Fibroadenoma with an unexpected lobular carcinoma in situ: A case report and review of the literature

Abstract

Abstract. Fibroadenoma (FA) is the most common type of breast lesion in young female individuals. Although malignant transformation in FA is rare, there is evidence of an association with breast carcinoma, particularly in middle-aged females with associated risk factors, such as a strong family history and/or BRCA-1/2 mutations. The current study presents the case of a 44-year-old female exhibiting lobular carcinoma in situ (LCIS) arising within an FA. Over the previous 20 years, numerous lumps were detected in the patient's breasts, all of which were clinically diagnosed as FA and expectantly managed. One year prior to presentation, the patient's father was diagnosed with esophageal cancer, older sister with kidney cancer and the patient herself with a benign ovarian teratoma. The patient presented with one lump in each breast and monitoring was performed using ultrasonography (US). US detected an increase in the size of the two lumps and analysis of the images was used to propose a diagnosis of FA. Therefore, a lumpectomy was performed. Analysis of the frozen section indicated a diagnosis of FA in the right breast, however, a 5-mm LCIS was identified within the FA of the left breast. Subsequent to the identification of three additional lumps in the left breast, a left mastectomy was performed. During a five-year follow-up period, no local recurrence or contralateral breast carcinoma occurred. The present study showed that FAs containing foci of carcinoma in situ can be indistinguishable from benign lesions following imaging, therefore, despite the incidence of carcinoma within FA is estimated at 0.1-0.3%, it should be considered a long-term risk factor for invasive breast cancer. The present describes a case of LCIS arising within an FA and conducts a review of the relevant literature.

Fibroadenoma in Blacks

“…Hua et al [27] reported that though the malignant transformation of fibroadenoma is very rare, the incidence of breast carcinoma within fibroadenoma is estimated at 0.1% to 0.3% and fibroadenoma may be a risk factor for malignant breast disease in the middle age. Similarly, the risk of breast carcinoma is 2.17, 3.1 and 3.88 times higher in patients with simple, complex and benign proliferative diseases adjacent to fibroadenoma respectively [30]. In our study, the age of our patient appears to be very low compared to mean age of 46.9 years reported by Wu et al [31] in Taiwan.…”

Invasive Lobular Carcinoma within a Fibroadenoma: A Case Report and Review of the Literature

“…FAD is a common type of benign breast lesion with a reported incidence rate of 7-13% in female individuals and commonly in the second and third decades of life [6]. A carcinoma arising in a FAD is extremely rare, with an incidence of 0.02% to 0.125% [1,7,12].…”

“…FAD may occur at any age, however is mostly encountered in premenopausal women and the peak age of incidence is the second and third decade of life [6]. On histology FAD is a benign tumour composed of both epithelial and stromal components.…”

“…The incidence of the above ranges from 0.02% to 0.125%, according to different reports [1,7,12]. So far, just over 100 cases have been reported in the literature [6,13,14].…”

Lobular Breast Cancer: Histomorphology and Different Concepts of a Special Spectrum of Tumors

“…LN may also be found adjacent to tubular BC and columnar cell lesions of the mammary epithelium ("Rosen triad") [132]. Pure LN without invasive BC may be encountered as an incidental finding in core needle biopsies (CNBs), reduction mammoplasties and benign lesions, such as fibroadenomas [133][134][135][136]. LN is often multifocal and bilateral [137].…”