You are on page 1of 26

Fibroadenoma breast (

Fibroadenoma of the breast is a noncancerous (benign) tumor.
Fibroadenoma is the most common benign tumor of the breast and the most common breast
tumor in women under age 30.
A fibroadenoma is made up of breast gland tissue and tissue that helps support the breast gland
Black women tend to develop fibroadenomas more often and at an earlier age than white women.
The cause of fibroadenomas is not known.
Fibroadenomas are usually single lumps, but about 10 - 15% of women have several lumps that
may affect both breasts.
Lumps may be:

Easily moveable under the skin




They have smooth, well-defined borders. They may grow in size, especially during pregnancy.
Fibroadenomas often get smaller after menopause (if a woman is not taking hormone
replacement therapy).
Exams and Tests
After a physical examination, one or both of the following tests are usually done:

Breast ultrasound


A core needle biopsy must be performed to get a definite diagnosis. Women in their teens or
early 20s may not need a biopsy if the lump goes away on its own or if the lump does not change
over a long period of time.
For more information on the different types of breast biopsies, see:

Breast biopsy - open

Breast biopsy - sterotaxic

Breast biopsy - ultrasound (core needle)

If a biopsy shows that the lump is a fibroadenoma, the lump may be left in place or removed.
The decision to remove the lump is made by the patient and the surgeon. Reasons to have it
removed include:

Abnormal biopsy results

Shape of the breast has changed

Worry or concern about cancer

If the lump is left in place, it may be watched over time with:


Physical examination


Alternative treatments include removing the lump with a needle and destroying the lump without
removing it (such as by freezing, in a process called cryoablation).
Possible Complications
If the lump is left in place and carefully watched, it may need to be removed at a later time if it
changes, grows, or doesn't go away.
In very rare cases, the lump may be cancerous and you may need further treatment.
When to Contact a Medical Professional

Call your health care provider if you have a lump that is thought to be a fibroadenoma and it
grows or changes in any way.

A fibroadenoma is a benign, or noncancerous, tumor of the breast. Timbul pada payudara remaja
dan wanita berusia <30 tahun. Benjolan biasanya kecil, solid, kenyal, bulat elastis dengan batas
tepi yang jelas. Fibroadenomas range in size from one to five cm, (0.39 inches to nearly two
inches). Giant fibroadenomas can be the size of a small lemon, about 15 cm (5.9 inches).

The incidence of fibroadenoma is occur in women during their reproductive years,
particularly during their twenties and thirties. The cause of these tumors is not known. However,
genetics is not likely to play a role in the development of fibroadenomas. Women with dark
skin tend to develop fibroadenomas more often and at an earlier age than light-skinned women.
Similarly, women of higher socioeconomic status tend to develop fibroadenomas more

1.Fibroadenoma Pericanaliculare
Yakni kelenjar berbentuk bulat dan lonjong dilapisi epitel selapis atau beberapa

2.Fibroadenoma intracanaliculare
Yakni jaringan ikat mengalami proliferasi lebih banyak sehingga kelenjar berbentuk
panjang-panjang (tidak teratur) dengan lumen yang sempit atau menghilang.


Adenoma laktasi kemungkinan adalah suatu fibroadenoma yang telah mengalami
perubahan laktasional. Adenoma lakasi dapat disertai dengan peningkatan ukuran secara
cepat, yang meningkatkan dugaan sebuah karsinoma. Disarankan untuk melakukan biopsy.

