Breast fibroadenoma is a benign lesion and arises from the proliferation of the breast tissue. Fibroadenomas occur at any age, but more so in women below the age of 30 years. There are different types, namely simple, giant juvenile, and multicentric fibroadenomas. Women who have a history of fibroadenomas have an increased risk of developing breast cancer [1]. Conversely, fibroadenomas in themselves have little chance (up to 0.125%) of undergoing malignant change [2]. Younger women, those with a history of a breast mass, and women of African descent are at a greater risk for developing fibroadenomas. Protective factors include the use of combined oral contraceptive pills and greater parity.

The majority of women have simple fibroadenomas and present with a single painless, smooth, mobile breast mass with a rubbery consistency, most often located in the upper outer quadrant. The average size of lesions is about 2-3 centimeters.

10%–25% of affected women have multicentric fibroadenomas [3]. These can occur in any quadrant of the breast. Giant juvenile fibroadenomas make up between 0.5% and 2% of all fibroadenomas [4] [5]. They are typically seen in adolescent girls, and are usually unilateral and grow rapidly, with a weight of more than 500 grams or diameter over 5 cm. They cause distortion and displacement of surrounding breast tissue, and may even cause skin changes and a distension of superficial veins [6].

The size of fibroadenomas may fluctuate, with a general tendency to decrease over time. They may enlarge or shrink in response to hormonal changes during the menstrual cycle and are particularly sensitive to estrogen [5]. Up to 40% of all fibroadenomas in adolescents resolve spontaneously.

• Breast Mass

  A family history should also be taken, with emphasis on breast masses and malignancies. Physical examination of the breasts and axillary lymph nodes is mandatory in determining the characteristics of the mass. [symptoma.com]

  The patient subsequently underwent excision of bilateral breast masses and reduction mammoplasty. Histopathologically, bilateral breast masses were confirmed to be juvenile fibroadenomas. [ncbi.nlm.nih.gov]

  Low-risk palpable breast masses removed using a vacuum-assisted hand-held device. Am J Surg 2003; 186 (4) 362-367 10 Wang ZL, Li JL, Su L, Zhang YF, Tang J. [doi.org]

Triple assessment may be used to investigate breast fibroadenoma. This includes clinical examination, imaging, and biopsy. It is important to take a full gynecological history, as well as the history of the presenting mass. A family history should also be taken, with emphasis on breast masses and malignancies. Physical examination of the breasts and axillary lymph nodes is mandatory in determining the characteristics of the mass.

Medical imaging modalities are a major part of the assessment of breast masses. Ultrasonography is widely used, especially in young women, and is advantageous when examining this population as they have dense breast tissue [7]. Mammography may be done and is especially advised for women over the age of 35 years. Magnetic resonance imaging (MRI) scanning is also useful and is a more sensitive test than mammography [8]. Follow up visits for repeated imaging is indicated for fibroadenomas [9].

Biopsy does not always need to be performed, especially when imaging suggests fibroadenoma, and in women in their 20s or younger. In postmenopausal women, however, breast lesions should be biopsied because of the greater chance of malignancy. Giant juvenile fibroadenomas should also be biopsied, as they resemble malignancies.

Treatment procedure The treatment session consisted of five steps: pretreatment ultrasonography, positioning, planning, energy setting, and treatment with HIFU pulses in the defined volume. [doi.org]

[…] ultrasound has been used successfully for many years for the treatment of tumors. [echotherapie.com]

Outlook (Prognosis) If the lump is left in place and watched carefully, it may need to be removed at a later time if it changes or grows. In very rare cases, the lump is cancer, and will need further treatment. [account.allinahealth.org]

Differential Diagnosis A fibroadenoma can be confused with: Breast cyst Breast carcinoma Phyllodes tumor Breast lymphoma Metastasis to the breast from another primary site Prognosis Prognosis of fibroadenoma is good because it is a benign mass which shrinks [ncbi.nlm.nih.gov]

Treatment and prognosis They are benign lesions with minimal or no malignant potential. The risk of malignant transformation is extremely low and has been reported to range around 0.0125-0.3%. [radiopaedia.org]

