Editing Benign breast lesions (section)

=== '''Fibroadenoma''' ===

** Epidemiology
*** Most common solid benign mass - 50% of all breast biopsies
*** Most commonly found 15-35yo, rare after 40yo
** Pathophysiology
*** Benign solid tumours composed of stromal and epithelial elements
*** Risk of cancer is 0.2%
*** Simple
**** Benign solid tumours containing glandular as well as fibrous tissue
**** No increased risk of developing breast cancer
*** Complex
**** Contains other proliferative changes, such as sclerosing adenosis, duct epithelial hyperplasia, epithelial calcification, or papillary apocrine changes
**** Associated with slightly increased risk of cancer
*** Giant fibroadenoma
**** >10cm or >5cm depending on source
**** Excision recommended
*** Juvenile
**** <18yo
**** Surgical removal is curative, despite rapid growth
** Presentation
*** Well-circumscribed, smooth edges, mobile, rubbery
*** May wax and wane with the menstrual cycle
*** Many patients will have multiple
*** Mildly symptomatic - tenderness or pain worse with menstruation or with pregnancy/COCP
** Natural history
*** Usually become less symptomatic with age, often calcifying in post-menopausal women
** Diagnosis
*** USS, especially in younger women - can readily distinguish between cysts and fibroadenomas
*** Mammogram is not particularly useful, but can show 'popcorn calcifications'
*** USS-guided biopsy confirms dx
** Management
*** Observation if small and asymptomatic
*** Excision indications
**** >3cm in diameter
**** Symptomatic (patient decision)
**** Enlarging rapidly
**** Any suspicious pathological condition associated with the lesion (to exclude phyllodes tumour)
***** Stroma mitoses, stromal overgrowth, nuclear pleomorphism, fragmentation, adipose tissue infiltration, or other concerns
*** Cryoablation is also safe and effective