Categories
Female Reproductive System

Fibroadenoma

Painless, unilateral, benign (non-cancerous) breast tumor presenting as a solid lump.

Painless, unilateral, benign (non-cancerous) breast tumor presenting as a solid lump.

  • M/C benign tumour in women under 30 years of age (2.2% in population)
    • Accounts for 68% of all breast masses and 44–94% of biopsied breast lesions
  • M/C breast masses in adolescents.
  • Although fibroadenomas are benign breast masses, women with fibroadenomas are at a 2.17 times increased risk for breast cancer.

Classification

  • Simple fibroadenoma (M/C subtype, 70-90%)
  • Giant juvenile fibroadenomas (rare, 0.5–2%): Rapidly enlarging encapsulated fibroadenoma > 5 cm or > 500 g, or displacing at least 4/5 of breast
    • M/C cause of unilateral macromastia in adolescent women.
  • Multicentric fibroadenomas (10–25%): Multiple fibroadenomas occurring in different quadrants of the breast

Etiology

Oestrogen influences the development of fibroadenomas

Risk factors:

  • Young age (<35 years old) (M/imp risk factor)
  • Self-breast examination
  • Prior history of benign breast disease
  • Body mass index

Protective factors:

  • Oestrogen-progesterone oral contraceptive before menopause
  • Increased number of live births

Syndromic associations:

  • Beckwith-Wiedemann syndrome
  • Maffucci syndrome
  • Cowden syndrome

Clinical features

Fibroadenomas can range from asymptomatic masses to painful and rapidly growing tumors that can cause significant esthetic distortions of the breast. Some fibroadenomas may remain dormant without any change in size. Others may grow slowly in size. Overall, most fibroadenomas decrease in size as they lose cellularity, infarct with resultant calcification and hyalinization. In the adolescent population, 10%–40% of fibroadenomas spontaneously regress.

Physical examination:

A fibroadenoma is most often detected incidentally during a medical examination or during self-examination, usually as a discrete solitary breast mass of 1 to 2 cm.
  • Non-tender/painless mass
  • Mobile
  • Solitary
  • Rapidly growing solid lump with rubbery consistency and regular borders.

Diagnosis

Imaging:

  • USG (<40 years)
  • Mammography (>40 years) : Popcorn calcifications may be seen
Sonographic appearance of a fibroadenoma
Sonographic appearance of a fibroadenoma. The mass is homogenous, with sharp and smooth margins. Slight posterior and edge enhancements are visible. Neither compression effects nor internal echoes are present. | Greenberg, R., Skornick, Y., & Kaplan, O. (1998). Management of breast fibroadenomas. Journal of general internal medicine, 13(9), 640–645. https://doi.org/10.1046/j.1525-1497.1998.cr188.x

Breast tissue biopsy:

The histological diagnostic features of fibroadenoma can be described as sheets of uniformly distributed epithelial cells that are typically arranged in a honeycomb pattern. There is a presence of foam cells and apocrine cells and an absence of excessive mitotic activity or anaplasia. Calcification may also be present. The basement membrane also remains intact in fibroadenoma which reflects its benign feature.
  • FNAC (Fine needle aspiration cytology)
  • Stereotactic core biopsy (older patients)
Histologic section of a fibroadenoma
Histologic section of a fibroadenoma (hematoxylin-eosin staining, × 40). The cellular fibroblastic stroma, which resembles intralobular stroma, encloses glandular and cystic spaces lined by epithelium. Round and oval gland spaces, lined by either single or multiple cell layers, are present in other areas. The stroma in the connective tissue appears to have undergone a more active proliferation with compression on the gland spaces. | Greenberg, R., Skornick, Y., & Kaplan, O. (1998). Management of breast fibroadenomas. Journal of general internal medicine, 13(9), 640–645. https://doi.org/10.1046/j.1525-1497.1998.cr188.x

Management

Conservative management:

Includes clinical observation with monitoring over 2-3 months. A change in character or growth in the mass requires further evaluation with breast imaging, utilizing primarily directed breast ultrasound in the adolescent population. With a typical sonographic appearance, conservative management with short-term follow-up exam and ultrasound as indicated, usually at 6-, 12-, and 24-month intervals. Alternatively, a core needle biopsy with ultrasound guidance can be performed for tissue diagnosis.
Management of a fibroadenoma (FA) in women younger than 35 years of age
Management of a fibroadenoma (FA) in women younger than 35 years of age. | Greenberg, R., Skornick, Y., & Kaplan, O. (1998). Management of breast fibroadenomas. Journal of general internal medicine, 13(9), 640–645. https://doi.org/10.1046/j.1525-1497.1998.cr188.x

Surgical management:

Indications include a rapidly enlarging breast mass, fibroadenoma or mass > 5 cm, or a breast mass causing distortion of the breast architecture with associated skin changes. Other factors that may prompt surgical excision include localized discomfort and interval growth.
(A) Enlarging fibroadenoma of the left breast and giant fibroadenoma of the right breast in a 17- year-old female. (B) Giant fibroadenoma measuring 5.7 × 5.8 × 5.0 cm. Note the solid, multinodular, well-circumscribed features of the mass. The left breast fibroadenoma (not shown) measured 2.7 × 2.4 × 2.2 cm. (C) Intraoperative incision planning by the breast surgeon and the plastic surgeon. Immediate breast reconstruction was planned due to the large size of the right breast mass and anticipated breast asymmetry following excision. Local advancement flaps of superior and inferior breast tissue were performed via a vertical scar mastopexy approach. (D) Right breast defect postresection of giant fibroadenoma, involving the upper-outer quadrant. (E) Postoperative result at one year.
(A) Enlarging fibroadenoma of the left breast and giant fibroadenoma of the right breast in a 17- year-old female. (B) Giant fibroadenoma measuring 5.7 × 5.8 × 5.0 cm. Note the solid, multinodular, well-circumscribed features of the mass. The left breast fibroadenoma (not shown) measured 2.7 × 2.4 × 2.2 cm. (C) Intraoperative incision planning by the breast surgeon and the plastic surgeon. Immediate breast reconstruction was planned due to the large size of the right breast mass and anticipated breast asymmetry following excision. Local advancement flaps of superior and inferior breast tissue were performed via a vertical scar mastopexy approach. (D) Right breast defect postresection of giant fibroadenoma, involving the upper-outer quadrant. (E) Postoperative result at one year. | Courtesy of Valerie Lemaine, MD, MPH, FRCSC

Leave a Reply