-
DEFINITIONFibroadenoma is one of the commonest benign breast lumps and results from excess proliferation of connective tissue.They characteristically contain glandular and fibrous connective tissue.Bones
-
EPIDEMIOLOGYThey usually occur in women between the ages of 10 and 40. It is the most common breast mass in the adolescent and young adult population.Their peak incidence is between 25 and 40 years. Incidence decreases after 40 years Bones
-
CLINICAL PRESENTATIONSThe typical presentation is in a women of reproductive age with a palpable breast lump. Due to their hormonal sensitivity, the fibroadenoma commonly enlarges during pregnancy and involute at menopause. Hence, they rarely present after the age of 40.Bones
-
CLINICAL PRESENTATIONSThe lesions are well defined and well circumscribed clinically and the overlying skin is normal.The lesions are not fixed to the surrounding parenchyma and slip around under the palpating hand, hence the colloquial term a breast "mouseRound, firm masses that may move when palpated. Tend to be painlessBones
-
PATHOLOGYA fibrodenoma is a type of adenomatous breast lesion. Itcontain epithelium and have minimal a malignant potential.Multiple fibroadenomas can occur in ~10-15% of patients.Patients with multiple fibroadenomas tend to have a strong family history of these tumours.Bones
-
PATHOLOGYThey are assumed to be aberrations of normal breast development (ANDI) or the product of hyperplastic processes, rather than true neoplasms.Fibroadenomas can be stimulated by oestrogen and progesterone. Some fibroadenomas also have receptors and respond to growth hormone and epidermal growth factor.Bones
-
LOCATIONSWhen found in an adolescent girl, the term juvenile fibroadenoma is more appropriate.Although they can be located anywhere in the breast, there may be a predilcetion towards majority are situated in the upper outer quadrantBones
-
RADIOLOGY : MAMMOGRAPHYFibroadenomas have a spectrum of features from the well circumscribed discrete mass, to the multilobulated mass. Involuting fibroadenomas in older, typically postmenopausal patientsmay contain calcification, often producing theclassic, coarsepopcorn calcificationappearance.Calcification may also present as microcalcification which makes differentiation from malignancy difficult.Bones
-
RADIOLOGY : ULTRASOUNDTypically seen as awell-circumscribed, round to ovoid, or macrolobulated mass with generally uniform hypoechogenicity.Intralesional sonographically detectable calcification may be seen in ~10% of cases .Sometimes a thin echogenic rim - pseudocapsule may be seen sonographically..Bones
-
RADIOLOGY : MRI
T1: typically hypointense or isointense compared with adjacent breast tissueT2: can be hypo- or hyperintenseT1 C+ (Gd): can be variable but amajority will show slow initial contrast enhancement and a persistent delayed phase (type I enhancement curve); non enhancing internal septations may be seen.Bones
-
INDICATION FOR BIOPSYEnlarging lesionAtypical findings on ultrasoundA lesion above 2.5 cm where there are no previous studies for comparisonPatient peace of mind: some patients are simply not happy with a palpable mass in the breast without a histological diagnosis. This is a valid and reasonable indication for biopsy.Bones
