Abstract
Introduction and importance
Fibroadenoma is one of the most common benign breast neoplasms, primarily affecting adolescents and young women. Infarction is uncommon in fibroadenomas, and when it occurs, it is usually associated with pregnancy or lactation, as well as FNA. We present a case of spontaneous infarction of breast fibroadenoma that was unrelated to the aforementioned risk factors and occurred outside of pregnancy and lactation.
Case presentation
A 22-year-old female presented with painful left breast lump with a sudden increase in size for 1 week duration. Physical examination revealed an irregular, well-defined, and mobile mass in the left breast measuring 5 cm × 4 cm. The mass was firm in consistency and showed tenderness. The clinical diagnosis of benign fibroadenoma of the breast was made and confirmed radiologically. A biopsy was planned. Microscopical examination showed pictures consistent with spontaneous infarction of benign fibroadenoma of the breast.
Clinical discussion
One case of infarcted fibroadenoma was diagnosed after one excision biopsy. No preceding fine-needle aspiration biopsy was performed in this case, nor was the patient pregnant or lactating at the time of the diagnosis.
Conclusion
Spontaneous infarction within fibroadenoma is a rare phenomenon in young females. The presence of painful lumps in fibroadenoma patients should be cautiously interpreted and diagnosed.
Keywords: Breast fibroadenoma, Infarction, FNA
Highlights
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Fibroadenoma may undergo secondary changes that include ossification, calcification, hyalinization, and metaplasia of myxoid and/or apocrine squamous cells
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Breast fibroadenoma infarction is an extremely rare phenomenon
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This complication creates a diagnostic quandary for inflammatory conditions and inflammatory carcinomas
1. Introduction
A relatively common benign tumor of the stroma and epithelium of the lobular unit of the terminal duct is called a fibroadenoma. Ossification, calcification, hyalinization, and metaplasia of myxoid and/or apocrine squamous cells are examples of secondary changes that can occur in fibroadenoma [1]. Rarely occurring breast fibroadenoma infarction can be brought on by traumatic injuries or a spontaneous fine needle aspiration (FNA) procedure [2].
This complication may also be related to oral contraceptive use [1]. The majority of spontaneous infarctions happen while a woman is pregnant or nursing. Due to the clinical and histopathologic similarities between these complications and inflammatory conditions and inflammatory carcinomas, a diagnostic dilemma is created [3], [4], [5]. Delarue and Redon [6] described the infarction of breast fibroadenoma for the first time in 1949. As far as we are aware, there are less than 50 documented cases of spontaneous fibroadenoma infarction in the literature [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. In this article, we describe a case of spontaneous breast fibroadenoma infarction that was not caused by any of the aforementioned risk factors and existed outside of pregnancy and lactation. This case report has been reported in line with the SCARE Criteria [15].
2. Presentation of case
A 22-year-old non-pregnant and non-lactating female was referred to our hospital from the surgical outpatient clinic for the assessment of a rapidly growing and painful breast lump for a 1-week duration. The above-mentioned patient was in her usual state of health till she starts feeling of lump on her left breast. She reported no history of nipple discharge. The patient reported no personal and/or family history of cancer, any acute, repeat, or discontinued medications, any allergies, or any genetic or psychosocial issues. Upon the first visit, the clinical appearance and physical assessment of the patient were insignificant except for an irregular, well-defined, and mobile mass in the left breast measuring 5 cm × 4 cm. The mass was firm in consistency and showed tenderness. The patient had no any breast lump and/or complain before. Examination of the other breast was unremarkable, along with impalpable axillary lymph nodes. Based on the clinical presentation, benign fibroadenoma of the breast was suspected. The patient underwent lumpectomy by a specialist surgeon and the resected breast tissue which was grossly appear as two brown pieces, one measures 2.5 cm × 2.5 cm, the other measures 2.6 cm × 2.5 cm, and then had been sent to the histopathological assessment. Step sectioning of the first piece revealed a hemorrhagic lesion measures 2.0 cm × 1.8 cm and Step sectioning of the other piece revealed a gelatinous cut surface. The microscopic examination showed a classical, nodular cellular and encapsulated fibroadenoma (Fig. 1) and areas of extensive hemorrhage and partial necrosis (Fig. 2A & B). Accordingly, the patient was confirmed to have a complicated fibroadenoma with hemorrhagic infarction. The patient was followed up for 6 months and she adhered to and tolerated the provided pieces of advice without any reported complications or adverse events.
