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MedPix® Teaching File Case No: 5590

Case Summary: 5590 - || - - || - -
Contributed by: John J. Combs ( National Capital Consortium ) - || - Author Info
Approved by: Claudia E Galbo ( Uniformed Services University ) - || - Author Info
DiagnosisInvoluting Fibroadenoma
Dx confirmed by* Not Provided by Author *
DemographicAge: 48 - Gender: woman - Caucasian
HistoryScreening mammogram
Exam and LabNormal
ImagesDisplay Case Images - Click Here to Display Images
FindingsSpot compression CC and spot compression magnification ML views of the right breast demonstrate pleomorphic calcifications without a perceptible mass.
DifferentialAdenosis (fibrocystic changes) (most common)
Atypical ductal hyperplasia
Ductal carcinoma in situ (DCIS)
Hyalinizing fibroadenoma
Infarcted papilloma
Fat necrosis
Patient DiscussionThis is an example of a fibroadenoma that is early in the process of hyalinizing.
Treatment and FollowupAt this early stage it is imossible to know if this represents DCIS or something more benign, and requires biopsy, either excisional or via stereotactic technique. If a mass is visible under ultrasound, it may be biopsied with a sprin-loaded biopsy gun this way as well. If pathology results in "fibroadenoma", annual screening mammogram may be recommended.
Disease TopicInvoluting Fibroadenoma
Disease DiscussionFibroadenomas represent expansile proliferations of lobular elements (epithelial and mesenchymal) under estrogenic stimulation. Typically, they are hard, movable masses most commonly seen in young patients, and are frequently multiple. Less commonly, they may present in older women on hormone replacement therapy. Occasionally, patients may report hormonally mediated (cyclic) changes in size and associated tenderness.

Fibroadenomas have a variable appearance on mammography. They may present as soft tissue masses of variable size, density and marginal characteristics. Particularly after withdrawal of hormonal stimulation (post-menopause) fibroadenomas tend to involute through a process of hyalinization, which leads to calcification. Early in this process, they may present as pleomorphic calcifications, with or without an associated perceptible mass. Ultimately they will develop characteristic coarse “popcorn” calcifications that are easily recognizable.
Reference(s)Cardenosa, Gilda. Breast Imaging Companion. 1997, Lippincott-Raven, p. 243.


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