Leaf-shaped fibroadenoma of the mammary gland or myxomatous is an uncommon disease that is a two-component formation. It is dominated by growths in the epithelium and in the connective tissue, and the latter is many times larger. Among all breast neoplasms, myxomatous fibroadenoma can be detected only in 3-5% of cases. The disease is rarely diagnosed on time, so the risk of malignancy is very high. In one case out of ten, fibroadenoma degenerates into sarcoma. In addition, the tumor is rapidly growing, often recurs, and surgery is indispensable.

Fibroepithelial dense in structure formation that does not have capsular limitation. The structure is lobulated, not involving the skin. However, with giant forms, ingrowth into the pectoral muscle can occur. Histological examination of the tissue reveals the presence of viscous mucus, which is contained in the cystic cavity. Slit-like cysts can be either in a single instance or represented by many polypoid inclusions. The color of the tumor is gray-white or pink with coarse-grained components and lobules. Also, the neoplasm can be in one breast or in both mammary glands. Cases of leaf-shaped formation have also been registered in men, despite the difference in the structure of tissues with the female breast.

The classification of a leaf-shaped tumor depends on the size, growth rate and forms of damage to the stroma of the mammary gland.

Small, up to 5 cm in diameter, leaf-shaped neoplasms have a structure of slit-like depressions, clearly localized. If the tumor is larger than 5 cm, histology shows cystic "clustered" growths that consist of more than one node.

The classification of leaf-shaped neoplasm forms is approved by an international degree. Distinguish:

• benign
• Intermediate or borderline
• Malignant

The growth rate does not depend on the malignancy of the process. Even a small education can be a threat to life. Phylloid fibroadenoma is characterized by a rapid pace of development.

How dangerous is she

The danger of a tumor is the possibility of developing proliferative processes that carry a carcinogenic threat. The risk of progression of cancer cells in phyllodes fibroadenoma is several times higher than in ordinary fibromastopathy.

Also, this formation is characterized by a rapidly growing tumor. The rapid replacement of healthy tissues with tumor-like growths contributes to the deformation of the shape of the breast. A leaf-shaped neoplasm grows to a gigantic size if there is no adequate therapy.

Metastasis of tumor cells in phyllodes fibroadenoma occurs along the intracanalicular pathway - through the channels and ducts of the mammary gland. It is very difficult to treat advanced cases.

Even after surgical treatment, the disease is capable of recurrence, therefore, a woman who has undergone leaf-shaped fibroadenoma should be monitored all her life.

The diagnosability of the disease is very low compared to other breast tumors. It is determined quite by chance during an examination using ultrasound.

Reasons for development

One of the main signs that contribute to the proliferation of pathological tissues of the leaf-like type is the hormonal factor. Active production of hormones falls on the reproductive age - from 20 to 40 years. It is during this period that the possibility of the formation of the progression of phyllodes fibroadenoma appears. Also, malfunctions in the hormonal system, and precisely estrogen and progesterone, are observed in the premenopausal period of a woman's life. There is a high risk of developing the disease from 50 years of age.

Provocateurs of pathology are considered:

• Frequent aborted cases.
• The lactation period and its violations (for example, abruptly interrupted breastfeeding).
• Disturbed metabolic processes, including failures of metabolic processes and obesity.
• Cancers of other organs, including the ovaries and uterus.
• Chronic diseases (diabetes mellitus type I and II, hepatitis and others).
• Possible disturbances in the activity of the endocrine system.
• Reduced protective functions of the immune system.

A particular cause of leaf-shaped fibroadenoma is a genetic predisposition to the formation of mutagenic cells and heredity.

Symptoms of manifestation

Leaf growths in the breast of a woman are of a two-stage nature: a long-term disease may not make itself felt for many years, but with a certain push (hormonal, immune, and others), progressive tumor growth is provoked. It has a rapid development and is called myxomatous giant fibroadenoma.

The initial period is characterized by the absence of symptoms of leaf-shaped fibroadenoma. Often, a breast lump is identified as a small movable ball to the touch, or with the help of diagnostic procedures: ultrasound or mammography.

