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== Cause == |
The cause of fibroadenoma is unknown (idiopathic). A connection between fibroadenomas and reproductive hormones has been suggested which may explain why they present themselves during reproductive years, increase in size during pregnancy, and regress post-menopause. |
Higher intake of fruits and vegetables, higher number of live births, lower use of oral contraceptives and moderate exercise are associated with lower frequency of fibroadenomas. |
=== Pathology === |
=== Cytology === |
The diagnostic findings on needle biopsy consist of abundant stromal cells, which appear as bare bipolar nuclei, throughout the aspirate; sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler-like pattern or a honeycomb pattern. These epithelial sheets tend to show typical metac... |
Cellular fibroadenoma, also known as juvenile fibroadenoma, is a variant type of fibroadenoma with increased stromal cellularity. |
=== Macroscopic === |
Approximately 90% of fibroadenomas are less than 3 cm in diameter. However, these tumors have the potential to grow reaching a remarkable size, particularly in young individuals. The tumor is round or ovoid, elastic, and nodular, and has a smooth surface. The cut surface usually appears homogenous and firm, and is grey... |
The pericanalicular type (hard) has a whorly appearance with a complete capsule, while the intracanalicular type (soft) has an incomplete capsule. |
=== Microscopic === |
Fibroadenoma of the breast is a benign tumor composed of a biplastic proliferation of both stromal and epithelial components. This biplasia can be arranged in two growth patterns: pericanalicular (stromal proliferation around epithelial structures) and intracanalicular (stromal proliferation compressing the epithelial ... |
These tumors characteristically display hypovascular stroma compared to malignant neoplasms. Furthermore, the epithelial proliferation appears in a single terminal ductal unit and describes duct-like spaces surrounded by a fibroblastic stroma. The basement membrane is intact. |
== Molecular pathology == |
Up to 66% of fibroadenomas harbor mutations in the exon (exon 2) of the mediator complex subunit 12 (MED12) gene. In particular, these mutations are restricted to the stromal component. |
== Diagnosis == |
A fibroadenoma is usually diagnosed through clinical examination, ultrasound or mammography, and often a biopsy sample of the lump. Suspicious findings on imaging may result in a person needing a biopsy in order to gain a definitive diagnosis. There are three types of biopsies: fine-needle aspiration, core-needle biops... |
== Treatment == |
Fibroadenomas can be expected to shrink naturally, so most are simply monitored. Monitoring fibroadenomas involves regular check-ups to make sure that the breast mass is not growing and is not potentially cancerous. Check-ups involve physical examinations performed every 3–6 months and optional diagnostic imaging perfo... |
Because needle biopsy is often a reliable diagnostic investigation, some doctors may decide not to operate to remove the lesion, and instead opt for clinical follow-up to observe the lesion over time using clinical examination and mammography to determine the rate of growth, if any, of the lesion. A growth rate of less... |
Some fibroadenomas respond to treatment with ormeloxifene. |
Fibroadenomas have not been shown to recur following complete excision or transform into phyllodes tumours following partial or incomplete excision. |
=== Non-invasive surgical interventions === |
There are several non-invasive options for the treatment of fibroadenomas, including percutaneous radiofrequency ablation (RFA), cryoablation, and percutaneous microwave ablation. With the use of advanced medical imaging, these procedures do not require invasive surgery and have the potential for enhanced cosmetic resu... |
==== Cryoablation ==== |
The FDA approved cryoablation of a fibroadenoma as a safe, effective, and minimally-invasive alternative to open surgical removal in 2001. During cryoablation, ultrasound imaging is used to guide a probe into the mass of breast tissue. Extremely cold temperatures are then used to destroy the abnormal cells, and over ti... |
The American Society of Breast Surgeons recommends the following criteria to establish a patient as a candidate for cryoablation of a fibroadenoma: |
The lesion must be sonographically visible. |
The diagnosis of a fibroadenoma must be confirmed histologically. |
The lesion should be less than 4 cm in diameter. |
==== High-intensity focused ultrasound ==== |
High-intensity focused ultrasound (HIFU) is a newer technique for the treatment of malignant and benign tumors of the breast and has shown promising results in the form of complete radiological removal of tumors. An ultrasound beam is focused on a target in the breast and leads to tissue death and protein degradation b... |
