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PubMed1995

Progression of fibroadenoma to phyllodes tumor demonstrated by clonal analysis.

BACKGROUND: The histogeneses of fibroadenoma and phyllodes tumor of the breast appear to be closely related, but it is still unclear whether fibroadenoma can progress directly to phyllodes tumor. METHODS: This issue was studied by conducting clonal analysis of fibroadenoma and phyllodes tumors that were obtained sequentially from the same patient. One patient developed local recurrence of phyllodes tumor twice, and the other two patients each developed a phyllodes tumor after excision of a primary fibroadenoma. The method for clonal analysis was based on trinucleotide repeat polymorphism of the X chromosome-linked androgen receptor (AR) gene and on random inactivation of the gene by methylation. RESULTS: Clonal analysis revealed that all the three primary fibroadenomas were monoclonal and all four recurrent phyllodes tumors were also monoclonal in origin. In addition, the same allele of the AR gene was inactivated in fibroadenoma and phyllodes tumor(s) in each patient. The probability that phyllodes tumors of different origin happen to inactivate the same allele of the AR gene as fibroadenomas in every case is quite low. Rather, it is more reasonable to assume that the phyllodes tumor has the same origin as fibroadenoma. CONCLUSIONS: These results identified monoclonal fibroadenomas that can progress to phyllodes tumors.

Adult↗

PubMed2005

Estrogen receptor-alpha, bcl-2 and c-myc gene expression in fibroadenomas and adjacent normal breast: association with nodule size, hormonal and reproductive features.

Fibroadenomas are the most common benign lump in females. The study of gene alterations and/or deregulation in reproductive years may help explain hormonal physiological processes involved in nodule development and evolution. The objective was to compare ER-alpha, c-myc, and bcl-2 gene expression in breast fibroadenomas and in normal tissue and evaluate menstrual cycle, parity, and oral contraceptive influences. Fifty-seven premenopausal women (14-49 years) undergoing surgical removal of fibroadenomas were selected. Samples from fibroadenomas and circumjacent normal tissue were obtained for RT-PCR paired analysis. Patients were divided in groups according to menstrual cycle, use of contraceptives and parity. Tissue from 32 patients was adequate for RT-PCR. Paired analysis showed higher expression of ER-alpha (P=0.012) and bcl-2 (P=0.001) in fibroadenomas than in normal breast, while c-myc presented a similar expression (P=0.655). ER-alpha was higher in fibroadenomas of patients in follicular phase versus contraceptive users and normal tissue (P=0.003); bcl-2 was higher in fibroadenomas of patients in luteal phase than in the normal samples from all groups (P=0.007). c-myc did not differ according to menstrual cycle, but was higher in fibroadenomas>3 cm versus<3 cm (P=0.015) and in nulliparous women (P=0.04). A positive correlation between c-myc levels and fibroadenoma diameter was demonstrated (r=0.536; P=0.007). Nulliparous mean nodule diameter was superior than parous women (P=0.008). In conclusion, the expression of ER-alpha, bcl-2 and c-myc depends on hormonal and reproductive factors, with a possible contribution to lump formation and evolution.

Adolescent↗

PubMed2001

Fibroadenoma of the breast: analysis of associated pathological entities--a different risk marker in different age groups for concurrent breast cancer.