The exact cause of fibroadenomas is unknown. They seem to be influenced
by estrogen, because they appear most often in premenopausal (Alasan:
Kadang-kadang, peningkatan kadar FSH digunakan untuk mengkonfirmasi
menopause. FSH adalah hormon yang dihasilkan oleh kelenjar hipofisis
anterior yang memicu ovarium untuk mengeluarkan estrogen. Sebagai
produksi ovarium estrogen menurun sekitar menopause, kelenjar pituitari
melepaskan lebih FSH ke dalam darah untuk merangsang produksi estrogen.
Jadi, jika tingkat FSH darah seorang wanita secara konsisten meningkat, dan
ia tidak lagi memiliki periode menstruasi, secara umum ia telah mencapai
menopause. Namun, tingkat FSH tunggal dapat menyesatkan dalam
premenopause karena produksi estrogen tidak jatuh pada tingkat yang stabil
dari hari ke hari. Sebaliknya, baik estrogen dan tingkat FSH berfluktuasi dari
yang cukup tinggi ke cukup rendah selama premenopause. Juga, jika
seorang wanita menggunakan terapi hormon tertentu (misalnya pil KB), tes











postmenopausal and taking HRT (hormone replacement therapy).

Most fibroadenomas come and go during your menstrual cycle, when your
hormone levels are changing.


A number of factors are thought to increase your chances of developing a

fibroadenoma. These risk factors include:

Dark-skinned race

High socioeconomic status

Low body mass index (BMI)

No or low number of full-term pregnancies


Fibroadenomas are the most common benign tumors of the female breast
and are associated with a slight increase in the risk of subsequent breast
cancer. Multiple fibroadenomas have been described in patients after renal
transplantation and are thought to be secondary to drug-related growth
stimulation. Epstein-Barr virus (EBV) has been detected in many neoplasms,
including breast cancer.
We set out to investigate whether EBV plays a role in the development of
rapidly growing fibroadenomas in immunocompromised patients. We studied
19 fibroadenomas and one invasive ductal carcinoma that developed after
organ transplantation or treatment for lupus erythematosus. As a control







patients. DNA was amplified using polymerase chain reaction (PCR) of the
EBV-encoded small RNA (EBER-2) DNA sequence. EBV latent membrane
protein 1 (LMP-1) transcripts were amplified using reverse transcription (RT)
PCR. Immunohistochemical (IHC) staining for LMP-1 protein was performed. A
total of 9 out of 20 tumors (45%) were concordantly positive by PCR and IHC.

IHC stained exclusively the epithelial cells. All the fibroadenomas in nonimmunocompromised patients were negative for LMP-1 (Fisher's exact test P
These data suggest that EBV is associated with fibroadenomas in this
immunosuppressed population and that the infection is specifically localized
to epithelial cells. This is the first study suggesting a role for EBV in the
pathogenesis of fibroadenomas.










fibroadenomas: however, thus far, none of the steroid hormone receptors

acting on breast tissues has been demonstrated in the stroma of breast


In this study, the expression of estrogen receptor (ER)-alpha and -beta was
investigated by immunohistochemistry in 33 fibroadenomas and in 30
benign, three borderline and seven malignant phyllodes tumors, all with
spindle cell growth and in one distant metastasis. In addition, the presence of
ER-beta mRNA and its variants was evaluated by RT-PCR in microdissected
stroma. The possible correlation between hormone receptor expression and
differentiation processes of stromal cells was investigated by smooth muscle
actin and calponin immunostaining. ER-beta was the only hormone receptor
expressed by stroma of fibroadenomas and phyllodes tumors, both at protein



The highest percentage of ER-beta was observed in fibroadenomas with

cellular stroma and in phyllodes tumors. In both lesions, ER-beta-positive
stromal cells showed expression of smooth muscle actin and/or calponin, as
demonstrated by double immunostaining. In addition, the mean age at
diagnosis was significantly lower in patients with ER-beta-positive vs ER-beta-

negative fibroadenomas. In contrast, in phyllodes tumors, ER-beta expression

was higher in older patients. In conclusion, (i) only ER-beta is detected in
























These two results, together with the young age of patients carrying
fibroadenomas with highly ER-beta-positive stroma cells, may further
indicate a hormone-receptor mechanism involved in regulating the growth of
fibroadenomas. Conversely, the older age of patients with ER-beta-rich
phyllodes tumors suggests that mechanisms, probably independent from
estrogen stimulation, act on the growth of these tumors.


