Breast Carcinoma within Fibroadenoma: A Systematic Review
Abstract
Introduction
Fibroadenoma is the most common benign breast lesion; however, it carries a potential risk of malignant transformation. This systematic review provides an overview of the presentation, management, and outcome of carcinomas arising within fibroadenomas.
Methods
A systematic search on Google Scholar was conducted for English-language studies on breast carcinoma within fibroadenomas. Studies on fibroadenomas with no malignant components, review articles, pre-prints, incomplete data, and those published in suspicious journals were excluded.
Results
On ultrasonography, 28 masses (36.8%) appeared benign, and 20 (26.3%) were suspicious, with ultrasonographic data unavailable for the remaining tumors (36.8%). Mammography data were available for 50 tumors, revealing 27 benign lesions (54%) and 23 suspicious lesions (46%). Among the 17 lesions with available magnetic resonance imaging data, five were benign lesions (29.4%), and 12 were suspicious (70.6%). Cytology evaluation among 46 tumors revealed that 20 (43.5%) were benign, 24 (52.2%) were malignant, and two (4.3%) were suspicious. The most commonly performed surgery was wide local excision (50.7%), followed by mastectomy (32.9%). On histopathology, 11 tumors exhibited more than one pathology. Ductal carcinoma in situ was the most frequent finding (40.8%), followed by invasive ductal carcinoma (28.9%) and lobular carcinoma in situ (28.4%). Recurrence was observed in one case (1.4%), and metastasis occurred in two cases (2.8%).
Conclusion
Although rare, carcinomas arising within fibroadenomas may present considerable challenges in preoperative diagnosis, whether through imaging or cytology. Therefore, clinicians may find it necessary to approach fibroadenomas with increased caution.
References
- Tagliati C, Lanni G, Cerimele F, et al. Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report. Breast Disease. 2021;40(4):283-6. doi:10.3233/bd-201080 DOI: https://doi.org/10.3233/BD-201080
- Pang FT, Kornecki A, Lynn K, et al. A rare case of lobular carcinoma in situ within a fibroadenoma. Arch Breast Cancer. 2022;119-22. doi:10.32768/abc.202291119-122 DOI: https://doi.org/10.32768/abc.202291119-122
- Hammood ZD, Mohammed SH, Abdulla BA, et al. Ductal carcinoma in situ arising from fibroadenoma; a rare case with review of literature. Ann Med Surg. 2022;75:103-8. doi:10.1016/j.amsu.2022.103449 DOI: https://doi.org/10.1016/j.amsu.2022.103449
- Brunetti N, Valente I, Pitto F, et al. Triple-negative breast cancer arising in a fibroadenoma in BRCA 1 mutated patient. J Med Ultrasound. 2023;31(1):63-5. doi:10.4103/jmu.jmu_83_21 DOI: https://doi.org/10.4103/jmu.jmu_83_21
- Wang M, Leong MY, Tan QT. A case of fibroadenoma with lobular carcinoma in situ and microinvasion in a young woman. J Surg Case Rep. 2022;2022(12). doi: N/A DOI: https://doi.org/10.1093/jscr/rjac602
- Shojaku H, Hori R, Yoshida T, et al. Low-grade ductal carcinoma in situ (DCIS) arising in a fibroadenoma of the breast during 5 years follow-up: a case report. Medicine. 2021;100(10). doi:10.1097/md.0000000000024023 DOI: https://doi.org/10.1097/MD.0000000000024023