== Epidemiology == |
Of all breast tissue samples taken, fibroadenomas comprise about 50%, and this rate rises to 75% for tissue sample in women under the age of 20 years. Fibroadenomas are more frequent among women in higher socioeconomic classes and darker-skinned people. Body mass index and the number of full-term pregnancies were found... |
== References == |
== External links == |
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1190308e181a07c7c3dfb617a97225a404dd9741f97544ebfa91fbed97de9447 wp-fibroadenoma.txt |
TITLE: Invasive carcinoma of no special type |
REVID: 1368882103 |
Invasive carcinoma of no special type (invasive carcinoma NST), invasive breast carcinoma of no special type (IBC-NST), invasive ductal carcinoma (IDC), infiltrating ductal carcinoma (IDC) or invasive ductal carcinoma, not otherwise specified (NOS) is a disease. For international audiences this article will use "invasi... |
Invasive carcinoma NST accounts for half of all breast cancer diagnoses in women and is the most common type of invasive breast cancer. It is also the most commonly diagnosed form of male breast cancer. Invasive carcinoma NST is classified by its microscopic, molecular, and genetic features. Microscopically it is a bre... |
Invasive breast carcinomas are most common in White women, followed by Black and Hispanic women. Black women tend to have greater severity of disease at diagnosis with worse overall survival. Breast cancer is often asymptomatic and diagnosis by screening, but may present with symptoms of pain, palpable mass, skin chang... |
Clinical disease or suspicious lesions on screening may evaluated further with tissue sampling. Diagnostic analysis will include histopathological typing, grading, and analysis for DNA markers and receptor-status. The prognosis for patients with invasive carcinoma NST is heterogenous and difficult to predict for every ... |
== Epidemiology == |
Invasive carcinoma NST is one of the most common types of all breast cancers, accounting for 55% of breast cancer incidence. Of the invasive breast cancers, invasive carcinoma NST accounts for up to 75% of cases. It is also the most common form of breast cancer occurring in men, accounting for 85% of cases. |
The incidence of ductal carcinomas as a whole is 86.3 cases per 100,000 women, with the incidence increasing sharply for women over 40 years of age and peaking at 285.6 cases per 100,000 for women between 70 and 79. This incidence has decreased slightly over time. Incidence of diagnosed cases is highest among White and... |
== Terminology == |
Invasive carcinoma NST is a type of breast cancer. It is one of the invasive breast cancers that originates from the breast ductal system, so that it is a type of ductal carcinoma. A defining feature of this ductal carcinoma is that it lacks the "specific differentiating features" of other types of ductal carcinomas. I... |
The terminology of invasive carcinoma NST has undergone change since 2012. Differing opinions within the medical and public health communities have led to some variance in how this disease is referred in research and clinical settings. |
In 2012 the International Agency for Research on Cancer (IARC), a sub-department of the WHO, published the 4th edition of the WHO Classification of Tumors of the Breast. Previously known as 'invasive ductal carcinoma, not otherwise specified', these most recent guidelines advocated for the use of 'invasive carcinoma of... |
There are, however, differing opinions and practices. The research literature continues to use IDC or invasive ductal carcinoma NOS, and some medical textbooks have offered support for continued use of IDC or invasive ductal carcinoma NOS. |
== Signs and symptoms == |
In most cases breast cancers are asymptomatic and are detected by routine clinical screening exams. In about 30% of cases a breast mass may be felt. The mass will not fluctuate with the menstrual period. Changes to the overlying skin including dimpling, pinching, orange peel-like texture, or nipple retraction may be se... |
== Diagnosis == |
The process of diagnosing invasive carcinoma NST is similar to that of other breast cancers. The process may be prompted by a patient presenting with a palpable mass or by evidence of a suspicious lesion on routine screening tests. Tissue sampling is required for complete classification which will help determine progno... |
This article will discuss the features specific to invasive carcinoma NST. More general and complete discussions can be found in articles on breast cancer screening and breast cancer classification. |
=== Histopathologic criteria === |
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