Breast cancer arising within fibroadenoma: collective analysis of case reports in the literature and hints on treatment policy

Wu, Yu; Chen, Shou Tung; Chen, Chih‐Jung; Kuo, Yiyo; Tseng, Ling Ming; Chen, Dar Ren; Kuo, Shou Jen; Lai, Hsin Yi

doi:10.1186/1477-7819-12-335

Cited by 70 publications

(50 citation statements)

References 47 publications

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“…Our unit currently manages presumptive FA that are clinically, radiologically, and pathologically concordant but have a dimension of greater than 30 mm with excision because of the postulated risk of underlying ductal carcinoma in situ (DCIS) or PT, particularly in larger lesions …”

Section: Introductionmentioning

confidence: 99%

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

et al. 2018

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Fibroadenomas (FA) are the most common benign tumor in the female breast. Most are managed conservatively provided there is clinical, radiologic, and pathologic concordance. However, surgical excision is typically recommended for cellular fibroepithelial lesions or those lesions with clinical, radiologic, or pathologic features concerning for phyllodes tumor (PT). Some studies have suggested surgical excision in all FA >30 mm to reduce core needle biopsy (CNB) sampling errors. The aim of our study was to evaluate, in the absence of any other concerning clinicopathologic features, whether surgical excision of FA was warranted based on size criteria alone. Cork University Hospital is a large academic center in Southern Ireland. Its breast cancer center provides both a screening and symptomatic service and diagnoses approximately 600 cancers per year. The breast histopathological data base was reviewed for all CNBs from January 1, 2010, to June 30, 2015, with a diagnosis of FA that went on to have excision at our institution. We excluded all cellular fibroepithelial lesions and those cases with co-existent lobular neoplasia, ductal carcinoma in situ, invasive carcinoma, atypical ductal hyperplasia, or lesions which would require excision in their own right. Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded. Patient demographics and preoperative radiologic size and the radiologic target were recorded in each case. All radiology was reviewed by a breast radiologist prior to inclusion in the study, and there was histologic radiologic concordance with a diagnosis of FA in all cases. A total of 12,109 consecutive radiologically guided CNB were performed January 2010-June 2015; 3438 with a diagnosis of FA were identified of which 290 cases went on to have surgical excision. Of those 290 cases; 98.28% (n = 285) were confirmed as FA on excision. The remaining 1.72% (n = 5) had atypical features-FA with LCIS (n = 1), benign PT (n = 3), and invasive ductal carcinoma (n = 1). Our study suggests that, excision based solely on size is not warranted in clinical and radiologically concordant cases with a diagnosis of FA on CNB.

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Section: Introductionmentioning

confidence: 99%

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

et al. 2018

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“…The patients with DCIS were treated with breast conservation, however, radiotherapy was given only to two patients based upon clinician's preference. Receptor status was not available for all cases, but where ever positive, hormonal treatment was given [10].…”

Section: Discussionmentioning

confidence: 99%

“…These include invasive as well as in-situ carcinomas. Carcinoma in-situ, both lobular and ductal, was found to be more common in such cases as compared to invasive types [10]. Due to rarity of such cases and unexpected incidental discovery on excision specimens, exact guidelines for further management are not available and management so far is dictated by the malignant component of fibroadenoma [11].…”

Section: Introductionmentioning

confidence: 99%

Ductal Carcinoma-in-situ within fibroadenoma of the breast: A case report with literature review

Zeeshan¹,

Siddique²,

Riaz³

2018

Int J Case Rep Images

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Introduction:Fibroadenoma is a most commonly diagnosed benign tumor of the breast with highest occurrence in adolescent and young women, but its coexistence with ductal carcinoma in-situ (DCIS) is extremely rare and infrequently reported. Case Report: We report a case of 34-year-old pregnant female who was diagnosed with DCIS within fibroadenoma on wide local excision. The diagnosis of DCIS was not identified on core biopsy. The patient was subsequently managed with radiation followed by endocrine therapy as DCIS was positive for expression of estrogen and progesterone receptors. Conclusion: Diagnosis of DCIS within fibroadenoma is a rare presentation and requires extensive tissue sampling by pathologist in order to avoid missing it. As this is a rare entity, management and follow-up remains a challenge in the absence of established guidelines.

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“…It has been reported that a small percentage of fibroadenomas in older women may harbor malignant tumors inside (0.02% to 0.125%) (3). However, the pathology of the surgical specimen revealed that in this case, these two lesions were completely independent, although located very close to each other.…”

Section: Discussionmentioning

confidence: 99%

“…This lesion is frequently associated with other benign pathologies (1, 2), but also has been reported as associated, or concomitant, with malignancies in up to 5% of cases, mainly in older patients (2). In extremely rare cases, these malignancies may be co-located with, or even within a fibroadenoma (0.02%) (3). It has been reported that a high percentage of these concurrent malignancies may be missed (1, 2), and for this reason, radiologists should be very cautious when evaluating fibroadenomas of a given patient within this specific age group.…”

Section: Introductionmentioning

confidence: 99%

A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions

Aja¹,

Muñoz²,

Rodríguez³

et al. 2016

Iran J Radiol

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Up to 19% of breast malignancies may be missed by conventional imaging techniques, especially when they are concurrent or co-located with other benign lesions. However, more sensitive techniques, such as magnetic resonance imaging (MRI), are often too expensive for routine use in developing countries. Contrast-enhanced, dual-energy digital mammography (CESM) is a recently introduced imaging modality whose performance has been reported to be similar to that of MRI. Being much cheaper, CESM may constitute a good alternative for improving diagnostic sensitivity in these countries. In this paper, we present a challenging case of the concurrent and co-located presentation of a fibroadenoma and a triple negative invasive carcinoma of no special type (TNBC-NST). The malignancy was indistinguishable from the fibroadenoma by mammography. By ultrasound, a suspicious area was observed and biopsied, but the histopathology did not confirm a cancer diagnosis. As the suspicion was not confirmed, a second stage of the imaging diagnosis using CESM was recommended. This technique allowed clear visualization of the malignancy, which was finally excised by breast-conserving surgery. This case reveals the potential of CESM as an easy, rapid and inexpensive new technique for the diagnosis of malignancies that might easily remain occult to mammography plus breast ultrasound (BUS).

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Breast cancer arising within fibroadenoma: collective analysis of case reports in the literature and hints on treatment policy

Cited by 70 publications

References 47 publications

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

Ductal Carcinoma-in-situ within fibroadenoma of the breast: A case report with literature review

A Case of a Concurrent and Co-Located Invasive Carcinoma and a Fibroadenoma to Illustrate the Potential of Dual-Energy, Contrast-Enhanced Digital Mammography on the Diagnosis of Complex Breast Lesions

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