||It has been suggested that Cellular fibroadenoma be merged into this article. (Discuss) Proposed since February 2015.|
Histopathologic image of breast fibroadenoma. Core needle biopsy. Hematoxylin & eosin stain.
|Classification and external resources|
|ICD-O:||M9010/0-M9012, M9020, M9030|
Fibroadenomas of the breast are noncancerous tumors composed of fibrous and glandular tissue. Because both fibroadenomas and breast cancer can appear as similar lumps, doctors may recommend an ultrasound and possibly a tissue sample (biopsy) to rule out cancer in some patients. Unlike typical lumps from breast cancer, fibroadenomas are easy to move, with clearly defined edges.
Fibroadenomas are sometimes called breast mice or a breast mouse owing to their high mobility in the breast.
Signs and symptoms
In the male breast, fibroepithelial tumors are very rare, and are mostly phyllodes tumors. Exceptionally rare case reports exist of fibroadenomas in the male breast, however these cases may be associated with antiandrogen treatment.
Etiology and epidemiology
Fibroadenomas arise in the terminal duct lobular unit of the breast. They are the most common breast tumor in adolescent women. They also occur in a small number of post-menopausal women. Their incidence declines with increasing age, and, in general, they appear before the age of thirty years. Fibroadenomas are partially hormone-dependent and frequently regress after menopause. They are hypovascular compared to typical (especially malignant) neoplasms.
Higher intake of fruits and vegetables, higher number of live births, use of oral contraceptives and moderate exercise are associated with lower frequency of fibroadenomas.
The diagnostic findings on needle biopsy consist of abundant stromal cells, which appear as bare bipolar nuclei, throughout the aspirate; sheets of fairly uniform-size epithelial cells that are typically arranged in either an antler-like pattern or a honeycomb pattern. These epithelial sheets tend to show typical metachromatic blue staining on DiffQuick staining. Foam cells and apocrine cells may also be seen, although these are less diagnostic features. The gallery images below demonstrate these features.
Approximately ninety percent of fibroadenomas are less than three centimetres in diameter. The vast majority of the remaining ten percent that are four centimetres or larger occur mostly in women under twenty years of age. The tumor is round or ovoid, elastic, and nodular, and has a smooth surface. The cut surface usually appears homogenous and firm, and is grey-white or tan in colour. The pericanalicular type (hard) has a whorly appearance with a complete capsule, while the intracanalicular type (soft) has an incomplete capsule.
Fibroadenoma of the breast is a benign tumor composed of two elements : epithelium and stroma.
It is nodular and encapsulated, included in breast.
The epithelial proliferation appears in a single terminal ductal unit and describes duct-like spaces surrounded by a fibroblastic stroma.
Depending on the proportion and the relationship between these two components, there are two main histological features-
~ intracanalicular ~ pericanalicular.
Often, both types are found in the same tumor.
A) Intracanalicular fibroadenoma : stromal proliferation predominates and compresses the ducts, which are irregular, reduced to slits.
B) Pericanalicular fibroadenoma : fibrous stroma proliferates around the ductal spaces, so that they remain round or oval, on cross section.
The basement membrane is intact  The gallery image below demonstrates both morphological subtypes.
Most fibroadenomas are left in situ and monitored by a doctor, or the patient in question. Some are treated by surgical excision. They are removed with a small margin of normal breast tissue if the preoperative clinical investigations are suggestive of the diagnosis. A small amount of normal tissue must be removed in case the lesion turns out to be a phyllodes tumour on microscopic examination.
Because needle biopsy is often a reliable diagnostic investigation, some doctors may decide not to operate to remove the lesion, and instead opt for clinical follow-up to serially observe the lesion over time using clinical examination and mammography to determine the rate of growth, if any, of the lesion. A growth rate of less than sixteen percent per month in women under fifty years of age, and a growth rate of less than thirteen percent per month in women over fifty years of age have been published as safe growth rates for continued non-operative treatment and clinical observation.
There are also natural treatments being touted to diminish fibroadenomas, such as Fibrosolve, but no definite studies have been made as to prove their effectiveness.