- Frisch O, De Jager LJ, Otto M, et al. A teenager with ductal carcinoma in situ arising in a fibroadenoma: a case report. S Afr J Surg. 2018;56(4):30-3. doi:10.17159/2078-5151/2018/v56n4a2766 DOI: https://doi.org/10.17159/2078-5151/2018/v56n4a2766
- Feijó CQ, da Costa RE, da Silva Fontinele DR, et al. Low-grade carcinoma in situ in fibroadenoma: a case report. Mastology. 2021;31:1-3. doi:10.29289/2594539420210058 DOI: https://doi.org/10.29289/2594539420210058
- Brock CM, Harper C, Tyler T. Fibroadenoma containing lobular carcinoma in situ, an unusual finding in a normally benign mass. J Surg Case Rep. 2020;2020(4). doi:10.1093/jscr/rjaa059 DOI: https://doi.org/10.1093/jscr/rjaa059
- Abdullah HO, Abdalla BA, Kakamad FH, et al. Predatory publishing lists: A review on the ongoing battle against fraudulent actions. Barw Med J. 2024;1(1):45-9. doi:10.58742/bmj.v2i2.91 DOI: https://doi.org/10.58742/bmj.v2i2.91
- Fujimoto A, Matsuura K, Kawasaki T, et al. Early HER2-positive breast cancer arising from a fibroadenoma: a case report. Oxf Med Case Rep. 2021;2021(9). doi:10.1093/omcr/omab083 DOI: https://doi.org/10.1093/omcr/omab083
- Shiino S, Yoshida M, Tokura M, et al. Locally advanced triple-negative breast cancer arising from fibroadenoma with complete response to neoadjuvant chemotherapy: a case report. Int J Surg Case Rep. 2020;68:234-8. doi:10.1016/j.ijscr.2020.02.059 DOI: https://doi.org/10.1016/j.ijscr.2020.02.059
- Gonthong A. Ductal carcinoma in situ within fibroadenoma: report of imaging features. J Dep Med Serv. 2021;46(2):151-8. doi: N/A
- Ni XH, An R, Shi QW, et al. Low-grade ductal carcinoma in situ within a fibroadenoma of the breast: A rare case report and review of the literature. OncoTargets Ther. 2023;16:399-406. doi:10.2147/ott.s413223 DOI: https://doi.org/10.2147/OTT.S413223
- Tiwari A, Singh BM, Varshney S, et al. Incidental detection of carcinoma in situ in fibroadenoma of the breast in a young woman: a rare finding. Cureus. 2018;10(12). doi:10.7759/cureus.3797 DOI: https://doi.org/10.7759/cureus.3797
- Marumoto A, Steinemann S, Furumoto N, et al. An uncommon pairing of common tumors: case report of ductal carcinoma in situ within fibroadenoma. Hawai'i J Med Public Health. 2019;78(2):39. doi:10.5348/100916z01sz2018cr
- Moreno M, Menegassi J, Neto OV, et al. Metachronous breast neoplasms: squamous cell carcinoma and lobular carcinoma in situ within a fibroadenoma. Mastology. 2020;30:1-4. doi:10.29289/25945394202020200016 DOI: https://doi.org/10.29289/25945394202020200016
- El-Essawy M, AL Haidary A, Khan AL. Ductal carcinoma in situ (DCIS) in breast fibroadenoma. Egypt J Radiol Nucl Med. 2020;51:1-7. doi:10.1186/s43055-020-00191-5 DOI: https://doi.org/10.1186/s43055-020-00191-5
- Zeeshan S, Siddique S, Riaz N. Ductal carcinoma in situ within fibroadenoma of the breast: a case report with literature review. Int J Case Rep Images. 2018;9:100916Z01SZ2018. doi:10.5348/100916Z01SZ2018CR DOI: https://doi.org/10.5348/100916Z01SZ2018CR
- Lim S, Shim MK, Cho EY, et al. Secretory carcinoma arising in a fibroadenoma: a brief case report. J Pathol Transl Med. 2018;52(3):198-201. doi:10.4132/jptm.2017.08.01 DOI: https://doi.org/10.4132/jptm.2017.08.01
