Woman with abnormal breast exam.

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

Woman with abnormal breast exam.

Woman with abnormal breast exam.

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.

• Fibroadenoma
• Lactating adenoma
• Tubular adenoma
• Phyllodes tumor
• Invasive ductal carcinoma

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.

Woman with abnormal breast exam.