An overview of fibroadenoma of breast and homoeopathic management

Dr Ashna E

ABSTRACT
The breast is a modified skin appendage which is functional in the females during lactation but rudimentary in the males. At the time of birth it is rudimentary and consists of only tiny nipples and few radiating ducts from it. In females the growth of breasts starts at the age of puberty. Fibroadenoma or adenofibroma is a benign tumor of fibrous and epithelial element. It is the most common benign tumor of female breast during reproductive life between 15 to 30 years of life. Management of the cases can be done using homoeopathic medicines.

Key words: Fibroadenoma, Homoeopathy

INTRODUCTION
The breast is a modified sweat gland lying on the musculature of the chest wall and pectoral fascia which is surrounded by skin and subcutaneous fat. Transversely extends from the side of the sternum to near the mid-axillary line. Vertically it extends from the 2nd to 6^thrib.The breast consists of (a)gland tissue,(b)fibrous tissue and (c)fatty tissue in the intervals between the lobes.^[1]The most common benign tumor of female breast is the fibroadenoma which implies a new growth comprising of both glandular and fibrous tissue. Fibroadenomas are usually multiple and sometimes bilateral.Fibroadenomas are occur in reproductive age group and more common in before 30 years of age.^[2]But bimodal age presentation is seen in giant fibroadenomas that is more common in between 14 to 18 and 45 to 50 years of age groups. When it occur in younger age groups it is called juvenile fibroadenoma.^[2]

AETIOLOGY
This tumour is said to develop as the result of increased sensitivity of a focal area of breast tissue to estrogen.It is acceptable that there is some relationship between the excess amount of estrogen and fibroadenoma.^[1]

PATHOLOGY

Morphologic features

1. a) Gross appearance

Typical fibroadenoma is small (2-4 cm diameter ), solitary, well encapsulated, spherical or discoid mass.The cut surface is firm, grey-white myxoid and may shows slit like spaces which is formed by the compressed ducts.

1. b) Microscopic features

Fibrous tissue comprises most of the fibroadenoma.The arrangements between fibrous over growth and ducts may produce two types of patterns. These are intracanalicular and pericanalicular patterns.

1. Intracanalicular type (Soft fibroadenoma)

In this type the stroma compresses the ducts. Due to this the glandular tissues and ductal system are very much compressed. So they are reduced to a slit- like clefts which are lined by the ductal epithelium.

2. Pericanalicular type (Hard fibroadenoma)

It is characterized by encircling masses of fibrous stroma around the patent or dilated ducts. The fibrous stroma may be quite cellular, or there may be area of hyalinised collagen. Sometimes, the stroma is loose and myxomatous.^[3]

VARIANTS OF FIBROADENOMA

A few morphologic variants of fibroadenomas are identified.

1. Tubular adenoma

In this type of tumors the fibrous tissue element is scanty. So instead of that it is predominately composed of closely- packed ductular or acinar proliferation .It is termed as tubular adenoma.

2. Lactating adenoma

This adenoma is composed of acini with secretory activity. Lactating adenomas are occur during pregnancy or lactation.

3. Juvenile fibroadenoma

It is an uncommon variant. These fibroadenomas are large and rapidly growing seen in adolescent girls.^[3]

CLINICAL FEATURES

Symptoms

(i) The pericanalicular type is more common in younger girls between 15 and 30 years of age. Intracanalicular type is more common in older group between 30 to 50 years of age.

(ii) This tumour is most commonly presented as a painless, slowly growing, solitary lump in the breast. More commonly seen in the lower part of the breast.

(iii) Multiple fibroadenomata may be present in about 10% cases.

(iv)Pain is usually conspicuous by its absence, but occasionally complained of pain when it is associated with fibroadenosis.

(v)Discharges are uncommon.^[1]

LOCAL EXAMINATION

Inspection

Always remain normal.

Nipples are normal.

Palpation

(a)They are smooth or slightly tabulated usually measuring 2 to 3 cm in diameter.

(b) Freely mobile, solitary lump with round smooth margins.

(c)Lump is not fixed to the overlying skin.It is not fixed within the breast and easily movable so it is called as breast mouse.

(d)Axillary lymph nodes are usually not enlarged.^[1]

DIAGNOSIS

Upto the age of 25 years clinical diagnosis is enough.

Fine needle aspiration cytology (FNAC)

Ultrasonography helpful for the differential diagnosis of palpable breast lumps.^[1]

TREATMENT

Excisional biopsy is the treatment of choices.^[1]

STUDIES DONE IN HOMOEOPATHY
Purnima et al conducted an open label prospective, single arm, observational study on 64 females having fibroadenoma of breast. Individualized homoeopathic medicines were prescribed. After the treatment complete disappearance of fibroadenoma occurred in 23 cases and partial improvement was noticed in 22 cases. Most commonly used medicines were Conium Mac, Phytolacca,Calcarea fluorica,Calcrea carbonica, Pulsatilla, Bryonia and Silicea.^[4]

Suraia parveen conducted one case report study on breast fibroadenoma using individualized homoeopathic medicine was also gave positive results. In this study pulsatilla was used .After the treatment there was 75% of regression in size of fibroadenoma.^[5]