1. Secara makroskopik : tumor bersimpai, berwarna putih keabu-abuan, pada
penampang tampak jaringan ikat berwarna putih, kenyal
2. Ada bagian yang menonjol ke permukaan
3. Ada penekanan pada jaringan sekitar
4. Ada batas yang tegas
5. Bila diameter mencapai 10 15 cm muncul Fibroadenoma raksasa ( Giant
Fibroadenoma )
6. Memiliki kapsul dan soliter
7. Benjolan dapat digerakkan
8. Pertumbuhannya lambat
9. Mudah diangkat dengan lokal surgery
10. Bila segera ditangani tidak menyebabkan kematian

Female breasts are made up of three main types of tissues: glandular
tissue (milk-producing glands), ductal tissue (ducts that carry milk from
the glands to the nipple), and stroma (a combination of fatty tissue and
fibrous or connective tissue). Fibroadenomas involve both fibrous and
glandular tissues in the breast. They are the most common form of
benign breast tumors.


The Mamm

(Mammary Gland; Breasts)

The mamm secrete the milk, and are accessory glands of the
generative system. They exist in the male as well as in the female; but
in the former only in the rudimentary state, unless their growth is
excited by peculiar circumstances. In the female they are two large
hemispherical eminences lying within the superficial fascia and situated
on the front and sides of the chest; each extends from the second rib
above to the sixth rib below, and from the side of the sternum to
near the midaxillary line. Their weight and dimensions differ at
different periods of life, and in different individuals. Before puberty they
are of small size, but enlarge as the generative organs become more
completely developed. They increase during pregnancy and especially
after delivery, and become atrophied in old age. The left mamma is
generally a little larger than the right. The deep surface of each is nearly
circular, flattened, or slightly concave, and has its long diameter

directed upward and lateralward toward the axilla; it is separated from

the fascia covering the Pectoralis major, Serratus anterior, and
Obliquus externus abdominis by loose connective tissue. The
subcutaneous surface of the mamma is convex, and presents, just below
the center, a small conical prominence, the papilla.
The Mammary Papilla or Nipple (papilla mamm) is a cylindrical or

conical eminence situated about the level of the fourth intercostal

space. It is capable of undergoing a sort of erection from mechanical
excitement, a change mainly due to the contraction of its muscular
fibers. It is of a pink or brownish hue, its surface wrinkled and provided
with secondary papill; and it is perforated by from fifteen to twenty
orifices, the apertures of the lactiferous ducts. The base of the
mammary papilla is surrounded by an areola. In the virgin the areola is
of a delicate rosy hue; about the second month after impregnation it
enlarges and acquires a darker tinge, and as pregnancy advances it may
assume a dark brown or even black color. This color diminishes as soon
as lactation is over, but is never entirely lost throughout life. These
changes in the color of the areola are of importance in forming a
conclusion in a case of suspected first pregnancy. Near the base of the
papilla, and upon the surface of the areola, are numerous large
sebaceous glands, the areolar glands, which become much enlarged
during lactation, and present the appearance of small tubercles beneath
the skin. These glands secrete a peculiar fatty substance, which serves
as a protection to the integument ( lapisan atas ) of the papilla during
the act of sucking. The mammary papilla consists of numerous vessels,
intermixed with plain muscular fibers, which are principally arranged in
a circular manner around the base: some few fibers radiating from base
to apex.

Development.The mamma is developed partly from mesoderm and

partly from ectodermits blood vessels and connective tissue being

derived from the former, its cellular elements from the latter. Its first
rudiment is seen about the third month, in the form of a number of small
inward projections of the ectoderm, which invade the mesoderm; from
these, secondary tracts of cellular elements radiate and subsequently
give rise to the epithelium of the glandular follicles and ducts. The
development of the follicles, however, remains imperfect, except in the
parous female.

