A Breast Fibroadenoma Case Presenting as Breast Hamartoma

Abstract

Turkish Abstract

Introduction

In recent years,  clinicians come across more benign breast lesions due to the increasing use of breast screening. Fibroadenomas are one of the most commonly seen breast lesions among all the bening breast lesions. Radiological imaging techniques are needed to distinguish those breast lesions which are mostly diagnosed by physical examination. In this case report,  we present a patient who was radiologically considered to have a breast hamartoma but  histopathologically she was diagnosed as having a fibroadenoma.

Case Report

A 16- year-old female patient attended to our outpatient clinic suffering from a palpable mass at her right breast for 4 months. She had no family history. During her breast examination no nipple and skin retraction or inflammation were found. But a 7 cm mobile, soft, nontender mass was palpated at her right breast. At the axillary examination there were no palpable lymph nodes. Ultrasonographic examination reported a 68 x 29 mm multilobulated, heterogeous and hypoechoic mass having inflammation and eudema around the lesion with extense echogenity increase and partly irregular and undefinite margins. Mammographic examination showed a 7 x 3 cm lesion at upper lateral quadrant of the right breast having lipoid and fibroglandular structural density and disorganised dilated ductal structures (Figure 1).

Figure 1 Mammographic examination images showing a 7 x 3 cm lesion at upper lateral quadrant of right breast having lipoid and fibroglandular structural dansity and disorganised dilated ductal structures

Mammographic examination  result  was initially considered that the mass was a  breast hamartoma  in differential diagnosis. Breast magnetic resonans imaging reported a 6 x 4 cm mass that was heterogenous in T1 and T2 sequences, with lipoid component inside, highly contrasted and showing contrasted areas in late stages which mostly looked like a hamartoma (Figure 2a, b, c).

Figure 2A Breast magnetic resonans images showing a 6 x 4 cm mass that is heterogenous in T1 and T2 sequences, with lipoid component inside, highly contrasted and showing contrasted areas in late stages which mostly looks like hemartomas

Figure 2B Breast magnetic resonans images showing a 6 x 4 cm mass that is heterogenous in T1 and T2 sequences, with lipoid component inside, highly contrasted and showing contrasted areas in late stages which mostly looks like hemartomas

Figure 2C Breast magnetic resonans images showing a 6 x 4 cm mass that is heterogenous in T1 and T2 sequences, with lipoid component inside, highly contrasted and showing contrasted areas in late stages which mostly looks like hemartomas

During surgery mass was excised from an incision made at the right upper quadrant of the breast. The mass was nearly 50 grams weighted, bilobulated, 6 x 5 cm in diameters having regular surface, yellowish in colour and capsulated macroscopically (Figure 3).

Figure 3 The image of the mass weighted 50 grs, bilobulated, 6 x 5 cm in diameters having regular surface, yellowish in colour and capsulated macroscopically

After the pathological examination the lesion was reported as a fibroadenoma having adenosis areas histopathologically. There had been no problem postoperatively and she had discharged from hospital postoperative second day.

Discussion

In most of the retrospective studies,  cases were initially considered  to have  fibroadenomas, but in  the final diagnosis they were reported to have pathologies like cystosarcoma phyllodes or hamartoma ¹. Gogas et al. reported a case in which they showed malignant changes in a lesion diagnosed as hamartoma and for this reason they performed modified radical mastectomy ². In another case presentation,  it was informed that a microinvasive lobular carcinoma was  observed  in hamartoma  but not previously reported  in fibroadenoma ³.

As a result, like other benign lesions hamartomas must also be  differentiated from the malignant lesions of the breast. There were  few studies which reported  that because of the glandular structure of hamartomas,  they have the potential for malignant transformation  like  in situ or invasive lobular carcinomas ^2-5. Hisopatholoical analysis of biopsy specimen taken  from the peritumoral tissues of hamartomas are advised for the patients who are operated for benign pathologies according to the patient?s age, the size of the tumor and the family history ¹. In benign breast lesions,  physical examination and radiological diagnosis may not  correlate with the histopathological diagnosis. In suspected cases the treatment procedure must be decided according to the histopathological results after  a biopsy.

References

1. Yağmurdur MC, Yabanoğlu H, Karakayalı H. Meme biyopsilerinde fibroadenomlara eşlik eden patolojiler. Türk Jinekolojik Onkoloji Dergisi. 2011; 14(3): 76-80.
2. Gogas J, et al. Hamartomas of the breast. Am Surg. 1994; 60(6): 447-50.
3. Hayes BD, Quinn CM. Microinvasive lobular carcinoma arising in a fibroadenoma. Int J Surg Pathol. 2013; 21(4): 419-21. doi: 10.1177/1066896912471854.
4. Sezer A, Yalcın Ö, Altan A. Memenin nadir görülen benign bir tümörü:Meme hamartomu. J Breast Health. 2009; 5(2): 104-6.
5. Murat A, et al.  Hamartoma of the breast. Australas Radiol. 2007; 51 Spec No.:B37-9.

Information Presentation

8. Cerrahi Araştırma Kongresi (2015, Konya, Türkiye)