04/16/2010
Breast lump.
California Hospital Medical Center
17-year-old female with right breast lump.
Procedure: Excisional biopsy.
Gross: The specimen consists of a pink-tan, elongated and lobulated nodular mass lesion, measuring 7 x 4 x 3.5 cm., and weighing 65 gms. The specimen is sectioned. The cut surface is pink-tan and lobulated. Representative sections are submitted.
Micro: Sections show a well circumscribed lesion composed of nodular proliferation of stromal tissue and entrapped small ducts. The entrapped small ducts exhibit intracanalicular growth pattern. Areas of florid ductal epithelial hyperplasia and cystic dilatation are also noted in the entrapped small ducts. The stroma exhibits pericanalicular pattern of proliferation of myxoid spindle cells with increased cellularity. There is no evidence of malignancy. H & E stain
Diagnosis:
Cellular fibroadenoma of breast (juvenile fibroadenoma or giant fibroadenoma), resected, 7 cm. in size.
Discussion:
Fibroadenomas larger than 5 cm (about 4% of the total) are commonly defined as being giant fibroadenomas; however, this terminology is not universally accepted. Giant fibroadenomas are usually encountered in pregnant or lactating women. When found in an adolescent girl, the term juvenile fibroadenoma is more appropriate. These lesions in young women constitute 0.5% to 2% of all fibroadenomas, and are rapidly growing masses that cause asymmetry of the breast, distortion of the overlying skin, and stretching of the nipple. Histologically, they appear to be more cellular and have less lobular components than do simple fibroadenomas. However, giant fibroadenomas are benign lesions that do not undergo transformation into malignancy.
References:
Ron Greenberg, MD, Yehuda Skornick, MD, and Ofer Kaplan, MD. Management of Breast Fibroadenomas. J Gen Intern Med. 1998 September; 13(9): 640–645.
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Comments
intracanalicular and pericanalicular form
The degree of epithelial proliferation and atypia in this case is intriguing. Some of the features present would even make you wonder if it is a low-grade DCIS. Thanks for sharing the case.