What is hidden under the leaf-shaped fibroadenoma of the breast? Fibroadenoma foliaceus: causes, symptoms and treatment Multinucleated cells in fibroadenoma foliaceus

It should be noted right away that leaf-shaped fibroadenoma is considered one of the most dangerous among breast tumors.

And all because it is the leaf-shaped form of such a tumor as breast fibroadenoma (albeit not often), in 10 percent of cases, that has the ability to degenerate into a malignant neoplasm.

At the same time, we hasten to reassure our readers - leaf-shaped fibroadenoma of the breast today is not so common. Rather, in most cases, young women are faced with other types and options for the diagnosis of breast fibroadenoma.

Despite this, of course, hearing such a diagnosis is always unpleasant and frightening. But still, knowing the danger "in the face", it is much easier to deal with it.

Possible types of fibroadenomas in the breast

Today, doctors distinguish only two main types of tumors such as breast fibroadenoma:

Firstly, we are talking about the usual fibrous node, which has the ability to be localized directly in the lactiferous duct of the affected gland. At the same time, according to localization, ordinary fibrous neoplasms can be divided into:

Pericanalicular type formation, which is characterized by a homogeneous structure and a rather dense consistency, with a clear restriction of the tumor-like process from the surrounding breast tissues. This type of breast fibroadenoma can sometimes undergo various kinds of dystrophic modifications, in which calcifications can be deposited.

Intracanalicular type of formation, when the described tumor is characterized by a lobular structure, not very clear contours, and even a heterogeneous structure.

And of course, a mixed type of tumor, which can have both a lobular and a homogeneous structure, both a homogeneous and somewhat heterogeneous structure, in general, with the simultaneous presence of obvious signs characteristic of the two types described above.

And secondly, we're talking about a condition called foliar fibroadenoma (or it's also called phyllodes). This is a condition that most often begins to form from a pre-existing intra-flow form of the disease.

It is believed that leaf-shaped fibroadenoma can be characterized by its rapid growth and rather large size. Moreover, in some cases, leaf-shaped fibroadenoma can cover a significant part of the mammary gland, namely, from one second to three quarters of the affected breast.

By the way, the leaf-shaped form is the only existing variety of the described disease, which, under certain circumstances, can still develop into a malignant breast formation, which, in general, does not happen often, namely, no more than 10% of all possible cases.

In addition, it is important to understand that fibroadenoma can be fully mature and not fully mature. At the same time, in the first case, the fibroadenoma has a dense elastic structure, a completely formed capsule, and is characterized by extremely slow progress. Such a seal may have constant dimensions over many years.

As a rule, the immature type of fibroadenoma has a softer consistency, such a neoplasm has the maximum tendency to the most active progressive growth.

How does the international classification of diseases describe such tumors?

According to the latest international classification of diseases, the leaf-shaped form of a breast tumor belongs to the group of so-called fibro-epithelial neoplasms. Moreover, this classification distinguishes at least two histological variants of tumors, which are a phylloid form:

This, of course, is a leaf-shaped form of a benign formation with the code 9020/0.
And this is a leaf-shaped tumor of a malignant nature with the code 9020/3.

It is believed that the leaf-shaped variants of tumors occupy the so-called intermediate value (or position) between benign tumors (fibroadenoma in particular) and malignant tumors or breast sarcoma.

How do leaf-shaped forms of fibroids manifest themselves

The ever-increasing demands for earlier detection of phylloidal forms of the disease require the most clear differentiation of the usual fibrous node from that with a leaf-like structure.

It can be argued that the symptoms of leaf-shaped variants of the disease, although not in many ways, still differ from the primary (less complex) manifestations of the problem.

For example, we can say that phylloidal forms have a much more redundant stroma, which in turn has a more complex even architectural structure. The main symptoms of such a tumor mean:

The neoplasm looks like a completely delimited formation, with a specific lobed structure.
If the size of such a tumor is large, then there is a clear thinning of the skin over the problem area.
Symptoms of such a tumor may include a pronounced venous pattern on the affected breast.
But the size of such a tumor can even reach 35 cm in diameter.