- You JK, Kim YJ, Kim B, et al. Ductal carcinoma in situ within a fibroadenoma: microcalcifications identified on mammography play a crucial role in diagnosis. J Korean Soc Radiol. 2016;74(6):361-4. doi:10.3348/jksr.2016.74.6.361 DOI: https://doi.org/10.3348/jksr.2016.74.6.361
- Zheng H, Chen J, Wu X, et al. Bilateral breast cancer with a unilateral carcinoma within a fibroadenoma: a case report. Oncol Lett. 2015;10(3):1513-6. doi:10.3892/ol.2015.3420 DOI: https://doi.org/10.3892/ol.2015.3420
- Hua B, Xu JY, Jiang L, et al. Fibroadenoma with an unexpected lobular carcinoma in situ: a case report and review of the literature. Oncol Lett. 2015;10(3):1397-401. doi:10.3892/ol.2015.3488 DOI: https://doi.org/10.3892/ol.2015.3488
- Wu YT, Chen ST, Chen CJ, et al. Breast cancer arising within fibroadenoma: collective analysis of case reports in the literature and hints on treatment policy. World J Surg Oncol. 2014;12:335. doi:10.1186/1477-7819-12-335 DOI: https://doi.org/10.1186/1477-7819-12-335
- Mele M, Vahl P, Funder JA, et al. Apocrine carcinoma arising in a complex fibroadenoma: a case report. Breast Dis. 2014;34(4):183-7. doi:10.3233/bd-140365 DOI: https://doi.org/10.3233/BD-140365
- Limite G, Di Micco R, Esposito E, et al. The first case of acinic cell carcinoma of the breast within a fibroadenoma: case report. Int J Surg. 2014;12. doi:10.1016/j.ijsu.2014.05.005 DOI: https://doi.org/10.1016/j.ijsu.2014.05.005
- Kwon MJ, Park HR, Seo J, et al. Simultaneous occurrence of ductal carcinoma in situ within juvenile fibroadenoma in both breasts: a brief case report. Korean J Pathol. 2014;48(2):164. doi:10.4132/koreanjpathol.2014.48.2.164 DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.2.164
- Kılıç F, Ustabaşıoğlu FE, Samancı C, et al. Ductal carcinoma in situ detected by shear wave elastography within a fibroadenoma. J Breast Cancer. 2014;17(2):180. doi:10.4048/jbc.2014.17.2.180 DOI: https://doi.org/10.4048/jbc.2014.17.2.180
- Dandin Ö, Karakaş DÖ, Balta AZ, et al. Invasive breast carcinoma occurring within fibroadenoma: case report. Turkiye Klinikleri J Case Rep. 2015;23(2):149-52. doi:10.5336/caserep.2013-37780 DOI: https://doi.org/10.5336/caserep.2013-37780
- Buteau AH, Waters RE, Boroumand N. Metastatic carcinoma arising from fibroadenoma of the breast. Int J Cancer Oncol. 2014;1:1-3. doi: N/A DOI: https://doi.org/10.15436/2377-0902.14.006
- Hayes BD, Quinn CM. Microinvasive lobular carcinoma arising in a fibroadenoma. Int J Surg Pathol. 2013;21(4):419-21. doi:10.1177/1066896912471854 DOI: https://doi.org/10.1177/1066896912471854
- Jahan F, Ghosh PK, Rahman S, et al. Fibroadenoma with foci of infiltrating ductal carcinoma. J Med. 2012;13(1):115. doi:10.3329/jom.v13i1.10088 DOI: https://doi.org/10.3329/jom.v13i1.10088
- Butler R, Pinsky R, Jorns JM, et al. Alveolar variant of invasive lobular carcinoma in a fibroadenoma. Breast J. 2012;18:645-50. doi:10.1111/tbj.12016 DOI: https://doi.org/10.1111/tbj.12016
- Ooe A, Takahara S, Sumiyoshi K, et al. Preoperative diagnosis of ductal carcinoma in situ arising within a mammary fibroadenoma: a case report. J Clin Oncol. 2011;41:918-23. doi:10.1093/jjco/hyr075 DOI: https://doi.org/10.1093/jjco/hyr075
- Lin IL, Lee YH, Kao WS, et al. Pre-operative diagnosis of invasive ductal carcinoma within a fibroadenoma by mammography. J Radiol Sci. 2011;36:28-31. doi:10.1097/pcr.0000000000000478 DOI: https://doi.org/10.1097/PCR.0000000000000478
