Manuel A. Torres-Salichs MD,FACS Surgical Oncology, Breast Surgeon

Edileidis Tarrio, ARNP-BC, OCN





Breast Solid Tumors

Fibroadenoma: This is the most common benign tumor in adolescent girls and young women. They usually present as a single breast mass. They are made up of both glandular and stromal (connective tissue that supports the breast elements such as the lobes, lobules and milk ducts) breast tissue. They can occur at any age but the peak incidence is between the 20's and 30's. Fibroadenomas are stimulated by estrogen and progesterone, pregnancy, and lactation. The epithelial elements can develop proliferative lesions similar to those found elsewhere in the breast. Fibroadenomas may fluctuate in size. They undergo atrophic changes during menopause and may undergo involution once the hormonal stimulation subsides.
Malignant transformation from fibroadenoma to cancer is extremely rare. The risk is approximately 0.01% to 0.3%. The established management of a biopsy-proven fibroadenoma is conservative unless they become symptomatic. Excisional biopsy is indicated if they cause local symptoms. They should also be excised if they grow significantly to rule out the possibility of a phylloides tumor.

A fibroadenoma is a benign solid tumor of the breast. Treatment options include observation, needle biopsy for tissue diagnosis and follow up, surgical removal or cryoablation.


Current management of patients with biopsy proven fibroadenoma includes:

• Conservative management and follow up
• Excisional biopsy (complete removal)
• Percutaneous core excision under sonographic guidance
• Cryoablation
• Radiofrequency

Complex Fibroadenoma:  Complex fibroadenoma is a subtype of this tumor presenting one or more complex features. These features include epithelial calcifications, papillary apocrine metaplasia, sclerosing adenosis, and cysts. The clinical relevance is unclear. The literature in the management of complex fibroadenomas is scarce. In the absence of atypical findings, the lesions should be monitored on mammography and sonography biannually for 2 years, and annually thereafter. If the biopsy confirms an atypical finding complete resection should be considered.

Breast ultrasound image showing a solid tumor close to a breast implant. A needle biopsy should be performed under sonographic guidance to prevent puncturing of the implant.

Phylloides Tumor: Cystosarcoma phylloides is a rare fibroepithelial breast tumor. It represents less than 1% of all breast tumors. They are generally divided into three groups: benign, low-grade malignant (borderline) and high-grade malignant. This classification does not always predict their natural behavior since some "benign" phylloides can manifest metastasis (spread). On the other hand, some cases of "malignant" phylloides have an excellent prognosis. These tumors present in women of all ages, with the majority ranging from 35 to 54 years. They are most commonly benign and only 10% of them present a malignant behavior. A frequent characteristic is their ability for local recurrence. Malignant phylloides tumors can spread through the bloodstream to the bones, lungs and viscera.

This contrast enhanced breast MRI illustrates a large left breast malignant phylloides tumor. The patient was treated with a mastectomy and immediate reconstruction due its large size.


The preferred surgical treatment is local resection with removal of a concentric rim of surrounding normal breast tissue. A total mastectomy is reserved in cases of large tumors that occupy most or the entire breast. Breast conservation in these cases may cause significant deformity of the breast. The patients are encouraged to undergo immediate breast reconstruction. The role of chemotherapy and radiation therapy remains uncertain.

Fibrocystic Mass:  A mass characterized by fibrocystic change is a pathological rather than a clinical diagnosis. A fibrocystic mass is diagnosed based on the presence of fibrous connective tissue and cysts. The term fibrocystic mass means a noncancerous mass or area of discrete nodularity. Fibrocystic changes are very common in premenopausal women, primarily as a result of the influence of ovarian hormones on the physiology of the breast tissue. It is not always possible to distinguish a fibrocystic mass from a breast cancer. A biopsy may be necessary to establish tissue diagnosis.