1 of 5

Woman with abnormal breast exam.

Our appreciation is extended to Dr.  Lauren Ladd,
Indiana University Department of Radiology,
for contributing this case.

History:  Woman with abnormal breast exam.
Click any thumbnail image to enlarge it.

Click for galleryClick for galleryClick for galleryClick for galleryPlease respond to the following with TRUE or FALSE.
Unilateral mass

True or False
Skin thickening

True or False
Architectural distortion

True or False
Pleomorphic microcalcifications

True or False
1 of 5
Case of the Day(SM) Copyright
AuntMinnie.com AuntMinnie.com Back To Top
Copyright © 2014 AuntMinnie.com. All Rights Reserved.
2 of 5

Woman with abnormal breast exam.

Here are some ultrasound images of the salient finding. Click to enlarge.

Click for galleryClick for galleryClick for galleryClick for gallery

2 of 5
Case of the Day(SM) Copyright
AuntMinnie.com AuntMinnie.com Back To Top
Copyright © 2014 AuntMinnie.com. All Rights Reserved.
3 of 5

Woman with abnormal breast exam.

Click for galleryClick for galleryClick for galleryClick for gallery

Mammogram findings:

There are scattered fibroglandular tissues.  There is a 4.3 x 2.9 cm lobular partly circumscribed, partly obscured mass in the anterior third left breast upper outer quadrant.  No associated calcification, skin thickening or architectural distortion is present.  There are no suspicious findings in the right breast.

Ultrasound Findings:

An oval circumscribed complex mass with internal color Doppler flow is seen in the left breast upper outer quadrant, corresponding to mammographic abnormality.  The left axilla is negative for pathologic adenopathy.


Differential diagnosis:

  • Fibroadenoma
  • Lactating adenoma
  • Tubular adenoma
  • Phyllodes tumor
  • Invasive ductal carcinoma
Diagnosis:  Fibroepithelial tumor of the breast
3 of 5
Case of the Day(SM) Copyright
AuntMinnie.com AuntMinnie.com Back To Top
Copyright © 2014 AuntMinnie.com. All Rights Reserved.
4 of 5

Woman with abnormal breast exam.


Key points:
 

  • What is a fibroepithelial tumor?
    • A fibroepithelial tumor is a tumor composed of epithelial and stromal tissue.
    • These include a range of benign and (rarely) malignant histologic tumors, specifically the spectrum of fibroadenomas (benign) to phyllodes (benign or malignant) tumors.
    • Highly cellular fibroadenomas and low grade phyllodes are most difficult to distinguish.
    • May be detected due to symptoms (rapidly growing mass/lump) or on routine screening.
  • Imaging features:
    • Mammogram:
      • Shape: round, oval, or lobulated
      • Margins: circumscribed/obscured
      • Other features: +/- calcification (if calcifications are seen à more likely fibroadenoma)
    • Ultrasound: **best tool for characterization
      • Shape: oval
      • Margins: circumscribed or gently lobulated
      • Density: hypo- to isoechoic
      • Orientation: parallel
      • Other features: echogenic septations, calcifications, posterior enhancement, (rare) small cystic foci (if cysts à more likely phyllodes tumor)
      • Doppler: peripheral feeding vessels, septal vessels if large
    • MRI:
      • T2: isointense to parenchyma
      • T1 with contrast: oval or macrolobulated, smooth borders, variable enhancement (most commonly: moderately rapid and homogeneously intense +/- non-enhancing septations)
  • Treatment is controversial, though surgical excision is most widely accepted due to the lack of specific imaging or core needle pathologic characteristics to entirely exclude malignant component.

References: 

  1. Hanby AM. Fibroepithelial neoplasms of the breast. Diagnostic Histopathology. 2009; 15(8):373-381.
  2. Resetkova E, et al. Diagnosis of cellular fibroepithelial lesion of the breast by core biopsy: Guide to management based on clinical, radiologic, and pathologic correlation and 6-year experience at a single institution. American Society of Clinical Oncology. 2009 Breast Cancer Symposium.
  3. My.statdx.com. "Fibroadenoma." Accessed 7/31/2011.
4 of 5
Case of the Day(SM) Copyright
AuntMinnie.com AuntMinnie.com Back To Top
Copyright © 2014 AuntMinnie.com. All Rights Reserved.
5 of 5

Woman with abnormal breast exam.


Congratulations!

You have completed AuntMinnie's Case of the Day(SM)!

We hope your experience has been fun and educational. Please view more at:
Case of the Day(SM) Home Page
Show / Update Score
5 of 5
Case of the Day(SM) Copyright
AuntMinnie.com AuntMinnie.com Back To Top
Copyright © 2014 AuntMinnie.com. All Rights Reserved.
Back To Case

Gallery

swipe or use buttons at the bottom
Back To Case

Gallery

swipe or use buttons at the bottom
All content on this Website is licensed to, or Copyright © 2011, AuntMinnie.com. All Rights Reserved. Images and text may be reused by permission only. All copyright watermarks must be left intact.

Powered by EDACTICTM Invented & Developed by Mark S. Frank, M.D.
Back