乳腺線維腺腫 （にゅうせんせんいせんしゅ、英: Fibroadenoma）は、性成熟期の女性の乳房に発生する良性乳腺腫瘍である（ICD10コード：D24 乳房の良性新生物 ICD-Oコード：9010/0）。自己触診で乳腺の弾力のあるしこり（英: lump）として触れることができる。乳がん検診でもマンモグラフィーで境界明瞭な類円形透亮像または粗石灰化を伴う腫瘤として検出されることが多い。線維腺腫から癌が発生することはほとんどない。画像診断で癌との鑑別が困難な例では，穿刺吸引細胞診や針生検による病理検査の対象となる。大多数は未治療のまま経過し閉経期を過ぎると自然退縮することが多い。
目次
- 1 疫学
- 2 症状
- 3 病理組織学的特徴
- 4 腫瘍発生論
- 5 鑑別疾患リスト
- 6 参考文献
- 7 外部リンク
疫学[編集]
良性病変であり正確な有病率は把握できないが、良性乳腺疾患の中では乳腺症と並んで最も頻度の高い疾患である。一般的に触知可能な腫瘤は20-30歳代に多く、マンモグラフィーで偶然発見される非触知腫瘤は40歳代から閉経期以後に多い。
症状[編集]
弾性に富み可動性良好な乳腺腫瘤として触知される。両側乳腺に複数の腫瘤が同時または異時性に発生することもある。長径2cm内外の腫瘤がほとんどだが，若年者では長径5cmを超える大型の線維腺腫（英: Giant fibroadenoma）も認められる。妊娠や授乳期には腫瘤の増大が認められる。閉経期前後では自然退縮し長径1cm前後の円形ないしポップコーン形の石灰化腫瘤としてマンモグラフィーで検出される。
病理組織学的特徴[編集]
周囲の乳腺組織との境界明瞭な円形ないし分葉状の病変を形成する。紡錘系から星芒形の間質細胞（fibroblastic stroma cell）の増殖が主体で、不規則に分岐した終末乳管や腺葉が島状に分布するパターンを示す。間質細胞には稀に大型多形細胞が出現する。乳管上皮は筋上皮細胞との二相性が明瞭である。月経周期に応じて乳管上皮の機能形態が修飾されるので、臨床医には月経周期の記載を求めるのが望ましい。
組織像の多様性に基づいて、管内性・管外性・乳腺症性の3亜型に分類する場合がある。特に乳腺症性線維腺腫は穿刺吸引細胞診で複雑な細胞組成を示す例が多く、癌との鑑別困難な例もある。
腫瘍発生論[編集]
乳腺線維腺腫のような上皮と間質細胞の両方が同調性に増殖する疾患では、どの細胞成分が腫瘍性増殖（クローン性増殖）の主体であるかが問われる。遺伝子再構成などの結果では間質細胞が単クローン性、乳管上皮成分は多クローン性という研究結果が報告されている。今後の研究動向に注目する必要がある。
鑑別疾患リスト[編集]
- 乳腺症
- 葉状腫瘍
- 乳管内乳頭腫
- 乳頭下腺腫
- 乳腺線維症
- 肉芽腫性小葉乳腺炎
- 乳癌
参考文献[編集]
- Cotran RS, Kumar VK, Collins T (ed.) Robbins’ Pathologic Basis of Disease. 6th ed, W.B.Saunders Co. ISBN 072167335X (1999)
外部リンク[編集]
- メルクマニュアル乳腺腫瘍
- [1]NCIの乳腺疾患啓蒙文書（PDFファイル、1.65MB）
Not to be confused with Fibroadenosis.
| Fibroadenoma |
| Classification and external resources |
Histopathologic image of breast fibroadenoma. Core needle biopsy. Hematoxylin & eosin stain.