Structure (Figs. 1172, 1173).The mamma consists of gland

tissue; of fibrous tissue, connecting its lobes; and of fatty tissue in
the intervals between the lobes. The gland tissue, when freed from
fibrous tissue and fat, is of a pale reddish color, firm in texture, flattened











circumference. The subcutaneous surface of the mamma presents

numerous irregular processes which project toward the skin and are
joined to it by bands of connective tissue. It consists of numerous lobes,
and these are composed of lobules, connected together by areolar
tissue, bloodvessels, and ducts. The smallest lobules consist of a cluster
of rounded alveoli, which open into the smallest branches of the
lactiferous ducts; these ducts unite to form larger ducts, and these end
in a single canal, corresponding with one of the chief subdivisions of the
gland. The number of excretory ducts varies from fifteen to twenty; they
are termed the tubuli lactiferi (klo di spalteholz sebutannya ductus
lactiferus). They converge toward the areola, beneath which they form
dilatations or ampull, which serve as reservoirs for the milk, and, at
the base of the papill, become contracted, and pursue a straight
course to its summit, perforating it by separate orifices considerably
narrower than the ducts themselves. The ducts are composed of
areolar tissue containing longitudinal and transverse elastic

fibers; muscular fibers are entirely absent; they are lined by columnar
epithelium resting on a basement membrane. The epithelium of the
mamma differs according to the state of activity of the organ. In the
gland of a woman who is not pregnant or suckling, the alveoli are very
small and solid, being filled with a mass of granular polyhedral cells.
During pregnancy the alveoli enlarge, and the cells undergo rapid
multiplication. At the commencement of lactation, the cells in the center
of the alveolus undergo fatty degeneration, and are eliminated in the
first milk, as colostrum corpuscles. The peripheral cells of the
alveolus remain, and form a single layer of granular, short columnar
cells, with spherical nuclei, lining the basement membrane. The cells,
during the state of activity of the gland, are capable of forming, in their
interior, oil globules, which are then ejected into the lumen of the
alveolus, and constitute the milk globules. When the acini are distended
by the accumulation of the secretion the lining epithelium becomes

FIG. 1172 Dissection of the lower half of the mamma during the period of

lactation. (Luschka.) (See enlarged image)

FIG. 1173 Section of portion of mamma. (See enlarged image)

The fibrous tissue invests the entire surface of the mamma, and

sends down septa between its lobes, connecting them together.

The fatty tissue covers the surface of the gland, and occupies the
interval between its lobes. It usually exists in considerable abundance,
and determines the form and size of the gland. There is no fat
immediately beneath the areola and papilla.

Vessels and Nerves.The arteries supplying the mamm are

derived from the thoracic branches of the axillary, the intercostals, and
the internal mammary. The veins describe an anastomotic circle around
the base of the papilla, called by Haller the circulus venosus. From
this, large branches transmit the blood to the circumference of the
gland, and end in the axillary and internal mammary veins. The
lymphatics are described on page 715. The nerves are derived from
the anterior and lateral cutaneous branches of the fourth, fifth, and
sixth thoracic nerves.



Physical examination
While doing your regular breast self-exam, you may feel a breast
fibroadenoma. These feel firm, round, smooth, rubbery, and are movable.
They are so mobile that women sometimes refer to them as breast mice
because they tend to run away from your fingers. A fibroadenoma may feel
tender, especially right before your period, when it may swell due to
hormonal changes.

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













fibroadenomas, see the images below.

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.

-Breast ultrasound
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.[4, 5, 6, 7]
(See the image below.)

Ultrasonogram demonstrates a hypoechoic mass with smooth, partially

lobulated margins typical of a fibroadenoma.

