General Surgery · Year 3 · from General Surgery

Case 2: Fibroadenoma in Young Woman

Patient Demographics

  • Age: 24 years
  • Sex: Female
  • Occupation: Graduate student

Chief Complaint

"I noticed a lump in my left breast that moves around."

History of Present Illness

The patient noticed a mass in her left breast 2 months ago while showering. The mass is not painful and seems to move easily when she touches it. She has not noticed any changes in size with her menstrual cycle. She denies nipple discharge, skin changes, or other breast masses. She is otherwise healthy with regular menstrual cycles.

Past Medical History

  • No significant medical history
  • Menarche at age 13
  • Regular menstrual cycles
  • G0P0
  • No prior breast biopsies

Family History

  • No family history of breast or ovarian cancer
  • Mother and sister healthy

Medications

  • Combined oral contraceptive pill

Physical Examination

  • Breast examination:
  • Left breast: 2 cm smooth, firm, rubbery, mobile mass in the lower outer quadrant
  • Non-tender
  • "Slippery" quality - moves easily with palpation
  • No skin changes, nipple discharge, or axillary lymphadenopathy
  • Right breast: Normal, no masses

Diagnostic Workup

Breast Ultrasound (first-line imaging in young women):

  • Left breast: 2.1 x 1.8 x 1.0 cm well-circumscribed, oval, hypoechoic mass
  • Parallel orientation (wider than tall)
  • Homogeneous internal echoes
  • No acoustic shadowing
  • BI-RADS Category 3 (probably benign)

Assessment

Clinical and sonographic features consistent with fibroadenoma in a young woman with no risk factors.

Management Options Discussed

  1. Short-term follow-up: Repeat ultrasound in 6 months
  2. Core needle biopsy: For definitive tissue diagnosis
  3. Excision: If patient prefers or lesion is growing

Patient expressed anxiety about the mass and requested biopsy for definitive diagnosis.

Core Needle Biopsy Result

  • Fibroadenoma
  • No atypia
  • Concordant with imaging findings

Management Plan

  • Reassurance provided
  • Options discussed:
  • Observation with periodic self-exam
  • Excision if mass grows or causes symptoms
  • Patient chose observation
  • Follow-up ultrasound in 6 months, then annually

Six-Month Follow-up

  • Ultrasound: Mass unchanged at 2.0 cm
  • Patient reassured, continued observation recommended

Teaching Points

  1. Fibroadenomas are the most common benign breast tumor in young women
  2. Classic features: smooth, mobile, "breast mouse"
  3. Ultrasound is first-line imaging in women under 30
  4. Core biopsy provides tissue diagnosis when needed
  5. Most fibroadenomas can be observed; excision for growth, symptoms, or patient preference
  6. Fibroadenomas do not increase breast cancer risk (unless complex features)

Clinical Image

Image Description: Breast ultrasound demonstrating a well-circumscribed, oval, hypoechoic mass with parallel orientation typical of a fibroadenoma. The smooth margins and homogeneous internal echoes are characteristic benign features.

Attribution: Image from Wikimedia Commons. Source: https://commons.wikimedia.org/wiki/Category:Breast_cancer

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