Clinical History:

While showering, a 24 year-old woman noted a somewhat firm mass in the upper-outer quadrant of her left breast. She went to see her family physician who also felt the mass, and he determined that it was firm with a rubbery consistency and appeared to be movable.

Image 1.1:

The excised breast mass was found to be light tan in color, rubbery in consistency, and well demarcated from the surrounding normal breast tissue. The mass was located radiographically prior to surgery and marked with blue dye to facilitate finding it for removal.

Images 1.2 and 1.3:

The microscopic appearance of the mass is shown at low and high power. Note the presence of both a stromal and epithelial proliferation in large rounded and demarcated nodules. Note the irregular-shaped epithelial clefts. The stroma is variably dense, and somewhat edematous adjacent to the epithelium. The cells lining the epithelial spaces are regular and uniform, and do not show mitotic activity (i.e., the cytologic features are benign). Also note that the stroma is paucicellular (does not have many cells) in comparison to what one would see in a phyllodes tumor.

Answers:

1. What is the diagnosis and the prognosis?

This is a fibroadenoma of the breast. Fibroadenoma is the most common solid breast lump in women from 15 to 30 years of age. This is not considered to be a premalignant lesion.

2. Describe diagnostic methods for breast disease.

Most breast lesions are benign, but malignancy cannot be ruled out by clinical examination alone. Mammography and ultrasound are imaging techniques applicable to the breast. Ultrasound is useful for diagnosis of masses and is particularly useful for cystic lesions in younger and older women. Mammography can help determine the location, size, and characteristics, such as presence of microcalcifications, in breast lesions. Following imaging studies, fine needle aspiration (FNA) or core needle biopsy can be done to obtain cells for microscopic diagnosis.