J Breast Cancer.  2015 Sep;18(3):291-295. 10.4048/jbc.2015.18.3.291.

Breast Cancer Arising Adjacent to an Involuting Fibroadenoma: Serial Changes in Radiologic Features

Affiliations
  • 1Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. mines@yuhs.ac
  • 2Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Fibroadenoma is a common benign breast lesion and its malignant transformation is rare. There have been several case reports and studies that retrospectively reviewed breast cancers that arose within fibroadenomas; however, none of these studies reported serial changes in radiologic features of the cancer, including findings from mammography and ultrasound (US). We report a case of breast cancer arising adjacent to an involuting fibro adenoma in a 39-year-old woman who was undergoing serial follow-up after her fibroadenoma was diagnosed. Seven years after her diagnosis, the lesion showed evidence of coarse calcifications, a typical sign of involution. Four years later, US revealed a newly developed hypoechoic lesion with irregular margins and peripherally located calcifications adjacent to the fibroadenoma. A core biopsy was performed, and histopathological examination resulted in a diagnosis of invasive ductal carcinoma. When new suspicious features are observed in a fibroadenoma, radiologists should raise the concern for breast cancer and proceed with diagnosis and treatment accordingly.

Keyword

Breast neoplasms; Fibroadenoma; Magnetic resonance imaging; Mammography; Ultrasonography

MeSH Terms

Adenoma
Adult
Biopsy
Breast Neoplasms*
Breast*
Carcinoma, Ductal
Diagnosis
Female
Fibroadenoma*
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Mammography
Retrospective Studies
Ultrasonography

Figure

  • Figure 1 Initial ultrasound image of left breast. Ultrasound image of a 0.7 cm, isoechoic, probably benign nodule in the upper-outer portion (1 o'clock) of the left breast.

  • Figure 2 Ultrasound image of left breast taken 2 years after original diagnosis. An ultrasound image taken 2 years after the original diagnosis, showing an 1.8 cm, circumscribed isoechoic mass lesion in the upper-outer portion (1 o'clock) of the left breast, which had increased in size compared to the previously noted nodule.

  • Figure 3 Radiologic images taken 5 years after the time when Figure 2 was taken. (A) Mammography. Mediolateral-oblique view (left) and cranialcaudal view (right). The nodule shows newly developed calcifications. Macrocalcification was noted centrally within the lesion and had a "popcorn-like" appearance. (B) Ultrasound. The image shows a 1.1 cm, newly developed, centrally located calcification that appears to be an isoechoic mass lesion in the upper-outer portion (1 o'clock) of the left breast, suggesting involuting fibroadenoma. Core biopsy confirmed this lesion as fibroadenoma.

  • Figure 4 Radiologic images taken 4 years after the time when Figure 3 were taken. (A) Mammography. Mediolateral-oblique view (left) and cranial-caudal view (right). It shows that the previously confirmed fibroadenoma was denser but had not changed significantly in size over time. (B) Ultrasound. Transverse view (left) and longitudinal view (right). It shows that the previously noted, centrally located calcification was now shifted into the periphery, with the nodule increasing in size with microlobulated margin (arrow) at the upper-outer portion (1 o'clock) of the left A breast.

  • Figure 5 Magnetic resonance imaging at an early phase after contrast injection with subtraction. Magnetic resonance imaging at an early phase after contrast injection with subtraction revealed an approximately 1.5 cm mass with arterial enhancing components (arrows) that correlated well with microlobulated hypoechoic lesions on ultrasound; this lesion was confirmed for invasive ductal carcinoma. The unenhancing portion (arrowhead) is considered fibroadenoma.

  • Figure 6 Histological examination revealed invasive ductal carcinoma arising adjacent to the fibroadenoma (H&E stain, ×40). Histological examination revealed invasive ductal carcinoma (arrows) arising adjacent to the fibroadenoma (arrowheads) that is well distinguished from the fibroadenoma due to its distinct margin. The distance between invasive ductal carcinoma and fibroadenoma is measured as 500 µm.


Reference

1. Kuijper A, Mommers EC, van der Wall E, van Diest PJ. Histopathology of fibroadenoma of the breast. Am J Clin Pathol. 2001; 115:736–742.
Article
2. 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; 92:30–36.
Article
3. Worsham MJ, Raju U, Lu M, Kapke A, Botttrell A, Cheng J, et al. Risk factors for breast cancer from benign breast disease in a diverse population. Breast Cancer Res Treat. 2009; 118:1–7.
Article
4. Sklair-Levy M, Sella T, Alweiss T, Craciun I, Libson E, Mally B. Incidence and management of complex fibroadenomas. AJR Am J Roentgenol. 2008; 190:214–218.
Article
5. Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer WD Jr, Rados MS, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. 1994; 331:10–15.
Article
6. Abe H, Hanasawa K, Naitoh H, Endo Y, Tani T, Kushima R. Invasive ductal carcinoma within a fibroadenoma of the breast. Int J Clin Oncol. 2004; 9:334–338.
Article
7. Monsefi N, Nikpour H, Safavi M, Lashkarizadeh MR, Dabiri S. Mucinous subtype of invasive ductal carcinoma arising within a fibroadenoma. Arch Iran Med. 2013; 16:366–368.
8. Iwamoto M, Takei H, Iida S, Yamashita K, Yanagihara K, Kurita T, et al. Contralateral breast cancer adjacent to a fibroadenoma: report of a case. J Nippon Med Sch. 2014; 81:168–172.
Article
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