The second stage is the growth of cells, which can take oncological form. This is manifested by the following symptomatic triad:

• Allocations
• Burning

Pain in the chest with leaf-shaped fibroadenoma can be constant, aching, or occur after physical exertion or stress and a sharp change in the emotional background. Discharge from the nipples is an interlobular effusion of cancer cells, it can be yellow, light gray or milky in color. With large tumors, the discharge has a reddish tint or with impurities of blood streaks, since the pectoral muscle is affected.

Burning is present in the chest, where a small nodule of fibroadenoma is located. At the same time, the skin above it begins to thin and turn blue. Dilated venous ducts are clearly visible, which also extend to the armpit.

In giant or advanced cases of leaf-shaped fibroadenoma, the formation of ulcers on the skin is considered a rare occurrence.

The general condition of the body also suffers. Among the symptoms of well-being, there is an increase to subfebrile temperature, weakness, malaise, loss of appetite or its absence at all. With further malignancy of the tumor, anemia develops. Medicines to relieve pain and other symptoms do not work.

When leaf-shaped fibroadenoma metastasizes, neighboring organs are affected, then the symptoms will be associated with them - pain in the liver, lungs, and so on.

Diagnostics

Diagnosis of leaf-shaped fibroadenoma is difficult, since it has been in "sleep mode" for many years. If a seal of any size is determined in the chest, you should immediately seek medical help by visiting a mammologist.

The doctor will prescribe an extended diagnostic examination, which includes:

• Ultrasound examination of both mammary glands.
• X-ray mammography (it is carried out depending on age - nulliparous women are often not done).
• Doppler ultrasound to study the blood flow of the mammary glands (in the presence of a tumor, the blood flow will be disturbed).
• Magnetic resonance imaging scans the breast tissue in layers.

Examination of the mammary glands with the help of an ultrasound machine allows you to determine the boundaries of the leaf-shaped fibroadenoma. The photo clearly shows a heterogeneous structure with numerous cavities and cystic gaps. In appearance, phyllodes fibroadenoma can be compared with a head of cabbage. Ultrasound also allows you to identify the structure of the neoplasm and the exact size and localization.

A symmetrical examination of the breast is also characteristic of mammography, which will very accurately characterize changes in the tissues of the mammary glands, will reveal the smallest formations at the earliest stages of progression, and will also give a complete description of the tumor about its structure. The structure can be coarse-grained, lobulated, or in the form of various cystic inclusions. The results are described by a competent specialist, it depends on him what the result will be:

• Positive
• Negative
• false positive
• false negative

To eliminate errors, mammography is always supplemented by other non-invasive examination methods.

MRI of the mammary glands is a unique study, which, according to doctors, is the most informative. It can be done with or without a contrast agent. In the first case, you can check for the presence of cystic elements, tissue density, and expansion of the milk ducts. When using contrast, MRI helps to find out what character the tumor has - benign or malignant, reveals enlarged and enlarged nearby lymph nodes, assesses the size and location of overgrown pathological tissues.

In fact, MRI is the most accurate method for identifying pathological cells in places where other diagnostics have been uninformative.

For optimal therapy, a progressive tumor should be clearly differentiated from a malignant process. In this case, a biopsy is taken of the tumor in different places using a puncture. The resulting tissue sample is then sent for cytological laboratory testing.

Treatment Method

The only and most effective way to treat leaf-shaped fibroadenoma is surgery. Only by excising pathological tissues can the development and growth of a tumor, as well as its degeneration into a malignant process, be prevented.

The volume of surgical intervention directly depends on the size of the tumor formation. If the process is of a benign form, then the following is performed:

1. Sectoral resection - the organ is preserved, performed under general anesthesia or with the help of local anesthesia. Has a faster recovery period. Among the advantages is an inconspicuous scar along the edge of the areola or a substernal suture.
2. Quadrantectomy - excision of the quadrant of the breast where the tumor is located. It is an organ-preserving operation.
3. Enucleation - the operation looks like the process of exfoliation of the tumor, is carried out through a small incision, applicable to small sizes of leaf-shaped fibroadenoma.