|
| ICD-10 |
D24 |
| ICD-9 |
217 |
| ICD-O: |
M9010/0-M9012, M9020, M9030 |
| DiseasesDB |
1595 |
| MedlinePlus |
007216 |
| eMedicine |
radio/109 |
| MeSH |
D018226 |
Fibroadenomas of the breast are lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors may recommend a tissue sample (biopsy) to rule out cancer in older patients. Unlike typical lumps from breast cancer, fibroadenomas are easy to move, with clearly defined edges.[1][2]
Fibroadenomas are sometimes called breast mice or a breast mouse owing to their high mobility in the breast.[3]
Contents
- 1 Signs and symptoms
- 2 Diagnosis
- 3 Etiology and epidemiology
- 4 Pathology
- 4.1 Cytology
- 4.2 Macroscopic
- 4.3 Microscopic
- 5 Treatment
- 5.1 Ultrasound Treatment
- 5.2 Cryoablation Treatment
- 6 Fibroadenoma images
- 7 Video on Fibroadenoma
- 8 External links
- 9 References
Signs and symptoms[edit source | edit]
The typical case is the presence of a painless, firm, solitary, mobile, slowly growing lump in the breast of a woman of child-bearing years.[2][4][5]
In the male breast, fibroepithelial tumors are very rare, and are mostly phyllodes tumors. Exceptionally rare case reports exist of fibroadenomas in the male breast, however these cases may be associated with antiandrogen treatment.[6]
Diagnosis[edit source | edit]
Fibroadenoma in ultrasound
A fibroadenoma is usually diagnosed through clinical examination, ultrasound or mammography, and often a needle biopsy sample of the lump.[4]
Etiology and epidemiology[edit source | edit]
Fibroadenomas arise in the terminal duct lobular unit of the breast.[citation needed] They are the most common breast tumor in adolescent women. They also occur in a small number of post-menopausal women. Their incidence declines with increasing age, and, in general, they appear before the age of thirty years. Fibroadenomas are partially hormone-dependent and frequently regress after menopause. They are hypovascular compared to typical (especially malignant) neoplasms.[2][5][7]
Higher intake of fruits and vegetables, higher number of live births, use of oral contraceptives and moderate exercise are associated with lower frequency of fibroadenomas.[8]
Pathology[edit source | edit]
Macroscopic view of fibroadenoma of the breast
Cytology[edit source | edit]
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 metachromatic blue staining on DiffQuick staining. Foam cells and apocrine cells may also be seen, although these are less diagnostic features.[4][7] The gallery images below demonstrate these features.
Macroscopic[edit source | edit]
Approximately ninety percent of fibroadenomas are less than three centimetres in diameter. The vast majority of the remaining ten percent that are four centimetres or larger occur mostly in women under twenty years of age. 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-white or tan in colour. The pericanalicular type (hard) has a whorly appearance with a complete capsule, while the intracanalicular type (soft) has an incomplete capsule.[7]
Microscopic[edit source | edit]
Fibroadenoma of the breast is a benign tumor composed of two elements : epithelium and stroma. It is nodular and encapsulated, included in breast. The epithelial proliferation appears in a single terminal ductal unit and describes duct-like spaces surrounded by a fibroblastic stroma. Depending on the proportion and the relationship between these two components, there are two main histological features : intracanalicular and pericanalicular. Often, both types are found in the same tumor. A) Intracanalicular fibroadenoma : stromal proliferation predominates and compresses the ducts, which are irregular, reduced to slits. B) Pericanalicular fibroadenoma : fibrous stroma proliferates around the ductal spaces, so that they remain round or oval, on cross section. The basement membrane is intact [9] The gallery image below demonstrates both morphological subtypes.
Treatment[edit source | edit]
Most fibroadenomas are left in situ and monitored by a doctor, or the patient in question. Some are treated by surgical excision. They are removed with a small margin of normal breast tissue if the preoperative clinical investigations are suggestive of the diagnosis. A small amount of normal tissue must be removed in case the lesion turns out to be a phyllodes tumour on microscopic examination.[7][10]
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 serially 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 than sixteen percent per month in women under fifty years of age, and a growth rate of less than thirteen percent per month in women over fifty years of age have been published as safe growth rates for continued non-operative treatment and clinical observation.[11]
Some fibroadenomas respond to treatment with ormeloxifene.[12]
Fibroadenomas have not been shown to recur following complete excision or transform into phyllodes tumours following partial or incomplete excision.[7]
There are also natural treatments being touted to diminish fibroadenomas, such as Fibrosolve, but no definite studies have been made as to prove their effectiveness.
Ultrasound Treatment[edit source | edit]
Europe recently recognized an alternative treatment that is called echotherapy and that uses high-intensity focused ultrasound to treat breast fibroadenoma.[13] This method is non-invasive and relies on tissue heating to destroy fibroadenoma cells. Focused ultrasounds have been used for a long time in the treatment of different tumors such as prostate, liver or uterus, where they proved their efficacy.[14][15][16][17]
A French company, Theraclion, develops an echotherapy device for benign tumors treatment especially breast fibroadenoma.
