Sclerosed Fibroadenoma: Key Insights and Surgical Considerations

Core needle biopsy

Hello, Doctor.
At the end of last month, during a breast ultrasound, a mass approximately 1.2 cm in size with a gourd shape was found at the 4 o'clock position of my left breast (mildly irregular well-circumscribed hypoechoic lesion, the nature is uncertain but is probably benign, no significant increase in vascularity is noted on Doppler ultrasound).
The report suggested a tissue biopsy.
Since I underwent a core needle biopsy on September 15, the report states: sections (6 levels) show 3 cores of benign breast tissue harboring a fibroepithelial lesion exhibiting a predominantly intracanalicular pattern.
The duct-like structures are lined by a layer of flattened to columnar luminal cells supported by myoepithelial cells.
The nuclei appear bland.
There is a moderate amount of dense collagenous fibrous stroma which is hypocellular.
Hyalinization of collagen is noted.
The spindle-shaped stromal cells have bland nuclei.
Mitosis is lacking.
A few pseudofronds are noted.
However, typical leaf-like structures commonly associated with phyllodes tumors are not seen.
There is no specific infection or malignancy.
Trucut biopsy of the left breast lesion at 4 o'clock shows a fibroepithelial lesion consistent with a sclerosed fibroadenoma of the breast.
My attending physician said it is a fibroepithelial tumor, and although there is a possibility of it being a phyllodes tumor, the report indicates it leans towards a sclerosed fibroadenoma, and I can return for follow-up in six months without the need for surgery at this time.
However, Doctor, 1.
What is a sclerosed fibroadenoma? Is it the same as sclerosing adenosis? (I heard that sclerosing adenosis requires surgery due to concerns about nearby tissue having in situ carcinoma.) 2.
My mass is gourd-shaped and somewhat irregular; is it really safe not to remove it surgically? 3.
Generally, what is the safe period after a biopsy before surgery is required? How long after the biopsy must surgery be performed? 4.
If I decide to have surgery now, but several weeks have passed since the last biopsy, is that a problem? 5.
Also, how long does it typically take to recover and return to work after surgery? I apologize for having so many questions, but I am quite worried.
Please help me with these concerns, thank you!

ting, 20~29 year old female. Ask Date: 2017/09/28

Dr. Chen Jiaming reply Surgery

1.
This is the diagnostic name for a pathological tissue section, essentially what is commonly referred to as a benign fibroadenoma.

2.
Since you have already had the biopsy, it confirms that its identity is benign; at this point, its mildly irregular shape is not too significant.
The original description indicates a "mildly irregular, well-circumscribed hypoechoic lesion," and the clinical physician has already suspected it to be benign.

3.
If you wish to have it removed, you can discuss and arrange that with your physician at any time; that is your right.

4.
The doctor has advised you to follow up in six months, so there is no need to worry about a few weeks.

5.
It depends on the nature of your work; it does not significantly affect limb activity, but there is concern about sweating potentially causing an infection at the wound site.
Generally, under normal conditions, the wound can heal well in about a week.

Reply Date: 2017/09/28

More Info

Sclerosed fibroadenoma is a specific type of benign breast tumor that is characterized by a combination of fibrous and glandular tissue. It is a subtype of fibroadenoma, which is the most common benign breast tumor, particularly in younger women. The term "sclerosed" refers to the presence of dense fibrous tissue that can make the lesion feel firm or hard upon examination. This condition is often discovered during routine breast imaging, such as ultrasound or mammography, and may present as a palpable mass.

1. Understanding Sclerosed Fibroadenoma vs. Sclerosing Adenosis: Sclerosed fibroadenoma and sclerosing adenosis are not the same, although they may share some histological features. Sclerosing adenosis is a condition characterized by the proliferation of glandular tissue and fibrosis, which can sometimes mimic malignancy on imaging studies. While sclerosing adenosis can be associated with an increased risk of breast cancer, sclerosed fibroadenomas are generally considered benign and do not carry the same risk. The management of sclerosing adenosis often involves surgical excision, particularly if there are atypical features or if it is associated with other risk factors for breast cancer.

2. Irregular Shape and Surgical Considerations: The irregular shape of your lesion raises valid concerns. While sclerosed fibroadenomas are typically benign, any lesion that exhibits irregular contours should be monitored closely. Your physician's recommendation to follow up in six months is standard practice, but if you have significant anxiety about the irregularity, discussing the option of surgical excision may be warranted. Surgical removal can provide peace of mind and definitive histological analysis.

3. Timing for Surgery Post-Biopsy: After a core needle biopsy, it is generally recommended to wait at least a few weeks before undergoing surgery. This allows for any potential inflammation or hematoma from the biopsy to resolve. Typically, a period of 2-4 weeks is considered safe, but this can vary based on individual circumstances and the surgeon's preferences.

4. Surgery Timing Concerns: If several weeks have passed since your biopsy and you are considering surgery, this is usually not a problem. However, it is essential to communicate with your surgeon about your concerns and the timing of your biopsy. They may want to reassess the lesion with imaging before proceeding with surgery.

5. Recovery Time Post-Surgery: Recovery time after breast surgery can vary depending on the extent of the procedure. For a lumpectomy or excisional biopsy, many patients can return to work within a few days to a week, provided their job does not involve heavy lifting or strenuous activity. It is crucial to follow your surgeon's postoperative care instructions and to listen to your body during the recovery process.

In summary, while sclerosed fibroadenomas are generally benign, the irregular shape of your lesion warrants careful monitoring. If you have concerns about the safety of not having surgery, discussing these with your healthcare provider is essential. They can provide personalized recommendations based on your specific situation and help alleviate your worries. Regular follow-up and imaging are crucial to ensure that any changes in the lesion are promptly addressed.

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