BACKGROUND: Fibroadenoma, one of the most common benign breast lesions, has a characteristic age-specific incidence and is associated with other pathological entities in 50% of cases. The clinical or imaging diagnosis of fibroadenoma may be erroneous, and in some cases is found to be invasive cancer. The clustering of such entities, their correlation with age, and the risk of synchronous breast malignancy are uncertain. OBJECTIVE: To explore the possibility of any significant clustering of fibroadenoma-associated benign breast diseases and to assess the possible risk of concomitant breast cancer. METHODS: We analyzed the pathological results of 147 women undergoing excisional biopsies for fibroadenoma diagnosed pre-operatively either by clinical examination and imaging (n = 17) or by radiology alone (n = 30). The inter-relationships among all entities associated with fibroadenoma were studied by hierarchical cluster analysis. The correlation of the various pathologies with the risk of invasive breast cancer in relation to the patient's age was also evaluated. RESULTS: Fibroadenoma-associated pathologies were found in 48% of the cases: sclerosing adenosis (23%), duct ectasia (17.7%), apocrine metaplasia (15.6%), florid fibrocystic disease (12.9%), duct papillomatosis (11.6%), infiltrating duct carcinoma (5.4%), duct carcinoma in situ (3.4%), and 1 case of lobular carcinoma in situ (0.6%). An orderly internal hierarchy and three significant clusters emerged: a) epithelial apocrine metaplasia, duct ectasia and sclerosing adenosis (similarity coefficients 16.0, 11.0 and 8.0 respectively); b) papillomatosis, florid fibrocystic disease and calcifications (similarity coefficients of 6.0, 4.0 and 2.0 respectively); and c) infiltrating duct carcinoma and duct carcinoma in situ (similarity coefficients of 1.8 and 1.6 respectively). Seven of the eight patients with breast cancer were older than 40 years. CONCLUSIONS: In about half of the cases fibroadenoma was associated with other pathological entities clustered in an orderly hierarchy. The rarity of synchronous breast cancer in the younger age group and its more common association with fibroadenoma in the older age groups dictate a different approach to each. The finding of fibroadenoma in women older than 40 indicates the need for surgical excision.

Adolescent↗

PubMed1993

[Value of fine needle aspiration cytology in the diagnosis and management of fibroadenoma of the breast].

Cytological and histopathological biopsies were obtained from 121 breast lumps clinically diagnosed as fibroadenomas. Of these 98.3 percent of the lesions were benign. The cytological diagnosis was benign in 95.1 percent of 101 (83.4% of total) cases confirmed as fibroadenomas, histopathologically, but inadequate for diagnosis in 4.9 percent. The remaining 20 lesions included one breast cancer and one primary malignant lymphoma. In this group aspiration cytology was inadequate for diagnosis in 20 percent of the cases (P < 0.05). The cytological reports cast suspicion in the two malignant cases. No lesion with benign cytology was subsequently shown to be malignant. Ninety-five (78.5%) cases of the lesions, representing 72 women under 35 years of age, which has been clinically diagnosed as fibroadenomas, showed fibroadenoma, histopathologically, in 89.5% of these cases. The other 26 (21.5%) lesions in 21 patients, who were over 35 years in age, had 61.5 percent fibroadenomas, cytological results cast suspicion of fibroadenoma in 87.1 percent of these cases. The other 16 histopathologically diagnosed fibroadenomas in patients over 35 years of age showed 62.5% were cytologically suspected of being fibroadenomas (P < 0.025). As a result of this study it is reasonable to suggest that a typical clinical fibroadenoma can be treated conservatively in women under 35 years, but only if an adequate cytological smear obtained by fine needle aspiration does not show malignant of suspicious cells.

Adenofibroma↗

PubMed2003

Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma.

