Fibroadenoma

Question 1

Fibroadenoma is a type of benign breast tumour and is the most common cause of breast mass, frequently seen in women of reproductive age. What is the incidence of fibroadenomas?

1 - 33 cases per 100,000
2 - 330 cases per 100,000
3 - 3300 cases per 100,000
4 - 33,000 cases per 100,000

Answer 1

1 - 33 cases per 100,000

Question 2

At what age does the incidence of fibroadenoma typically occur?

1 - 10-20
2 - 20-30
3 - 40-60
4 - >65

Answer 2

2 - 20-30

Most common in women of reproductive age, very rare in men

Question 3

When are fibroadenomas most likely to occur?

1 - During menses
2 - During pregnancy
3 - Whilst using combined oral contraceptives
4 - all of the above

Answer 3

4 - all of the above

Linked to oestrogen levels and sensitivity in breast tissue

Question 4

Are fibroadenomas always benign?

Answer 4

• yes

They do proliferate and this is linked with oestrogen, but does not present with any cancerous changes

Question 5

Do patients with fibroadenomas always present with symptoms?

Answer 5

• no

May be asymptomatic

Question 5

Where do the fibroadenomas typically originate from in the breast tissue?

1 - terminal duct lobular unit
2 - areola
3 - lobules
4 - lactiferous sinus

Answer 5

1 - terminal duct lobular unit

Composed of both stromal tissue and epithelial connective tissue cells

On histology they appear as sheets of epithelial cells in a honeycomb or antler-like pattern.

Question 6

Which of the following is NOT a common characteristic in a patient with a symptomatic fibroadenoma?

1 - Painful
2 - Mobile / non-tethered
3 - Smooth
4 - Well-circumscribed
5 - Solitary
6 - 2-3 cm in diameter (except for giant fibroadenoma, which comprises 1% of breast masses and can measure up to 5cm)

Answer 6

1 - Painful

Typically painless / non-tender

Question 7

Which region of the breast are fibroadenomas most commonly found?

1 - nipple
2 - areola
3 - outer upper quadrant
4 - inner upper quadrant

Answer 7

3 - outer upper quadrant

Question 8

As per NICE guidelines, women with a breast lump should be referred on a 2-week wait at what age?

1 - >16
2 - >25
3 - >30
4 - >40

Answer 8

3 - >30
This is regardless of if the lump is painful or painless

Women <30 will be referred on a non-urgent referral to be examined

Question 8

Do fibroadenomas typically cause skin changes?

Answer 8

• no

Question 9

What imaging is recommended for women <35 y/o?

1 - MRI
2 - mammogram
3 - ultrasound
4 - CT

Answer 9

3 - ultrasound

> 35 = mammogram

Question 10

A tissue sample for diagnosis can be performed using a needle aspiration or a cone biopsy. Which is only suitable for cytology?

Answer 10

• needle aspiration = cytology
• cone biopsy = histology

Question 10

Hospitals typiucally have a ‘one-stop’ clinic where clinical examination, imaging and pathology investigations are offered, or CRP:

C = clinical examination
R = radiography
P = pathology of tissue

Answer 10

Based on CRP, patients will be risk assessed including:

• examination score graded from P1 (normal) - P5 (malignant)
• imaging scores from M1-M5 or U1-U5, depending on modality
• pathology scores from B1-B5.

Question 11

According to NICE guidelines, are asymptomatic fibroadenomas treated?

Answer 11

• no

If fibroadenoma is troublesome, removal is on a case by case basis

However, if fibroadenoma grows, the patient should be followed up for further investigations

Question 12

If the fibroadenoma is to be treated, which of the following are typically used?

1 - Surgical lumpectomy or excisional biopsy
2 - Vacuum-assisted biopsy
3 - Cryoablation
4 - High intensity focussed ultrasound for ablation of fibroadenoma tissue
5 - all of the above

Answer 12

5 - all of the above

Surgery indications include:

• large size
• continued growth of mass
• patient requests

No consensus guidance on surgical treatment of fibroadenoma, though giant fibroadenomas (mass greater than 500 g or size larger than 5 cm) are generally removed.