Naturally, with large and even gigantic tumors, the possibility of quickly making an absolutely correct diagnosis can increase dramatically. Note that for leaf-shaped forms, the most typical picture may be when the neoplasm occupies almost the entire affected mammary gland. In this case, the tumor may have an oval or completely irregular, but always rounded shape.

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It is important to treat such a disease as quickly as possible, always by surgery, and with a strictly mandatory histological examination of the excised material.

It is always important to remember that a timely detected disease, its timely treatment (operation is no exception) gives a woman every chance for further health and a completely happy life.

Do you still think that it is completely impossible to cure your body?

How can they be identified?

nervousness, sleep disturbance and appetite;
allergies (watery eyes, rashes, runny nose);
frequent headaches, constipation or diarrhea;
frequent colds, sore throat, nasal congestion;
pain in the joints and muscles;
chronic fatigue (you get tired quickly, no matter what you do);
dark circles, bags under the eyes.

One of the most common pathologies in our time has become leaf-shaped fibroadenoma of the mammary gland, which is one of the varieties of mastopathy.

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Description of the disease

Fibroadenoma occurs against the background of hormonal disorders, it is a benign formation, which over time can transform into cancer.

A leaf-shaped tumor has several names - phylloin, myxomatous or intracanalicular fibroadenoma. There are also three stages of fibroadenoma:

benign;
border;
malignant.

This is a two-component neoplasm in the mammary gland, when the proliferating epithelial and connective tissue merges, with the former predominating. Among the variety of fibroadenomas found in women, the leaf-shaped form makes up a share of 0.3-1%.

It's important to know: the transition to a malignant formation occurs in 3-5% of cases, this is the highest rate among all breast fibroadenomas encountered.

In 10% of cases, transformation into sarcoma occurs. 90% of patients have a single nodule of education, only 9.3% of the occurring formations are bilateral, 9.4% are multiple.

Outwardly, fibroadenoma looks like a seal with a lobed structure, has a distinct contour and a smooth surface, and can consist of several nodes.

note: a characteristic feature of the disease is the rapid growth of the neoplasm.

There are three types of formations, most often the first develops:

pericanalicular;
intracanalicular;
mixed.

Doctor's comment: most often the disease is common in the age group of women from 40 to 50 years, and also from 11 to 20 years.

In extremely rare cases, the disease is diagnosed in men. During pregnancy, the development of fibroadenoma is especially dangerous because it blocks the milk ducts and prevents the timely outflow of milk. Such moments provoke mastitis, which entails extremely negative consequences for the newborn and his mother.

Causes

The main reason for the occurrence of fibroadenoma itself is serious hormonal disorders caused by a lack of progesterone and / or excessive production of estrogen. An excess of estrogen provokes proliferation, that is, the growth of glandular tissue cells in the form of separate foci.

Often occurs against the background of natural changes in hormonal levels as a result of puberty, pregnancy, lactation or menopause. In most cases, the development of the disease is accompanied by pathologies of the ovaries and thyroid gland.

Factors provoking the development of phyllodes fibroadenoma:

excess body weight;
natural hormonal changes: pregnancy, lactation, menopause, puberty;
abortion;
the formation of nodes in the thyroid gland;
liver disease;
disorders of the pituitary and adrenal glands;
diabetes;
mastopathy of fibrocystic form;
ovarian dysfunction;
the use of hormonal contraceptives, especially emergency ones.

Symptoms and diagnosis of the disease

The course of the disease takes place in two phases. The first can be very long in time, when cells grow slowly. In the second phase, rapid and sharp cell growth starts.

They are most often located in the center or on top of the mammary gland. If the size of the tumor is large, then it can gradually fill the entire hemisphere of the chest. The danger of a malignant tumor is the rapid development of metastases to the liver, bones and lungs, without affecting the lymph nodes.

Symptoms:

visible dense formation on the mammary gland;
discharge from the nipple of the affected breast;
tracking a clear contour of the tumor;
thinning and blue skin over the mammary gland;
pain sensations;
the formation is mobile and does not disappear during palpation of the lying patient.

