong and full of fat. Sitting at the side of the line, maintaining a beautiful posture, especially can not contain the chest, should be chest, head up, abdomen, straight knee, so that the beautiful breasts can proudly stand out, women's style fully displayed.
2. Pay attention to protect your breasts from accidental injuries, especially when you are on a crowded bus and teasing children.
3. According to the condition of your breasts, wear a soft, sized bra. I am not a casual person. I am not a human being! It gives the breast a good shape and can be well fixed and supported.
4. Perform self-examination on the breast, regular physical examination of the breast at the specialist, and regular mammography if necessary. When you feel uncomfortable or have problems with your examination, you should seek medical advice promptly to diagnose and treat various breast diseases early.
Complication
Breast fibroadenoma complications Complications
The breast is hardened and the breast is stinging.
Symptom
Breast fibroadenoma symptoms Common symptoms Nipple discharge
Patients often inadvertently find a painless mass in the milk, mostly single, or multiple, or in the bilateral mammary gland, more common in the upper quadrant of the breast, sometimes in the size of the milk Tumors of different grades, called breast fibroadenomas, usually grow slowly, but grow faster during pregnancy and lactation. Tumors are 1 to 3 cm in diameter and more than 10 cm in length. They are often round, oval, and texture. It is tough, clear in edge, smooth in surface, good in movement, palpable in sliding, no tenderness, no nipple discharge, and can be divided into 3 types according to clinical manifestations.
1. Ordinary type: Most common, the diameter of the tumor is often 1 to 3 cm, and the growth is slow.
2. Youth type: rare, occurs before menarche, tumor growth rate is fast, the tumor is large, can cause skin tension and thinning, skin venous anger.
3. Giant fibroadenomas: also known as lobular fibroadenomas, more common in 15 to 18 years of puberty and premenopausal women over 40 years old, the tumor often exceeds 5cm, and even up to 20cm, the tumor is lobulated .
Examine
Examination of breast fibroadenomas
1. Fine needle aspiration cytology examination: smear can be seen in the pile of ductal epithelial cells, scattered or clusters of fibroblasts, see mucus in the background, the diagnostic coincidence rate can reach more than 90%.
2. Histopathological examination: used in the following situations:
1 The patient is older, or has enlarged lymph nodes under the ipsilateral armpit;
2 special examination of the breast is suspected of malignant possibility;
3 have a family history of breast cancer;
4-needle aspiration cytology for patients with abnormal cells or suspected cancer cells.
3. Molybdenum target X-ray film: X-ray image shows a round, elliptical edge with a smooth mass, the density is higher than that of the breast gland, a few patients can see calcification, mostly granular columnar, dendritic, fine sand, if Large granular or massive calcification is diagnostic.
4. B-ultrasound examination: the sound image shows that the tumor is round, elliptical, substantial, and the boundary is clear. The interior is a homogeneous weak light spot, the back wall line is intact, the side wall sound shadow is present, and the rear echo is enhanced.
5. Liquid crystal heat map: The tumor is a low temperature image or a normal thermal image, and the skin blood vessels are not abnormal.
6. Infrared transillumination: The tumor is basically consistent with the surrounding normal breast tissue, the tumor is large, the boundary is clear, and there is no shadow of blood vessel changes around.
Diagnosis
Diagnosis and diagnosis of breast fibroadenomas
diagnosis
According to young women, tumor growth and palpation characteristics, such as smooth tumor surface, firm and firm, clear edges, good activity, etc., can often be a clear diagnosis, for the diagnosis of difficult cases, with the special examination of the breast can confirm the diagnosis.
Differential diagnosis
Breast fibroadenomas need to be differentiated from breast hyperplasia and breast cancer.
1. Hyperplasia of the breast: more common in the age group of 30 to 40 years old, and most of them can touch the nodules or masses in both sides of the breast. The size and pain of the mass are often related to the menstrual cycle, often tender, occasionally nipple discharge.
2. Breast cancer: occurs in the age group over 40 years old. It is a painless single mass, the edge of the tumor is not complete, the boundary is unclear, the common axillary lymph nodes are enlarged and hardened, and the fine needle aspiration cytology is often found.
