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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Breast fibradenoma (1).jpg | |||
| Width = | |||
| Caption = Fibroadenoma. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = abundant (intralobular) stroma usu. white/pale +/-hyalinization, typically paucicellular, compression of glandular elements with perserved myoepithelial cells | |||
| Subtypes = juvenile, complex, myxoid, cellular, tubular adenoma of the breast | |||
| LMDDx = [[phyllodes tumour]], [[sarcoma]], [[pseudoangiomatous stromal hyperplasia]], [[adenomyoepithelioma]] for [[tubular adenoma of the breast]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = well-circumscribed, rubbery, tan/white, +/-lobulated appearance, +/-short slit-like spaces, +/-calcifications | |||
| Grossing = | |||
| Site = [[breast]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = very common | |||
| Bloodwork = | |||
| Rads = typically BIRADS4 - see ''[[BIRADS]]'' | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = other breast tumours - esp. [[phyllodes tumour]] | |||
| Tx = conservative excision | |||
}} | |||
'''Fibroadenoma''', abbreviated '''FA''', is a common benign tumour of the [[breast]]. | |||
It is a type of [[fibroepithelial tumours of the breast|fibroepithelial tumour]]. | |||
==General== | |||
*Very common benign finding. | |||
*The pathology is in the stroma; so, the lesion is really a misnomer by the naming rules. | |||
**It ought to be called ''adenofibroma'' (as a few occasionally do<ref name=pmid15797289>{{Cite journal | last1 = Guinebretière | first1 = JM. | last2 = Menet | first2 = E. | last3 = Tardivon | first3 = A. | last4 = Cherel | first4 = P. | last5 = Vanel | first5 = D. | title = Normal and pathological breast, the histological basis. | journal = Eur J Radiol | volume = 54 | issue = 1 | pages = 6-14 | month = Apr | year = 2005 | doi = 10.1016/j.ejrad.2004.11.020 | PMID = 15797289 }}</ref>), as the glandular component is benign and the stromal component lesional; there is [[no truth in names]] in pathology. | |||
Management: | |||
*Local excision -- without a large margin. | |||
==Gross== | |||
Features:<ref>{{Ref PCPBoD8|550}}</ref> | |||
*Well-circumscribed. | |||
*Rubbery - '''classic descriptor'''. | |||
*Tan/white. | |||
*+/-Lobulated appearance. | |||
*+/-Slit-like spaces - short. | |||
*+/-Calcification. | |||
===Images=== | |||
*[http://webpathology.com/image.asp?n=2&Case=276 Fibroadenoma - slit-like spaces (webpathology.com)]. | |||
*[http://webpathology.com/image.asp?case=276&n=3 Fibroadenoma - lobulated appearance (webpathology.com)]. | |||
*[http://www.surgical-tutor.org.uk/default-home.htm?tutorials/fibroadenoma.htm~right Fibroadenoma (surgical-tutor.org)]. | |||
==Microscopic== | |||
Features:<ref name=Ref_BP110>{{Ref BP|110}}</ref> | |||
*Abundant (intralobular) stroma - most '''key feature'''. | |||
**Stroma is usually: | |||
***White/pale, i.e. [[myxoid stroma|myxoid]], on H&E (normal stroma is pink). | |||
****May be hyalinized (dark pink) if infarcted. | |||
***Paucicellular - typical. | |||
*Compression of glandular elements - very commonly seen. | |||
**Glandular elements have at least two cell layers - epithelial and myoepithelial. | |||
Notes: | |||
#There is stuff about ''intracanalicular'' vs. ''pericanalicular''.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970216-9 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970216-9]. Accessed on: 16 March 2011.</ref> It is irrelevant; there is no prognostic difference between the two. | |||
#Do '''not''' comment on the margin - it is irrelevant. | |||
DDx: | |||
*[[Phyllodes tumour]] - long slit-like spaces (seen grossly), stroma is more cellular. | |||