HYPOTHESIS: Core needle biopsy is a useful diagnostic tool in differentiating phyllodes tumor from fibroadenoma. DESIGN: The radiology database was queried for patients who underwent core needle biopsies of fibroepithelial lesions that raised the possibility of phyllodes tumor. These diagnoses were then compared with the final pathological diagnoses after surgical excision. SETTING: The data were gathered from the Comprehensive Breast Center, Columbia Presbyterian Medical Center, a tertiary care, university-based medical center. RESULTS: From August 21, 1998, to December 14, 2001, 57 core needle biopsies were identified in which the specimen raised the possibility of phyllodes tumor. The median age of the patients was 42 years (range, 16-77 years). The median diameter of all lesions was 1.1 cm (range, 0.6-3.6 cm). Of the 57 specimens, 25 had core biopsies in which the pathological findings favored a diagnosis of fibroadenoma over phyllodes tumor. Twenty-three had initial core biopsies favoring phyllodes tumor. Nine of the core biopsies were equivocal. Of the 25 patients with specimens favoring fibroadenoma, excisional biopsy confirmed the diagnosis of fibroadenoma in 23, and phyllodes tumor was found in 2. The negative predictive value was 93%. Of the 23 core biopsies favoring phyllodes tumor, 19 were confirmed on excisional biopsy, while 4 were fibroadenoma. The positive predictive value was 83%. In the equivocal core biopsies, 5 were fibroadenoma and 4 were phyllodes tumor on final pathological analysis. None of the lesions studied were determined to be malignant on final analysis. CONCLUSIONS: Core needle biopsy can significantly reduce the need for operative management of fibroepithelial lesions. A core needle biopsy with results favoring fibroadenoma should allow the breast physician to treat the lesion as a fibroadenoma, with observation and close follow-up or with enucleation. Core needle histologic examination of phyllodes tumor allows the physician to preoperatively plan the definitive management at one surgical procedure, reducing the need for reoperations.

Adolescent↗

PubMed1995

Demonstration of polyclonal origin of giant fibroadenoma of the breast.

We have shown that fibroadenoma of the breast is polyclonal and that phyllodes tumour is monoclonal in origin. It is not known whether a giant fibroadenoma which is histologically identical to the more usual type of fibroadenoma but grows to be a huge mass, like a phyllodes tumour, is polyclonal or monoclona. Clonal analysis was conducted on the DNA samples extracted from the paraffin sections of a giant fibroadenoma resected from a 21-year-old woman. The method used was based on trinucleotide repeat polymorphism of the X-chromosome-linked androgen receptor gene and on random inactivation of the gene by methylation. Clonal analysis showed that the giant fibroadenoma and the adjacent normal breast tissue are polyclonal in origin. Although the term giant fibroadenoma has often been used interchangeably with the term benign phyllodes tumour, because of their similarity in clinical appearance, our present results demonstrate that a giant fibroadenoma is a polyclonal fibroadenoma that has attained an immense size and is different from the monoclonal phyllodes tumour.

Adult↗

PubMed2005

Interim results from the FibroAdenoma Cryoablation Treatment Registry.

OBJECTIVE: The aim of this prospective study was to assess the intermediate- (6 months) and longer-term (12 months) follow-up of patients with breast fibroadenomas treated by cryoablation in community-based practice settings. METHODS: The FibroAdenoma Cryoablation Treatment (FACT) registry was created to systematically collect procedural and follow-up data for patients with fibroadenomas treated by cryoablation without subsequent excision. This report summarizes the experience from 55 different practice settings across the United States. Baseline and follow-up clinical data at 6 months and 12 months were tabulated for all patients. RESULTS: Data from 444 treated fibroadenomas were analyzed. The mean tumor diameter was 1.8 cm. Before cryoablation, 75% of fibroadenomas were palpable by the patient. Follow-up at 6- and 12-month intervals revealed palpability of the treated site in 46% and 35%, respectively. When fibroadenomas were grouped by size, for lesions </=2 cm, residual cryoablation induce changes were visible by ultrasound in 35% of patients at 6 months. The treatment area was palpable in 31% of cases at this time. Visibility by ultrasound was 27%, and palpability was 28% at 12 months follow-up in these patients with smaller fibroadenomas. For lesions >2 cm, residual cryoablation induce changes were visible by ultrasound in 39% of the patients at 6 months. The treatment area was palpable in 78% of the cases at the same time. Visibility by ultrasound was 32%, and palpability was 59% at 12 months follow-up. Patient satisfaction with the procedure was rated as high at 91% and 88% at 6 and 12 months follow-up, respectively. CONCLUSIONS: Before implementing this technique, patients should be apprised of the likely persistence of a palpable mass of the treated site for a prolonged period that will reabsorb over time. Palpability of the treated site persists for a substantially longer period of time for lesions greater than 2 cm in diameter. For patients with a fibroadenoma smaller than 2 cm, complete resolution can be expected in two thirds and three quarters of the patients at 6 and 12 months, respectively. We will continue to follow these patients to better define the length of time and factors influencing the resolution of the treatment induced physical and radiographic findings.

