Giant fibroadenoma

Case contributed by Dr Ammar Ashraf

Presentation

Left breast mass for a few months. No pain, breast skin changes or nipple discharge.

Patient Data

Age: 45 years
Gender: Female
mammography

Heterogeneous fibroglandular tissue (ACR type C breast density) in the central breasts. Large, well-defined, lobulated non-calcified soft tissue abnormality with a radiolucent halo around the lesion noted in the lower inner quadrant of the left breast. Small cluster of calcifications without any associated soft tissue abnormality noted in the upper-outer quadrant of the left breast. Multiple scattered micro and macrocalcifications noted in both central breasts. No abnormal skin thickeningnipple retraction or significant axillary lymphadenopathy is noted on either side. 

ultrasound

Well-defined, lobulated solid hypoechoic mass measuring 3.8 x 6.2 cm, showing mild internal vascularity, noted at 6 o'clock position in the left breast. 

Large well-circumscribed lobulated solid left breast mass lesion; possible differentials include phyllodes tumor and fibroadenoma. Possibility of malignancy is less likely; however, regarding the size of the lesion and the patient's age, tissue diagnosis/biopsy is recommended.

Case Discussion

Procedure: Tru-cut biopsy left breast mass. Diagnosis: Fibroepithelial lesion. Comments: The mesenchymal component of the lesion is cellular and shows moderate nuclear atypia with very rare mitosis. The ductal component is hyper plastic. These features are suggestive of low-grade phyllodes tumor/fibroadenoma and complete resection of the tumor with wide margins is recommended.

Procedure: Simple nipple sparing left cutaneous mastectomy with implant insertion. Histopathology showed benign fibroepithelial tumor with features suggestive of fibroadenoma. Size: 5 cm. Nipple and areola area: uninvolved by the tumor. Margins: uninvolved by the tumor (completely excised). Background breast: usual ductal hyperplasia and fibrocystic changes.  

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