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Fibroadenoma of the breast is a noncancerous (benign) tumor.
Causes
Fibroadenoma is the most common benign tumor of the breast and the most common breast
tumor in women under age 30.
A fibroadenoma is made up of breast gland tissue and tissue that helps support the breast gland
tissue.
Black women tend to develop fibroadenomas more often and at an earlier age than white women.
The cause of fibroadenomas is not known.
Symptoms
Fibroadenomas are usually single lumps, but about 10 - 15% of women have several lumps that
may affect both breasts.
Lumps may be:
Firm
Painless
Rubbery
They have smooth, well-defined borders. They may grow in size, especially during pregnancy.
Fibroadenomas often get smaller after menopause (if a woman is not taking hormone
replacement therapy).
Exams and Tests
After a physical examination, one or both of the following tests are usually done:
Breast ultrasound
Mammogram
A core needle biopsy must be performed to get a definite diagnosis. Women in their teens or
early 20s may not need a biopsy if the lump goes away on its own or if the lump does not change
over a long period of time.
For more information on the different types of breast biopsies, see:
Treatment
If a biopsy shows that the lump is a fibroadenoma, the lump may be left in place or removed.
The decision to remove the lump is made by the patient and the surgeon. Reasons to have it
removed include:
Mammogram
Physical examination
Ultrasound
Alternative treatments include removing the lump with a needle and destroying the lump without
removing it (such as by freezing, in a process called cryoablation).
Possible Complications
If the lump is left in place and carefully watched, it may need to be removed at a later time if it
changes, grows, or doesn't go away.
In very rare cases, the lump may be cancerous and you may need further treatment.
When to Contact a Medical Professional
Call your health care provider if you have a lump that is thought to be a fibroadenoma and it
grows or changes in any way.
DEFINISI
A fibroadenoma is a benign, or noncancerous, tumor of the breast. Timbul pada payudara remaja
dan wanita berusia <30 tahun. Benjolan biasanya kecil, solid, kenyal, bulat elastis dengan batas
tepi yang jelas. Fibroadenomas range in size from one to five cm, (0.39 inches to nearly two
inches). Giant fibroadenomas can be the size of a small lemon, about 15 cm (5.9 inches).
EPIDEMIOLOGI
The incidence of fibroadenoma is occur in women during their reproductive years,
particularly during their twenties and thirties. The cause of these tumors is not known. However,
genetics is not likely to play a role in the development of fibroadenomas. Women with dark
skin tend to develop fibroadenomas more often and at an earlier age than light-skinned women.
Similarly, women of higher socioeconomic status tend to develop fibroadenomas more
frequently.
KLASIFIKASI
1.Fibroadenoma Pericanaliculare
Yakni kelenjar berbentuk bulat dan lonjong dilapisi epitel selapis atau beberapa
lapis.
2.Fibroadenoma intracanaliculare
Yakni jaringan ikat mengalami proliferasi lebih banyak sehingga kelenjar berbentuk
panjang-panjang (tidak teratur) dengan lumen yang sempit atau menghilang.
ETIOLOGI
The exact cause of fibroadenomas is unknown. They seem to be influenced
by estrogen, because they appear most often in premenopausal (Alasan:
Kadang-kadang, peningkatan kadar FSH digunakan untuk mengkonfirmasi
menopause. FSH adalah hormon yang dihasilkan oleh kelenjar hipofisis
anterior yang memicu ovarium untuk mengeluarkan estrogen. Sebagai
produksi ovarium estrogen menurun sekitar menopause, kelenjar pituitari
melepaskan lebih FSH ke dalam darah untuk merangsang produksi estrogen.
Jadi, jika tingkat FSH darah seorang wanita secara konsisten meningkat, dan
ia tidak lagi memiliki periode menstruasi, secara umum ia telah mencapai
menopause. Namun, tingkat FSH tunggal dapat menyesatkan dalam
premenopause karena produksi estrogen tidak jatuh pada tingkat yang stabil
dari hari ke hari. Sebaliknya, baik estrogen dan tingkat FSH berfluktuasi dari
yang cukup tinggi ke cukup rendah selama premenopause. Juga, jika
seorang wanita menggunakan terapi hormon tertentu (misalnya pil KB), tes
FSH
tidak
valid.)
or
pregnant
women,
or
in
women
who
are
FAKTOR PREDISPOSISI
Dark-skinned race
we
included
11
fibroadenomas
from
non-immunocompromised
patients. DNA was amplified using polymerase chain reaction (PCR) of the
EBV-encoded small RNA (EBER-2) DNA sequence. EBV latent membrane
protein 1 (LMP-1) transcripts were amplified using reverse transcription (RT)
PCR. Immunohistochemical (IHC) staining for LMP-1 protein was performed. A
total of 9 out of 20 tumors (45%) were concordantly positive by PCR and IHC.
