Fibroadenoma vs Phyllodes Tumor

mmowl

Did your fibroadenoma turn out to be something else?

I have history of 3 excisional biopsies (right) that were 2 fibroadenomas, 1 was ADH. Late last year I had a spot show up on the left, did a core biopsy and it came back another fibroidenoma - I elected close watching and the 6-mo showed no change. (Home free again - right? - wrong!) My husband noticed a lump about a week and a half ago, but didn't stress over it as I had my next screening mammogram scheduled this week. But this past weekend I notice the "lump" has increased dramatically in size and can now be seen.  The best I could gather from watching the u/s is that it is 3cm+ by 3+cm.

Did the mammo and u/s - the result was she felt it was the same area that was biopsied last year and biopsy said fibroidadenoma, and that something in my hormone levels has set it off.

Needless, to say I have an appointment with the BS on the 19th and this is coming out, but after some accidental research am concerned about alternative results.  The info says that its almost impossible to tell the difference between a fibroidenoma and the phyllodes, even going further to say that needle/core biopsies are ineffective and recommend a "wide excision" - I am also 45 and age is a factor.

 I have a wonderful BS, and having been down the road before can be patient and ok with getting to the final word, but just curious if you had a similar experience or and key questions to add to my appointment list?

alligans

Hi!  I'm sorry to hear about your lump growing in size.  I have a fibroadenoma.  The general rule of thumb, which you most likely already know as you've gone through this before, is that after a core fibroadenomas are monitoried for a period of time to make sure they are stable.  Core + concordant imaging + concordant clincial picture + stability = 99% accuracy that the core is correct.  When one of them doesn't fit the core pathology then an excisional biopsy is warranted to be sure that the core pathology results are accurant.  A core biopsy only removes a small amount of tissue which leaves the door open for other things to be lurking within the tumor.  If a tumor's behavior changes then there is a chance that something else is going on.  That being said, fibroadenomas can grow.  Mine has not but I've read this many times.  If you are premenopause then your hormone levels may be the culprit for a changing fibroadenoma.  After menopause, some fibroadenomas calcify and get smaller or go away all together. 

I too have read that sometimes it can be difficult to differentiate a fibroadenoma from a phyllodes.  This is why fibroadenomas are monitored.  Phyllodes are considered more serious and are usually completely excised.  They do have cellular differences which a trained pathologist can see.  Once could consider them cousins; they have a similar genetic and cellular makeup and come from a similar breast disease spectrum.  However there are differences.  A fast growing fibroadenoma does raise a red flag and it's a good thing to get it checked out and possibly taken out.  If my fibroadenoma was growing, I'd want it taken out ASAP.  Phyllodes are known for growing rapdily over a short period of time so you are taking the right steps.  There is also a type of fibroadenoma known for rapidly growing.  I think it's called a juvenile fibroadenoma but I'm not sure if this applies to you.  I think young girls get this, not adults. 

My mom will be having surgery for a papilloma this Friday.  Her tumor is smaller than yours so her surgery may be different from what you may face.  She will first have a wire localization procedure to find the tumor via mammogram.  Then she will get twilight sedation (type of sedation you usually get when undergoing a colonoscopy...this is not full anesthesia).  A small incision will be make and then tumor will be taken out along with a margin of healthy tissue to be sure that she has clear margins (this ensures that a tumor will not grow back as there are no mutated cells left behind).  The whole thing should take approximately 2 hours.  After that, no heavy lifting for a week or two.  My friend underwent a lumpectomy for DCIS and stated that it was easier than her core biopsy. 

I wish you a lot of luck!  This stupid fibroadenomas are a pain in the butt.  Mine has caused me more anxiety and gray hairs than I wish to mention.

loopy123

Yes my 'fibroadenoma' turned out to be a phyllodes tumour.  My symptoms were similar - I had a lump, had mammogram, ultrasound and fine needle biopsy.  The lump was 1.5 cm.  Results came back fibroadenoma and the doctor said nothing to worry about.  Over 12 months it more than doubled in size so I asked for it to be removed and it was a phyllodes.  Great that you're getting it removed.  One question to ask is whether they are willing to assume it is a phyllodes and remove a wide margin in the first surgery.  If it does turn out to be phyllodes it is safest to have wide margins taken to prevent a recurrence and easier if they can do it all in one surgery.

mmowl

Thanks alligans and loopy,

Loopy - I am going to talk to my BS (who is great!) about that on Wednesday - I have other medical issues and having gyn surgery tomorrow I really don't want to add an un-necessary general anesthetic if possible.  If you don't mind me asking - Was your phyllodes malignant?

Aua

Hi Loopy,

Was wondering if you had any recurrence since the removal? And what type of Phyllodes Tumor were you diagnosed with?

I went in for my breast exam last march, biopsy came out as benign fibroadenoma, decided to get a second opinion 5 months later from a well known oncologist, without doing any biopsy but, just from mammogram and ultrasound he concluded that it was indeed a benign fibroadenoma. Now, 6 months later, i went in for my follow up check yesterday, and my lump has doubled it's size(approx. 4 x3cm), perhaps its because i'm about to start my period, but the radiologist looked very alarmed, and advised that i have it removed. I will be seeing my oncologist next week to schedule a date to have it excised, and also to hear the results of the ultrasound results.

