Treatment of breast fibroma

Adenofibroma of breast is also called fibroadenoma. It is the most common breast benign tumor, accounting for about 3/40 of breast benign tumors. /kloc-in the middle of 0/9th century, foreign scholars described and named this disease. In the process of understanding this disease, it was once called breast fibroadenoma, adenofibroma and adenoma. In fact, this is only caused by the difference of fiber composition and glandular epithelial hyperplasia. When the tumor is mainly composed of glandular epithelial hyperplasia, it is called fibroadenoma. If there are many fibrous tissues and few glandular duct components in the tumor, it is called adenofibroma; If the tumor tissue is mainly composed of a large number of glandular duct components, it is called adenoma. However, the above components are only different in pathomorphology, and there is no difference in clinical manifestations, treatment and prognosis.

First, the cause of breast adenofibroma is more common in young women, and rarely occurs before menarche or after menopause; It is related to the following factors: (1) The level of estrogen is relatively or absolutely increased, and excessive stimulation of estrogen can lead to abnormal proliferation of mammary duct and interstitial components and form tumors. (2) The local breast tissue is excessively sensitive to estrogen. (3) Dietary factors, such as high-sugar and high-fat diet. (4) genetic tendency.

Pathology 1. Generally speaking, tumors are round or oval with a diameter less than 3cm. Smooth surface, nodular shape, clear boundary, tenacity and elasticity. It seems to have a capsule, but there is no real capsule. Tumor sections are generally gray, similar to normal breast tissue. When the tumor contains more epithelial components, its section is slightly brownish red. There are often mucinous luster in the duct (in the duct) and the section of lobulated adenofibroma, and there are cracks of different sizes. The section of peritubular adenofibroma is granular. Cystic hyperplasia adenofibroma is a common small cyst on the section. 2. According to the relationship between fibrous tissue and glandular duct structure in tumor, microscopic observation can be divided into five types. (1) Catheter type (intraductal type) is mainly a tumor formed by the proliferation of subcutaneous connective tissue on the glandular duct. At the initial stage of the lesion, the fibrous tissue under the duct and acinus proliferated and thickened, gradually protruding to the mammary duct, then squeezing the lumen, gradually evolving and finally becoming a tumor. This type of lesion covers a wide range and may involve one or several mammary duct systems. In addition to mammary duct and glandular duct, smooth muscle tissue under the epidermis also proliferates, but there are no elastic fibers, and there are often mucinous changes in the stroma. (2) Periductal adenofibroma is mainly the proliferation of periductal connective tissue outside the elastic fiber layer around the glandular duct. Elastic fibers also participate in tumor formation, but there is no smooth muscle and mucinous degeneration. The lobular structure of the breast partially or completely disappeared, and the glandular ducts were diffuse. The hyperplastic fibrous tissue surrounds and squeezes the glandular duct, making it an glandular duct. Fibrous tissue is dense, often collagen-like or glassy, and even calcified, cartilaginous or ossified. (3) Mixed adenofibroma has both ductal and periductal glands in the tumor.

Fibroma has two kinds of pathological changes. (4) Cystic proliferative fibroadenoma is a single mass in the breast, which has a clear boundary with the surrounding breast tissues and may be encapsulated. The tumor is formed by hyperplasia of glandular duct epithelium and connective tissue under the skin or outside elastic fibers. Epithelial lesions include cysts, ductal epithelial hyperplasia of different degrees, papillomatosis, adenopathy and apical metaplasia. Epithelial cells and fibroblasts were normal. (5) Lobular fibroadenoma (giant fibroadenoma) is more common in adolescence and women over 40 years old. The tumor is large and its basic structure is similar to tubular fibroadenoma. Because the connective tissue of the subepithelial tissue protrudes from several points into the highly dilated lumen and does not completely fill the latter, the specimen is obviously lobulated by naked eye observation and microscopic examination. The difference between this type and tubular type is that the lobulated tumor is larger and the lobulated tumor is obvious, and the difference between this type and phyllodes cystsarcoma is that the latter often has no complete capsule, and the interstitial cells are abnormal and mitosis can be seen.