IHC stained exclusively the epithelial cells. All the fibroadenomas in nonimmunocompromised patients were negative for LMP-1 (Fisher's exact test P
=.0006).
These data suggest that EBV is associated with fibroadenomas in this
immunosuppressed population and that the infection is specifically localized
to epithelial cells. This is the first study suggesting a role for EBV in the
pathogenesis of fibroadenomas.
2. ESTROGEN RECEPTOR-BETA
An
estrogen
dependency
has
been
suggested
for
the
growth
of
lesions.
In this study, the expression of estrogen receptor (ER)-alpha and -beta was
investigated by immunohistochemistry in 33 fibroadenomas and in 30
benign, three borderline and seven malignant phyllodes tumors, all with
spindle cell growth and in one distant metastasis. In addition, the presence of
ER-beta mRNA and its variants was evaluated by RT-PCR in microdissected
stroma. The possible correlation between hormone receptor expression and
differentiation processes of stromal cells was investigated by smooth muscle
actin and calponin immunostaining. ER-beta was the only hormone receptor
expressed by stroma of fibroadenomas and phyllodes tumors, both at protein
and
mRNA
level.
stroma
expression
markers
of
fibroadenomas
correlates
and
with
suggests
differentiation
and
the
role
of
phyllodes
expression
of
of
ER-beta
in
stromal
tumors;
smooth
(ii)
its
muscle
myofibroblastic
cells.
These two results, together with the young age of patients carrying
fibroadenomas with highly ER-beta-positive stroma cells, may further
indicate a hormone-receptor mechanism involved in regulating the growth of
fibroadenomas. Conversely, the older age of patients with ER-beta-rich
phyllodes tumors suggests that mechanisms, probably independent from
estrogen stimulation, act on the growth of these tumors.
HISTOLOGI
Female breasts are made up of three main types of tissues: glandular
tissue (milk-producing glands), ductal tissue (ducts that carry milk from
the glands to the nipple), and stroma (a combination of fatty tissue and
fibrous or connective tissue). Fibroadenomas involve both fibrous and
glandular tissues in the breast. They are the most common form of
benign breast tumors.
ANATOMI
The Mamm
The mamm secrete the milk, and are accessory glands of the
generative system. They exist in the male as well as in the female; but
in the former only in the rudimentary state, unless their growth is
excited by peculiar circumstances. In the female they are two large
hemispherical eminences lying within the superficial fascia and situated
on the front and sides of the chest; each extends from the second rib
above to the sixth rib below, and from the side of the sternum to
near the midaxillary line. Their weight and dimensions differ at
different periods of life, and in different individuals. Before puberty they
are of small size, but enlarge as the generative organs become more
completely developed. They increase during pregnancy and especially
after delivery, and become atrophied in old age. The left mamma is
generally a little larger than the right. The deep surface of each is nearly
circular, flattened, or slightly concave, and has its long diameter
before
backward
and
thicker
in
the
center
than
at
the
fibers; muscular fibers are entirely absent; they are lined by columnar
epithelium resting on a basement membrane. The epithelium of the
mamma differs according to the state of activity of the organ. In the
gland of a woman who is not pregnant or suckling, the alveoli are very
small and solid, being filled with a mass of granular polyhedral cells.
During pregnancy the alveoli enlarge, and the cells undergo rapid
multiplication. At the commencement of lactation, the cells in the center
of the alveolus undergo fatty degeneration, and are eliminated in the
first milk, as colostrum corpuscles. The peripheral cells of the
alveolus remain, and form a single layer of granular, short columnar
cells, with spherical nuclei, lining the basement membrane. The cells,
during the state of activity of the gland, are capable of forming, in their
interior, oil globules, which are then ejected into the lumen of the
alveolus, and constitute the milk globules. When the acini are distended
by the accumulation of the secretion the lining epithelium becomes
flattened.
FIG. 1172 Dissection of the lower half of the mamma during the period of
The fibrous tissue invests the entire surface of the mamma, and
PATOLOGI-ANATOMI
PEMERIKSAAN
Physical examination
While doing your regular breast self-exam, you may feel a breast
fibroadenoma. These feel firm, round, smooth, rubbery, and are movable.
They are so mobile that women sometimes refer to them as breast mice
because they tend to run away from your fingers. A fibroadenoma may feel
tender, especially right before your period, when it may swell due to
hormonal changes.
Radiography
On mammograms, a fibroadenoma may be occult or may appear as a
smooth-margined oval or round mass sized 4-100 mm. Occasionally,
tumors contain coarse
The
hamartomas,
cysts,
mammographic
and
findings
carcinomas
overlap.
of
fibroadenomas
For
with
mammograms
of
-Breast ultrasound
Ultrasonography
Fibroadenomas appear oval on ultrasonograms, and their width is larger
than their anteroposterior diameter. Gentle lobulations (typically fewer
than 4) may be present, but the margins should be circumscribed.[4, 5, 6, 7]
(See the image below.)
