Introduction
Fibroepithelial lesions of the breast are frequently encountered tumors with both stromal and epithelial components. Although they are both fibroepithelial lesions, phyllodes tumor, and fibroadenoma are managed differently. A fibroadenoma does not require additional workup, while a phyllodes tumor has to be surgically removed. It is challenging to differentiate between the more aggressive phyllodes tumor and the benign fibroadenoma due to their numerous overlapping histological characteristics. Fibroepithelial lesions of the breast affect 10 to 15 % of women. Breast phyllodes tumors make up about 2.5 % of all fibroepithelial tumors and 0.3 % to 1 % of all primary breast tumors.
The World Health Organization has recommended that phyllodes tumors be classified as benign, borderline, or malignant. Malignant phyllodes tumors often spread, have a poor clinical prognosis, and have high rates of recurrence, in contrast to benign and borderline phyllodes tumors, which have favorable prognoses and low rates of recurrence.
What Is a Fibroadenoma?
A benign (non-cancerous) breast bulge is called a fibroadenoma. This smooth, spherical, solid tumor is made up of glandular and fibrous tissue that combine to form a mass. Breast cancer can very rarely be found inside a fibroadenoma. Untreated fibroadenomas frequently shrink or disappear. The physician may suggest surgery to remove a fibroadenoma or monitor it over time to see how it changes. The breast tissue's lobules are where fibroadenomas develop. The glands in the breasts, called lobules, are responsible for producing milk during lactation. Some people think the cause of fibroadenoma is estrogen sensitivity. This is because fibroadenomas are more likely to shrink during menopause (when estrogen levels are lower) than to develop during pregnancy or hormone treatment (when estrogen levels are greater).
Fibroadenomas come in two primary forms:
Simple Fibroadenoma: The most prevalent kind is simple fibroadenomas. They are often smaller. The probability of breast cancer is not increased by these bumps. The biopsied tissue appears uniform under a microscope, meaning that all cells have the same appearance.
Complex Fibroadenomas: People over 35 are more likely to develop complex fibroadenomas, which also tend to be larger. The doctor may discover some cell variations under a microscope (they are not uniform like a simple fibroadenoma). On the mammography, the doctor can also see cysts or calcifications. They may raise the chance of breast cancer slightly when compared to that of people without breast lumps. Complex fibroadenomas are complex in 15 % of cases.
Other forms of fibroadenomas include:
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Giant Fibroadenomas: Fibroadenomas that develop to be greater than five centimeters (cm) are known as giant fibroadenomas.
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Juvenile Fibroadenoma: Between the ages of 10 and 18, children and teens can develop juvenile fibroadenoma. They are rare.
What Are Phyllodes Tumors of the Breast?
A phyllodes tumor is an uncommon kind of tumor that develops in the breast's connective tissue. Most likely, the fatty tissue that makes up the breast's volume or the glandular tissue that secretes milk comes to mind when anyone thinks about breast tissue. Connective tissue is The fibrous, supporting tissue that keeps these other tissues in place. Tumors in phyllodes are composed of this material. Similar to scar tissue, they are tough and fibrous. Their name, phyllon, comes from the Greek word "leaf," which describes the pattern they display under a microscope. Another name for them is "cystosarcoma phyllodes." Although they are often benign (not cancerous), they can occasionally be malignant (cancerous).
What Is the Difference Between a Phyllodes Tumor and Fibroadenoma?
The most prevalent kind of benign breast lumps are fibroadenomas. They are also found in the connective tissue of the breast. Even with medical imaging, they can be difficult to distinguish from phyllodes tumors. Although fibroadenomas are benign, they may occasionally transform into another type of tumor. Many think fibroadenomas might develop into phyllode tumors.
The healthcare providers must identify if the tumor is a phyllodes tumor or a fibroadenoma. Providers handle the two categories differently because of the differences in their behavior. Fibroadenomas usually do not change much over time, although even benign phyllode tumors can develop rapidly and cause discomfort. They are frequently taken out in advance.
How Are Fibroepithelial Lesions Diagnosed?
Anytime anyone detects changes in the breasts, such as a lump, get in touch with a medical professional. Certain fibroadenomas are too rare to be detected. If a medical professional discovers a lump, the physician may do these tests to identify the type of lump:
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Imaging scans, such as ultrasounds and mammograms.
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Core needle breast biopsy with image guidance. To perform this test, a sample must be taken and sent to a laboratory for examination.
To differentiate between a phyllodes tumor and a fibroadenoma, a biopsy is usually necessary. If the diagnosis remains uncertain, the doctor may recommend an excision biopsy, which involves removing the entire tumor. In any case, this would be the suggested course of action for a phyllodes tumor. They will find out from the biopsy what kind of tumor it is and whether it is suspicious or malignant. If so, they will check to see whether it did not spread to any other parts of the body.
How Are Fibroepithelial Lesions Treated?
When left untreated, some fibroadenomas get smaller or disappear. The doctor could advise follow-up sessions to check on the lump for any changes if a biopsy results in non-cancerous results (typically in three to six months). This might entail a mammography, ultrasound, or physical breast exam. A physician may occasionally advise surgery to remove a fibroadenoma. This occurs if the lump is painful or if they are worried about the outcome of the biopsy or imaging testing. Large fibroadenomas may require surgery. Surgical excision is the most typical method of fibroadenoma removal (cutting the lump out). Cryoablation is a different approach that entails freezing the fibroadenoma.
By removing a benign phyllodes tumor, one can stop it from spreading, getting worse, or changing and turning cancerous in the future. Because it might grow and alter fast, it also eliminates the need for both the patient and the doctor to do biopsy examinations regularly.
Treatment for benign and malignant phyllode tumors involves lumpectomy, which is the surgical excision of the tumor along with a margin of healthy tissue surrounding it. The margin aids in preventing them from recurring again, which can happen with both types. The surgeon could advise radiation treatment to the breast after surgery if the tumor is malignant.
Conclusion
Fibroepithelial lesions (FELs) are one of the most prevalent types of lesions in the breast. These tumors exhibit biphasic behavior, with both the stromal/mesenchymal and epithelial components proliferating. Fibroadenoma (FA) and phyllode tumors are two of the main components of this class of tumors (PT). Since FELs have similar morphologies and differ significantly in how they are managed, further information from genetic research is required to help doctors diagnose and treat each entity more precisely.