**+/-Mitoses, | |||
**+/-"Stromal overgrowth" = large area where there is a 'loss of glands'. | |||
*Sarcoma. | |||
*[[Pseudoangiomatous stromal hyperplasia]]. | |||
**Small capillary-like structures in the stroma. | |||
***Epithelial component often not compressed - as in fibroadenoma. | |||
*[[Adenomyoepithelioma]] - for [[tubular adenoma of the breast]]. | |||
===Images=== | |||
<gallery> | |||
Image:Breast fibradenoma (1).jpg | Fibroadenoma. (WC/KGH) | |||
Image:Breast_fibradenoma_(2).jpg | Fibroadenoma. (WC/KGH) | |||
</gallery> | |||
www: | |||
*[http://radiographics.rsna.org/content/27/suppl_1/S101/F40.expansion.html Infarcted fibroadenoma (rsna.org)].<ref name=pmid18180221>{{Cite journal | last1 = Sabate | first1 = JM. | last2 = Clotet | first2 = M. | last3 = Torrubia | first3 = S. | last4 = Gomez | first4 = A. | last5 = Guerrero | first5 = R. | last6 = de las Heras | first6 = P. | last7 = Lerma | first7 = E. | title = Radiologic evaluation of breast disorders related to pregnancy and lactation. | journal = Radiographics | volume = 27 Suppl 1 | issue = | pages = S101-24 | month = Oct | year = 2007 | doi = 10.1148/rg.27si075505 | PMID = 18180221 }}</ref> | |||
*[http://www.imagingpathways.health.wa.gov.au/includes/images/image/fibroadenoma_he.jpg Fibroadenoma (gov.au)].<ref>URL: [http://www.imagingpathways.health.wa.gov.au/includes/dipmenu/image/image.html http://www.imagingpathways.health.wa.gov.au/includes/dipmenu/image/image.html]. Accessed on: 15 February 2012.</ref> | |||
===Variants=== | |||
Four variants are described by the ''Washington Manual'':<ref name=Ref_WMSP262>{{Ref WMSP|262}}</ref> | |||
#Juvenile. | |||
#Complex. | |||
#Myxoid. | |||
#Cellular. | |||
Considered a variant of fibroadenoma by many authorities:<ref name=Ref_BP116>{{Ref BP|116}}</ref> | |||
*''[[Tubular adenoma of the breast]]''. | |||
====Juvenile fibroadenoma==== | |||
*As the name suggests, is typically found in younger patients. | |||
*Classic history: rapid growth. | |||
Features (juvenile variant):<ref>URL: [http://www.breastpathology.info/fibro_variants.html#juvenile http://www.breastpathology.info/fibro_variants.html#juvenile]. Accessed on: 3 October 2011.</ref> | |||
*Stromal and epithelial hyperplasia - '''key feature'''. | |||
*+/-Tapering, thin micropapillae (''[[gynecomastoid hyperplasia]]'').<ref name=Ref_BP116>{{Ref BP|116}}</ref> | |||
*Mitoses uncommon. | |||
====Myxoid fibroadenoma==== | |||
*May be associated with ''[[Carney's complex]]''. | |||
Features: | |||
*[[Myxoid stroma]]. | |||
====Cellular fibroadenoma==== | |||
Features (cellular variant): | |||
*Cellular. | |||
*Mitoses. | |||
Note: | |||
*"Cellular" is something that can be subjective. One definition of "cellular" is: "stromal cells are touching one another". Jacobs ''et al.'' has a stromal cellularity picture gallery showing ''mild'' (rare stromal cells touching), ''moderate'' and ''marked'' (many stromal cells touching).<ref name=pmid16191502>{{Cite journal | last1 = Jacobs | first1 = TW. | last2 = Chen | first2 = YY. | last3 = Guinee | first3 = DG. | last4 = Holden | first4 = JA. | last5 = Cha | first5 = I. | last6 = Bauermeister | first6 = DE. | last7 = Hashimoto | first7 = B. | last8 = Wolverton | first8 = D. | last9 = Hartzog | first9 = G. | title = Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision? | journal = Am J Clin Pathol | volume = 124 | issue = 3 | pages = 342-54 | month = Sep | year = 2005 | doi = 10.1309/5N2C-4N5X-CB8X-W8JL | PMID = 16191502 }}</ref> | |||
====Complex fibroadenoma==== | |||
*Contain proliferative epithelium which outside and inside a fibroadenoma is associated with an increased risk of malignancy. | |||
