What are Fibroepithelial Lesions?
Fibroepithelial lesions are a group of breast conditions that involve both the fibrous (connective) tissue and the epithelial (glandular) tissue of the breast. The two most common types are fibroadenomas and phyllodes tumors. These are typically benign (non-cancerous) but may sometimes require monitoring or treatment, especially in the case of phyllodes tumours.
What is a Fibroadenoma?
A fibroadenoma is a benign, solid breast lump made up of glandular and fibrous tissues. It is the most common type of breast lump found in young women, typically between the ages of 15 and 35, although it can occur at any age. Fibroadenomas are usually painless and feel smooth, firm, and mobile under the skin.
Types of Fibroadenomas:
- Simple Fibroadenomas: These are small, uniform, and typically not associated with an increased risk of breast cancer.
- Complex Fibroadenomas: These contain additional components, such as calcifications or cysts, and may slightly increase the risk of breast cancer.
Symptoms:
A round, firm, rubbery lump in the breast.
The lump moves easily under the skin when touched.
Typically painless, but may cause discomfort for some women.
Can vary in size and may enlarge during pregnancy or with hormonal changes.
Diagnosis:
Fibroadenomas are typically diagnosed through:
Clinical Breast Exam: Your doctor will feel the lump and assess its characteristics.
Imaging Tests: An ultrasound or mammogram may be used to evaluate the lump.
Biopsy: In some cases, a biopsy is done to confirm that the lump is a fibroadenoma.
Treatment:
Observation: Many fibroadenomas do not require treatment and may shrink over time, especially after menopause.
Surgical Removal: If the fibroadenoma is large, painful, or growing, it may be surgically removed (lumpectomy).
Prognosis: Most fibroadenomas are benign and do not increase the risk of breast cancer, though monitoring is recommended to observe any changes in size or shape.
FAQs
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Simple fibroadenomas do not increase the risk of breast cancer, but complex fibroadenomas may slightly increase the risk.
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Yes, due to their potential for rapid growth and recurrence, phyllodes tumours are typically surgically removed, even if they are benign.
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Yes, phyllodes tumours, particularly borderline and malignant ones, can recur. Regular follow-up is important.
What is a Phyllodes Tumour?
Phyllodes tumours are rare fibroepithelial lesions that can be benign, borderline, or malignant. These tumours tend to grow more quickly than fibroadenomas and can recur after removal. Phyllodes tumours can occur at any age but are most common in women in their 40s.
Diagnosis: Phyllodes tumours are often diagnosed through
Clinical Breast Exam: Your doctor will assess the size and mobility of the lump.
Imaging Tests: Ultrasound or mammogram can help visualise the tumour.
Biopsy: A core needle biopsy or excisional biopsy is needed to differentiate a phyllodes tumour from other types of breast lumps, such as fibroadenomas.
Types of Phyllodes Tumours:
Benign: Non-cancerous and typically do not spread beyond the breast.
Borderline: Exhibit some characteristics that may suggest an increased risk of recurrence.
Malignant: Cancerous and can spread to other parts of the body, although this is rare.
Symptoms:
A fast-growing lump in the breast, which may become large.
The lump may cause the breast skin to stretch or feel tight.
Some patients may experience discomfort or pain as the tumour enlarges.
When to See a Doctor
You should see a doctor if you notice:
A new lump in your breast.
Changes in the size, shape, or texture of a breast lump.
Any unusual changes in your breast, such as skin dimpling, nipple discharge, or pain.
Prognosis:
Benign Phyllodes Tumours: Generally have an excellent prognosis after surgical removal, but there is a risk of recurrence.
Borderline and Malignant Phyllodes Tumours: These have a higher chance of recurring and may spread, but early detection and treatment improve outcomes.
Conclusion
Fibroadenomas and phyllodes tumours are common types of fibroepithelial lesions of the breast. While fibroadenomas are typically benign and may not require treatment, phyllodes tumours are rare and often need surgical intervention. Early detection and proper diagnosis are essential for effective management.