-Mammogram
A core needle biopsy must be performed to get a definite diagnosis. Women in their teens or
early 20s may not need a biopsy if the lump goes away on its own or if the lump does not
change over a long period of time.
For more information on the different types of breast biopsies, see:
A stereotactic breast biopsy uses mammography to help pinpoint the spot in the breast
that needs to be removed.
You must sign an informed consent form. If you are going to have general anesthesia, you
may be asked not to eat or drink anything for 8 - 12 hours before the test.
A stereotactic biopsy includes the following steps:
-The health care provider will first clean the area on your breast, and will then inject a
numbing medicine. This may sting a little bit.
-The breast is pressed down to hold it in position during the procedure. You need to hold
still while the biopsy is being performed.
-The doctor will make a very small cut on your breast over the area that needs to be
biopsied.
-Using a special machine, a needle or sheath is guided to the exact location of the
abnormal area. Up to six or more tissue samples are taken.
-A small metal clip or needle may be placed into the breast in the biopsy area to mark it
for biopsy, if needed.
-After the tissue sample has been taken, the catheter or needle is removed. Ice and
pressure are applied to the site to stop any bleeding. A bandage will be applied to absorb
any fluid. You will not need stitches after the needle is taken out. Steristrips may be
placed over any wound, if needed.
-A small metal clip or needle may be placed into the breast in the area of the biopsy to
mark it, if needed.
The biopsy is done using one of the following:
-Fine needle aspiration
-Hollow needle (called a core needle)
-Vacuum-powered device
-Both a hollow needle and vacuum-powered device
Once the tissue sample has been taken, the catheter or needle is removed. Ice and
pressure are applied to the site to stop any bleeding. A bandage will be applied to absorb
any fluid. You will not need any stitches after the needle is taken out. Steri-Strips may be
placed over any wound, if needed.
TEMAAAAAAAANNNNNNNNN
BUKA
INI
YAA
http://www.breastpathology.info/phyllodes.html
UNTUK BISA NGEBEDAIN
PHYLLODES TUMOUR DENGAN FIBROADENOMA ,SOALNYA DIAGNOSIS
PASTINYA DARI BIOPSI (HISTOLOGI)
PENCEGAHAN
all women should examine their breasts monthly and have regularly scheduled clinical breast
exams and other screenings as recommended by their healthcare providers.
GAMBAR
.fibroadenoma.
.phyllodes tumour.
TATALAKSANA
In some cases, your healthcare provider may recommend leaving the lump in place and checking
it on a regular basis. This is called observation and is most often recommended for small
tumors that can be monitored and are not causing any physical deformities or anxiety.
However, your healthcare provider may recommend removing a fibroadenoma if it is large, the
biopsy results are not normal, or it is causing physical deformities or anxiety. Most likely, a
breast surgeon will be involved in your decision to remove a fibroadenoma. There are a variety
of techniques your surgeon can use to remove a fibroadenoma, including:
Percutaneous excision (removing the tumor with a needle through the skin)
DIAGNOSIS BANDING
1. ADENOMYOEPI-THELIOMA
Adenomyoepithelioma, strictly defined, is a proliferation of both
epithelial and myoepithelial elements.
2. PHYLLODES TUMOR
(http://www.breastcancer.org/symptoms/types/phyllodes/diagnosis.js
p)
tell if the growth is a phyllodes tumor. Your doctor can perform one of
two procedures:
o core needle biopsy, which uses a special hollow needle to take
samples of the tumor through the skin
KOMPLIKASI
In very rare cases, the lump may be cancerous and you may need further treatment.
PROGNOSIS
Women with fibroadenoma have a slightly higher risk of breast cancer later in life. Lumps that
are not removed should be checked regularly by physical exams and imaging tests, following the
doctor's recommendations.
Fibroadenoma
(http://theoncologist.alphamedpress.org/content/11/5/435.full)
Fibroadenoma is the most common lesion of the breast; it occurs in 25% of asymptomatic
women [101]. It is usually a disease of early reproductive life; the peak incidence is between the
ages of 15 and 35 years. Conventionally regarded as a benign tumor of the breast, fibroadenoma
is also thought to represent a group of hyperplastic breast lobules called aberrations of normal
development and involution [10, 101, 102]. The lesion is a hormone-dependent neoplasm that
lactates during pregnancy and involutes along with the rest of the breast in perimenopause [102].
A direct association has been noted between oral contraceptive use before age 20 and the risk of
fibroadenoma [103]. The Epstein-Barr virus might play a causative role in the development of
this tumor in immunosuppressed patients [104].
