Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 394
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 4  |  Issue : 2  |  Page : 44-45

Giant fibroadenoma of the breast mimicking phyllodes tumor in an adult female: emphasizing the role of cytology in the diagnosis


1 Department of Surgery, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
2 Department of Anesthesia, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India
3 Department of Surgery, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
4 Hebei Medical University, Shijiazhuang, Hebei, China

Date of Submission20-May-2014
Date of Acceptance04-Aug-2014
Date of Web Publication21-Jan-2015

Correspondence Address:
Dr. Bhushan Shah
Department of Surgery, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-7095.149772

Rights and Permissions
  Abstract 

Giant fibroadenoma is an uncommon variant of fibroadenoma with an overall incidence of <4%. It is common in adolescent age group and is seldom seen in elderly. Often surgeons might encounter a diagnostic dilemma between phyllodes tumor (PT) of the breast and a giant fibroadenoma. We herein report a similar case of a middle-aged woman with an unusually large fibroadenoma of the breast mimicking a PT and emphasize the role of fine-needle aspiration cytology in differentiation of these two different breast entity.

Keywords: Cytology, giant fibroadenoma, lump, phyllodes tumor


How to cite this article:
Shah B, Shah BB, Sharma K, Sahu S, Singh P. Giant fibroadenoma of the breast mimicking phyllodes tumor in an adult female: emphasizing the role of cytology in the diagnosis. Int J Stud Res 2014;4:44-5

How to cite this URL:
Shah B, Shah BB, Sharma K, Sahu S, Singh P. Giant fibroadenoma of the breast mimicking phyllodes tumor in an adult female: emphasizing the role of cytology in the diagnosis. Int J Stud Res [serial online] 2014 [cited 2019 Nov 14];4:44-5. Available from: http://www.ijsronline.net/text.asp?2014/4/2/44/149772


  Introduction Top


Fibroadenoma is a benign breast tumor with an abnormal growth of glandular and fibrous tissue. It is commonly encountered in women of reproductive age group. On rare occasions, a fibroadenoma can demonstrate a rapid and massive growth (>5 cm) resulting in what is known as giant fibroadenomas. Histologically, a giant fibroadenoma is more cellular than its usual counterpart. It is clinically relevant to differentiate a giant fibroadenoma from virginal hypertrophy in its asymmetrical, early form and phyllodes tumor (PT), as the management, and the prognosis of these tumors are entirely different [1],[2],[3] . We here in the report a rare case of a giant fibroadenoma in a 32-year-old Indian woman that mimicked as a PT of the breast. We also lay emphasis on the importance of fine needle aspiration cytology (FNAC) in demarcating between these tumoral entities.


  Case Report Top


A 32-year-old woman presented with a painless lump on her left breast since last 6 months. There was no history of trauma. Her menstrual cycles were regular, and her family history was negative for breast cancer. Local examination demonstrated 18 × 12 × 6 cm sized lump extending from the left upper and inner quadrant to the left lower quadrant. It was firm in consistency, nontender, freely mobile within the breast tissue and free from the chest wall. There was no discoloration of the skin over the swelling and no discharge from the nipple. Ultrasonography of left breast was done, which showed large hypoechoic mass in upper and inner quadrant of the left breast. Mammography showed features suggestive of a benign tumor [Figure 1]. FNAC performed on the mass revealed hypercellularity with few clusters of monomorphic ductal epithelial cells on hemorrhagic background and lack of leaf-like stromal appearance. The cytolo-radiological and clinical findings favored the diagnosis of a giant fibroadenoma. In view of this, an excision biopsy was planned under general anesthesia. A semicircular incision was taken 8 cm above the nipple-areola complex. The giant, firm lump was excised from left breast that measured 15 × 8 cm [Figure 2]. A cut section of the lump showed few cystic spaces filled with serous fluid, the largest measuring 2 cm in diameter. Multiple, grayish white hard areas were found in between these cystic spaces. Histopathological diagnosis of the excised lump was consistent with giant fibroadenoma with extensive hyalinization. Postoperatively, period was uneventful. Patient was asymptomatic at followups.
Figure 1 Mammography of left breast showing giant fibroadenoma