Complete excision of the mammary gland with leaf-shaped fibroadenoma occurs in the following cases:

• With a malignant process, which is dangerous in terms of rapid metastasis.
• With a gigantic size of education.
• With necrotic skin, which is often overstretched.

Upon receipt of data on the malignancy of the process, it is necessary to treat phyllodes fibroadenoma according to the principle of cancer therapy. After surgical treatment, chemotherapeutic drugs are applied to the body to increase the prognosis of survival and avoid recurrence of the disease.

The prognosis for leaf-shaped fibroadenoma is varied and depends on the type of tumor. With a benign course of the disease, the prognosis will be positive if measures are taken in time to remove tumor cells and further monitor the woman. With a malignant phenomenon after a radical mastetomy, fibroadenoma can recur in another breast, so regular visits to a mammologist-oncologist and the necessary diagnostics are strictly required.

Leaf-shaped tumors and sarcomas of the mammary glands: clinic, diagnosis, treatment.

Nonepithelial and fibroepithelial tumors mammary glands are quite rare (1.54%) and therefore little studied. All these tumors are characterized as neoplasms having a two-component structure with a predominant development of the connective tissue component, which is absolute in sarcomas, and in the group of fibroepithelial tumors it is combined with the parallel development of epithelial tissue. The rarity of these neoplasms, the peculiarity of the clinical course, and the polymorphism of the morphological structure explain the limited awareness of doctors about them and the heterogeneity of their views both on the nature of these processes and on the principles of treatment approaches.

In order to assess the modern possibilities of diagnosing and optimizing therapeutic approaches for leaf-shaped tumors and sarcomas of the mammary glands, we have summarized more than 25 years of experience of the Oncological Center in the treatment of these tumors; We also tried to analyze the receptor status of tumors and study the proliferative characteristics of tumors using laser flow cytofluorometry.

During this period, we identified 168 (1.2%) patients with leaf-shaped tumors and 54 (0.34%) with breast sarcomas (one of the largest observations in the world practice). During the year, no more than 10 patients with this tumor pathology receive complex treatment at the Oncological Center.

The clinical picture is not specific and varies from small tumors with clear contours to neoplasms occupying the entire mammary gland (Fig. 1). In the latter case, the skin is purple-bluish in color, thinner, with sharply dilated subcutaneous vessels. Often there is ulceration of the skin, which, however, does not always indicate the malignancy of the process.

Rice. 1. Breast sarcoma

Fig.2. Distribution of patients depending on the histological type of tumor

There are 3 histological variants of leaf shaped tumors that differ in the ratio of stromal and epithelial components, clarity of tumor contours, cellularity, nuclear polymorphism, the number of mitotic figures, and the presence of heterogeneous elements. As can be seen from fig. 2, the benign variant of the tumor predominates. The presence of various histological types of leaf-shaped tumors, which determine the characteristics of the clinical course, contributed to the emergence of numerous variants of clinical terminology for designating these neoplasms. The most common term is phyllodes cystosarcoma, indicating an aggressive course of the tumor. Of the histological variants of sarcomas, angiosarcomas and malignant fibrous histiocytomas predominate (49%). These neoplasms are detected at almost any age (from 11 to 74 years), but the peak incidence occurs at 40-50 years of age. We found benign leaf-shaped tumors significantly more often at a younger age - 38 years (Fig. 3).

Fig.3. Distribution of patients with different histological types of tumor by age (in %)

As the malignancy of the process increases, the average size of neoplasms increases: with a benign leaf-shaped tumor - 6.9 cm, with an intermediate variant - 11.6 cm, with a malignant variant and sarcomas - 14.1 cm. When analyzing the possibilities of various methods the study found no reliable diagnostic criteria. Thus, the primary conclusions of mammographic examination coincided with the histological diagnosis only in 29% of cases with leaf-shaped tumors (n=147) and in 24% with sarcomas (n=39). The so-called depletion zone was revealed by us only in 21% of cases. The greatest difficulties arise in neoplasms with a diameter of less than 5 cm. Radiological criteria have not been established to distinguish the malignant variant of leaf-like tumors from breast sarcoma (Fig. 4, 5).

