Review of Radiologic and Pathologic Features of Carcinomas and High Risk Lesions Arising from Fibroadenomata: Need for Continued Surveillance for Fibroadenomata and Lessons Learnt from our own Experience

Abstract

Carcinoma arising within a fibroadenoma is a rare entity. However, fibroadenomas are fairly common, and can arise in young women. A clinical dilemma arises as how to detect early malignant change, with the aim that early detection can result in curative therapy. Most published articles emphasize on pathologic findings, and not radiological findings of this entity. We report a series of four cases of carcinoma and high risk lesions found within fibroadenomas encountered over a five year period, with emphasis on mammographic and ultrasound findings, with pathologic correlation, taken from archived files from a single institution. We aimed to evaluate the radiology features, and determine if there are any unique radiological findings, which are unique to these high risk lesions. There were three cases of ductal carcinoma in situ, one lobular carcinoma in situ with atypical ductal hyperplasia arising within fibroadenomas. A brief literature review on the radiological and pathologic appearances was performed. We found that although some of the lesions may appear mammographically or sonographically suspicious, others may appear benign. Findings that were considered suspicious included large size, indistinct margins, and clustered microcalcifications, which should alert the radiologist of a suspicious finding and prompt a biopsy. When fibroadenomas undergoes malignant change, they behave like any other carcinoma, both radiologically and clinically. Unfortunately, in our review of the literature, there is no early radiologic sign that can predict malignant change. Hence, these should be lifelong follow-up of these lesions, whether clinical or radiologic, as malignant change, though rare, has dire circumstances.