Breast Neoplasms↗

PubMed2006

Percutaneous radiofrequency-assisted excision of fibroadenomas.

INTRODUCTION: Fibroadenomas are a frequently encountered benign tumor that will occur in approximately 10% of women during their lifetime. Although the natural history would suggest fibroadenomas diagnosed with minimally invasive needle core biopsy can be safely observed, the majority are still surgically removed in the operating room. In an effort to limit the more than 500,000 surgical fibroadenoma removals performed each year, percutaneous excision has become a viable alternative. Percutaneous excision of intact fibroadenomas versus removal with a multiple core sampling technique has the dual potential advantage of causing minimal intervention combined with provision of adequate sample for thorough histopathology and margin analysis for confirmation of complete removal. An 18-month retrospective analysis was undertaken to evaluate the utilization of a new radiofrequency-assisted biopsy device in the successful removal and continued absence of histologically confirmed fibroadenomas on 4- to 6-month follow-up imaging. METHODS: Between April 2004 and November 2005, 100 patients underwent ultrasound- or stereotactic-guided, radiofrequency-assisted intact percutaneous excision of 106 diagnosed fibroadenomas of the breast. Patients were comprised of 100 women whose ages ranged from 18-70 years (median age, 45 years). RESULTS: Indications for the procedure included palpable mass, 77; abnormal mammogram, 13; and abnormal ultrasound, 10, as the patient's initial presentation. Ultrasound was used to guide the procedure in 82 patients, and stereotactic was used in 18 patients. One early study procedure was performed under general anesthesia; the remaining studies were performed under local anesthesia (1% lidocaine) using from 10 to 45 mL. On pathologic examination, the tumors ranged in size from 6 to 27 mm (mean diameter, 14 mm) and weighed from 0.6 to 2.0 g (mean weight, 1.0 g). Patients reported minimum discomfort related to the procedure; pain scores ranged from 0 to 10 (mean pain score, <1). Complications were minimal, with only 2 patients having bleeding, which was controlled by conservative measures. At the 4- to 6-month follow-up, 79 of 85 (93%) evaluable patients showed no physical or imaging evidence of residual fibroadenoma, an additional 5 patients have reported no physical findings or further complaints and have required no further need for medical evaluation, 8 have been lost to follow-up, and 2 have yet to be reevaluated. CONCLUSIONS: Percutaneous ultrasound- or stereotactic-guided, radiofrequency-assisted excision of fibroadenomas of the breast may be performed in an ambulatory setting under local anesthesia. The procedure provides intact specimens that in most cases appear to be completely removed after follow-up of 4 to 6 months. The procedure is well tolerated by patients and is associated with minimal complications.

Adolescent↗

PubMed2006

Estrogen receptor-beta is expressed in stromal cells of fibroadenoma and phyllodes tumors of the breast.