Fig.4. Benign leaf-shaped tumor in patient B., 39 years old. In the right mammary gland in the lower outer quadrant, a lobular nodular formation of a homogeneous structure with clear contours, 6.5 * 5.0 cm in size, is determined. The skin, nipple and areola are not changed.

Fig.5. X-ray of the right mammary gland of the craniocaudal projection of patient A., 20 years old. Neurogenic sarcoma of the right breast. In the upper quadrant, a lobular nodular formation sized 7*6 cm is determined, the contours are clear, a strip of enlightenment along the perimeter of the tumor node.

We tried to find out the possibilities of ultrasound of the mammary glands (21 patients with leaf-shaped tumors and 3 with sarcoma). A small number of observations has not yet made it possible to identify clear diagnostic criteria for distinguishing histological variants of leaf-shaped tumors (Fig. 6, 7). The only sign that drew attention to itself was the low blood flow velocity (2.4-6.4 cm/sec), including the peak one.

Fig.6. Benign leaf-shaped tumor (patient K., 21 years old). Hypoecogenic formation with clear even contours, heterogeneous structure, slit-like cavities inside the formation.

Fig.7. Breast sarcoma (patient M., 49 years old). Hypoecogenic formation of a heterogeneous structure, with uneven fuzzy contours, infiltration rim.

An analysis of the possibilities of cytological examination of tumor punctures showed that the primary conclusions in 29% of cases with leaf-shaped tumors and in 29% with sarcomas corresponded to the actual diagnosis. Failures, in our opinion, are due to the peculiarities of the histological structure of tumors and polymorphism (a combination of epithelial and stromal components, the presence of cystic cavities). The analysis of preoperative diagnoses showed that the latter corresponded to the histological conclusion only in 42% of cases. Thus, in most cases, the diagnosis of a non-epithelial or fibroepithelial tumor of the breast was a histological diagnosis. When analyzing treatment approaches for benign and intermediate leaf-shaped tumors in 144 patients (Table 1), it can be seen that all variants of surgical interventions were used. More often performed sectoral resection of the mammary glands. The use of mastectomy or radical resection is due either to the large size of the tumors or to errors in diagnosis. An increase in the volume of surgical intervention significantly leads to a decrease in the likelihood of local recurrence. So, if after sectoral resection recurrence occurred in 19.7% of cases, after mastectomy - in 4.8%. In general, recurrence was noted in 19.4% of cases. Tumor enucleation in 100% leads to the development of local recurrence. Distant metastasis in the indicated histological forms was not noted. With these histological variants, we consider a sectoral resection to be a sufficient volume; in the case of a total lesion of the mammary gland - a mastectomy.

Table 1. Treatment of patients with benign and intermediate leaf tumors

The course of malignant leaf-shaped tumors (23 patients) was due to malignancy of the stromal component (development of sarcoma against the background of a leaf-shaped tumor). The analysis showed that the structure of surgical interventions differed significantly from that in benign tumors. Various types of mastectomy accounted for 76% (with a higher recurrence rate of 26%). Recurrence after sectoral resection was observed 2 times more often than after mastectomy (Table 2). Metastasis - hematogenous (lungs, bones, liver). Metastases to regional lymph nodes were not noted. Sufficient amount of surgical intervention - mastectomy. There is no need for a lymphadenectomy.