It is worth noting: the benignity of the tumor does not depend on its size: small nodules may be malignant, while a tumor that fills the entire breast may be benign.

You can diagnose the disease in various ways and in several stages:

Carrying out examination and palpation of the chest, according to the results of which to prescribe mammography and ultrasound. X-rays show fuzzy contours of the tumor and heaviness along the periphery. Ultrasound shows an area of indistinct contours and heterogeneous echogenicity, acceleration of blood flow.
Based on the data of ultrasound and mammography, the doctor prescribes a biopsy of the fibroadenoma, which allows you to determine the nature of the disease as accurately as possible. A biopsy takes place as follows: a tiny incision is made, tumor tissue is taken, which is then examined, as a result of which the presence of atypical cells is detected.

Fibroadenoma is mobile, while in some cases it can increase or decrease, depending on hormonal processes in the body.

Treatment options

Treatment of myxomatous fibroadenoma is carried out exclusively through surgical intervention. Directly, the method of removing the tumor is chosen by a specialist based on the history, tests and histological examination.

Possible surgical options:

Enucleation: performed only in cases where there is no suspicion of malignancy of the tumor. The tumor is removed directly.
Sectoral resection: a sector of the breast is removed, including the tumor itself. The operation is performed within healthy tissues.

Sectoral resection is performed only at the first two stages of fibroadenoma development: benign or borderline. The operation is performed under local or general anesthesia, depending on the indications. The length of stay in the hospital after the end of the operation is from 2 to 24 hours. If it is necessary to remove the sutures, this occurs on the 10th day after the operation.

If the tumor is 8 mm in size, then an urgent histological examination of the removed tissues will be an obligatory procedure. Then a sectoral resection is performed. These measures are aimed at excluding malignancy and sarcoma.

This type of operation is also indicated for patients planning a pregnancy. And urgently. The reason is simple: hormonal changes during pregnancy can provoke a new round in the development of the disease, or, even worse, provoke the transformation of cells into a malignant variant.

In cases where the fibroadenoma reaches a large size, the patient is shown a radical dissection or a complete mastectomy. A similar method is also used for the degeneration of tumor cells into a malignant stage.

The consequences of the disease and relapses

Leaf-like fibroadenoma is characterized by a tendency to relapse. Benign ones reappear in about 8% of cases, 20% malignant and 25% intermediate.

In this case, there is a risk of a tumor of a different stage than before. After a radical mastectomy, patients undergo reconstructive mammoplasty using implants or their own tissues.

After the operation, patients need to provide psychological assistance and rehabilitation measures to avoid depressive disorders and the development of lymphostasis, that is, lymphatic edema of the upper extremities.

What is fibroadenoma, see the doctor's comments in the following video:

Leaf-shaped (it is also called phyloid) fibroadenoma most often affects the soft tissues of the mammary glands and appears as an active proliferation of epithelial cells, which, in turn, should not turn into malignant tumors. In addition, leaf-shaped fibroadenoma of the mammary gland over time can turn into a sarcoma, which will significantly aggravate the course of the entire disease.

Phylloid fibroadenoma usually occurs as a separate disease that is benign. The development of the disease is the formation of a single node, which, in turn, will consist of glandular tissues and connective skin areas. Quite often, the fibrous form of adenoma affects women whose age has reached 30 years. In this case, small nodules over time can form into giant tumors, the diameter of which will be greater than 3 centimeters.

Fibroadenoma received such an unusual name due to the fact that the tumor resembles in its structure the shape of a leaf and its veins. Scientists managed to prove the fact that this type of fibroadenomas is considered very dangerous and the risk of developing a malignant tumor increases several times.

Physiological features of leaf-shaped fibroadenoma

This form of fibroadenoma is most often diagnosed in women aged 11 to 20 years, as well as in the period from 40 to 50 years. There are cases when the disease affected the stronger sex. The formation of this kind of formation occurs spontaneously and very quickly increases in size.
It is known that fibroadenoma can degenerate into a malignant tumor, and also manifest itself in recurrent cases. If leaf-shaped fibroadenoma is present, veins become clearly visible on the skin of the breast, which in turn gives a bluish tint to a certain area of \u200b\u200bthe breast.

