When Friend Becomes Foe: Complications of Fibroadenoma Imaging Spectrum

AbstractFibroadenoma are the most common benign breast lesions. Complications in fibroadenoma although rare in occurrence, are reported. It is important to be aware of the possible complications, both benign and malignant which may require surgical management. Commonly encountered benign complications in a fibroadenoma are infarction, rapid increase in size, and lactational changes. A common differential of a giant fibroadenoma is phyllodes tumor which has subtle imaging differences. Malignant transformation of a fibroadenoma is very rare although cases are reported (0.02%). Breast is a dynamic organ and is influenced by the hormone surges occurring typically during pregnancy and lactation, it causes changes in morphology of prior existing fibroadenoma which may mimic like a malignancy and hence knowledge of these benign complications in a fibroadenoma is also important. To identify the subtle radiologic imaging features which may suggest complication developing in a known fibroadenoma, prompting for a histopathological examination correlation. In this article, we discuss the imaging features of complications in a fibroadenoma—benign and malignant. Sinister etiology secondarily engulfing a fibroadenoma and sinister focus developing in a fibroadenoma will be discussed. Also, the benign complications in a fibroadenoma like lactational changes, spontaneous infarction within a fibroadenoma, and excessive increase in the size of fibroadenoma with degenerative changes due to the estrogen and progesterone effect which can mimic like a malignancy will be illustrated. A careful history, meticulous scanning, close monitoring, and histopathological correlation is invaluable to identify these complications in a known fibroadenoma and thus guide in the appropriate management of these lesions.