Updated: 12/1/2021

Fibroadenoma

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  • Snapshot
    • A 26-year-old woman presents to the gynecology clinic with a mass in the left breast. She discovered this mass while showering. Her last menstrual period was 10 days ago. There is no family history of breast cancer. On physical exam, you palpate a 3 cm, firm, non-tender mass in the upper lateral quadrant of the left breast. The mass is smooth, well-circumscribed, and mobile. There are no skin changes, nipple discharge, or axillary lymphadenopathy. Ultrasound of the breast was carried out as shown.
  • Introduction
    • Clinical definition
      • benign solid tumor of the breast with epithelial and stromal components
    • Associated conditions
      • breast cancer
      • phyllodes tumor of the breast
    • Prognosis
      • natural history of disease
        • patient presents with a small, firm, mobile, and non-tender breast lump
          • most small tumors reabsorb
          • rapid increase in size is a cause for concern
            • giant forms (up to 15 cm) have malignant potential
  • Epidemiology
    • Incidence
      • common in women 15-35 years of age
      • second most common benign breast mass
        • most common breast tumor in women under 30
    • Demographics
      • mostly women
      • in males may be associated with anti-androgen treatment
    • Risk factors
      • use of oral contraceptives
      • pregnancy
  • Etiology
    • Pathophysiology
      • unclear, but partially hormone dependent
        • seen mostly during reproductive years
        • increases during pregnancy
        • regresses during menopause
  • Presentation
    • Physical exam
      • firm
      • painless
      • freely movable
      • well circumscribed round breast mass 2-3 cm in diameter
      • does not change with menstrual cycle ("unchanged for three months")
        • grows slowly in response to estrogen vs rapid change of fibrocystic disease
  • Imaging
    • Ultrasonography
      • indications
        • initial diagnostic test for a breast mass in a female under 30 years of age
      • findings
        • reveals a hypoechoic mass with sharp margins
        • can determine if the mass is cystic or solid
  • Studies
    • Fine needle aspiration or core biopsy of the mass to confirm diagnosis and/or exclude malignancy
    • Histology
      • proliferative breast lesions without atypia
        • epithelial proliferation occuring in a single terminal ductal unit
        • surrounded by a fibroblastic stroma
        • basement membrane is intact
    • Any enlarging mass warrants excision
  • Differential
    • Fibrocystic disease
      • pain and tenderness varies with menstrual cycle
      • ill-defined mass
    • Breast cyst
    • Galactocele
      • key distinguishing factor
        • appears cystic (smooth anechoic mass) on sonography
  • Treatment
    • Conservative
      • observation
        • indication
          • small tumors with slow or no growth rate
            • repeat breast exam and sonogram in 3-6 months
    • Operative
      • surgical excision
        • indications
          • tumors enlarging on follow-up
          • initial presentation of a large mass
          • patient's preference
      • cryoablation
        • an alternative to surgery
        • indications
          • visible on sonogram
          • mass < 4 cm
          • diagnosis confirmed by histology
  • Complications
    • May be a risk factor for future cancer
      • if the fibroadenoma is complex
      • positive family history of breast cancer
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Questions (2)

(M2.GN.17.4732) A 16-year-old female presents to her physician’s office after noticing a round lump in her left breast 2 months ago. She reports that the lump seemed to enlarge and became tender just preceding her last 2 menses. It is otherwise painless, and the patient denies any discharge or skin changes. She has no past medical history but her grandmother, age 72, was just diagnosed with invasive ductal carcinoma of the breast. The patient is an avid softball player at her high school and denies alcohol, smoking, or illicit drug use. On exam, the breasts appear symmetric and normal. A 3-cm round, mobile mass is palpated in the upper outer quadrant of the left breast. There is slight tenderness to deep palpation of the mass. There is no axillary lymphadenopathy on either side. Which of the following is the most likely outcome of this patient’s condition?

QID: 108618
1

This mass will likely require excision

7%

(2/27)

2

This mass will decrease in size if the patient starts oral contraceptives

19%

(5/27)

3

This mass slightly increases this patient’s risk of breast cancer in the future

7%

(2/27)

4

This mass will most likely decrease in size or disappear over time

59%

(16/27)

5

If this mass grows rapidly to greater than 5 cm, radiation and chemotherapy are indicated

4%

(1/27)

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