Fibrous tumor of the leaf-shaped form can be divided into the following varieties:

benign neoplasms;
malignant neoplasms;
intermediate neoplasms of the mammary glands.

When diagnosing a leaf-shaped tumor, its size can range from 1 to 35 centimeters. The difference in diameter during the course of the disease is not of great importance. After all, the presence of even the smallest fibroadenoma increases the risk of transition to a malignant tumor.

With the development of an adenoma of this nature, a woman experiences regular pain in her chest, and there is also a slight discharge from the nipples. In the case of diagnosing a malignant formation, metastases can affect the skeletal system, lungs and even the liver.

Symptoms of the disease

Symptoms of the development of leaf-shaped fibroadenoma appear already at the initial stages of the course of the disease. In this case, a woman can clearly see the following signs of the disease:

With the passage of time and an increase in the age of the patient, the fibroadenoma may not increase in diameter, but this does not mean that in the future it will completely resolve.

With the development of nodular fibroadenoma at the age of 40, the chances that such a formation will be malignant increase significantly.

Diffuse mastopathy and nodular fibroadenoma can often be concomitant diseases of the breast. The main reason for the appearance is considered to be changes in the production of female hormones. When diagnosing several ailments, cysts form, which in turn will be filled with a clear liquid.

Diagnosis and treatment of the disease

Thanks to modern technologies and developments, it is quite simple to establish the nature of education and the place of its localization. Most often, the specialist recommends an ultrasound diagnosis of the breast, a mammography procedure, a thorough palpation of the glands, and also, if a malignant tumor is suspected, a biopsy.

A biopsy is most often performed immediately before surgery is planned. Palpation also makes it possible to establish the number of nodules and their limitation from the soft tissues of the chest. On ultrasound, you can clearly see how the veins and arteries are located around the adenoma. This gives a lot of information for successful surgical treatment.

Depending on the type of diagnosed adenoma, the specialist can choose different methods of treatment. Most often, with such a diagnosis, radiation and hormonal therapy are prescribed.

If the size of the tumor does not reach 1 centimeter, then surgical treatment is not mandatory. In this case, the patient must be regularly observed by doctors and follow all the recommendations and prescriptions of specialists.

If in the dynamics it is possible to note the growth of the neoplasm, then "enucleation" will be required. This procedure involves removing the tumor by removing some part of the breast.

When diagnosing a malignant tumor, surgery is considered the only right decision in such a situation. The operation is performed by the method of sectoral resection, that is, during the procedure, a cancerous tumor is removed along with the adjacent soft tissues.

Do not forget that leaf-shaped fibroadenoma is prone to relapse. Usually, the tumor can make itself felt in a month or 5 years after the treatment. If the formation has degenerated into a cancerous tumor, then an operation is urgently performed, during which the mammary gland and the frolicking tumor are completely removed.

In order to avoid the development of severe consequences of the disease, it is very important to diagnose the disease at its initial stages. The sooner the course of treatment is carried out, the less likely it is that the formation will be converted into a malignant tumor.

Fibroadenoma of the mammary gland or phylloid tumor is a fibroepithelial formation and a borderline form between normal fibroadenoma and sarcoma, arises from intraductal fibroadenoma. The leaf-shaped tumor got its name because of a certain structure resembling leaf veins. This fibroadenoma belongs to the group of potentially malignant tumors.

Characteristic

A leaf-shaped tumor is a clearly demarcated seal with a lobed structure that does not have its own capsule. Fibroadenoma is usually very mobile and does not adhere to the skin. In the section, a dense focus contains a viscous mass of mucus and consists of slit-like cavities with small cysts. A large tumor has polypoid growths in the cystic cavities. This type of tumor may contain one or more nodules. Compared with the usual fibroadenoma, the leaf-shaped tumor has a more complex structure and a greater polymorphism of stromal cells.

