Guray 2006:

Fibroadenoma is the most common lesion of the breast; it occurs in 25% of asymptomatic women
[101]. It is usually a disease of early reproductive life; the peak incidence is between the ages of
15 and 35 years. Conventionally regarded as a benign tumor of the breast, fibroadenoma is also
thought to represent a group of hyperplastic breast lobules called aberrations of normal
development and involution [10, 101, 102]. The lesion is a hormone-dependent neoplasm that
lactates during pregnancy and involutes along with the rest of the breast in perimenopause
[102]. A direct association has been noted between oral contraceptive use before age 20 and the
risk of fibroadenoma [103]. The Epstein-Barr virus might play a causative role in the development
of this tumor in immunosuppressed patients [104].
BRANT:
Fibroadenomas are the most common well-defi ned solid
masses seen on mammography ( Fig. 20.13 ). They are homogenous,
but frequently show large, coarse calcifi cations. They
may have a lobulated contour, but there are usually only a few
large lobulations. If a fi broadenoma is not calcifi ed, it cannot be
distinguished from a cyst by mammography. Sonography will
allow characterization of fi broadenomas as solid hypoechoic
masses. The peak age of patients with clinically detected fi broadenomas
is 20 to 30 years; however, fi broadenomas are seen into
the eighth decade. They rarely appear or grow after menopause.
Fibroadenomas can calcify in various patterns. Sometimes
the calcifi cations are indeterminate, but the classic calcifi cations,
associated with an atrophic fi broadenoma, are large,
coarse, and irregular in shape

FIGURE 20.26. Degenerated Fibroadenoma. Typical large, coarse,

irregular calcifi cations are seen in a fi broadenoma.
CASE:

LIN et al, 2011:

Fibroadenoma is a common cause of a palpable lump in young premenopausal
women. The diagnosis is often made confidently when pathognomic popcorn-like
calcifications are observed in a mammography. These tumors are traditionally
believed not to be associated with malignancy. Carcinoma arising in a fibroadenoma
is rare, with a reported prevalence of 0.02% in a screened population

Mammographically, dense large calcifications of a benign involuting fibroadenoma,

such as popcorn-like calcifications, when observed within a circumscribed mass, are
diagnostic and do not require any biopsy.
Pathology:

Fibroadenomas usually form during menarche (15 25 years of age), a time at which
lobular structures are added to the ductal system of the breast (Fig. 1). Hyperplastic
lobules are common at that time, and may be regarded as a normal phase of breast
development.16 Hyperplastic lobules were shown to be histologically identical with
fibroadenomas.10, 17 Analyses of the cellular components of fibroadenomas by means
of polymerase chain reaction demonstrated that both the stromal and the epithelial
cells are polyclonal,18supporting the theory that fibroadenomas are hyperplastic
lesions associated with aberration of the normal maturation of the breast, rather
than true neoplasms

Natural history:
From their incidence in mastectomy specimens, it has been assumed that
fibroadenomas tend to regress and loss their cellularity with age. The rare finding of
fibroadenomas in the older age groups also supports the hypothesis of regression of
fibroadenomas.48 The mechanisms offered to explain the regression of
fibroadenomas are infarction, calcification, and hyalinization
Pilnik 2003:
Usually asmptomatic, however in cases in which an intratumoral hemorrhage has
occurred, pain could be the initial presenting symptom - More common in pregnant
or lactating women.

Causes: unknown: but because fibroadeomas do not occur before menarche, relp
with ovarian secretion of estrogen is likely. Peak incidence: women over 30.

Do not change in size during menstrual cycle, but a preexisting fibroadenoma may
increase in size during pregnancy

Fibroadenomas may undergo involutional change, This degenerative change is due

either to increased stromal growth or an unrecognized infarction with necrosis. The
result is calcification or a hyalinized fibroadenoma. Calcified fibroadenomas,
(popcorn lesions)