An estrogen dependency has been suggested for the growth of fibroadenomas: however, thus far, none of the steroid hormone receptors acting on breast tissues has been demonstrated in the stroma of breast fibroepithelial lesions. In this study, the expression of estrogen receptor (ER)-alpha and -beta was investigated by immunohistochemistry in 33 fibroadenomas and in 30 benign, three borderline and seven malignant phyllodes tumors, all with spindle cell growth and in one distant metastasis. In addition, the presence of ER-beta mRNA and its variants was evaluated by RT-PCR in microdissected stroma. The possible correlation between hormone receptor expression and differentiation processes of stromal cells was investigated by smooth muscle actin and calponin immunostaining. ER-beta was the only hormone receptor expressed by stroma of fibroadenomas and phyllodes tumors, both at protein and mRNA level. The highest percentage of ER-beta was observed in fibroadenomas with cellular stroma and in phyllodes tumors. In both lesions, ER-beta-positive stromal cells showed expression of smooth muscle actin and/or calponin, as demonstrated by double immunostaining. In addition, the mean age at diagnosis was significantly lower in patients with ER-beta-positive vs ER-beta-negative fibroadenomas. In contrast, in phyllodes tumors, ER-beta expression was higher in older patients. In conclusion, (i) only ER-beta is detected in the stroma of fibroadenomas and phyllodes tumors; (ii) its expression correlates with the expression of smooth muscle markers and suggests a role of ER-beta in myofibroblastic differentiation of stromal cells. These two results, together with the young age of patients carrying fibroadenomas with highly ER-beta-positive stroma cells, may further indicate a hormone-receptor mechanism involved in regulating the growth of fibroadenomas. Conversely, the older age of patients with ER-beta-rich phyllodes tumors suggests that mechanisms, probably independent from estrogen stimulation, act on the growth of these tumors.

Actins↗

PubMed2002

Detection of Epstein-Barr virus in rapidly growing fibroadenomas of the breast in immunosuppressed hosts.

Fibroadenomas are the most common benign tumors of the female breast and are associated with a slight increase in the risk of subsequent breast cancer. Multiple fibroadenomas have been described in patients after renal transplantation and are thought to be secondary to drug-related growth stimulation. Epstein-Barr virus (EBV) has been detected in many neoplasms, including breast cancer. We set out to investigate whether EBV plays a role in the development of rapidly growing fibroadenomas in immunocompromised patients. We studied 19 fibroadenomas and one invasive ductal carcinoma that developed after organ transplantation or treatment for lupus erythematosus. As a control group we included 11 fibroadenomas from non-immunocompromised patients. DNA was amplified using polymerase chain reaction (PCR) of the EBV-encoded small RNA (EBER-2) DNA sequence. EBV latent membrane protein 1 (LMP-1) transcripts were amplified using reverse transcription (RT) PCR. Immunohistochemical (IHC) staining for LMP-1 protein was performed. A total of 9 out of 20 tumors (45%) were concordantly positive by PCR and IHC. IHC stained exclusively the epithelial cells. All the fibroadenomas in non-immunocompromised patients were negative for LMP-1 (Fisher's exact test P =.0006). These data suggest that EBV is associated with fibroadenomas in this immunosuppressed population and that the infection is specifically localized to epithelial cells. This is the first study suggesting a role for EBV in the pathogenesis of fibroadenomas.

Adult↗

PubMed1994

Invasive ductal carcinoma with a predominant intraductal component arising in a fibroadenoma of the breast.

A rare case of invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma of the breast in a 42 year old Japanese female was investigated by light microscopy. The patient, who had a well-defined, rubbery breast tumor measuring 2.0 x 3.0 cm, had undergone a tumorectomy 21 months after she noticed the tumor. Histologically, the fundamental architecture of the tumor showed an intracanalicular-type of fibroadenoma, but extensive proliferation of atypical cells was noticed in the lumen of the ducts. Tumor cells in the canaliculi had characteristics of ductal carcinoma, such as solid, comedo and cribriform patterns. As most of the ducts were occupied by carcinoma cells with several foci of microinvasion in the stroma of the fibroadenoma, it was diagnosed as invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma. This coexistence of in situ proliferation and invasive lesions of carcinoma within a fibroadenoma suggest the origin of the carcinoma to have been in the epithelial component of the fibroadenoma. In addition, this study clarifies the fact that carcinoma cells may proliferate and spread along the lumen of pre-existing ducts of the fibroadenoma and speculates that the duct system of the fibroadenoma has complete continuity.

Adult↗

PubMed2005

Differentiation of phyllodes breast tumors from fibroadenomas on MRI.