Leaf type fibroadenoma can occur in women of any age, but the periods of hormonally active age are considered the most frequent: 11-20 years, 40-50 years. Quite rarely, such an education is found in men. This neoplasm is prone to rapid development, degeneration into a malignant tumor and relapses. With a large size of leaf-shaped breast fibroadenoma, the skin of the breast becomes thinner, with clearly visible dilated saphenous veins and a bluish tinge of the affected area of the chest.

Leaf tumor is divided into 3 main forms:

benign;
malignant;
border or intermediate.

The size of a leaf-shaped tumor of the breast varies between 1-35 cm, which does not matter, because even the smallest neoplasm can be malignant. Fibroadenoma foliaceus may be accompanied by chest pain and discharge from the nipple. Breast cancer can metastasize to the bone system, liver, or lungs.

Causes

It has not yet been possible to find out the exact causes of the occurrence of a phyllodes tumor, but usually a leaf-shaped fibroadenoma and its appearance is associated with an imbalance in estrogen performance and a decrease in progesterone. The factors provoking its occurrence are considered to be the following:

pregnancy;
lactation;
repeated abortions;
fibrocystic mastopathy;
diabetes;
obesity;
thyroid tumor;
ovarian tumors;
fibroadenoma of the uterus;
pathological processes of the liver;
other processes that cause hormonal imbalance in the body.

The course of this disease has a staging; at the beginning, the process of development of education can proceed hidden and without obvious symptoms. A leaf-shaped tumor can be in a frozen state for a long time, but various factors can provoke its growth, among which there is pregnancy. Fibroadenoma of the mammary gland of the leaf-like type can develop slowly, the terms of its growth sometimes reach up to 10 years.

Diagnostics

To accurately determine the type of tumor and its nature, you need to undergo a series of examinations, including ultrasound, palpation, mammography, dopplerography, needle biopsy and cytological examination of the material.

Palpation reveals compaction, delimitation of the tumor, the number of nodes. Ultrasound of the breast reveals a hypoechoic connection with multiple fluid cavities and crevices, resembling a cabbage head in structure. Doppler ultrasound reveals a network of various veins and arteries surrounding the fibroadenoma. Mammography determines the form of fibroadenoma, its structure and intensity of development. Cytological assessment of the tumor is needed in the preoperative time.

Treatment

With leaf-shaped fibroadenoma, radiation and hormonal therapy are not indicated, and the operation of lymphadenectomy, during which lymph is removed, is also not performed. A benign leaf-shaped tumor with a diameter of not more than 1 cm does not require urgent treatment, it is enough to be regularly observed and examined using ultrasound and mammography tests. With an increase in benign phyllodes fibroadenoma or its increased growth, an “enucleation” operation is performed - exfoliation of the tumor or “quadrantectomy”, removing a quarter of the mammary gland.

Fibroadenoma of a malignant nature with rapid growth and large size requires immediate surgical intervention. Such an operation is performed by sectoral resection - the removal of a cancerous formation along with its surrounding tissue.

A leaf-shaped tumor is also dangerous in that it is prone to relapses, the terms of which range from a month to 5 years. Benign fibroadenoma of the mammary gland is able to degenerate into a borderline or malignant form. In case of repeated recurrence, the entire mammary gland is removed. After radical measures, mammoplasty can be performed both with the help of one's own tissue and with endoprostheses.

Leaf-shaped fibroadenoma is an insidious disease, the course of which is characterized by unstable and sudden development, which can lead to malignancy of the tumor. With early detection, the prognosis of treatment is quite favorable. Therefore, women are advised to undergo a timely examination by a mammologist and regularly examine their breasts by touch in order to identify and prevent the development of a dangerous leaf-type breast fibroadenoma in time, as well as to avoid surgical interventions that deform the mammary gland.

What is it: leaf-shaped fibroadenoma of the breast? This is a tumor that some doctors call phyllodes. By its nature, it represents a fibroepithelial neoplasm, initially of benign origin.

It can be confused with a cyst, but in fact it has the appearance of leaf-shaped lobed veins with small cysts. The neoplasm does not have a separate capsule, and its contents are a jelly-like mass.