Table 2 Recurrence of malignant leaf tumors by treatment options

Treatment of metastases has been unsuccessful; The 5-year survival rate was 58.5%. Adjuvant treatment resulted in non-significant improvement in outcomes. The most unfavorable prognostically are breast sarcomas (53 women and 1 man). The large size of the tumor node, the rapid growth of the neoplasm, and the threat of ulceration in most cases predetermined the need for surgical treatment. Surgical intervention in the volume of sectoral resection is clearly insufficient - after it, the development of relapses was noted in 71% of cases, while after mastectomy - in 22%. At the same time, in 12 out of 18 patients with recurrence, the tumor turned out to be angiosarcoma. Necessary and sufficient amount of surgical intervention for breast sarcomas is mastectomy. There is no need to perform lymphadenectomy (metastases to regional lymph nodes have never been detected). Distant metastasis was noted in 41% of cases. Adjuvant therapy does not improve long-term outcomes; during its implementation, some deterioration in the results of treatment was noted, which, in our opinion, is due to a more pronounced initial prevalence of the process (Table 3).

Table 3. Features of the clinical course of breast sarcomas depending on the primary treatment options

Postoperative radiation therapy was performed in 12 cases, chemotherapy - in 9 (including a combination of these regimens - in 5), in which various schemes were used: from TIOTEF monochemotherapy to the use of platinum preparations and anthracycline antibiotics. Treatment of sample metastases is lematic. Radiation therapy was performed in 11 cases, chemotherapy - in 18 cases, including 9 combined treatment. Treatment was successful in 2 cases: excision of solitary lung metastasis (liposarcoma) and full effect after 9 courses of chemotherapy for malignant fibrohistiocytoma (carminomycin, vincristine, interferon); The 5-year survival was 37.8%. Data on the survival of patients with various morphological variants of the tumor is presented in Fig. 1. 8.

Fig.8. Survival of patients (in %) with different morphological variants of tumors.

We do not have our own experience with hormone therapy. Tamoxifen was used as a step of desperation in 2 cases with steady progression of the process. The receptor status was analyzed in 48 patients (30 patients with leaf shaped tumor and 18 with sarcoma). It has been established that as the process becomes malignant, the content of steroid hormone receptors decreases, including estrogens (ER) - at the level of a trend, and progesterones (PR) - with significant differences.

Comparison of the level of receptors and the course of the disease in benign and intermediate leaf-shaped tumors showed an inversely proportional relationship between ER and PR (differences are not significant), while in malignant primary neoplasms in the case of development of local recurrences of receptor-positive tumors was not observed. In breast sarcomas, there were no differences in the content of receptors in primary tumors and in local relapses, while in the case of distant metastases in the primary tumor, a higher level of both ER and PR was noted.

Another equally important criterion characterizing the tumor process is the proliferative activity of the tumor, which is detected by flow cytofluorometry. As the process becomes more malignant, the frequency of aneuploid tumors (103 paraffin blocks) increases: with malignant leaf-shaped tumors, aneuploidy is 20%, with sarcomas - more than 92%. It should be noted that with a favorable course of leaf-shaped tumors, there were no aneuploid formations. An analysis of the distribution of cells by phases of the cell cycle showed that, in addition to significant differences in the content of cells in different phases of the cycle, there were significant differences between the primary and recurrent tumors in each of the histological variants of leaf-shaped tumors. The proliferation index in benign and intermediate leaf-shaped tumors in the case of recurrence was significantly higher than in tumors with a favorable course, and in malignant leaf-shaped tumors it corresponded to that in breast sarcomas. The development of the metastatic process in sarcomas was accompanied by a significantly higher proliferation index in primary tumors.

Thus, based on the study, the following conclusions can be drawn:

1. Existing research methods (X-ray, ultrasound of the mammary glands, routine cytological examination with Leishman staining), lacking reliable criteria for diagnosing non-epithelial and fibroepithelial tumors of the mammary glands, do not allow differentiating different histological variants of these neoplasms.
2. Necessary and sufficient volume of surgical intervention for benign and intermediate forms of leaf-shaped tumor - sectoral resection; with a total lesion of the mammary gland, with a malignant variant of leaf-shaped tumors and sarcomas of the mammary glands - mastectomy; there are no grounds for performing lymphadenectomy.
3. Adjuvant therapy for malignant leaf-shaped tumors and sarcomas of the mammary glands does not lead to a significant improvement in treatment outcomes: relapse-free 5-year survival rate for malignant leaf-shaped tumors in the case of adjuvant treatment - 81.8 ± 16.4%, without it - 53.4± 17.0% (p>0.05); with sarcomas - 33.73±12.5% ​​and 49.0±10.8%, respectively (p>0.05). The overall 5-year survival rate for malignant leaf-shaped tumors is 58.5 ± 15.0%, for sarcomas - 37.8 ± 8.5%.
4. Different morphological variants of leaf-shaped tumors significantly differ in proliferative characteristics: the proliferation index for benign leaf-shaped tumors is 20.08±1.35%, for intermediate ones - 25.33±2.02%, for malignant ones - 31.23±2.71 % (p<0,05). Индекс пролиферации при саркомах молочных желез соответствует таковому при злокачественных листовидных опухолях - 31,88±2,43%.
5. The high proliferative activity of the primary tumor in benign and intermediate leaf shaped tumors was significantly (p<0,05) ассоциируется с развитием местного рецидива. Так, индекс пролиферации при развитии местных рецидивов достоверно превышал та ковой при благоприятном течении заболевания (соответственно 26,78 ± 1,41 и 15,82±1,31%; 32,85±2,72 и 22,39±1,37%).
6. Metastatic process in breast sarcomas significantly more often (p<0,05) развивается в случае высоких значений индекса пролиферации первичной опухоли (34,46±2,77%), при отсутствии отдаленных метастазов - в 26,35±0,69%.
7. The morphological variant of the tumor is interrelated with the degree of aneuploidy of the neoplasm. In benign and intermediate leaf-shaped tumors, aneuploid neoplasms were not observed, while in its malignant variants and sarcomas of the mammary glands, aneuploidy was detected in 20 and 92.3% of cases, respectively (p<0,05).
8. As the malignancy of neoplasms increases (from benign leaf-like tumors to breast sarcomas), the level of PR decreases (44.46±8.75 and 9.05±2.57 fmol/mg protein, respectively; p<0,05). Различия в уровне ЭР недостоверны.
9. The development of recurrence in benign and intermediate variants of leaf-shaped tumors is associated with a higher level of ER compared with that in a favorable course of the disease (51.71±8.35 and 24.53±7.34 fmol/mg, respectively; p>0.05) ; changes in PR have the opposite direction, reaching maximum values ​​in the primary tumor with a favorable course of the disease (48.97±8.64 and 32.7±8.32 fmol/mg protein; p>0.05).
10. In breast sarcomas, the level of steroid hormone receptors in the primary tumor in the case of the development of a metastatic process is higher than in its absence (ER - 24±14.92 and 10.02±3.56 fmol/mg protein, respectively; PR - 15, 9±5.24 and 5.13±1.81 fmol/mg protein, p>0.05).

PHYLLODES TUMORS AND SARCOMAS OF THE BREAST: CLINICAL PICTURE, DIAGNOSIS, TREATMENT

I.K. Vorotnikov, V.N. Bogatyrev, G.P. Korzhenkova N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences

The material is taken from the journal "Mammology", No. 1, 2006

Many women perceive any neoplasm in the breast as malignant. However, in the diagnosis, in 80% of cases, benign changes are detected - fibroadenomas. They may have a different shape. Phylloid fibroadenoma (leaf-shaped) is often detected. In most cases, it is treatable and does not turn into cancer.

Types of benign neoplasms

Fibrous adenoma of the breast is a collection of glandular and fibrous tissues. When probing the chest, it is possible to detect tissue compaction in the form of a round or oval nodule. It can cause discomfort to a woman when pain occurs. However, such a neoplasm does not pose a serious danger, since it belongs to the class of non-cancerous ones.

There are several types of fibroadenomas. They differ in localization, shape and structure:

Increased attention should be paid to the last type of fibrous adenomas. To determine the nature of changes in the mammary gland, it is necessary to know what properties a leaf-shaped fibroadenoma has.

Characteristics of the phyllodes neoplasm

Despite the fact that the tumor is benign, there is an increased risk of its transition to sarcoma. Therefore, it is important to know what properties distinguish it from other forms of formations.