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
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.[8]

A core needle biopsy must be performed to get a definite diagnosis. Women in their teens or
early 20s may not need a biopsy if the lump goes away on its own or if the lump does not
change over a long period of time.
For more information on the different types of breast biopsies, see:

Breast biopsy - open

Breast biopsy - stereotactic

You will most likely be asked to lie facing down on the biopsy table. The breast that is
being biopsied will hang through an opening in the table. The table is raised and the
doctor will perform the biopsy from underneath. In some cases, stereotactic breast biopsy
is done while the woman sits in an upright position.

A stereotactic breast biopsy uses mammography to help pinpoint the spot in the breast
that needs to be removed.
You must sign an informed consent form. If you are going to have general anesthesia, you
may be asked not to eat or drink anything for 8 - 12 hours before the test.
A stereotactic biopsy includes the following steps:
-The health care provider will first clean the area on your breast, and will then inject a
numbing medicine. This may sting a little bit.
-The breast is pressed down to hold it in position during the procedure. You need to hold
still while the biopsy is being performed.
-The doctor will make a very small cut on your breast over the area that needs to be
-Using a special machine, a needle or sheath is guided to the exact location of the
abnormal area. Up to six or more tissue samples are taken.
-A small metal clip or needle may be placed into the breast in the biopsy area to mark it
for biopsy, if needed.
-After the tissue sample has been taken, the catheter or needle is removed. Ice and
pressure are applied to the site to stop any bleeding. A bandage will be applied to absorb
any fluid. You will not need stitches after the needle is taken out. Steristrips may be
placed over any wound, if needed.

Breast biopsy - ultrasound (core needle)

If you are going to have general anesthesia, you may be asked not to eat or drink anything
for 8 - 12 hours before the test.
You will be awake during the biopsy. You will lie on your back.
-The health care provider will first clean the area on your breast, and then inject a
numbing medicine.
-The doctor will make a very small cut on your breast over the area that needs to be
-The doctor will use an ultrasound machine to guide the needle to the abnormal area in
your breast that needs to be biopsied.
-Several biopsies may be taken.

-A small metal clip or needle may be placed into the breast in the area of the biopsy to
mark it, if needed.
The biopsy is done using one of the following:
-Fine needle aspiration
-Hollow needle (called a core needle)
-Vacuum-powered device
-Both a hollow needle and vacuum-powered device
Once the tissue sample has been taken, the catheter or needle is removed. Ice and
pressure are applied to the site to stop any bleeding. A bandage will be applied to absorb
any fluid. You will not need any stitches after the needle is taken out. Steri-Strips may be
placed over any wound, if needed.


all women should examine their breasts monthly and have regularly scheduled clinical breast
exams and other screenings as recommended by their healthcare providers.


gambar atas.Fibrocystic Breast Tissue on a Mammogram-(National

Cancer Institute).
Fibroadenomas appear as round or oval smooth-edged masses. The
outline of the mass will be clearly defined, not blurry. Sometimes they
are accompanied by coarse calcifications. Fibroadenomas can look
like cysts or a well-contained tumor. It will appear as a dark area, with a definite outline,
homogeneous, round or oval, and may have smooth-edged bumps.


.phyllodes tumour.

In some cases, your healthcare provider may recommend leaving the lump in place and checking
it on a regular basis. This is called observation and is most often recommended for small
tumors that can be monitored and are not causing any physical deformities or anxiety.
However, your healthcare provider may recommend removing a fibroadenoma if it is large, the
biopsy results are not normal, or it is causing physical deformities or anxiety. Most likely, a
breast surgeon will be involved in your decision to remove a fibroadenoma. There are a variety
of techniques your surgeon can use to remove a fibroadenoma, including:

Cryoablation (destroying the lump by freezing it rather than removing it)

is a fast, efficient way to freeze a fibroadenoma to death. In one office visit, cryoablation
simply freezes the lump so that healthy tissue can take over. This procedure takes less
than 30 minutes and results in a tiny scar.

