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MedPix® Teaching File Case No: 5486

Case Summary: 5486 - || - - || - -
Contributed by: William A Mercanti ( National Capital Consortium ) - || - Author Info
Approved by: Claudia E Galbo ( Uniformed Services University ) - || - Author Info
DiagnosisDegenerating Fibroadenoma
Dx confirmed by* Not Provided by Author *
DemographicAge: 77 - Gender: woman -
History77 yo female for routine screening mammogram with multiple prior studies for comparison.
Exam and Lab* Not Provided by Author *
ImagesDisplay Case Images - Click Here to Display Images
FindingsCoarse popcorn like calcifications without associated mass in the left breast lower inner quadrant. This finding is stable over many years.
Differential* Not Provided by Author *
Treatment and FollowupBenign finding - continue routine screening mammograms.
Disease TopicDegenerating Fibroadenoma
Disease DiscussionFibroadenoma:

Fibroadenomas are the most common solid breast masses in women. They usually do not develop as new masses after menopause. Their peak age of incidence as palpable masses are in women in their 20’s. They can be multiple in about 20% of cases. Many fibroadenomas begin to involute in the postpartum period and after menopause. Fibroadenomas are benign tumors composed of fibrous and epithelial tissue. Gross examination shows a circumscribed rubbery nodule without a capsule.

On mammography, fibroadenomas are usually circumscribed round, oval or lobular masses and may be indistinguishable from cysts or lymph nodes. Ultrasound is useful to demonstrate these solid masses. Involuting fibroadenomas may have “popcorn-like” calcifications which usually begin at the periphery of the mass and progress more centrally. Some fibroadenomas have atypical mammographic appearance and can mimic carcinoma with irregular shapes or indistinct or spiculated borders or microcalcifications.

Management:

For women younger than 30 years with a typical mammographic or sonographic appearance, close clinical follow up can be performed. For women older than 30, close interval follow up can be recommended if no prior studies are available and after appropriate compression images and ultrasound imaging is performed. If the lesion is large or increasing in size, especially after menopause, a biopsy should be performed.
The risk of developing carcinoma within a fibroadenoma is no higher than for the general population.
Reference(s)Kopans, Breast Imaging 2nd ed 1998, Lippincott-Raven


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