Etiology Causes of fibroadenoma are debatable, but professionals believe that the lesion has a hormonal etiology related to the increased sensitivity of breast tissue to the female reproductive hormone estrogen. [ncbi.nlm.nih.gov]

It is thought that increased estrogen receptor sensitivity is responsible for the etiology of GF [ 1 ]. [link.springer.com]

The etiology incriminated is changes in plasma estrogen levels and changes in the estrogen%progesterone ratios. Breast Fibroadenoma Causes Of Breast Fibroadenoma Fibroadenomas are benign tumors composed of stromal and epithelial cells. [doctortipster.com]

Conclusion For such a common tumor, relatively little is known about the etiology and risk factors of FA. [panafrican-med-journal.com]

Due to this relationship, medical professionals believe that etiology is linked to estrogen levels. Similarly, research has found that changes in the size of the masses often align with changes in the menstrual cycle. [news-medical.net]

[…] condensation, no cytologic atypia, no mitotic figures > 3/10 HPF Excision is curative Terminology Also called juvenile fibroadenoma Giant fibroadenoma: terminology used inconsistently; refers to size, often children but not a distinct histopathologic entity Epidemiology [pathologyoutlines.com]

Further possible causes are: certain immunosuppressive drugs Carneyís complex Epstein-Barr virus 3 Epidemiology Fibroadenomas particularly often occur in young women between the ages of 20 and 30 years, but they can basically occur from puberty on. [flexikon.doccheck.com]

Epidemiology of Fibroadenoma Fibroadenomas are believed to be under-reported with an estimated incidence of 13% in women examined in a clinic. [lecturio.com]

Introduction Clinical definition benign solid tumor of the breast with epithelial and stromal components Epidemiology incidence common in women 15-35 years of age second most common benign breast mass most common breast tumor in women under 30 demographics [step2.medbullets.com]

It thus makes sense on epidemiologic grounds to lump these lesions together under the rubric “complex fibroadenoma.” However, it is not clear that these lesions are necessarily related by a common underlying cause. [nejm.org]

Genetics Mediator complex subunit 12 (MED12) gene is also important in the pathophysiology of fibroadenomas. [ncbi.nlm.nih.gov]

Pathophysiology of Fibroadenoma Fibroadenomas arise from the lobular structures of the breast; hence they are usually formed during menarche. During menarche, distinct areas of lobular hyperplasia form, which is a normal physiological change. [lecturio.com]

[…] incidence common in women 15-35 years of age second most common benign breast mass most common breast tumor in women under 30 demographics mostly women in males may be associated with anti-androgen treatment risk factors use of oral contraceptives pregnancy Pathophysiology [step2.medbullets.com]

[…] self-examination.2 The incidence of fibroadenoma has also been shown to directly correlate with body mass index (BMI), with peak incidence seen with BMI 25 to 29.9 kg/m.2 Increased parity and the use of oral contraceptives appear to decrease fibroadenoma risk.2 Pathophysiology [jaocr.org]

None of these preventive measures prevents 100% of all breast cancers. Even prophylactic mastectomy cannot remove all breast tissue, so some of these women still get breast cancer. Got a question for our experts? Submit it here [thechart.blogs.cnn.com]

Fibroadenoma of the Breast is difficult to prevent, because it is most likely caused by abnormal or fluctuating reproductive hormone levels Since prevention is generally not possible, it is important to be aware of the risk factors of breast lumps. [dovemed.com]

Prevention Breast fibroadenomas cannot be prevented. They can be discovered early by regular breast self-examination. [medical-dictionary.thefreedictionary.com]

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3. Williamson ME, Lyons K, Hughes LE. Multiple fibroadenomas of the breast: a problem of uncertain incidence and management. Ann R Coll Surg Engl. 1993;75(3):161–163.
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8. Smith RA. The evolving role of MRI in the detection and evaluation of breast cancer. N Engl J Med. 2007;356(13):1362-1364.
9. Harvey JA, Nicholson BT, Lorusso AP, Cohen MA, Bovbjerg VE. Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 2009;193(6):1723–1730.