Click here to view
Figure 2 Intraoperative picture of giant fibroadenoma being removed with nipple sparing surgery

Click here to view



  Discussion Top


Fibroadenoma is a benign tumor composed of stromal and epithelial component. It has bi-modal presentation, of which 90% is seen in reproductive age group and 10% in postmenopausal age group [4] . With an unknown etiology, it is often thought to be due to an aberration in normal development of breast and involution. Pathophysiologically, fibroadenoma is of pericanalicular and intracanalicular types based on fibrous and adenomatous component [5] . Patient usually comes with a history of a painless lump in the breast, firm in consistency freely mobile, and with size >5 cm. It is critical for a surgeon to differentiate a giant fibroadenoma from cystosarcoma phyllodes. Even though, ultrasound of the breast, mammography and other imaging modalities like the magnetic resonance imaging (MRI) aid in its diagnosis and differentiation from PT, cytological evaluation is of utmost importance. It is cost-effective and more specific tool that aids in the differentiation. The lack of leaf-like structures and stromal cell atypia as determined from aspiration cytology differentiates giant fibroadenoma from PT, whereas the lack of mammary lobules distinguished fibroadenoma from the breast hamartoma and asymmetric breast hypertrophy. It is utmost necessary to have the distinction owing to the fact that both giant fibroadenoma and PT have different therapeutic approach [6] . Giant fibroadenoma appears as large hypoechoic mass that may have gentle lobulations on ultrasonography and as a smooth mass on MRI with enhancement with administration of gadalium-based contrast agents. Surgical treatment for giant fibroadenoma is excision and biopsy [7] . It should include normal breast tissue. Absolute indication for excision of a lump is when it is causing physical discomfort to the patient and for cosmetic appearance.


  Conclusion Top


Giant fibroadenoma is a rare entity and therefore should be histologically differentiated from phyllodes and virginal hypertrophy in clinical practice by aspiration cytology.

Authors' Contributions

BS, BBS and KS were involved in patient care and operated upon the patient. KS and SS participated in sequence alignment, drafting the manuscript and literature review. KS and PS helped in data acquisition. KS and SS made useful contributions in the revision of the manuscript. All authors read and approved the final manuscript.

Consent

The authors certify that a written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editor-in-chief of this journal.

Competing Interests

Nil

Funding

Sources of funding: None

 
  References Top

1.
Hughes LE, Mansel RE, Webster DJ. Aberrations of normal development and involution (ANDI): a concept of benign breast disorders based on pathogenesis. In: Hughes LE, Mansel RE, Webster DJ, editors. Benign Disorders and Disease of Breast Concepts and Clinical Management. 2 nd ed. Philadelphia: WB Saunders; 2000. p. 21, 73.  Back to cited text no. 1
    
2.
Archer F, Omar N. The fine structure of fibroadenoma of the human breast. Edinburgh: Churchill Livingstone; 1987.  Back to cited text no. 2
    
3.
Rowe PM. ACS orders mammography for younger women. Lancet 1997;349:928.  Back to cited text no. 3
    
4.
Guerin C, Loget P, Watier E, et. al. Giant juvenile fibroadenoma in an adolescent. A case report. Rev Fr Gynecol Obstet 1993;88(1):27-31.  Back to cited text no. 4
    
5.
Stehr KG, Lebeau A, Stehr M, Grantzow R. Fibroadenoma of the breast in an 11-year-old girl. Eur J Pediatr Surg 2004;14(1):56-9.  Back to cited text no. 5
    
6.
Anavi BL, Mishev GG, Ivanov GP. Giant fibroadenoma of the breast. Folia Med (Plovdiv) 2002;44(4):50-2.  Back to cited text no. 6
    
7.
Rattan K, Kumar S, Dhull AK, Kaushal V, Kaur P. Giant fibroadenoma mimicking phylloides tumor in a young female: a cytological dilemma. Internet J Third World Med 2007;6(2).  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Giant Fibroadenoma of Breast: A Diagnostic Dilemma in a Middle Aged Woman
Sonam Sharma
Advances in Cytology & Pathology. 2017; 2(4)
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed4235    
    Printed205    
    Emailed0    
    PDF Downloaded227    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]