OBJECTIVE: The purpose of our study was to evaluate the MRI appearance of phyllodes breast tumors and to differentiate them from fibroadenomas. MATERIALS AND METHODS: MR images were obtained on a 1.5-T imager. T1- and T2-weighted sequences and dynamic 2D fast-field echo T1-weighted sequences were performed. MR images of 23 patients with 24 phyllodes breast tumors (one malignant, 23 benign) were analyzed with respect to morphology and contrast enhancement. The tumors were compared with the MRI appearance of 81 fibroadenomas of 75 patients. RESULTS: Well-defined margins were seen in 87.5% of the phyllodes tumors and 70.4% of the fibroadenomas, and a round or lobulated shape in 100% and 90.1%, respectively. A heterogeneous internal structure was observed in 70.8% of phyllodes tumors and in 49.4% of fibroadenomas. Nonenhancing internal septations were found in 45.8% of phyllodes tumors and 27.2% of fibroadenomas. A significantly greater increase in signal was seen on T2-weighted images in the tissue surrounding phyllodes tumors (21%) compared with fibroadenomas (1.2%). Most of both lesions appeared with low signal intensity on T1- and T2-weighted images. After the administration of contrast material, 33.3% of phyllodes tumors and 22.2% of fibroadenomas showed a suspicious signal intensity-time course. CONCLUSION: Phyllodes breast tumors and other fibroadenomas cannot be precisely differentiated on breast MRI. Phyllodes tumors have benign morphologic features and contrast enhancement characteristics suggestive of malignancy in 33% of cases.

Adolescent↗

PubMed1992

Fibroadenoma of the breast: diagnostic pitfalls of fine-needle aspiration.

On fine-needle aspiration (FNA), fibroadenomas have a characteristic cytological appearance, although occasional cases are misinterpreted as carcinomas and vice versa. In a review of 521 breast aspirates correlated with the subsequent histology, six of 87 fibroadenomas (7%) were malignant or suspicious of malignancy on FNA (false positives). Following cytological review, four were still suspicious of malignancy because of cellular dyscohesion and prominent nucleoli, while two were fibroadenomas. On FNA, four of 145 carcinomas (3%) were diagnosed as fibroadenomas (false negatives). On review, three were malignant or suspicious of malignancy, while one was consistent with a fibroadenoma. Three false negative diagnoses were due to underappreciation of single malignant cells present between epithelial groupings typical of a fibroadenoma, while one was due to undersampling of the carcinoma. Cytologically, some fibroadenomas are sufficiently atypical that histological confirmation is necessary to exclude a malignancy. Misinterpreting carcinomas as fibroadenomas could be avoided by careful study of the morphology of isolated cells.

Adenofibroma↗

PubMed1986

The spectrum of sonographic findings of fibroadenoma of the breast.

There are a number of sonographic findings seen in fibroadenoma of the breast. In a retrospective study, we examined the biopsy results of 59 masses given the sonographic diagnosis of fibroadenoma. We also reviewed the sonograms of an additional 26 biopsy-proven fibroadenomas that were not diagnosed as such with ultrasound. The ultrasound diagnosis was correct in 50 of 76 fibroadenomas (65.8%). Only 12 of the 76 biopsy-proven fibroadenomas had the classic sonographic appearance of a smooth round or oval mass with homogeneous internal echoes. Fourteen fibroadenomas were not visible on the sonograms, even in retrospect. The remaining 50 biopsy-proven fibroadenomas demonstrated one or more "atypical" signs of border irregularity, lobulation, inhomogeneous internal echo texture, or posterior shadowing. There were nine sonographic false positives: five patients had other benign lesions on histology, and four masses believed to be sonographically compatible with fibroadenoma were found to be carcinomas. While breast sonography is frequently a useful modality for breast mass detection, particularly as an adjunct to x-ray mammography, the common overlap in characteristics of benign and malignant masses makes histologic evaluation of all solid masses essential.

Adenofibroma↗

PubMed2004

Color Doppler imaging of fibroadenomas of the breast with histopathologic correlation.