Fig. 1.
Hematoxylin & Eosin (H&E) slide of the resected tissue showing a classical, nodular and encapsulated fibroadenoma.
Fig. 2.
Illustrates an infracted fibroadenoma with (A) showing an extensive parenchymal hemorrhage and (B) showing shows coagulative necrosis.
3. Discussion
Fibroadenomas are the most frequent benign breast tumors that typically affect young women and adolescents [11] making up for around one-third of all benign breast tumors in women [1]. A fairly uncommon consequence of fibroadenoma is spontaneous infarction that can pose a diagnostic challenge for doctors due to clinical manifestations that resemble inflammatory or malignant breast conditions [3].
Numerous benign breast lesions, such as fibroadenoma, intraductal papilloma, lactating adenoma, and Phyllodes tumor, can exhibit spontaneous infarction [16]. It is typically linked to pregnancy, lactation, or a recent FNA (Fine Needle Aspiration) [4], [5]. A patient with a spontaneous infarction may develop multiple fibroadenomas [17]. Oral contraceptive use has also been linked to infarction [1]. It can happen in young people with no known risk factors, as it did in our case.
Many theories have been proposed regarding infarction in fibroadenoma. One possible explanation for the pathogenesis is that infarction represents a spectrum of regressive changes that may also include calcification and hyalinization, both of which are much more common in fibroadenomas [18]. Newman et al. discovered thrombooclusive vascular changes within fibroadenomas as a possible cause of infarction due to the trauma and fine needle aspiration [7]. In pregnancy, lactation, thrombo-occlusive diseases, trauma, and fine-needle aspiration cytology, risk factors associated with an infarcted fibroadenoma were described in the literature (FNAC). This could be explained by physiological conditions like ischemia in hyperplastic tumor tissue. Another theory proposed by a few authors is torsion and subsequent ischemia of the mobile mass. Oral contraceptive-induced hormonal changes could potentially cause spontaneous fibroadenoma infarction, but direct clinical evidence is lacking [19].
In this case, the patient complained of a painful breast lump that was growing rapidly. Based on the clinical picture and microscopic examination, a benign fibroadenoma with spontaneous infarction, which is uncommon in young women without known risk factors, was identified and confirmed.
4. Conclusion
We conclude that spontaneous infarction of breast fibroadenoma is a rare event with characteristics of either inflammatory carcinoma or the same as benign fibroadenoma, may not be linked to any known risk factor, and may present diagnostic challenges to clinicians. It is important to interpret and diagnose fibroadenoma patients' painful lumps with caution.
Ethical approval
This study is exempt from ethical approval in our institution.
Sources of funding
The authors declare that writing and publishing this manuscript was not funded by any organization.
Consent
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Author contribution
Writing the manuscript: Oadi N. Shrateh, Duha R.A. Doudin, Yousef Torman.
Imaging description: Mohand Abulihya.
Reviewing & editing the manuscript: Oadi N. Shrateh, Duha R.A. Doudin, Yousef Torman, Mohand Abulihya.
Guarantor
Oadi N. Shrateh.
Research registration
Not applicable.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Declaration of competing interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Acknowledgements
None.
Contributor Information
Oadi N. Shrateh, Email: oadi.shrateh@students.alquds.edu.
Mohand Abulihya, Email: mohannad.abulihya@iah.ps.
