Page 417 - Medicine and Surgery

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Chapter 10: Benign disorders of the breast 413

fromasinglecellandareundernormalhormonalcontrol excision. Larger lesions and those with equivocal his-
theyarebestconsideredasanaberrationofnormalbreast tology should be excised.
development (ANDI).

Prognosis
Incidence Untreated only 10% of fibroademonas increase in size
Most common cause of a discrete breast lump in young over a 2-year period most of which occur in teenage
women. women. It is thought that most fibroadenomas involute
if left untreated.
Age
Peak 25–35 years, but can occur any time from menarche
Breast cysts
to menopause.
Definition
Pathophysiology Acommon fluid filled epithelial lined space in the breast
Fibroadenomas are usually solitary lesions that result presenting as a mass.
fromahyperplasticorproliferativeprocessinasingleter-
minal ductal unit. Fibroadenomas are under hormonal
Incidence
control,theymayenlargeduringpregnancyandinvolute
Palpable cysts occur in 7% of women in Western coun-
at menopause.
tries and account for 15% ofall discrete breast masses.
Clinical features
Aetiology/pathophysiology
Patients (normally young women) present with a
Breast cysts are a very common finding in the years lead-
smooth, firm, painless nodule that is well-demarcated
ing up to the menopause and are thought to arise due to
and freely mobile (breast mouse). Fibroadenomas may
an anomaly of breast involution.
be multiple in 10–15%.
Juvenile fibroadenoma is a rare subtype that occurs in
femaleadolescentsandgrowsrapidly.Histologicallythey Clinical features
resemble common fibroadenomas and are benign. How- Patients present with a solitary or multiple lump(s).
ever, local recurrence can only be prevented by complete These are typically well-demarcated, soft or firm and
excision. not fixed to underlying tissue. There should not be any
associated lymphadenopathy.
Macroscopy/microscopy
An encapsulated rubbery white lesion with a glisten- Investigations
ing cut surface. It consists of a fibrous connective tissue Patients require a triple assessment consisting of clinical
component and abnormally proliferated ducts and acini examination (see page 409), imaging using ultrasound
(adenoma) in varying proportions. or mammography (see page 412) and in the case of a cyst
fine needle aspiration (see page 412).
Investigations
Investigation of any breast lump involves a triple assess- Management
ment consisting of clinical examination (see page 409), Patients with a single cyst do not need to be reviewed fol-
imaging normally by ultrasound as patients are young lowing an otherwise normal ultrasound and successful
and sampling by core biopsy or fine needle aspiration fineneedleaspiration.Patientswithmultiplecystsdonot
(see page 412). needalltheircystsaspiratedandthereforeshouldremain
under regular review. Indications for surgical biopsy in-
Management clude bloody fluid detected on fine needle aspiration,
If confirmed as a fibroadenoma on triple assessment, aresidual mass following aspiration, or multiple recur-
small lesions may be left unless the patient requests rence at the same site.