Cryoablation Treatment[edit source | edit]
The FDA has approved cryoablation (the use of extreme cold to destroy tissue) of a fibroadenoma as a safe, effective and minimally-invasive alternative to open surgical removal.[18] In the procedure, 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,[19] and over time the cells are reabsorbed into the body. The procedure can be performed in an office setting with local anesthesia only, and leaves substantially less scarring than open surgical procedures.[19]
The American Society of Breast Surgeons recommends the following criteria to establish a patient as a candidate for cryoablation of a fibroadenoma:[18]
- The lesion must be sonographically visible.
- The diagnosis of fibroadenoma must be confirmed histologically.
- Lesions should be less than 4 cm in diameter.
Fibroadenoma images[edit source | edit]
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Fibroadenoma Histology (H&E). The image demonstrates intracanalicular morphology (top right) and pericanalicular morphology (bottom left)
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Fibroadenoma, Fine Needle Aspiration Biopsy (Giemsa or DiffQuickTM stain). The image shows abundant bare bipolar stromal nuclei surrounding sheets of metachromatic epithelial cells.
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Fibroadenoma, Fine Needle Aspiration Biopsy (Papanicolou stain). The image shows a sheet of epithelial cells in the typical antler pattern.
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Histopathologic image of breast fibroadenoma. Core needle biopsy. Hematoxylin & eosin stain.
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Video on Fibroadenoma[edit source | edit]
- Fibroadenoma Video
- The Doctors Show: Fibroadenoma Cryoabltaion on YouTube
External links[edit source | edit]
- Benign Breast Lumps on Breast Specialist.co.uk
- Theraclion EchoPulse Ultrasound Therapy for Breast Fibroadenomas Cleared in EU
- Theraclion official website
References[edit source | edit]
- ^ Fibroadenomas at Merck Manual of Diagnosis and Therapy Home Edition
- ^ a b c Tavassoli, F.A., Devilee, P., ed. (2003). World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs. Lyon: IARC Press. ISBN 92-832-2412-4.
- ^ Scott-Conner, edited by Carol E.H.; Dirbas, Frederick (2010). Breast surgery office management and surgical techniques. New York: Springer. p. 71. ISBN 978-1-4419-6075-7.
- ^ a b c DeMay, M. Practical Principles of Cytopathology (Revised ed.). ASCP Press. p. 2007. ISBN 0-89189-549-3.
- ^ a b Pathology Outlines Website. [1] Accessed 12 February 2009.
- ^ Shin SJ, Rosen PP (July 2007). [1126:BPOFWD2.0.CO;2 "Bilateral presentation of fibroadenoma with digital fibroma-like inclusions in the male breast"]. Arch. Pathol. Lab. Med. 131 (7): 1126–9. doi:10.1043/1543-2165(2007)131[1126:BPOFWD]2.0.CO;2. PMID 17617003.
- ^ a b c d e Rosen, PP. Rosen's Breast Pathology (3rd ed.). ISBN 978-0-7817-7137-5.
- ^ Nelson, Z. C.; Ray, R. M.; Wu, C.; Stalsberg, H.; Porter, P.; Lampe, J. W.; Shannon, J.; Horner, N. et al. (2010). "Fruit and Vegetable Intakes Are Associated with Lower Risk of Breast Fibroadenomas in Chinese Women". Journal of Nutrition 140 (7): 1294–1301. doi:10.3945/jn.109.119719. PMC 2884330. PMID 20484549. edit
- ^ "Fibroadenoma of the breast". Retrieved 2007-12-15.
- ^ Rosai, J. (2004). Rosai and Ackerman's Surgical Pathology (9th ed.). ISBN 0-323-01342-2.
- ^ Gordon PB, Gagnon FA, Lanzkowsky L (October 2003). "Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up". Radiology 229 (1): 233–8. doi:10.1148/radiol.2291010282. PMID 14519878.
