Clinical Diagnosis Of Fibroadenoma Research Articles

A Rare Case of Chondrolipoma of the Breast

In 1971, Arrigoni MG et al., used the term “hamartoma” for breast lesions in 10 patients who presented with encapsulated breast tumours clinically and grossly resembling fibroadenomas. Hamartomas in breast lesions are very uncommon and include adenolipoma and chondrolipoma. Despite the availability of imaging modalities, it is often difficult to distinguish fibroadenoma from breast carcinoma. Chondrolipoma of the breast is a rare benign mesenchymal tumour composed of adipose and mature cartilaginous tissue, which is often mistaken for malignant lesions in preoperative studies, leading to overdiagnosis and overtreatment. Hence, a proper histopathological examination is required for a correct diagnosis. Only eight cases have been reported in the literature. This report presents one such rare case of lump in a 67-year-old female, which was suspected to be a fibroadenoma clinically and radiologically, but was diagnosed as chondrolipoma on histopathological examination. All routine investigations were within normal limits, and a clinical diagnosis of fibroadenoma was made. Mammography was done, comprising fat, soft tissue, and calcific strandings along with coarse calcific specks suggestive of BI-RADS (Breast Imaging-Reporting and Data System) Category 3: high probability of being benign.

Angiolipoma of the mammary region: A report of two cases

Angiolipoma is a benign variant of lipoma that is rare in the breast and may be confused clinically, radiologically and pathologically with other benign tumours. It accounts for 5 - 17% of all benign fatty tumours. Clinicians, radiologists and pathologists in particular should not forget the existence of an angiolipoma of the breast to avoid unnecessary re-aspiration of the lesion considering the smears with only adipose tissue fragments as inadequate. We report two cases of angiolipoma who presented with solitary lumps in the breast, and a clinical diagnosis of fibroadenoma was suggested in both the cases. Both were diagnosed as lipoma on cytology and, on subsequent histopathology, a diagnosis of angiolipoma was given.

Ultrasound diagnosis of fibroadenoma — is biopsy always necessary?

To review the ultrasound characteristics of fibroadenoma and the necessity to biopsy all fibroadenomas in the under 25 years age group. The details of all patients under 25 years of age who attended a large district general hospital in the UK between 1995 and 2005 with a clinical diagnosis of fibroadenoma and subsequently, underwent a breast biopsy were obtained. The report of the targeted ultrasound for these patients was reviewed and this was correlated with the histopathology report (n=447). If there was a significant discrepancy between the ultrasound and the pathology report, the ultrasound images were reviewed. Out of 447 patients 357 had an ultrasound diagnosis of fibroadenoma. This was histologically proven in 281 (78.8%) cases. In 75 (21.5%) of these patients the final histology was either another benign pathology or normal. One patient (0.3%) had an invasive carcinoma. The majority of patients in the 25 years and under age group have benign breast pathology, most commonly fibroadenoma. Modern ultrasound is a reliable technique to diagnose fibroadenoma in the hands of experienced breast radiologists. Therefore, in this age group, it is proposed that a palpable lump that has the ultrasound characteristics entirely consistent with a fibroadenoma need not be biopsied unless there is overriding clinical concern. The patients should be reassured, discharged, and advised to return for further evaluation only if they detect a change in the palpable abnormality.

Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy.

Ultrasound-guided vacuum-assisted biopsy (UGVAB) can serve as an efficient tool for the diagnosis and excision of breast fibroadenomas. Patients with a clinically and radiographically suspected breast fibroadenoma were prospectively referred for UGVAB to confirm the diagnosis and to attempt to excise the lesion. Fifty-two female patients, aged 19 to 68 years, were included in the 2-year study. All had at least 1 suspected fibroadenoma. The procedure was performed for a total of 56 lesions. Imaging modalities prior to biopsy to confirm the clinical suspicion included Doppler ultrasound and mammography or Doppler ultrasound alone. Tumor size and volume were recorded. Ultrasound-guided vacuum-assisted biopsy was performed in all cases, with guidance using the 11-gauge Mammotome handheld vacuum-assisted biopsy system (Ethicon Endo-Surgery Inc, Cincinnati, Ohio). Major end points included diagnosis compatibility rate, excision rate, complications, and short-term follow-up. A tissue diagnosis was obtained in all cases and was compatible with the clinical diagnosis of fibroadenoma. Complete excision was achieved in all lesions less than or equal to 1.5 cm (mean volume, 0.25 mL). All lesions greater than 2 cm (mean volume, 1 mL) were incompletely excised. Of the 20 lesions measuring 1.5 to 2.0 cm, 11 (55%) were completely excised. The volume of all completely excised lesions was less than 0.9 mL. Four lesions with a volume less than 0.9 mL were incompletely excised due to bleeding. Ten of the 13 cases with incomplete excision were confident enough with the diagnosis to choose imaging follow-up instead of surgery. Two patients (16%) were referred by the radiologist for surgical excision. Only 1 patient with incomplete removal (8%) felt uncomfortable with the remnant lump and requested surgical excision. Although the breast fibroadenoma is a common benign breast tumor, the treatment and follow-up of these lesions is still debatable. We suggest that UGVAB, which has a well-documented role in the diagnosis of breast lesions, may provide an option for the definitive treatment of breast fibroadenomas.

Fibroadenoma of the breast.

Fibroadenoma of the breast is a common cause of a benign breast lump in premenopausal women. The consensus view is that women with fibroadenomas are not at significant increased risk of developing breast cancer. Diagnosis is based on the combination of clinical examination, imaging and non-surgical tissue biopsy (the triple test). A clinical diagnosis of fibroadenoma alone is unreliable and does not exclude malignancy even in younger women. The choice of imaging is mammography, combined with ultrasound in older women, and ultrasound alone in younger women. Tissue biopsy, by either fine-needle aspiration or core biopsy, is the most accurate means of establishing the diagnosis. Traditionally, symptomatic fibroadenomas were treated by surgical excision, and this option should always be offered. There is increasing evidence that a conservative approach is safe and acceptable, provided the result of an adequate triple test is both negative for cancer and consistent with a fibroadenoma. Patients who choose conservative management need to be informed of the limitation of the tests, and must be assessed promptly if there is symptomatic or clinical change.

Risk of breast cancer subsequent to histological or clinical diagnosis of fibroadenoma - retrospective longitudinal study of 3938 cases

The widespread belief that fibroadenoma is associated with an increased risk of subsequent breast cancer is based on studies of histologically-confirmed fibroadenomas. In current practice only a minority of fibroadenomas are excised; most of them are diagnosed on the basis of palpation and imaging, and are not surgically removed. The decision for surgical excision may be influenced by the presence of individual risk factors, and this can act as a confounder and bias studies that are based only on surgically excised fibroadenomas. To investigate this hypothesis we linked data from a consecutive series of 3938 fibroadenomas diagnosed histologically (n = 1335) or clinically (n = 2603) in women aged 30 to 69 years to the Tuscany Cancer Registry database. After exclusion of concurrent breast cancers or cancers occurring within six months after the diagnosis of fibroadenoma, the observed and expected incidence of subsequent breast cancer were compared. The overall Standardized Incidence Ratio (SIR) for excised and non-excised fibroadenomas was 1.38 (95% CI = 1.1-1.7). The SIR for histologically-confirmed fibroadenomas was 2.0 (95% CI 1.4-2.7) whereas there was no apparent risk for non-excised fibroadenomas (SIR = 0.97, 95% CI = 0.7-1.4). This study suggests that assessment of breast cancer risk subsequent to a diagnosis of fibroadenoma may be biased if the analysis is limited to surgically-excised fibroadenomas.