Percutaneous excision (removing the tumor with a needle through the skin)

Lumpectomy, or surgical removal of a fibroadenoma, can be done if

you're worried about keeping it in your breast. Depending on the
relative size of this lump and your breast, a lumpectomy may cause a
change your breast's size or shape. New fibroadenomas may grow
in the neighborhood of the first lump, so you should know that
surgery is not a guarantee that you'll never have another
fibroadenoma. On the other hand, your fibroadenoma can be
carefully examined by the pathology lab to make sure the diagnosis
was correct and breast cancer can be ruled out.

Adenomyoepithelioma, strictly defined, is a proliferation of both
epithelial and myoepithelial elements.

Unlike breast cancers called carcinomas, which develop inside the

ducts (milk-carrying tubes) or lobules (milk-producing glands) of the
breast, phyllodes tumors start outside of the ducts and lobules.
Phyllodes tumors develop in the breast's connective tissue, called the
stroma. The stroma includes the fatty tissue and ligaments that
surround the ducts, lobules, and blood and lymph vessels in the breast.
It may be helpful to think of the stroma as the tissue that "holds
everything together" inside the breast. In addition to stromal cells,
phyllodes tumors can also contain cells from the ducts and lobules
Diagnosis of phyllodes tumors
Like other less common types of breast tumors, phyllodes tumors can
be difficult to diagnose because doctors don't encounter them all that
often. A phyllodes tumor also can look like a more common type of

benign breast growth called a fibroadenoma. A fibroadenoma is a solid,

growing lump of normal breast cells that is the most common kind of
breast mass, especially in younger women.
Two key differences between fibroadenomas and phyllodes
tumors are that phyllodes tumors tend to grow more quickly
and develop about 10 years later in life in the 40s as opposed
to the 30s. These differences can help doctors distinguish phyllodes
tumors from fibroadenomas.
Diagnosing phyllodes tumors usually involves a combination of steps:

A physical examination of the breasts. Your doctor may be able to

feel the lump in the breast, or you may feel it yourself during a breast

A mammogram to obtain X-ray images of the breast and locate the

tumor. On a mammogram, a phyllodes tumor appears as a large round
or oval mass with well-defined edges. Sometimes the tumor might look
like it has rounded lobes inside it. Calcifications can show up as well.
Calcifications are tiny flecks of calcium like grains of salt in the soft
tissue of the breast. Your doctor likely will need to do additional testing
to confirm that the lump is a phyllodes tumor.

Ultrasound to obtain sound-wave images of the breast. The images

form as the sound waves are "echoed back" by the tissue. On
ultrasound, phyllodes tumors look like well-defined masses with some
cysts inside of them.

MRI to obtain additional images of the tumor and help in planning


Biopsy to take samples of the tumor for examination under a

microscope. Although imaging tests are useful, biopsy is the only way to

tell if the growth is a phyllodes tumor. Your doctor can perform one of
two procedures:
o core needle biopsy, which uses a special hollow needle to take
samples of the tumor through the skin

In very rare cases, the lump may be cancerous and you may need further treatment.

Women with fibroadenoma have a slightly higher risk of breast cancer later in life. Lumps that
are not removed should be checked regularly by physical exams and imaging tests, following the
doctor's recommendations.

Fibroadenoma is the most common lesion of the breast; it occurs in 25% of asymptomatic
women [101]. It is usually a disease of early reproductive life; the peak incidence is between the
ages of 15 and 35 years. Conventionally regarded as a benign tumor of the breast, fibroadenoma
is also thought to represent a group of hyperplastic breast lobules called aberrations of normal
development and involution [10, 101, 102]. The lesion is a hormone-dependent neoplasm that
lactates during pregnancy and involutes along with the rest of the breast in perimenopause [102].

