Morphology and Histopathology

Figure 1. Morphology of Fibroadenoma Mammae

Fibroadenoma is a benign mass due to overgrowth of the breast lobule's

specialized connective tissue stroma. In girls younger than 19 years, it comprises
91% of all solid breast masses. Microscopic or large fibroadenomas may occur;
multiple lesions may occur. These tumors that are sensitive to estrogen are usually
not seen before puberty. They may have a contour macrolobulated. Its inner
echotexture may be heterogeneous or homogeneous (Kaneda et al., 2013).

The fibroadenomes form discrete masses with a diameter of 1 cm to 10 cm

and a firm consistency (Figure 1). A cut section displays a uniform tan-white
color, punctuated by softer yellow-pink specks that represent the glandular areas.
Histological examination shows a loose fibroblastic stroma containing various
shapes and sizes of duct-like, epithelium-lined spaces (Figure 2). These glandular
spaces, as in normal breast tissue, are lined with luminous and myoepithel cells
with a well-defined, intact basement membrane (Robbins et al., 2013).

Figure 2. Microscopic of Fibroadenoma Mammae

Fibroadenoma is biphasic neoplasms that are associated by both epithelial

and stromal components proliferation. The large majority of benign breast tumors
are caused by fibroadenoma. Except for rare gigantic fibroadenomas, they are
slow-growing tumors with a size of less than 3 cm. In patients with a history of
fibroadenoma, the general risk of developing breast carcinoma is small. It may be
greater in females with family history of breast cancer or females with BRCA1
gene mutation, justifying excision of complicated fibroadenoma in females at high
danger of developing cancer (Xiaofang et al., 2014).

Microscopically, fibroadenomas display biphasic development with

ductular and stromal proliferation; the latter may indicate predominant
intracanalicular or pericanalicular growth patterns with variable degrees of
cellularity, but neither pattern is predictably significant. Common histological
stromal patterns in fibroadenoma include diffuse myxoid shift, hyalinization, and
enhanced cellularity, as in cellular fibroadenoma; in relation to other stromal
changes, such as pseudoangiomatous stromal hyperplasia, soft muscle
differentiation foci may be seen in fibroadenoma less frequently. Cellular stroma
may also raise the possibility of other spindle cell neoplasms, including mammary
myofibroblas-toma, fibromatosis, or spindle cell carcinoma. Epithelial alterations
within fibroadenoma include squamous and apocrine metaplasia and various
degrees of hyperplasia, including atypical ductal and lobular hyperplasia
(Xiaofang et al., 2014).

Complex fibroadenomas are described as those that contain cysts, adenosis

sclerosing, epithelial calcifications, or regions of metaplasia papillary apocrine. In
elderly patients, they are more typically seen. The risk of developing breast cancer
is slightly greater for children and adolescents with complicated fibroadenomas
(Kaneda et al., 2013).
 Clinical Manifestatiom

Typically, fibroadenomas are asymptomatic, but can cause pain over

menstrual onset. Most fibroadenomas do not indicate progressive development,
but the growth stage is followed by a static stage in about 80% of patients, with
regression in about 15% and development in just 5%-10% (Firdaus et al, 2017).
More than 70% of fibroadenomas occur as a single mass, and 10%–25% of
fibroadenomas occur as various masses. Typically, fibroadenoma is a painless,
soft, mobile, rubbery mass with distinct borders, generally between 1 cm and 3 cm
in size, but can also exceed 10 cm in size. (Begum et al, 2017).

They are most frequently found in the breast's top outer quadrant. These
benign masses usually expand slowly without associated pain or changes in the
nipple and skin, but fluctuations in size can occur with the menstrual cycle; when
symptoms occur, they last an average of 5 months (Khanbhai et al, 2017).

Fibroadenoma greater than 5 cm (about 4% of the total) is commonly

defined as giant fibroadenomas; however, this term is not universally accepted. In
women who are pregnant or lactating, giant fibroadenoma is usually found. The
term juvenile fibroadenoma is more appropriate if found in an adolescent girl.
These lesions in young women make up 0.5% to 2% of all fibroadenoma and are
rapidly growing masses that cause breast asymmetry, overlying skin distortion,
and nipple stretching (Samy and Pusushothaman, 2015).
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Khanbai M, Borgen R, Dobrashian R. 2017. Ultrasound Can Accurately Diagnose

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