3I. FibroadenomaArise from a single TDLU and contain both stromal (fibroma) & epithelial (adenoma) elementsEdge is “pushing” not infiltrating & becomes “encapsulated” by compressed breast tissueFAs with cysts, apocrine metaplasia, or sclerosing adenosis are called COMPLEX
4FA – cont. Peak incidence – 20-30 yr & again 40-50 yr Usually 2-3 cm but giant FA & juvenile FA can grow to 10 cmEstrogen stimulation is important so most common when unopposed (anovulatory) i.e.. in adolescence and perimenopauseMultiple in 25% also bilateral
5FA – sonographic appearance Oval, lobulatedCircumscribed with echogenic capsuleParallelIso or hypoechoicNormal or enhanced transmission with edge shadowsTiny ones (<1cm) may be round & can’t DD from a complex cystMay mimic duct extension
10FA – cont. Wide variability in histologic composition Wide variability in sonographic appearanceBilateral multiple FAs up to 10 nodules in each breast no need to Bx all of them new ones will almost always develop need 6 mo. F/U
11II. FA variants – Complex FA The epithelial components undergo proliferative change and we may see: sclerosing adenosis, cysts, apocrine metaplasia, amorphous calcificationsAbout 20% of all FAs are complex ! (-) FHx increases risk for CA 3x (+) FHx increases risk for CA 4xRisk is generalized for the whole of both breasts.
12II. FA variants – Complex FA The diagnosis is histologicalU/S: may see internal cysts or heterogeneous echo patternSeen at older age – median age 47 yrsOnly 1.5% contained a CAAJR:2008;190:
14II. FA variants – Tubular Adenoma & Lactating Adenoma Almost pure epithelial growth with very little or NO stromal componentTubular adenoma is very rareLactating adenoma is common during pregnancy (mainly 3rd trimester) and lactation
15II. FA variants – Tubular Adenoma & Lactating Adenoma Lactating adenoma may arise de novo, from a FA or from a tubular adenomaU/S: oval, spindle shaped, parallel, hypo-hyperechoic, enhancement, Doppler (+), microlobulated
18III. Phylloides TumorRare – peak at yr but can occur in teenagersVery rapid growth – up to 15 cm2/3 benign 1/3 malignantMix of very cellular stromal and epithelial elementsU/S: oval, well circumscribed, capsule, hypo, enhancement, “cystic slits”
21IV. HamartomaLocalized overgrowth of fibrous, epithelial and fatty elements = normal breast tissueOther names: adenolipofibroma, lipoadenofibroma, fibroadenolipomaU/S: oval, very heterogeneous, capsule, parallel
24V. Lipoma Overgrowth of fatty tissue They are actually in the skin NOT in the breastMay grow up to 20 cm !!!!U/S: completely isoechoic with the other fat lobules or mildly hyperechoic, soft and compressible
27VI. Focal Fibrosis FIBROUS MASTOPATHY Can cause tender/non-tender palpable lumpMay see focal asymmetry on mammo – UOQ
28VI. Focal FibrosisPathology: dense stromal fibrous tissue without cellsU/S: purely hyperechoic & homogeneous, no capsule tapers into Cooper’s ligaments so can be teardrop or spindle shaped BEWARE: DD with echogenic rim !!!
34VIII. Fibrocystic Change Huge spectrum from all the types of cystic change to benign proliferation forming a solid noduleAdenosis & Sclerosing Adenosis: TDLUs enlarge and increase in number normal lobules – 2 mm adenosis – 5 mmMammo: focal asymmetry, masses, “starry night” calcificationsU/S: extremely varied