The FDA has approved cryoablation (the use of extreme cold to destroy tissue) of a fibroadenoma as a safe, effective and minimally-invasive alternative to open surgical removal in 2001. In the procedure, ultrasound imaging is used to guide a probe into the mass of breast tissue. Extremely cold temperatures are then used to destroy the abnormal cells, and over time the cells are reabsorbed into the body. The procedure can be performed in an office setting with local anesthesia only, and leaves substantially less scarring than open surgical procedures and no breast tissue deformation.
- The lesion must be sonographically visible.
- The diagnosis of fibroadenoma must be confirmed histologically.
- Lesions should be less than 4 cm in diameter.
Europe recently recognized an alternative treatment that is called echotherapy and that uses high-intensity focused ultrasound to treat breast fibroadenoma. This method is non-invasive and relies on tissue heating to destroy fibroadenoma cells. Focused ultrasounds have been used for a long time in the treatment of different tumors such as prostate, liver or uterus, where they proved their efficacy.
High frequency ultrasound waves are used for a short period of time under simulation inorder to achieve best results. Multiple sittings may be required inorder to attain optimum results.
A French company, Theraclion, develops an echotherapy device for benign tumors treatment especially breast fibroadenoma.
Further research on its effectiveness and usage are still under progress.
Fibroadenoma, Fine Needle Aspiration Biopsy (Giemsa or DiffQuickTM stain). The image shows abundant bare bipolar stromal nuclei surrounding sheets of metachromatic epithelial cells.
Histopathologic image of breast fibroadenoma showing proliferation of intralobular stroma compressing and distorting the epithelium. H&E stain.
Video on Fibroadenoma
- Fibroadenoma Histopathology Video
- The Doctors Show: Fibroadenoma Cryoablation on YouTube
- Fibroadenoma excision surgery
- Breast Health Options was inspired by women concerned about their fibroadenoma treatment options.
- IceCure Medical, Inc, makers of IceSense3 Cryoablation System for fibroadenoma
- Benign Breast Lumps on Breast Specialist.co.uk
- Theraclion EchoPulse Ultrasound Therapy for Breast Fibroadenomas Cleared in EU
- Theraclion official website
- Fibroadenomas at Merck Manual of Diagnosis and Therapy Home Edition
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- DeMay, M. Practical Principles of Cytopathology (Revised ed.). ASCP Press. p. 2007. ISBN 0-89189-549-3.
- Pathology Outlines Website.  Accessed 12 February 2009.
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- Rosen, PP. Rosen's Breast Pathology (3rd ed.). ISBN 978-0-7817-7137-5.
- Nelson, Z. C.; Ray, R. M.; Wu, C.; Stalsberg, H.; Porter, P.; Lampe, J. W.; Shannon, J.; Horner, N.; Li, W.; Wang, W.; Hu, Y.; Gao, D.; Thomas, D. B. (2010). "Fruit and Vegetable Intakes Are Associated with Lower Risk of Breast Fibroadenomas in Chinese Women". Journal of Nutrition 140 (7): 1294–1301. doi:10.3945/jn.109.119719. PMC 2884330. PMID 20484549.
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- Rosai, J. (2004). Rosai and Ackerman's Surgical Pathology (9th ed.). ISBN 0-323-01342-2.
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- Management of Fibroadenomas of the Breast
- WebMD — Cryotherapy Shrinks Benign Breast Lumps
- Jolesz FA, Hynynen K, McDannold N, Tempany C. MR imaging-controlled focused ultrasound ablation: a non-invasive image-guided surgery. Magn Reson Imaging Clin N Am 2005;13(3):545-60.
- Gombos EC, Kacher DF, Furusawa H, Namba K. Breast focused ultrasound surgery with magnetic resonance guidance. Top Magn Reson Imaging 2006;17(3):181-8.
- Hynynen K, Pomeroy O, Smith DN, Huber PE, McDannold NJ, Kettenbach J, Baum J, Singer S, Jolesz FA. MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology 2001;219:176-185.
- Marret H, Bleuzen A, Guérin A, Lauvin-Gaillard MA, Herbreteau D, Patat F, Tranquart F. French first results using magnetic resonance-guided focused ultrasound for myoma treatment. Gynecol Obstet Fertil. 2011 Jan;39(1):12-20. Epub 2010 Dec 24.