17-02: Fibroadenoma of the Breast

This common benign neoplasm occurs most frequently in young women, usually within 20 years after puberty. It is somewhat more frequent and tends to occur at an earlier age in Black women. Multiple tumors are found in 10–15% of patients.

The typical fibroadenoma is a round or ovoid, rubbery, discrete, relatively movable, nontender mass 1–5 cm in diameter. It is usually discovered accidentally. Clinical diagnosis in young patients is generally not difficult. In women over 30 years, fibrocystic condition of the breast and carcinoma of the breast must be considered. Cysts can be identified by aspiration or ultrasonography. Fibroadenoma does not normally occur after menopause but may occasionally develop after administration of hormones.

No treatment is usually necessary if the diagnosis can be made by core needle biopsy. Excision with pathologic examination of the specimen is performed if the diagnosis is uncertain or the lesion grows significantly. Cryoablation, or freezing of the fibroadenoma, appears to be a safe procedure if the lesion is a biopsy-proven fibroadenoma prior to ablation. Cryoablation is not appropriate for all fibroadenomas because some are too large to freeze or the diagnosis may not be certain. There is no clinical advantage to cryoablation of a histologically proven fibroadenoma beyond the relief that some patients experience when the mass is gone. However, at times a mass of scar or fat necrosis replaces the mass of the fibroadenoma. Reassurance seems preferable to treatment. Distinguishing a large fibroadenoma from a phyllodes tumor based on needle biopsy results or imaging alone is usually not possible; histologic examination after excision is usually required. Presumed fibroadenomas larger than 3–4 cm should be excised to rule out phyllodes tumors.

Phyllodes tumor is a fibroadenoma-like tumor with cellular stroma that grows rapidly. It may reach a large size and, if inadequately excised, will recur locally. The lesion can be benign or malignant. If benign, phyllodes tumor is treated by local excision. The treatment of malignant phyllodes tumor is more controversial, but complete removal of the tumor with a margin of normal tissue avoids recurrence. Because these tumors may be large, total mastectomy is sometimes necessary. Lymph node dissection is not performed, since the sarcomatous portion of the tumor metastasizes to the lungs and not the lymph nodes.