|LETTER TO EDITOR
|Year : 2011 | Volume
| Issue : 3 | Page : 376-377
An unusual histomorphological presentation of fibroadenoma
GB Nagaraj1, R Kalyani1, MLH Kumar1, A Bhaskaran2
1 Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
2 Department of Surgery, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
|Date of Web Publication||14-Sep-2011|
G B Nagaraj
Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nagaraj G B, Kalyani R, Kumar M, Bhaskaran A. An unusual histomorphological presentation of fibroadenoma. Indian J Cancer 2011;48:376-7
Fibroepithelial lesions of the breast are commonly seen in clinical practice. These lesions are composed of a combination of prominent stroma and varying glandular elements. Fibroadenomas (FA) are benign lesions common in young adolescent girls and reproductive women, usually identified at clinical examination or by mammography as circumscribed masses. Calcification of fibroadenoma in the reproductive age is uncommon. It is in the postmenopausal population that FA regresses and becomes hyalinised, sometimes being superimposed with calcification.  We present a case of FA with calcification and ossification in a 30-year-female.
The patient presented with a lump in the left breast since 20 years, with associated pain in the lump since 2 days. The pain was dull aching and continuous. She was P1L1, attained menarche at the age of 13 years and delivered her first child at 26 years. She was not on oral contraceptives or hormone treatment. There was no family history of cancer, no history of trauma or previous surgery. Local examination revealed a firm, mobile swelling at the lower outer quadrant of the left breast measuring 1.5 cm x 1 cm. No regional lymphadenopathies were noted.
On fine needle aspiration cytology, a few benign ductal epithelial cells were seen. But, diagnosis of FA was inconclusive. Mammography was reported as calcified fibroadenoma of the left breast [Figure 1]a and b. The patient subsequently underwent lumpectomy. Gross examination showed a globular mass measuring 2 cm × 1 cm and was bony hard to cut. The tissue was decalcified and processed. Histopathological sections showed capsulated lesion with intracanalicular pattern of FA with extensive secondary changes like calcification, ossification and hyalinization [Figure 2]. Other features like cystic change, sclerosing adenosis and papillary apocrine metaplasia were not seen on microscopy.
|Figure 1: Mammography. (a) Craniocaudal view and (b) mediolateral oblique view showing high-density coarse popcorn-shaped calcification|
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|Figure 2: Microphotograph showing predominantly secondary changes with foci of ossification in fibroadenoma (Hematoxylin and Eosin, ×100)|
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Complex fibroadenoma constitutes about 22% of the proven fibroadenomas. They are usually smaller in size compared with simple FA and occur in the older age group, with a median age of 47 years.
The risk of breast carcinoma occurring within a FA is about 3%. The relative risk of carcinoma increases in women having FA associated with cysts, sclerosing adenosis, calcifications or papillary apocrine change. In one study, of 63 complex FAs, one invasive lobular carcinoma was found, with an incidence of 1.6%. 
The literature on the management of complex fibroadenomas is scarce. In one study, the presence of atypia in a fibroadenoma did not increase the risk of future breast carcinoma in long-term follow-up, and recommended against excisional biopsy.  However, in another study, excisional biopsy was recommended shortly after the diagnosis of a complex fibroadenoma. Therefore, diagnosis of a complex FA in a patient with a family history should be given additional incentive to undergo regular mammographic surveillance starting at the age of 35 or 40 years. Although it may occasionally be technically difficult, the inclusion of some adjacent parenchyma when a FA is removed also seems appropriate. 
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|3.||Carter BA, Page DL, Schuyler P, Parl FF, Simpson JF, Jensen RA, et al. No elevation in long term breast carcinoma risk for women with fibroadenomas that contain atypical hyperplasia. Cancer 2001;92:30-6. |
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[Figure 1], [Figure 2]