Third, the clinical manifestations of breast adenofibroma can occur in women of any age, mostly around the age of 20, mostly inadvertently found, often touching the painless lump in the breast when taking a bath. There was no tenderness and abnormal nipple secretion, and the masses were mostly round, oval or flat. The boundary is clear, the surface is smooth, the texture is firm and tough, the activity is large, and there is no adhesion with epidermis or pectoral muscle. Tumors can be 0.3~24m in size, of which 2/3 less than 3cm can be located in various parts of the breast, mostly in the outer upper quadrant. Most of them are single, and about 10%~ 15% are multiple mammary glands on one or both sides. It can be multiple at the same time or multiple at different times. The proliferation rate of tumor is very slow, and it has not changed for several years or even longer. Menstrual cycle has no effect on tumor. Some have mild pain during menstruation, which is slightly aggravated during pregnancy and lactation. In a few cases, it suddenly increases, which is called giant fibroma. Generally, axillary lymph nodes do not swell. If the tumor that has been static for many years suddenly increases rapidly, and there are symptoms such as pain and axillary lymph node enlargement, it is highly suspected that malignant transformation has taken place. A few adolescent adenofibromas occur before menarche, and increase rapidly within a few months or 1~2 years after menarche, mostly >: 5cm, reaching 2Ocm. The breast skin is tense, shiny, red and varicose, which looks like a malignant tumor. But it doesn't stick to the epidermis, it doesn't hurt, it can be pushed, and the axillary lymph nodes are not swollen.

Fourth, diagnosis According to its age, symptoms and signs, the diagnosis of breast adenofibroma is generally easy, and a few need special inspection instruments to make a diagnosis. 1. Mammography Mammary gland adenofibroma is round, oval and lobulated, and its density is slightly higher than that of surrounding tissues, even with shadows. The tumor boundary is smooth and tidy, and sometimes a thin layer of translucent halo can be seen around the tumor. The elderly may have flaky or arc calcification, but there is no sand calcification. 2.b-ultrasound can show that adenofibromas are mostly round or oval dark areas with clear and tidy boundaries. The internal echo is evenly distributed, showing a weak light spot, and the rear wall line is complete, with lateral sound shadow. The echo behind the tumor is enhanced. If there is calcification, sound shadow can appear behind the calcification point. 3. Liquid crystal thermogram The tumor is a low temperature image or a normal thermal image, and there is no abnormality in the skin and blood vessels. 4. The transmittance of infrared ray irradiated tumor is basically the same as that of normal breast tissue around it. The larger tumor has a clear boundary and no shadow of vascular changes around it. 5. Needle aspiration cytology is between toughness and brittleness, and the amount of needle aspiration cells is often large. The diagnostic coincidence rate is above 90%. The diagnosis of this disease should be differentiated from hyperplasia of mammary glands and cancer.

The ancients also discussed the etiology and pathogenesis of benign tumors. For example, Xue Jiyun said, "If the husband has a tumor, he will stay and be depressed, all because of the injury of the viscera and the qi and blood are not smooth." It is pointed out that the occurrence of tumor is caused by dysfunction of viscera and disharmony between qi and blood. Authentic Surgery says more clearly: "The disease of wife's furuncle is not caused by swelling of yin and yang, but by blood stasis, turbid qi and phlegm and blood stasis in five internal organs." From the point of view of modern medicine, the breast is the target organ of ovarian hormones, and the occurrence of benign breast tumors is related to the excessive stimulation of estrogen, just like other chronic breast diseases.

According to the pathology of "blood stasis, turbid qi and phlegm and blood stasis", young female benign tumors can be treated with traditional Chinese medicine. After 3 months of treatment, if the mass is still not slightly loose, surgical resection is feasible.

The main principles of internal treatment are regulating qi, dispersing stagnation, removing blood stasis and swelling, resolving phlegm and softening hardness. Patients with weak vital qi, deficiency of spleen and stomach, and deficiency of kidney qi can be treated by invigorating qi and nourishing blood, regulating spleen and stomach, and nourishing kidney qi. In addition to the above-mentioned main treatment methods, specific treatment rules and methods must be formulated according to the specific conditions of each benign tumor and the principle of syndrome differentiation and treatment.