Fibroadenoma

Today I went to the one-stop breast clinic, where you get a triple assessment: history and clinical examination, U/S if < 40 yrs or mammogram and U/S if > 40yrs, and a biopsy. I was with one of the surgical doctors and saw four women with fibroadenomas. They were basically told- good news. This is a benign fatty lump. We don’t need to do anything about it but keep an eye on it and carry on self-examining and if it changes, if it grows significantly bigger, then see your GP.

There is a lot of anxiety surrounding breast lumps and the women that come to clinic are often very nervous, but fibroadenomas are nice lumps- they don’t usually hurt and don’t need treatment. So, it’s re-assuring for patients to receive this diagnosis.


Fibroadenomas

Definition: benign overgrowth of collagenous mesenchyme of one breast lobule

Aetiology/risk factors:

-results from hyperplasia of a breast lobule and contains both normal epithelial and connective tissue elements

-may be less common in those on the OCP

Epidemiology:

-Usually presents < 30 yrs (most common in 15-25yrs) but can occur up to menopause (usually disappear after menopause unless on HRT)

-May be multiple or giant, especially in Afro-Caribbeans

Symptoms:

painless lump

-may have multiple lumps but usually isolated

Signs:

firm, smooth, well-circumscribed, mobile lump, about 1-2 cm in diameter (I’m going to go with a marble to remember this)

-features of malignancy absent: skin tethering or puckering, enlarged axillary lymph nodes, peau d’orange skin changes

Investigations:

-Triple assessment:

1) History and clinical examination

2) Imaging: mammogram (Mediolateral Oblique & Craniocaudal view +/- spot compression & magnification view) and U/S if > 35 yrs (40 in the hospital I’m at), U/S if < 35 yrs- will not usually see calcification in benign breast disease.

-For fibroadenomas it will mostly be ultrasounds as most of the women will be young ( < 35 yrs) with dense breasts that aren’t visualised very well on mammogram and you don’t really want to expose them to radiation.

Image result for fibroadenoma ultrasound

U/S of a Fibroadenoma- U/S is my worst modality. Just looks like static to me…

3) Cytology/ histology: by Fine Needle Aspiration cytology or core biopsy

Management:

-observation and re-assurance of patient

-Surgical excision if large ( > 4cm, because of a theoretical miniscule risk of a Phyllodes tumour) or on request

Complications:

-Recurrence

-Extremely miniscule risk of developing into a Phyllodes tumour (there are a few case reports)

Prognosis:

-1/3 stay the same, 1/3 regress, 1/3 get bigger

References: Cheese & Onion, Rapid Surgery
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