Sathish Kumar et al conducted a study on a case of left mammary fibroadenoma was successfully cured by homoeopathy. Medicine was prescribed on the basis of individualization. Calcarea phos was given to the patient and it was completely cured.^[6]

REPRESENTATION OF FIBROADENOMA IN REPERTORIES

1.HOMOEOPATHIC MEDICAL REPERTORY^[7]

• Breasts –LUMPS, breasts – ars-i., bell-p., calc-f.,chim.,con.,,PHYT.,puls.,sep.,sil.

                aching,deep in left – arum-t

girls, in young, painful, affecting arm –  phyt.,puls.

hard – calc-f., con., SIL.,

hard and painful –con.,

    left and beneath arm,hard and burning – aster., lyc.,

  right,in,near nipple towards the right, scirrhus, uneven surface ,movable, size of a       hazelnut – sil.

• Breasts – NODULES, breasts – ars-i., arum-t., , aur., bar-c.,bell.,BELL-P.,berb-a., brom.,bry.,bufo., calc., calc-f., calc-i., calc-p., calen., CARB-AN.,carb-v.,carc., cham., chim.,coloc., CON.,dulc., gnaph.,graph., hecla., hydr., iod.,kreos.,lac-c.,lyc.,merc-i-f., nit-ac.,phos.,PHYT.,psor.,puls., rut., sabin., sep.,SIL.,sulph., thuja.,thyr

    hard – calc-f., CARB-AN., con., phos.

    Left – arum-t., calc-p., lyc.,pitu-a., sil.,

    Movable, tender, moving arms,agg – calc-i

    Puberty, before – puls.

      Right – con.,phyt., pitu-a., sil.

• Cancer – BREASTS,cancer

      Fibroadenoma – calc-f.

2. BOGER BOENNINGHAUSEN’S CHARACTERISTICS AND REPERTORY^[8]

• CHEST – MAMMAE – Nodes, induration : , Bell.,bry., buf., CARB-AN., Cham.,clem., colo., CON., dul., Grap., kali-c.,lac-c.,lyc.,nat-m., nit-ac., Pho., PHYT., pul.,rhus-t., sep., SIL., Sul.

3. REPERTORY OF HOMOEOPATHIC MATERIA MEDICA-J.T KENT ^[9]

• CHEST – NODULES,sensitive: Carb-an.,,mang.

Mammae, in : Bell-p.,bry.,bufo.,calc-f.,calc-p.,Carb-an.,carb-v.,cham.,chim.,chin.,clem.,coloc.,Con.,cund.,dulc.,graph.,iod.,kreos.,lac-c.,lyc.,mang.,nit-ac.,phos.,Phyt.,puls.,ruta.,Sil.,sulp.

right : Sil

left  : Arum-t.,calc-p.,lyc.

menses,during : Lac-c.

pregnancy,during : Fl-ac

INDICATIONS OF SOME HOMOEOPATHIC MEDICINES^[10][11]

ARSENICUM IODATUM
Cancer of breast after ulceration has set in. Lumps in mamma, sensitive to touch and painful, nipple retracted.

ASTERIAS RUBENS
Remedy for sycotic diathesis;flabby,lymphatic constitution, flabby with red face. Breast swollen, indurated. Nightly lancinating pains in the breasts have led to its successful use in cases of mammary cancer.Petroz used this remedy and found that it only acted on the latter when on the left side.Whole chest painful<motion.Sensation as if breast were drawn in, nightly anxiety, caused by undulating beating in chest.

BRYONIA
Acts on all serous membranes and the viscera they contain.The general character of pain here produced is as stitching, tearing; worse by motion, better by rest.Pain in breasts at menstrual period. Breasts hot and painful hard. Abscess of mammae.Lumps, indurations,and inflammations of the mammae,with diminished or retracted secretion of milk.

BUFO RANA
Acts on the nervous system and skin.Uterine symptoms marked. Desire solitude, feeble minded. Induration of mammary glands. Palliative in cancer of the mammae.

CALCAREA FLUORICA
A powerful tissue remedy for hard,stony glands.Hard knots in female breast. Induration threatening to suppuration. Bearing down; dragging pain in uterus and thighs. Aggravation- damp weather, rest.

CALCAREA IODATA
It is in the treatment  of scrofulous affections, especially enlarged glands, tonsils etc, that is this remedy has gained marked beneficial results. Clinically indicated in cancer, consumption, glandular swelling,and tumors of breast.C.L Nicholls has cured a number of cases of breast tumour with the 3x; nodular tumors, movable ,tender to touch, painful on moving arm.

CARBO ANIMALIS
Seems to be especially adapted to scrofulous and venous constitutions. Glands are indurated, veins distended. Weakness of nursing women. Darting in breast; painful indurations in breast, especially right. Painful nodosities.

CONIUM MACULATUM|
Cancerous diathesis, enlarged glands. Acts on the glandular system, engorging and indurating it,alternating its structure like scrofulous and cancerous conditions.Mammae lax and shrunken, hard painful to touch. Want to press breast with hands. Breasts enlarge and become painful before and during menses.