- Kato F, Omatsu T, Matsumura W, et al. Dynamic MR findings of ductal carcinoma in situ within a fibroadenoma. Magn Reson Med Sci. 2011;10:129-32. doi:10.2463/mrms.10.129 DOI: https://doi.org/10.2463/mrms.10.129
- Abu-Rahmeh Z, Nseir W, Naroditzky I, et al. Invasive ductal carcinoma within fibroadenoma and lung metastases. Int J Gen Med. 2012;5:19-21. doi:10.2147/ijgm.s26115 DOI: https://doi.org/10.2147/IJGM.S26115
- Rao S, Latha PS, Ravi A, et al. Ductal carcinoma in a multiple fibroadenoma: diagnostic inaccuracies. J Cancer Res Ther. 2010;6:385-7. doi:10.4103/0973-1482.73350 DOI: https://doi.org/10.4103/0973-1482.73350
- Petersson F, Tan PH, Putti CT, et al. Low-grade ductal carcinoma in situ and invasive mammary carcinoma with columnar cell morphology arising in a complex fibroadenoma in continuity with columnar cell change and flat epithelial atypia. Int J Surg Pathol. 2010;18:352-7. doi:10.1177/1066896910373096 DOI: https://doi.org/10.1177/1066896910373096
- Tajima S, Kanemaki Y, Kurihara Y, et al. A case of a fibroadenoma coexisting with an invasive lobular carcinoma in the breast. Breast Cancer. 2011;18:319-23. doi:10.1007/s12282-009-0122-z DOI: https://doi.org/10.1007/s12282-009-0122-z
- Gashi-Luci LH, Limani RA, Kurshumliu FI, et al. Invasive ductal carcinoma within fibroadenoma: a case report. Cases J. 2009;2:1-4. doi:10.1186/1757-1626-2-174 DOI: https://doi.org/10.1186/1757-1626-2-174
- Borecky N, Rickard M, et al. Preoperative diagnosis of carcinoma within fibroadenoma on screening mammograms. J Med Imaging Radiat Oncol. 2008;52:64-7. doi:10.1111/j.1440-1673.2007.01913.x DOI: https://doi.org/10.1111/j.1440-1673.2007.01913.x
- Tiu CM, Chou YH, Chiou SY, et al. Development of a carcinoma in situ in a fibroadenoma: color Doppler sonographic demonstration. J Ultrasound Med. 2006;25:1335-8. doi:10.7863/jum.2006.25.10.1335 DOI: https://doi.org/10.7863/jum.2006.25.10.1335
- Shin JH, Choi HY, Lee SN, et al. Microinvasive ductal carcinoma arising within a fibroadenoma: a case report. Acta Radiol. 2006;47:643-5. doi:10.1080/02841850600698838 DOI: https://doi.org/10.1080/02841850600698838
- Blanco M, Egozi L, Lubin D, et al. Adenoid cystic carcinoma arising in a fibroadenoma. Ann Diagn Pathol. 2005;9:157-9. doi:10.1016/j.anndiagpath.2005.02.008 DOI: https://doi.org/10.1016/j.anndiagpath.2005.02.008
- Gogo-Abite M, Seleye-Fubara D, Jamabo RS, et al. Fibroadenoma coexisting with infiltrating ductal carcinoma: a case report. Niger J Med. 2005;14:221-3. doi:10.4314/njm.v14i2.37185 DOI: https://doi.org/10.4314/njm.v14i2.37185
- Stafyla V, Kotsifopoulos N, GrigoriC ades K, et al. Lobular carcinoma in situ of the breast within a fibroadenoma: a case report. Gynecol Oncol. 2004;94:572-4. doi:10.1016/j.ygyno.2004.04.031 DOI: https://doi.org/10.1016/j.ygyno.2004.04.031
- Abe H, Hanasawa K, Naitoh H, et al. Invasive ductal carcinoma within a fibroadenoma of the breast. Int J Clin Oncol. 2004;9:334-8. doi:10.1007/s10147-004-0401-9 DOI: https://doi.org/10.1007/s10147-004-0401-9
- Adelekan MO, Tresadern JC, Prescott R, et al. Multiple metastatic deposits of a left breast cancer into a right fibroadenoma. Breast. 2003;12:294-6. doi:10.1016/s0960-9776(03)00097-3 DOI: https://doi.org/10.1016/S0960-9776(03)00097-3
