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Definition: Benign breast lesion that result from hyperplasia of the normal lobules. Circumscribed, often large, breast mass usually occuring in adolescent females with stromal and epithelial hypercellularity but lacking the leaf-like growth pattern of phyllodes tumors.

Synopsis

 Common
 Benign
 Usually aged 20–35 years
 Multiple in 20%: in same breast or bilaterally
 Increase in size during pregnancy
 Tend to regress as patient ages

Pathogenesis

 Appears to be benign neoplasm of specialized stroma of breast with accompanying epithelial component
 Rapidly growing fibroadenomas in immunosuppressed individuals contain Epstein–Barr virus
 No differences between fibroadenomas removed from patients taking oral contraceptives and those in controls except occasional formation of acini in former

Gross Pathology

 sharply demarcated
 firm
 <3 cm diameter
 Cut surface: solid, grayish white, bulging
 whorl-like pattern
 slit-like spaces
 No necrosis

Histopathology

 Appearance varies and depends on: relative amount and configuration of glandular tissue; relative amount of connective tissue
 slightly hypercellular stroma but not to a degree that would justify a diagnosis of phylloides tumor.
 intracanalicular (a misnomer) when connective tissue invaginates into glandular spaces and appears to be within them
 pericanalicular when regular glandular configuration of glands maintained
 often both types in same lesion
 distinction has no practical connotations

 Tubule cells:
 cuboidal or low columnar
 round uniform nuclei
 rest on myoepithelial cell layer

 Stroma:
 usually loose connective tissue rich in acid mucopolysaccharides
 may be partially or totally dense fibrous type
 spindle cells:
 predominantly CD34-positive fibroblasts
 admixed with scattered FXIIIa-positive dendrophages4,5
 no elastic tissue
 consistent with presumed terminal duct–lobular unit (TDLU) origin of lesion
 cellularity varies from case to case:
 if unduly hypercellular consider alternative diagnosis phylloides tumor

Special Stains and Immunohistochemistry

 progesterone receptors: almost universal
 estrogen receptors: ≈25% of cases

Predisposition

If multiple and highly myxoid may be component of Carney complex, which includes:
 endocrine hyperactivity
 cardiac myxoma
 cutaneous hyperpigmentation
 other abnormalities
 other breast abnormalities:
 lobular and nodular myxoid changes26
 ductal adenoma with tubular features

Differential Diagnosis

 mammary phylloides tumor

• The mammary fibroadenoma has a slightly hypercellular stroma but not to a degree that would justify a diagnosis of phylloides tumor.
   mammary tubular adenoma
   mammary adenomyoepithelioma

Genetics

 ≈20% have clonal chromosome aberrations in stromal component

Prognosis

 Low long-term risk for breast carcinoma: increased risk if:

• complex
• ductal hyperplasia
• family history of breast carcinoma

 not increased risk if foci of atypical epithelial hyperplasia

 Malignant changes in 0.1% of cases:

• usually epithelial component
• most in situ (low-grade intraductal carcinoma)
• +/- entirely within confines of fibroadenoma
• +/- involves surrounding breast
• +/- may represent extension into fibroadenoma by carcinoma
• +/- originating elsewhere in breast

 sarcomatous transformation of stroma even rarer

Differential diagnosis: mammary biphasic lesions

 adenomyoepithelioma
 mammary fibroadenomas

• mammary juvenile fibroadenoma

 mammary hamartoma
 metaplastic mammary carcinoma
 phyllodes tumor
 pleomorphic adenoma
 gynecomastia
 pubertal macromastia

See also

 mammary tumors

• mammary biphasic tumors

References

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 Fletcher JA, Pinkus GS, Weidner N, Morton CC. Lineage-restricted clonality in biphasic solid tumors. Am J Pathol. 1991;138:1199–1207.

 Kleer CG, Tseng MD, Gutsch DE, Rochford RA, Wu Z, Joynt LK, et al. Detection of Epstein-Barr virus in rapidly growing fibroadenomas of the breast in immunosuppressed hosts. Mod Pathol. 2002;15:759–764.

 Fechner RE. Fibroadenomas in patients receiving oral contraceptives. A clinical and pathologic study. Am J Clin Pathol. 1970;53:857–864.

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