Chloe15

Hi - I am 44 years old,

• I have breast composition of 3 (51-75%) - heterogeneously dense breasts.
• I have a strong family history of BC and cancer in general (maternally and paternally). Maternal grandmother, my mother, two of her sisters, and paternal grandmother, and an aunt.
• I am getting the genetic testing done. not just for my knowledge but my daughter and granddaughters.

Sept 10, I had in 1.5 hour period my Mammogram( tomosynthesis), with spot magnifications,and a breast sonogram of both breasts.

The Mammo results showed no significant change from previous films. The Sonogram findings however were:

RT Breast: solid nodule 8:00, 7 cmfn, 1.4x0.4x0.7 cm, lobular

LT Breast: solid nodule 2:00, 6 cmfn, 0.9x0.5x0.7 cm, oval, may account for area of concern.

Recommendation for a biopsy of both: with a Bi-RADS of 4-Suspicious RT & LT breast.

I had an ultrasound guided core needle Biopsy done OCT 2, 2015 left breast only, my radiologist after reviewing my two lesions again thought the right one we could watch and wait 6 months and reevaluate it for any changes.

BIOPSY RESULTS: had a differential diagnosis of Phyllodes Tumor vs Fibroadenoma.

1. Should i have it surgically removed with hopefully clean margins?

2. Or do I take the wait and watch it approach?

My thought and feelings on it are; take it out now while it is relatively small (actually is now a little over 2cm) and try and get clean margins and a more definitive pathology,

ADVICE???? SUGGESTIONS???

I have done my research (NOT GOOGLE, alone)

Thank you in advance for any suggestions to my question

Moderators

Welcome to the Community Chloe,

We are sorry that you are having breast issues but glad that you reached our for help and information. We notice that this thread has not had recent activity. You may want to start a new topic if you don't get timely responses. Let us know if you need any help with that. Here is a link to information on our site about Phyllodes Tumors. Keep us posted. The Mods

PamO

Hi Chloe, I am in a similar situation. I'm 49. Getting a core needle biopsy in 3 days. I'm not that worried about it. I had a fibroadenoma in the other breast in my early twenties, but I have a history of breast cancer in the family on the maternal side, all the great aunts had BC, one died in her 50's. Now all the granddaughters are growing lumps of various sorts, sister had 2 separate huge benign ovarian masses, my cousin has a phyllodes tumor, and now I have this lump. I'm sure they will say its a fibroadenoma, as all the radiologic features point to that, so do I wait the 6 months to a year to see if it grows, and then have to get a bigger lump taken out our just get it out now, given how all of us have this tendency to grow lumps....

Interested in how you are thinking it through and what you decide

Best, Pam

Emaca

hi there

I had a Core Needle Biopsy 5 years ago (@age 40) with results of fibroadenoma with mild proliferative changes, small micro-calcification, and prominent stromal component. Note to monitor lesion size.

The lesion has begun to grow and has doubled in size in a year.

Had a mammogram and follow up ultrasound. Dr. did not have my pathology results but said not to worry. I should leave it.

Of course my primary Dr. is on vacation for a week so I went to Internet. (Maybe not best choice).

From my readings

1. If grows over age of 35...should remove

2. Could be misdiagnosed phyllodes tumor

3. Complex fibroadenoma should be removed

Anyone have insight?

Thank you in advance

MelissaDallas

I don't know that "mild proliferative changes" constitutes a "complex fibroadenoma" unless that specific language was used in your pathology report. From John Hopkins:

Fibroadenoma is the most common tumor of the breast and is usually diagnosed in adolescents and young women. This benign tumor is composed of a mixture of glands and stroma (connective tissue). It is derived from the hormonally responsive stroma of the terminal duct lobular unit, which is thought to induce benign proliferation of the epithelium. Fibroadenomas are overall associated with a very slight (approximately 2X) long-term increase in the risk of breast cancer. A "complex fibroadenoma" has one of the following 4 features: sclerosing adenosis, papillary apocrine hyperplasia, cystic change, or epithelial calcification. These 4 features are basically those of benign fibrocystic change, which is also exceedingly common in the breast. The size of the lesion does not determine if it is or is not complex. A recent study found that, compared with controls, patients with complex fibroadenomas had a slightly increased risk of breast cancer compared to those with non-complex (or simple) fibroadenomas. However, the relative risk (3.1X) was lower than that previously associated with atypical duct or lobular hyperplasia (4-5X) or carcinoma in situ (10X). Moreover, two thirds of the population with fibroadenomas had noncomplex (simple) fibroadenomas and no family history of breast cancer: these patients had no appreciable increased risk of breast carcinoma. Dupont WD, Page DL, Parl FF et. al. Long-term risk of breast cancer in women with fibroadenoma. New England Journal of Medicine 1994;331: 10-15.