Treatment:
Surgical Removal: The primary treatment is surgical removal of the tumour with a margin of healthy tissue to reduce the risk of recurrence. This may involve a wide local excision (lumpectomy) or a mastectomy in some cases.
Radiation Therapy: For borderline or malignant phyllodes tumours, radiation may be recommended after surgery to reduce the risk of recurrence.
Chemotherapy: This is rarely used but may be considered for malignant phyllodes tumours that have spread.
FAQs
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A fibroadenoma and a Phyllodes tumour are not the same. The two types of tumours are not related but can present in similar fashion and also look similar under the microscope
In general fibroadenomas tend to occur in younger women aged (20-40), but have been reported in teenagers and the elderly. The incidence tends to reduce after menopause. This differs to Phyllodes tumours that tend to occur in patients who are post-menopausal (ages 50-70) and are rarely seen in teenagers.
Both types of tumours usually present as a painless lump that may be firm and mobile. Phyllodes tend to enlarge at a faster rate than fibroadenomas.
Fibroadenomas are benign and have no ability to spread around the body. They are not dangerous in any way. This is unlike Phyllodes tumours which all have the potential to spread throughout the body. Phyllodes tumours are graded as benign (low chance of spreading), intermediate risk or malignant (with a high risk of spreading).
Clinically these two tumours can be hard to distinguish and a biopsy is required to distinguish the two apart.
Fibroadenomas are benign and not dangerous. Therefore, a fibroadenoma does not necessarily have to be removed. There are certain circumstances where removal of the fibroadenoma is recommended.
Possibility the lesion is a Pyllodes tumour – if the biopsy is atypical
The fibroadenoma is enlarging rapidly. This raises the suspicion that it is a Phyllodes tumour.
Enlargement on follow up imaging- If the fibroadenoma is growing on follow up imaging the possibility of a Phyllodes is raised and removal is indicated.
If the fibroadenoma is causing pain, removal is recommended.
If none of the above reasons are met some patients would prefer to not have a lump within the breast. In these cases of patient concern, removal is indicated.
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Most of the time these lumps can be removed as a day case under general anaesthetic. If your lump is more likely to be a Phyllodes tumour an overnight stay is most likely to be offered.
For fibroadenomas the incision will be dependent on where the lump is within the breast. The aim is to try and hide the scar as much as possible. Usually an incision around the nipple / areolar complex is used.
Phyllodes tumours often need a margin of normal breast tissue removed at the same time. This will require a slightly larger incision. The incision will be placed in a skin crease within the Bra line so as not seen if wearing a low cut top.
All wounds are closed with dissolving sutures and will be covered with a waterproof dressing.
You should be able to return to work within a few days of having the procedure performed.
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Most of the time these lumps can be removed as a day case under general anaesthetic. If your lump is more likely to be a Phyllodes tumour an overnight stay is most likely to be offered.
For fibroadenomas the incision will be dependent on where the lump is within the breast. The aim is to try and hide the scar as much as possible. Usually an incision around the nipple / areolar complex is used.
Phyllodes tumours often need a margin of normal breast tissue removed at the same time. This will require a slightly larger incision. The incision will be placed in a skin crease within the Bra line so as not seen if wearing a low cut top.
All wounds are closed with dissolving sutures and will be covered with a waterproof dressing.
You should be able to return to work within a few days of having the procedure performed.
Common (up to 10% of cases)
Bruising
Need for second operation to obtain clear margins if a Phyllodes is present
Long term pain/discomfort
Prominent scarring
Uncommon (up to 5% of cases)
Wound infection
Bleeding requiring second operation
Defect in the breast with poor cosmesis
Reduction in size of breast (Phyllodes)
Keloid (lumpy) scarring
Rare but important (less than 1% of cases)
Anaesthetic complications
DVT/PE – blood clots in legs and lungs
Heart attack
Allergic reaction