Fibroadenoma presents as a highly mobile, firm, non-tender, and often palpable breast mass.
Although most frequently unilateral, in 20% of cases, multiple lesions occur in the same breast
or bilaterally. Fibroadenoma develops from the special stroma of the lobule. It has been
postulated that the tumor might arise from bcl-2-positive mesenchymal cells in the breast, in a
manner similar to that proposed for solitary fibrous tumors [105]. Macroscopically, the lesion is a
well-circumscribed, firm mass, <3 cm in diameter, the cut surface of which appears lobulated
and bulging (Fig. 4A). If the tumor assumes massive proportions (>10 cm), more commonly
observed in female adolescents, it is called giant fibroadenoma. Microscopically,
fibroadenoma consists of a proliferation of epithelial and mesenchymal elements. The
stroma proliferates around tubular glands (pericanalicular growth) or compressed cleft-like ducts
(intracanalicular growth). Often both types of growth are seen in the same lesion (Fig. 4B)
[103].
Cytogenetic studies have reported chromosomal aberrations in both epithelial and stromal cells,
suggesting that the two components may involve neoplastic changes [106, 107]. Phyllodes tumor
is a fibroepithelial tumor of the breast with a spectrum of changes. Benign phyllodes tumor is
usually difficult to differentiate from fibroadenoma. Hypercellular stroma with cytologic atypia,
increased mitoses, and infiltrative margins of the lesion are the most reliable discriminators to
separate lesions with recurrence and malignant behavior. In terms of surgical treatment of these
tumors, it is important to recognize phyllodes tumor because it should be excised completely
with clear margins to obviate any chance of local recurrence. In cases of recurrent disease,
mastectomy is often performed [108, 109].
Approximately 50% of fibroadenomas contain other proliferative changes of breast, such as
sclerosing adenosis, adenosis, and duct epithelial hyperplasia. Fibroadenomas that contain these
elements are called complex fibroadenomas. Simple fibroadenomas are not associated with any
increased risk for subsequent breast cancer. However, women with complex fibroadenomas may
have a slightly higher risk for subsequent cancer [110]. The presence of atypia (either ductal or
lobular) confined to a fibroadenoma does not lead to a greater risk for long-term breast
carcinoma compared with fibroadenomas in general [110].
Fibroadenomas in older women or in women with a family history of breast cancer have a higher
incidence of associated carcinoma [101, 111]. Two studies, which were considered to provide
strong evidence of reliability according to El-Wakeel et al. [101], show that the relative risk of
developing breast cancer in patients who had surgically excised fibroadenomas increases in the
presence of complex features within the fibroadenomas, ductal hyperplasias, or a family history
of breast carcinoma (in a first-degree relative). Progressive somatic genetic alterations that are
associated with the development of breast cancer have been studied in fibroadenomas. No
genetic instabilities, manifested as loss of heterozygosity or microsatellite instability, have been
found in any fibroadenoma components regardless of their association with breast cancer or their
histologic complexity [106].
The current management of patients with clinically or radiologically suspected fibroadenoma
varies. Some physicians prefer excision for tissue diagnosis, but conservative management will
likely replace surgical treatment in the near future, on the basis of the young age of the patient,
findings of benign imaging and clinical characteristics, and benign findings on either FNA
biopsy or needle core biopsy [110, 112]. Minimally invasive techniques, such as ultrasound-
guided cryoablation, seem to be an excellent treatment option for fibroadenoma in women who
wish to avoid surgery [1], or else the lesion may simply be treated with observation and followed
up periodically.
Juvenile fibroadenoma is a variant of fibroadenoma that presents between 10 and 18 years of
age, usually as a painless, solitary, unilateral mass >5 cm. It can reach up to 15 or 20 cm in
dimension, so although it is an entirely benign lesion, surgical removal is recommended [113].
REFERENCES
http://breastcancer.about.com/od/mammograms/p/fibroadenomas.htm
http://emedicine.medscape.com/article/345779-overview#a01
http://books.google.co.id/books?
id=NbbKwDbXsmkC&pg=PA228&lpg=PA228&dq=histologis+payudara&source=bl&
ots=SMWe8AIUTu&sig=LlZAt1HAjwJuwmySqJe_1NR2bSI&hl=id&ei=hTg2ToraAsThrA
eQwOTSCw&sa=X&oi=book_result&ct=result&resnum=9&ved=0CEwQ6AEwCA#v=
onepage&q&f=false
http://radiology.rsna.org/content/210/1/233.full
http://theoncologist.alphamedpress.org/content/11/5/435.full
http://en.wikipedia.org/wiki/Fibroadenoma
http://www.scribd.com/doc/37702845/neoplasma-fibroadenoma-mammae