Features:<ref>URL: [http://www.breastpathology.info/fibro_variants.html#complex http://www.breastpathology.info/fibro_variants.html#complex]. Accessed on: 3 October 2011.</ref> | |||
# [[Apocrine metaplasia]]. | |||
# Cysts > 3 mm. | |||
# Calcification. | |||
# [[Sclerosing adenosis]]. | |||
Memory devices: | |||
*''FACS'': complex '''f'''ibroadenoma, '''a'''pocrine metaplasia, '''c'''alcs & '''c'''ysts, '''s'''clerosing adenosis. | |||
*''CAMS'': '''c'''alcs, '''a'''pocrine metaplasia, '''m'''icrocysts, '''s'''clerosing adenosis. | |||
====Tubular adenoma of the breast==== | |||
*Considered by many a variant of ''fibroadenoma''. | |||
**[[IHC]] features of ''[[tubular adenoma]] of the breast'' and ''fibroadenoma'' are similar.<ref>{{Cite journal | last1 = Maiorano | first1 = E. | last2 = Albrizio | first2 = M. | title = Tubular adenoma of the breast: an immunohistochemical study of ten cases. | journal = Pathol Res Pract | volume = 191 | issue = 12 | pages = 1222-30 | month = Dec | year = 1995 | doi = | PMID = 8927570 }}</ref> | |||
*Most present in adults between menarche and menopause. | |||
Features:<ref name=Ref_BP116>{{Ref BP|116}}</ref> | |||
*Well circumscribed lesion. | |||
*Closely packed uniform tubules, lined by a single layer of epithelial cells and an attenuated myoepithelial cell layer. | |||
*Stroma is generally more sparse than in conventional fibroadenoma | |||
Images: | |||
*[http://www.webpathology.com/image.asp?case=277&n=1 Tubular adenoma of the breast (webpathology.com)]. | |||
<gallery> | |||
Image:Breast TubularAdenoma LP CTR.jpg|Breast - Tubular Adenoma - low power (SKB) | |||
Image:Breast TubularAdenoma MP CTR.jpg|Breast - Tubular Adenoma - medium power (SKB) | |||
Image:Breast TubularAdenoma HP CTR.jpg|Breast - Tubular Adenoma - high power (SKB) | |||
Image:Breast TubularAdenoma LP SNP.jpg|Breast - Tubular Adenoma - low power (SKB) | |||
Image:Breast TubularAdenoma MP SNP.jpg|Breast - Tubular Adenoma - medium power (SKB) | |||
Image:Breast TubularAdenoma LactationalChange pa.JPG|Breast - Tubular Adenoma with lactational change (SKB) | |||
Image:Tubular_Adenoma_of_Breast_(myosin_immunostain)_(4351463966).jpg | TA of the breast - myosin IHC. (WC) | |||
</gallery> | |||
==Sign out== | |||
<pre> | |||
Right Partial Breast, Lumpectomy: | |||
- Fibroadenoma. | |||
</pre> | |||
====Micro==== | |||
The sections show a lesion with a pale mildly cellular stroma, and bland glandular elements. No apparent proliferative activity is present. The border is well-circumscribed where seen. Focally, the lesion approaches the inked margin; partial lesion transection cannot be excluded. | |||
No cytologic atypia is present. No leaf-like architecture is present. No stromal overgrowth is seen. No calcifications are evident. No large cysts are seen. | |||
===Complex=== | |||
<pre> | |||
Right Breast, Lumpectomy: | |||
- Complex fibroadenoma with apocrine metaplasia. | |||
- Negative for carcinoma in situ and negative for malignancy. | |||
</pre> | |||
====Micro==== | |||
The sections show a lesion with a pale mildly cellular stroma, and bland glandular elements. Minimal mitotic activity is present (2 mitosis/10 HPF, where 1 HPF ~ 0.2376 mm*mm). The border is well-circumscribed where seen. The lesion was shelled-out. | |||
No cytologic atypia is present. No leaf-like architecture is present. No stromal overgrowth is seen. No calcifications are evident. No large cysts are seen. | |||
==See also== | |||
*[[Breast pathology]]. | |||
*[[Phyllodes tumour]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | |||
[[Category:Breast pathology]] |
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