A direct association has been noted between oral contraceptive use before age 20 and the risk of
fibroadenoma [103]. The Epstein-Barr virus might play a causative role in the development of
this tumor in immunosuppressed patients [104].
Fibroadenoma presents as a highly mobile, firm, non-tender, and often palpable breast mass.
Although most frequently unilateral, in 20% of cases, multiple lesions occur in the same breast
or bilaterally. Fibroadenoma develops from the special stroma of the lobule. It has been
postulated that the tumor might arise from bcl-2-positive mesenchymal cells in the breast, in a
manner similar to that proposed for solitary fibrous tumors [105]. Macroscopically, the lesion is a
well-circumscribed, firm mass, <3 cm in diameter, the cut surface of which appears lobulated
and bulging (Fig. 4A). If the tumor assumes massive proportions (>10 cm), more commonly
observed in female adolescents, it is called giant fibroadenoma. Microscopically,
fibroadenoma consists of a proliferation of epithelial and mesenchymal elements. The
stroma proliferates around tubular glands (pericanalicular growth) or compressed cleft-like ducts
(intracanalicular growth). Often both types of growth are seen in the same lesion (Fig. 4B)

Figure 4. Fibroadenoma. (A): The cut surface of fibroadenoma is lobulated, solid,

and gray-white, with a characteristic bulging appearance. (B): Histologically the
lesion consists of densely fibrotic stroma and compressed cleft-like ducts.

Cytogenetic studies have reported chromosomal aberrations in both epithelial and stromal cells,
suggesting that the two components may involve neoplastic changes [106, 107]. Phyllodes tumor

is a fibroepithelial tumor of the breast with a spectrum of changes. Benign phyllodes tumor is
usually difficult to differentiate from fibroadenoma. Hypercellular stroma with cytologic atypia,
increased mitoses, and infiltrative margins of the lesion are the most reliable discriminators to
separate lesions with recurrence and malignant behavior. In terms of surgical treatment of these
tumors, it is important to recognize phyllodes tumor because it should be excised completely
with clear margins to obviate any chance of local recurrence. In cases of recurrent disease,
mastectomy is often performed [108, 109].
Approximately 50% of fibroadenomas contain other proliferative changes of breast, such as
sclerosing adenosis, adenosis, and duct epithelial hyperplasia. Fibroadenomas that contain these
elements are called complex fibroadenomas. Simple fibroadenomas are not associated with any
increased risk for subsequent breast cancer. However, women with complex fibroadenomas may
have a slightly higher risk for subsequent cancer [110]. The presence of atypia (either ductal or
lobular) confined to a fibroadenoma does not lead to a greater risk for long-term breast
carcinoma compared with fibroadenomas in general [110].
Fibroadenomas in older women or in women with a family history of breast cancer have a higher
incidence of associated carcinoma [101, 111]. Two studies, which were considered to provide
strong evidence of reliability according to El-Wakeel et al. [101], show that the relative risk of
developing breast cancer in patients who had surgically excised fibroadenomas increases in the
presence of complex features within the fibroadenomas, ductal hyperplasias, or a family history
of breast carcinoma (in a first-degree relative). Progressive somatic genetic alterations that are
associated with the development of breast cancer have been studied in fibroadenomas. No
genetic instabilities, manifested as loss of heterozygosity or microsatellite instability, have been
found in any fibroadenoma components regardless of their association with breast cancer or their
histologic complexity [106].
The current management of patients with clinically or radiologically suspected fibroadenoma
varies. Some physicians prefer excision for tissue diagnosis, but conservative management will
likely replace surgical treatment in the near future, on the basis of the young age of the patient,
findings of benign imaging and clinical characteristics, and benign findings on either FNA
biopsy or needle core biopsy [110, 112]. Minimally invasive techniques, such as ultrasound-

guided cryoablation, seem to be an excellent treatment option for fibroadenoma in women who
wish to avoid surgery [1], or else the lesion may simply be treated with observation and followed
up periodically.
Juvenile fibroadenoma is a variant of fibroadenoma that presents between 10 and 18 years of
age, usually as a painless, solitary, unilateral mass >5 cm. It can reach up to 15 or 20 cm in
dimension, so although it is an entirely benign lesion, surgical removal is recommended [113].