- Yano Y, Ueno E, Kamma H, et al. Non-invasive lobular carcinoma within a fibroadenoma: a preoperatively diagnosed case. Breast Cancer. 2001;8:70-3. doi:10.1007/bf02967481 DOI: https://doi.org/10.1007/BF02967481
- Gebrim LH, Bernardes Júnior JR, Nazário AC, et al. Malignant phyllodes tumor in the right breast and invasive lobular carcinoma within fibroadenoma in the other: case report. Sao Paulo Med J. 2000;118:46-8. doi:10.1590/s1516-31802000000200004 DOI: https://doi.org/10.1590/S1516-31802000000200004
- Psarianos T, Kench JG, Ung OA, et al. Breast carcinoma in a fibroadenoma: diagnosis by fine needle aspiration cytology. Pathology. 1998;30:419-21. doi:10.1080/00313029800169736 DOI: https://doi.org/10.1080/00313029800169736
- Shah A, Pathak R, Banerjee S, et al. Lobular carcinoma-in-situ within a fibroadenoma of the breast. Postgrad Med J. 1999;75:293. doi:10.1136/pgmj.75.883.293 DOI: https://doi.org/10.1136/pgmj.75.883.293
- Kurosumi M, Itokazu R, Mamiya Y, et al. Invasive ductal carcinoma with a predominant intraductal component arising in a fibroadenoma of the breast. Pathol Int. 1994;44:874-7. doi:10.1111/j.1440-1827.1994.tb01687.x DOI: https://doi.org/10.1111/j.1440-1827.1994.tb01687.x
- Morimoto T, Tanaka T, Komaki K, et al. The coexistence of lobular carcinoma in a fibroadenoma with a malignant phyllodes tumor in the opposite breast: report of a case. Surg Today. 1993; 23:656-60. doi:10.1007/bf00311918 DOI: https://doi.org/10.1007/BF00311918
- Gupta RK, Dowle C, et al. Fine needle aspiration of breast carcinoma in a fibroadenoma. Cytopathology. 1992; 3:49-53. doi:10.1111/j.1365-2303.1992.tb00022.x DOI: https://doi.org/10.1111/j.1365-2303.1992.tb00022.x
- Gupta RK, Simpson J, et al. Carcinoma of the breast in a fibroadenoma: diagnosis by fine‐needle aspiration cytology. Diagn Cytopathol. 1991; 7:60-2. doi:10.1002/dc.2840070116 DOI: https://doi.org/10.1002/dc.2840070116
- Fukuda M, Nagao K, Nishimura R, et al. Carcinoma arising in fibroadenoma of the breast—A case report and review of the literature—. Jpn J Surg. 1989; 19:593-6. doi:10.1007/bf02471669 DOI: https://doi.org/10.1007/BF02471669
- Yoshida Y, Takaoka M, Fukumoto M, et al. Carcinoma arising in fibroadenoma: case report and review of the world literature. J Surg Oncol. 1985; 29:132-40. doi:10.1002/jso.2930290213 DOI: https://doi.org/10.1002/jso.2930290213
- Fondo EY, Rosen PP, Fracchia AA, et al. The problem of carcinoma developing in a fibroadenoma. Cancer. 1979; 43:563-7. doi:10.1002/1097-0142(197902)43:2%3C563::AID-CNCR2820430224%3E3.0.CO;2-H DOI: https://doi.org/10.1002/1097-0142(197902)43:2<563::AID-CNCR2820430224>3.0.CO;2-H
- Buzanowski‐Konakry K, Harrison EG Jr, Payne WS, et al. Lobular carcinoma arising in fibroadenoma of the breast. Cancer. 1975; 35:450-6. doi:10.1002/1097-0142(197502)35:2%3C450::AID-CNCR2820350223%3E3.0.CO;2-R DOI: https://doi.org/10.1002/1097-0142(197502)35:2<450::AID-CNCR2820350223>3.0.CO;2-R
- Durso EA, et al. Carcinoma arising in a fibroadenoma: a case report. Radiology. 1972; 102:565. doi:10.1148/102.3.565 DOI: https://doi.org/10.1148/102.3.565
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.