A Rare Case of Recurrent Giant Fibroadenoma

Abstract

Fibroadenomas are benign solid tumor associated with aberration of normal lobular development. Giant fibroadenoma is usually single and >5 cm in size /or >500 gms in weight. Their rapid growth, associated with skin congestion and ulceration, and tendency to recur, gives rise to a suspicion of malignancy.[1,2]. Important differential diagnoses are: phyllodes tumor and juvenile gigantomastia. These tumours are almost always benign and should be treated with breast conserving surgery. We present a case of 40year old female who presented with a large lump in the right breast. The diagnosis was made on fine needle aspiration cytology, mammography and ultrasonography. Simple excision of the lump was done. The diagnosis was confirmed on histopathology. Patient again presented twice with similar complaints with no evidence of malignancy of histopathology. CASE REPORT: A 40 year old female presented to surgical opd with complaints of large lump in the right breast since 2months.It was insidious in onset and rapidly progressive in nature, pt also complained of associated pain since 15 days, dragging type nonradiating type. No history of discharge or ulcer over the skin. No history of fever, weight loss loss of appetite. On examination there was a large mass measuring 8*10cm occupying all the four quadrants of the right breast. Surface was bosselated. Dilated veins were noted over the lump. The lump was tender to palpate and margins were irregular. Lump was mobile .Skin was pinchable. Axillary nodes were not enlarged. Left breast and axilla was normal. All routine blood investigations and urine examinations were within normal limits. Fine needle aspiration cytology revealed-features suggestive of benign lesion, s/o giant fibroadenoma. USG of the right breast showed a solid mass with features suggestive of fibroadenoma. Patient was posted for surgery and simple excision of the lump was done. Post operative histopathology revealed it as a benign lesion of right breast. After 3 years patient presented with similar complaints again on the right breast. On examination, there was large lump occupying all the four quadrants of the right breast measuring 8*8cm. Surface was bosselated and dilated veins were noted .The lump was tender to palpate with variable consistency. Skin was pinchable and lymph nodes were not palpable in the right axilla. Left breast and axilla were normal. FNAC and ultrasonography showed features suggestive of fibroadenoma which had recurred. Mammography also revealed features suggestive of fibroadenoma Patient was operated again and simple excision of the lump was done. Histopathology of the specimen showed pericanalicular and intracanalicular type of fibroadenoma. No features suggestive of malignancy. Patient presented again with similar complaints after 5 years of initial presentation. The lump was excised for the third time and the histopathological specimen showed no evidence of malignancy.