HYDRASTIS CANADENSIS
Hydrastis especially act in old, easily tired people with great debility. Lancinating pain in breast extending up to shoulder and down arm.(cancer of breast ,pains like knives thrust into part) Hard irregular tumor of breast, painful, cachectic appearance.

IODIUM
All glandular structures, respiratory organs, circulatory system are especially affected.Dwindling of mammary glands. Nodosities in skin of Mammae. Mammary hyperaesthesia. Heaviness of breasts as if they would fall off. Bluish red nodosities size of hazel nut; in both breasts;dry,black  points at tips.

LAC CANINUM
The keynote symptom is erratic pain alternating sides. Breasts swollen; painful before and better on appearance of menses. Worse by least jar. Breasts seem very full, sensitive to deep pressure.

LACHESIS MUTUS
The modalities are most important in guiding to the remedy.Sensation of tension in various parts. Cannot bear anything tightly anywhere. Climateric troubles, palpitations, flushes of heat.Pain all relieved by the flow.Mammae inflamed,bluish.

PHYTOLACCA DECANDRA
Pre-eminently a glandular remedy.Glandular swelling with heat and inflammation.Has a powerful effect on fibrous and osseous tissues. Mammae hard and very sensitive.Tumors of the breasts with enlarged axillary glands.Breast is hard,painful and of purple hue.Irritable breasts,before and during menses.Breasts full of nodosities.

PULSATILLA
The disposition and mental state are the chief guiding symptoms to selection of pulsatilla.It pre-eminently a female remedy, yielding disposition. Symptoms ever changing. Thirstless, peevish. Swelling of breasts,with tensive pain. Lumps on breasts of girls, before puberty; or escape of thin, milk-like fuid.

SILICEA
Imperfect assimilation and consequent defective nutrition. Silicea patient is cold,chilly,hugs the fire. Prostration of mind and body. Nipples very sore; ulcerated easily; drawn in .Hard lumps in breast.

CONCLUSION
Fibroadenoma of breast is a benign disease most commonly seen during the reproductive age group. Excess level of estrogen is the main cause of the disease. The only available option for the condition is surgery. After lumpectomy it may cause a change in breast’s size and shape. There are some studies conducted in homoeopathy for the management of fibroadenoma. Individualized homoeopathic medicines are used for the treatment and it showed significant improvement in the cases. So Homoeopathic medicines are found effective in the treatment of fibroadenoma of breast.

REFERENCES

1. Das S.A concise textbook of surgery. S Das publishers,Kolkata.2016.9^th edition;580,601-603.
2. Shah B, Shah BB, Sharma K, Sahu S, Singh P. Giant fibroadenoma of the breast mimicking phyllodes tumor in an adult female: emphasizing the role of cytology in the diagnosis. International Journal of Students’ Research. 2014 Jul 1;4(2)[Cited on 21-05-2022]
3. Giant fibroadenoma of the breast mimicking phyllodes tumor in an adult female: emphasizing the role of cytology in the diagnosis Shah B, Shah BB, Sharma K, Sahu S, Singh P – Int J Stud Res (ijsronline.net) Harsh Mohan text book of pathology.Jaypee brothers publishers, New Delhi 2015.7^th edition;748-749.
4. .Shukla P, Misra P, Misra RK, Jain RK, Shukla R, Manchanda RK, Khurana A. Homoeopathic Management of Breast Fibroadenoma—An Open Label, Single Arm, Observational Trial. Homœopathic Links. 2020 Jun;33(02):090-8.[Cited on 22-05-2022] https://sci-hub.se/10.1055/s-0040-1712479/
5. Parveen S. Individualized homoeopathic treatment of breast fibroadenoma: A case report.[Cited on 21-05-2022] Individualized homoeopathic treatment of breast fibroadenoma: A case report Parveen S – Indian J Res Homoeopathy (ijrh.org)
6. Kumar S, CV C, Mohan CK, Sugathan NV. A case of left mammary fibroadenoma successfully cured by homoeopathic therapy.[Cited on 22-05-2022] A case of left mammary fibroadenoma successfully cured by homoeopathic therapy. (openaccessjournals.com
7. Murphy R.Homoeopathic Medical Repertory. Revised 3e:B Jain publishers, New Delhi:2009;255-256,280.
8. Boger C M.Boger Boenninghausen’s Characteristics and Repertory. B Jain publishers, New Delhi.770
9. Kent J T.Repertory of the Homoeopathic Materia Medica.6 American edition:IBPP,New Delhi:2016;838
10. William Boericke’s New Manual of Homoeopathic Materia Medica with Repertory. Revised and augmented 3e:B Jain publishers, New Delhi:2017.
11. Clarke J H.A Dictionary of Practical Materia Medica.Jain publishers, New Delhi,1982.

Dr Ashna.
PG Scholar Department of Practice of Medicine
U/G/O Dr Praveen Kumar P.D (HOD of Dept of Medicine)
Government Homoeopathic Medical College and Hospital
Dr.Siddhaiah Puranik Road,Basaveshwar Nagar,Bengaluru,560079