FIBROADENOMA

OF THE BREAST
M. IRVANIE RAMA HARAHAP, MD et al
Radiology Departement Hasan Sadikin General
Hospital

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DEFINITION
Fibroadenoma is one of the commonest

benign breast lumps and results from

excess proliferation of connective tissue.
They characteristically contain glandular

and fibrous connective tissue.

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EPIDEMIOLOGY
They 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

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CLINICAL PRESENTATIONS
The 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.

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CLINICAL PRESENTATIONS
The 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 "mouse
Round, firm masses that may move when

palpated. Tend to be painless

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PATHOLOGY
A 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.

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PATHOLOGY
They 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.

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LOCATIONS
When 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 quadrant

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RADIOLOGY : MAMMOGRAPHY
Fibroadenomas 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.

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RADIOLOGY : ULTRASOUND
Typically

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
pseudocapsule
may
be
sonographically..

rim seen

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RADIOLOGY : MRI
T1: typically hypointense or isointense

compared with adjacent breast tissue

T2: can be hypo- or hyperintense
T1 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.

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INDICATION FOR BIOPSY

Enlarging lesion
Atypical findings on ultrasound
A lesion above 2.5 cm where there are no

previous studies for comparison

Patient 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.