PURPOSE: This study was conducted to characterize the spatial distribution of blood vessels in breast fibroadenomas. METHODS: We performed a prospective study to map the anatomic distribution of the vessels in 29 fibroadenomas of the breast using color Doppler sonography. We categorized the detected vessels according to their location in or on the fibroadenoma, counted the different types of vessels, and tested for correlations between vessel distributions or numbers and histopathologic findings. RESULTS: Blood flow was demonstrated in 24/29 (83%) of fibroadenomas. We found 3 vessel types: feeding vessels, which are prominent vessels leading from the surrounding breast tissue into the fibroadenoma; capsular vessels, which are located within the tissue capsule; and segmental vessels, which are located within the fibrous septa of the fibroadenoma. Capsular and segmental vessels were demonstrated in 23/24 (96%) and 24/24 (100%) of the cases, respectively. Feeding vessels were seen in 12/24 (50%) of the cases. Histopathologic analysis revealed the same location and distribution of the vessels as color Doppler imaging. However, there was no correlation between numbers of vessels counted on sonograms and on histopathologic specimens. CONCLUSIONS: Examination of the vascularity demonstrated on color Doppler imaging helps in the diagnosis of benign breast neoplasms such as fibroadenomas.

Adult↗

PubMed2006

Clinical and pathologic features of fibroadenoma of the mastopathic type.

PURPOSE: Fibroadenoma with mastopathic change (FAM) is a relatively uncommon subtype of fibroadenoma of the breast, with a high incidence of pathological misdiagnosis. This histological subtype remains poorly understood because of its rarity. Many questions remain unanswered about its clinicopathological importance, especially in the differential diagnosis of breast cancers. METHODS: Among 218 breast fibroadenomas surgically resected as excisional biopsies at our institute between 1990 and 2004, 19 were pathologically diagnosed as FAM. We reviewed these 19 patients. RESULTS: The ages of the patients ranged from 20 to 51 years (mean 36.8 years). The tumor sizes ranged from 0.8 to 7 cm (mean 2.1 cm). Six of the 19 patients underwent core needle biopsy, resulting in a diagnosis of fibroadenoma in four patients and atypical ductal hyperplasia in two patients. Ultrasonography showed findings suggestive of solid tubular carcinoma in seven patients, fibroadenoma in ten patients, and unspecific malignant tumors in two. They were not specified clinically. CONCLUSION: Recognition of this distinctive variant of fibroadenoma is important because it resembles intraductal carcinoma and is increasing in incidence. It is crucial to distinguish FAM from intraductal carcinoma in biopsy specimens. Thus, not only pathologists but also clinicians must be able to recognize this type of fibroadenoma, and cooperate closely to establish an accurate diagnosis.

Adult↗

PubMed2004

Lobular carcinoma in situ of the breast within a fibroadenoma. A case report.

BACKGROUND: Fibroadenoma is a benign breast tumor that is effectively treated by local excision. Although uncommon, breast fibroadenoma may harbor breast carcinoma, either in situ or invasive. CASE: We present a 27-year-old woman who presented for the management of an apparently benign mass in the right breast. The clinician and ultrasonographic characters of the mass were indicative of a breast fibroadenoma. A local excision of the mass was performed. Histology showed the presence of LCIS within the fibroadenoma. After a detailed discussion with the patient about the available management options, the conservative approach (which includes local excision/biopsy only and regular follow-up) was preferred. CONCLUSION: LCIS within a breast fibroadenoma is a rare entity. Carcinomas arising within a fibroadenoma have the same biological behavior as those arising independently and, therefore, their management should be the same. Close surveillance following local excision/biopsy is the preferred management for LCIS within a fibroadenoma.

Adult↗

PubMed2002

Office-based ultrasound-guided cryoablation of breast fibroadenomas.

BACKGROUND: Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas. METHODS: A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation. RESULTS: Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent. CONCLUSIONS: With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.

Adolescent↗