Leaf-shaped tumor is most often diagnosed in women experiencing a period of hormonal surge. This is usually the time of puberty (11-20 years) or the onset of menopause (45-55 years).

The occurrence of this type of fibroadenoma is influenced by many factors, among which are noted:

When a leaf-shaped fibroadenoma occurs, a seal is observed in the mammary gland, which has a limited localization. It is characterized by a lobed structure. When probing, you can detect the connection of several nodes into a single whole.

During the growth of the neoplasm, the appearance of the breast changes. The skin above it is stretched, has a cyanotic, sometimes purple color. A vascular and venous network is visible through it.

If there is a rapid growth of the neoplasm within 3-4 months, then doctors are inclined to make a diagnosis of "phylloid type fibroma". However, it can be confirmed only with the help of various instrumental studies.

Diagnostic methods

If you suspect a phyllodes fibroadenoma, you must definitely visit a mammologist. She will prescribe the necessary examinations to confirm or refute the diagnosis. Before the appointment, the doctor will conduct a complete examination of the breast, palpation, and also collect anamnesis data. In the future, the patient will need to undergo research using laboratory and instrumental diagnostics.

Only after the diagnosis, the doctor can prescribe treatment for the neoplasm.

Method of treatment of phyllodes fibroadenoma

If there is a formation in the breast less than 1 cm in size, doctors prescribe dynamic observation. In this case, a woman must visit a mammologist, repeat ultrasound and mammography after a while to identify the condition of phyllodes fibroadenoma.

If the neoplasm is large, then surgery is prescribed. It is shown when:

• rapid growth of neoplasm;
• the presence of a visible breast defect;
• an extensive neoplasm, the size of which exceeds 5 cm;
• planned pregnancy.

The operation is carried out in two
persons:

• enucleation method;
• sectoral resection.

During enucleation, the neoplasm is husked through a small incision made in the chest. In this case, there are practically no scars, they are insignificant.

Sectoral resection is distinguished by the removal of the neoplasm. The elimination of the tumor itself can be shown directly. In more severe cases, it is necessary to remove the tissue that surrounds it (3 cm from the edge of the nodes). The disadvantage of the method is the possible recurrence of fibroadenoma. In this case, amputation of the breast will be indicated.

Sometimes doctors resort to prescribing conservative treatment. It is indicated for small tumors, the size of which does not exceed 8 mm. Therapy is aimed at resorption of education. However, it does not always lead to a positive result.

After any medical manipulations, a woman needs to undergo a control ultrasound. Indeed, with complications and the absence of positive dynamics, the neoplasm can turn into a malignant one for no apparent reason. Therefore, with changes in the mammary gland, a woman should definitely consult a doctor.

Fibroadenoma of the breast - video

Fibroadenoma foliaceus is a rare breast tumor that usually develops in women in their 40s. These tumors are also called phyllodes, from the Greek word phyllodes, which means leaf-like. We can say that the more correct name is “leaf-shaped tumors”, since this is a group of neoplasms, whose representatives can have very different behavior.

This name is due to the fact that tumor cells have a leaf-shaped growth pattern. Fibroadenoma foliaceus tends to grow rapidly but rarely spreads beyond the breast.

Phylloid fibroadenoma is observed in approximately 0.5% of all breast tumors, it is formed from a combination of stromal and epithelial cellular elements. A neoplasm can develop both in the right and in the left breast.

There are three main types of phyllodes tumors:

• Benign (non-cancerous) - make up approximately 50-60% of phyllodes tumors.
• Borderline tumors are not yet malignant, but they can turn into them.
• Malignant - make up approximately 20-25% of all leaf-shaped tumors.

In their least aggressive form, phyllodes tumors are similar to benign fibroadenomas, which is how they got their name, leaf-shaped breast fibroadenoma. On the other hand, malignant leaf-shaped neoplasms can metastasize with the bloodstream to distant organs, sometimes turning into sarcomatous lesions.

How do phyllodes tumors develop in the breast?

