Radiography
Craniocaudal mammograms obtained 1 year apart demonstrate a newly developing mass in the outer part of the breast.
Spot compression mammogram of the outer part of the breast demonstrates a new mass as smooth, margined, and oval. The findings are consistent with a fibroadenoma, a cyst, or a malignancy. In this patient, the diagnosis was a rapidly growing fibroadenoma.
Findings
On mammograms, a fibroadenoma may be occult or may appear as a smooth-margined oval or round mass sized 4-100 mm. Occasionally, tumors contain coarse calcifications, which suggest infarction and involution. Calcifications may be useful in diagnosing the mass, but occasionally, they may mimic malignant microcalcifications. Although fibroadenomas often have coarse calcifications, cystosarcomas rarely have calcifications.
False Positives/Negatives
The mammographic findings of fibroadenomas with hamartomas, cysts, and carcinomas overlap.
Magnetic Resonance Imaging
Findings
Fibroadenomas appear as round or oval masses that are smooth or gently lobulated and enhance with gadolinium-based contrast material. Internal enhancement in homogeneity may be noted.2
Morphology is of utmost importance for correct classification of benign lesions. Fibroadenomas are typically round, ovoid, or lobulated, with smooth margins; however, on early contrast-enhanced images, they may exhibit an irregular shape or margin resulting from the progression of enhancement. Therefore, morphology should be assessed on the noncontrast or late postcontrast images. Nonenhancing internal septa, which are best seen on T2-weighted images, are a specific indicator that a mass is a fibroadenoma; however, they are only seen in a minority of fibroadenomas.
Enhancement kinetics and characteristics are highly variable with fibroadenomas and may be dependent on the degree of fibrosis within the tumor. Enhancement rates of fibroadenomas overlap with those of breast cancers. Mean enhancement is slower in fibroadenomas than in cancers, but this is not useful in assessment of individual cases.
See also Magnetic Resonance Mammography.
Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy. The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans.
NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.
Degree of Confidence
When internal septa are present in a smooth mass, the confidence that the mass is a fibroadenoma is high. When septa are not present, the findings of fibroadenomas and carcinomas overlap.
Ultrasonography
Ultrasonogram demonstrates a hypoechoic mass with smooth, partially lobulated margins typical of a fibroadenoma.
Findings
Fibroadenomas appear oval on ultrasonograms, and their width is larger than their anteroposterior diameter. Gentle lobulations (typically fewer than 4) may be present, but the margins should be circumscribed.3,4,5,6
Internal echogenicity may be homogeneous, and findings may range from isoechoic to lobules of fat to hypoechoic. The through-transmission of the tumor is variable. A thin echogenic capsule is typical of a fibroadenoma and indicates that the lesion is benign. A vague or thick surrounding region of echogenicity may indicate malignancy. Fibroadenomas do not have a true capsule; the thin echogenic capsule seen on ultrasonograms is a pseudocapsule caused by the compression of adjacent tissue.
When using color-flow Doppler or power Doppler imaging, the amount and distribution of vascularity among fibroadenomas is highly variable. Therefore, the vascularity of solid masses does not help distinguish a cancer from a fibroadenoma.
Cysts seen in a solid mass are suggestive of cystosarcoma phyllodes rather than fibroadenomas.
One study found that histologic type, tumor size, and patient age significantly influence ultrasound characteristics of breast fibroadenomas.7
Degree of Confidence
Of masses with a thin, smooth echogenic capsule, 93% are benign. Of circumscribed masses, 91% are benign. Of masses that are round or oval, 94% are benign. Of fibroadenomas, 60% are oriented parallel to the skin (ie, they appear oval).
False Positives/Negatives
Overlap may exist between the US appearances of carcinomas, fibroadenomas, cystosarcoma phyllodes, and complicated cysts.
More on Breast, Fibroadenoma |
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References
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Wurdinger S, Herzog AB, Fischer DR. Differentiation of phyllodes breast tumors from fibroadenomas on MRI. AJR Am J Roentgenol. Nov 2005;185(5):1317-21. [Full Text].
Hruska D, O'Brien WD, Oelze M. Mammary tumor classification using envelope statistics from ultrasound backscatter and the homodyned K distribution. J Acoust Soc Am. Apr 2009;125(4):2512. [Medline].
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Földi M, Klar M, Orlowska-Volk M, Hanjalic-Beck A, Osterloh B, Stickeler E, et al. Ultrasound Characteristics of Breast Fibroadenomas Are Related to Clinical and Histological Parameters. Ultraschall Med. Jun 18 2009;[Medline].
Kaufman CS, Littrup PJ, Freeman-Gibb LA. Office-based cryoablation of breast fibroadenomas with long-term follow-up. Breast J. Sep-Oct 2005;11(5):344-50. [Full Text].
Littrup PJ, Freeman-Gibb L, Andea A, et al. Cryotherapy for breast fibroadenomas. Radiology. Jan 2005;234(1):63-72. [Medline].
Acha T, Picazo B, Garcia-Martin FJ, et al. Carney''s triad: apropos of a new case. Med Pediatr Oncol. 1994;22(3):216-20. [Medline].
Alle KM, Moss J, Venegas RJ, et al. Conservative management of fibroadenoma of the breast. Br J Surg. Jul 1996;83(7):992-3. [Medline].
Courcoutsakis NA, Chow CK, Shawker TH, et al. Syndrome of spotty skin pigmentation, myxomas, endocrine overactivity, and schwannomas (Carney complex): breast imaging findings. Radiology. Oct 1997;205(1):221-7. [Medline].
Dupont WD, Page DL, Parl FF. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. Jul 7 1994;331(1):10-5. [Medline].
Frayne J, Sterrett GF, Harvey J. Stereotactic 14 gauge core-biopsy of the breast: results from 101 patients. Aust N Z J Surg. Sep 1996;66(9):585-91. [Medline].
Greenberg R, Skornick Y, Kaplan O. Management of breast fibroadenomas. J Gen Intern Med. Sep 1998;13(9):640-5. [Medline].
Kleer CG, Tseng MD, Gutsch DE, et al. Detection of Epstein-Barr virus in rapidly growing fibroadenomas of the breast in immunosuppressed hosts. Mod Pathol. Jul 2002;15(7):759-64. [Medline].
Kuhl CK. MRI of breast tumors. Eur Radiol. 2000;10(1):46-58. [Medline].
Markopoulos C, Kouskos E, Mantas D, et al. Fibroadenomas of the breast: is there any association with breast cancer?. Eur J Gynaecol Oncol. 2004;25(4):495-7. [Medline].
Further Reading
Related eMedicine topics
Fibroadenomatous Lesions of the Breast
Breast Abscess and Masses
Disorders of the Breast
Molecular Pathology of the Breast
Carney Syndrome
Clinical guidelines
Diagnosis of Breast Disease
Common Breast Problems
Clinical studies
American Breast Laser Ablation Therapy Evaluation (ABLATE)
Keywords
fibroadenoma of the breast, benign breast tumors, breast tumors, breast lesions, stromal tumors, myxomatous stroma, intralobular stroma, interlobular stroma, epithelial tumors, multiple fibroadenomas, complex fibroadenomas, breast hyperplasias, juvenile fibroadenomas, giant fibroadenomas