- ^ Dhar, A.; Srivastava, A. (2007). "Role of Centchroman in Regression of Mastalgia and Fibroadenoma". World Journal of Surgery 31 (6): 1178–1184. doi:10.1007/s00268-007-9040-4. PMID 17431715. edit
- ^ http://www.medgadget.com/2012/12/theraclion-echopulse-ultrasound-therapy-for-breast-fibroadenomas-cleared-in-eu.html
- ^ Jolesz FA, Hynynen K, McDannold N, Tempany C. MR imaging-controlled focused ultrasound ablation: a non-invasive image-guided surgery. Magn Reson Imaging Clin N Am 2005;13(3):545-60.
- ^ Gombos EC, Kacher DF, Furusawa H, Namba K. Breast focused ultrasound surgery with magnetic resonance guidance. Top Magn Reson Imaging 2006;17(3):181-8.
- ^ Hynynen K, Pomeroy O, Smith DN, Huber PE, McDannold NJ, Kettenbach J, Baum J, Singer S, Jolesz FA. MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology 2001;219:176-185.
- ^ Marret H, Bleuzen A, Guérin A, Lauvin-Gaillard MA, Herbreteau D, Patat F, Tranquart F. French first results using magnetic resonance-guided focused ultrasound for myoma treatment. Gynecol Obstet Fertil. 2011 Jan;39(1):12-20. Epub 2010 Dec 24.
- ^ a b Management of Fibroadenomas of the Breast
- ^ a b WebMD — Cryotherapy Shrinks Benign Breast Lumps
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Connective/soft tissue tumors and sarcomas (ICD-O 8800–9059) (C45–C49/D17–D21, 171/214–215)
|
|
| Not otherwise specified (8800–8809) |
Soft tissue sarcoma · Desmoplastic small round cell tumor
|
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| Connective tissue neoplasm |
|
Fibromatous (8810–8839)
|
Fibroma/fibrosarcoma: Dermatofibrosarcoma · Dermatofibrosarcoma protuberans · Desmoplastic fibroma
Fibroma/fibromatosis: Aggressive infantile fibromatosis · Aponeurotic fibroma · Collagenous fibroma · Diffuse infantile fibromatosis · Familial myxovascular fibromas · Fibroma of tendon sheath · Fibromatosis colli · Infantile digital fibromatosis · Juvenile hyaline fibromatosis · Plantar fibromatosis · Pleomorphic fibroma · Oral submucous fibrosis
Histiocytoma/histiocytic sarcoma: Benign fibrous histiocytoma · Malignant fibrous histiocytoma · Atypical fibroxanthoma
Solitary fibrous tumor
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Myxomatous (8840–8849)
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Myxoma/myxosarcoma (Cutaneous myxoma, Superficial acral fibromyxoma) · Angiomyxoma · Ossifying fibromyxoid tumour
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Fibroepithelial (9000–9039)
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Brenner tumour · Fibroadenoma · Phyllodes tumor
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Synovial-like (9040–9049)
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Synovial sarcoma · Clear-cell sarcoma
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| Lipomatous (8850–8889) |
Lipoma/liposarcoma (Myelolipoma, Myxoid liposarcoma) · PEComa (Angiomyolipoma)
Chondroid lipoma · Intradermal spindle cell lipoma · Pleomorphic lipoma · Benign lipoblastomatosis · Spindle cell lipoma · Hibernoma
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| Myomatous (8890–8929) |
general: Myoma/myosarcoma
smooth muscle: Leiomyoma/leiomyosarcoma
skeletal muscle: Rhabdomyoma/rhabdomyosarcoma: Embryonal rhabdomyosarcoma (Sarcoma botryoides) · Alveolar rhabdomyosarcoma
Leiomyoma · Angioleiomyoma · Angiolipoleiomyoma · Genital leiomyoma · Leiomyosarcoma · Multiple cutaneous and uterine leiomyomatosis syndrome · Multiple cutaneous leiomyoma · Neural fibrolipoma · Solitary cutaneous leiomyoma · STUMP
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| Complex mixed and stromal (8930–8999) |
Adenomyoma · Pleomorphic adenoma · Mixed Müllerian tumor · Mesoblastic nephroma · Wilms' tumor · Rhabdoid tumour · Clear-cell sarcoma of the kidney · Hepatoblastoma · Pancreatoblastoma · Carcinosarcoma
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| Mesothelial (9050–9059) |
Mesothelioma · Adenomatoid tumor
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see also Template:Connective tissue
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anat (h/n, u, t/d, a/p, l)/phys/devp/hist
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noco (m, s, c)/cong (d)/tumr, sysi/epon, injr
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