The leaf-shaped form has a more complex structure compared to other types of fibroadenoma.

In advanced cases, the tumor can reach a significant size. At the same time, it becomes visually noticeable, as the skin on the chest acquires a bluish tint and becomes thinner due to the existing tension. Changes also occur inside - polypoid growths are formed.

Forms of the disease

Important! The leaf-shaped form of fibroadenoma is the most dangerous, as it can become malignant within a short period of time.

In total, there are three types of it:

Benign. It does not threaten the health of a woman, since the tissues do not undergo pathological changes.
Border. This is an intermediate stage between benign and malignant neoplasm.
Malignant. Acquires the properties of oncology, turning into breast sarcoma, capable of metastasizing.

Reasons for development

The exact causes of the pathology, as well as its degeneration into oncology, are unknown, but a number of provoking factors can be distinguished:

hormonal surges during puberty;
diseases of the reproductive system, such as ovarian cysts or uterine fibroadenoma;
pathology of the endocrine system, incl. diabetes;
fibrocystic mastopathy;
pregnancy;
lactation;
previous abortions;
excess weight;
violation of metabolic processes in the body;
liver pathology;
bad habits;
stress;
reduced immunity;
other circumstances that affect the level of hormones in the body.

Important! Fibroadenoma foliaceus is very sensitive to the level of hormones in the body. If the balance of estrogen and progesterone is disturbed, the risks of developing a tumor in the mammary glands increase.

Symptoms of manifestation

Depending on the factors affecting the tumor, it may not manifest itself clinically for a long time and grow at a slow pace. There are cases when the tumor did not manifest itself for more than 10 years. As long as its size is small, it does not cause concern to the patient. If the neoplasm increases to a size of more than 5 cm, it causes significant discomfort. In addition, such a development of pathology causes a lot of suspicion and requires immediate medical intervention.

Symptoms of leaf-shaped fibroadenoma of the breast are as follows:

palpation in the chest of a movable seal;
the appearance of a subcutaneous tubercle;
thinning of the skin, a change in its color at the site of neoplasm growth;
the appearance of pain and discomfort in the chest;
engorgement of the mammary glands;
the appearance of discharge from the nipple;
increased fatigue;
expansion of the saphenous veins;
a slight increase in body temperature is possible;
loss of appetite.

Diagnostics

If a woman has noticed similar symptoms or simply has suspicions about the presence of a pathological neoplasm in the breast, she should immediately contact a medical facility.

Important! In rare cases, the disease is diagnosed in men.

After examining the patient and palpation of the neoplasm, the following diagnostic measures can be prescribed:

ultrasound. Leaf-shaped fibroadenoma on ultrasound looks like a cystic neoplasm with a complex structure.

Dopplerography. Allows you to additionally examine the vessels in the area of pathology and identify hypervascularization of the neoplasm.
Mammography. X-ray examination of the mammary glands, revealing changes in their structure. Especially recommended for women of middle and older age.
Needle biopsy. It is carried out under ultrasound control. The material taken is sent for histological and cytological examination to find out the exact type of neoplasm and the degree of risk to the patient's health.

Treatment Method

Fibroadenoma can be treated in a variety of ways. With small sizes and the absence of intensive growth, conservative methods are sufficient.

Important! It is necessary to establish the right lifestyle in order to naturally equalize the hormonal background of the patient.

Medications are prescribed according to individual indications. Otherwise, it is important to see a doctor regularly to monitor the condition of the tumor.

Advice! Alternative methods can be used only with the approval of the attending physician. For example, a cabbage leaf with fibroadenoma is applied at night to the affected mammary gland to relieve discomfort and inflammation of the tissues.

With sizes of more than 1 cm, as well as identifying the risk of degeneration of the neoplasm, surgical intervention is required. You can remove the tumor in the following ways:

radio or laser enucleation;
quadrantectomy;
sectoral resection;
cryoablation;
mastectomy.

If necessary, further mammoplasty is performed to restore the shape of the breast. In the future, it is necessary to be regularly examined by a doctor, since the disease can relapse.