Unlike breast cancer called carcinoma, which develops inside the ducts or lobules of the breast (intracanalicular tumor), leaf-shaped tumors start growing outside of them (like pericanalicular fibroadenoma). Phylloidal tumors develop in the connective tissue (stroma) of the breast, which includes fatty tissue and ligaments surrounding the ducts, lobules, blood and lymph vessels in the breast. In addition to stromal cells, they may also contain cells from the ducts and lobules of the mammary gland.

Symptoms and signs of leaf-shaped fibroadenoma

The most common symptom of phyllodes tumors is a nodule in the breast, which the patient or physician may find on self-examination or breast examination. These neoplasms can grow rapidly over several weeks or months to a size of 2-3 cm, and sometimes more. Such rapid cell proliferation does not mean that a phyllodes tumor is malignant, because benign tumors can also grow rapidly.

The nodule is usually painless. If left untreated, the nodule can create a visible bulge. In more advanced cases, a leaf-shaped tumor can lead to the formation of an ulcer or an open sore on the skin of the breast.

Diagnostics

Like other, rare, types of breast tumors, leaf-shaped fibroadenoma is difficult to diagnose, since doctors almost never encounter it. Phylloid tumors may also look similar to the more common benign fibroadenomas.

The two key differences between fibroadenomas and leaf-shaped tumors are that the latter grow more rapidly and develop about 10 years later in age (after 40 as opposed to 30). These differences can help doctors distinguish between these growths.

Establishing a diagnosis is usually carried out in several steps:

• Physical examination of the mammary glands;
• Mammography;
• Ultrasound procedure;
• Magnetic resonance imaging.

Biopsy and histology is the only way to accurately establish the diagnosis of a leaf-shaped tumor. In addition, it is possible to determine the type of neoplasm (benign, borderline or malignant) and the degree of cell proliferation.

The term "benign tumor" often leads people to think that the disease is not dangerous and does not require treatment. But benign phyllodes tumors, like malignant tumors, can grow to large sizes, create visible nodules on the breast, and even break through the skin, causing pain and discomfort. Therefore, any type of these neoplasms requires treatment.

Treatment

Whether a leaf tumor is benign, malignant, or borderline, the treatment is the same - surgery to remove the tumor along with at least 1 cm of surrounding healthy breast tissue. Some doctors believe that even more healthy tissue needs to be removed.

Wide excision is important because, when it is not done, phyllodes tend to recur in the same area of ​​the breast. This applies to both malignant and benign neoplasms.

Possible surgeries:

1. Lumpectomy - The surgeon removes the tumor and at least 1 cm of normal tissue around it.
2. If the mass is very large or the breast is small, it can be very difficult to perform a wide excision and retain enough healthy tissue to provide a natural looking breast. In this case, the doctor may recommend carrying out:
   • Partial or segmental mastectomy - the surgeon removes the part of the breast that contains the tumor.
   • Total or simple mastectomy - the surgeon removes the entire breast, but nothing else.

Phylloidal tumors rarely spread to the axillary lymph nodes, so in most cases they do not need to be removed.

Malignant leaf-shaped tumors are rare. If they have not spread beyond the breast, radiation therapy may be used to stop cell proliferation. If they have metastasized to other parts of the body, treatment should include chemotherapy.

Care after treatment

The doctor should observe the patient after treatment. Phylloidal tumors can sometimes recur. Relapse usually develops within a year or two after surgery. Malignant leaf-shaped tumors may reappear faster than benign ones.

Physician and patient should cooperate by scheduling visits and examinations, which may include:

• Physical examination of the breast by a doctor within 4-6 months;
• Mammography and ultrasound examination 6 months after treatment;
• Magnetic resonance or computed tomography - as prescribed by the doctor, if he suspects the risk of distant metastases.

If malignant leaf-shaped tumors reappear in the breast, treatment includes wide excision or mastectomy. Some doctors also recommend radiation therapy.

Less than 5% of phyllodes tumors recur in other areas of the body (distant metastases). Possible treatments include surgical removal, radiation therapy, and chemotherapy.