References
- 1.Tavassoli F.A. McGraw Hill Professional; 1999. Pathology of the Breast. [Google Scholar]
- 2.M. Radha Spontaneous Infarction of Fibroadenoma of Breast-A Clinical and Cytohistopathological Study of Three Cases with Brief Review of Literature.n.d.
- 3.Kuo Y.-L., et al. Spontaneous infarction of breast fibroadenoma in a young non-pregnant woman. J. Med. Sci. 2001;21(2):97–100. [Google Scholar]
- 4.Majmudar B., Rosales-Quintana S. Infarction of breast fibroadenomas during pregnancy. JAMA. 1975;231(9):963–964. [PubMed] [Google Scholar]
- 5.Raju G.C., Naraynsingh V. Infarction of fibroadenoma of the breast. J. R. Coll. Surg. Edinb. 1985:162–163. [PubMed] [Google Scholar]
- 6.Pambakian H., Tighe J. Mammary infarction. J. Br. Surg. 1971;58(8):601–602. doi: 10.1002/bjs.1800580816. [DOI] [PubMed] [Google Scholar]
- 7.Newman J., Kahn L.B. Infarction of fibro-adenoma of the breast. J. Br. Surg. 1973;60(9):738–740. doi: 10.1002/bjs.1800600921. [DOI] [PubMed] [Google Scholar]
- 8.Agorogiannis E., et al. Primary infarction of breast fibroadenoma in the absence of pregnancy or lactation. Breast J. 2016;23(1):100–101. doi: 10.1111/tbj.12689. [DOI] [PubMed] [Google Scholar]
- 9.Singh S.K., et al. International Cancer Conference Journal. Springer; 2017. Giant fibroadenoma with massive infarction masquerading as malignancy: a case report. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Fukui S., et al. Breast MRI findings of fibroadenoma with hemorrhagic infarction. Breast J. 2018;24(6):1078–1079. doi: 10.1111/tbj.13137. [DOI] [PubMed] [Google Scholar]
- 11.P.P. Bhadani et al, Prominant squamous metaplasia with extensive myxoid degeneration and associated ischaemic infarction in fibroadenoma of breast: A diagnostic dilemma.n.d.
- 12.N. Ahmad et al Infarcted Fibroadenoma: An unusual case with its Cyto-histopathological Correlation.n.d.
- 13.Agarwal P., Badkur M., Dausage C. Spontaneous infarction in fibroadenoma of breast: a rare pathological finding in a common pathological entity. Int. Surg. J. 2018;5(3):1145–1148. [Google Scholar]
- 14.Salih A.M., Kakamad F.H. Spontaneous infarction of fibroadenoma of breast-a case report with literature review. Int. J. Surg. Case Rep. 2016;24:1–3. doi: 10.1016/j.ijscr.2016.04.040. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Agha R.A., et al. The SCARE 2020 guideline: updating consensus surgical CAse REport (SCARE) guidelines. Int. J. Surg. 2020;84:226–230. doi: 10.1016/j.ijsu.2020.10.034. [DOI] [PubMed] [Google Scholar]
- 16.Verslegers I., et al. Massive infarction of a recurrent phyilodes tumor of the breast: MRI findings. JBR BTR. 2004;87(1):21–22. [PubMed] [Google Scholar]
- 17.Akdur N.C., et al. Spontaneous infarction of multiple fibroadenoma in a postlactational woman: case report. TURKIYE KLINIKLERI TIP BILIMLERI DERGISI. 2012;32(5):1429–1432. [Google Scholar]
- 18.Greenberg R., Skornick Y., Kaplan O. Management of breast fibroadenomas. J. Gen. Intern. Med. 1998;13:640–645. doi: 10.1046/j.1525-1497.1998.cr188.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Wilkinson L., Green W.O., Jr. Infarction of breast lesions during pregnancy and lactation. Cancer. 1964;17(12):1567–1572. doi: 10.1002/1097-0142(196412)17:12<1567::aid-cncr2820171208>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]