Cyclosporine-Induced Fibroadenomatosis

Case report

The following is a report of a 45-year-old female who suffered terminal renal failure due to nephronophthisis in 1985. The patient needed dialysis from September 1985 to July 1998. In July 1998, the patient underwent renal transplantation and has had stable renal function since then. The initial immunosuppressive therapy was done with cyclosporine at a serum level adapted dosage. The post-transplantation period was uneventful except for a traffic accident in 1993 resulting in multiple fractures. In June 2005 the patient discovered a lump in the left upper part of her left breast. Ultrasound examination revealed a fibroadenoma with a size of 46 × 21 mm, which was finally confirmed by histology ([Fig. 1] a–c). Because of case reports of cyclosporine-induced fibroadenomas, the immunosuppressive therapy was altered to tacrolimus and mycophenolat mofetil. Ultrasound follow-up 12 months after the therapy change confirmed regression of the fibroadenoma with a size of 27 × 7 mm ([Fig. 2] a–c). In addition to the regression in size, the elastographic character of the lesion changed from soft to hard. With contrast-enhanced ultrasound, the originally investigated fibroadenoma showed signs of hypervascularization. However, the regressive fibroadenoma subsequently showed signs of hypovascularization. The effect of regression continued after a later switch from mycophenolat mofetil therapy to cellcept. The last ultrasound measurement of the fibroadenoma in 2009 showed a size of 24 × 6 mm.

Fig. 1 a B-mode of large fibroadenoma of the breast (panoramic imaging) at time of diagnosis (46 × 21 mm). b Elastographic image of fibroadenoma (FAD) at time of diagnosis. c Contrast-enhanced ultrasound of the respective fibroadenoma at the time of diagnosis revealed primarily peripherally located vessels.

Abb. 1 a B-mode-Darstellung eines großen Fibroadenoms der Mamma (Panorama-Einstellung) zum Zeitpunkt der Diagnose (46 × 21 mm). b Elastografische Darstellung des Fibroadenoms (FAD) zum Zeitpunkt der Diagnosestellung. c Kontrastverstärkter Ultraschall des Fibroadenoms zum Zeitpunkt der Diagnosestellung: Es zeigen sich überwiegend peripher lokalisierte Gefäße.

Fig. 2 a B-mode of large fibroadenoma of the breast 12 months after stopping treatment with cyclosporine leading to regression in size (27 × 7 mm), vascularity and changes in the elastographic features (27 × 7 mm). b Elastographic image of fibroadenoma (FAD) 8 months later, showing decreased size and slight changes in elasticity. Mu: Thoracic muscle. Knochen: Rib.

Abb. 2 a B-Mode Darstellung eines Fibroadenoms der Mamma 12 Monate später nach Therapieende des Cyclosporins, was zu einer Regression und zur Veränderung der Vaskularisation bzw. des elastografischen Eindrucks geführt hat (Größe 27 × 7 mm). b Elastografische Darstellung des Fibroadenoms (FAD) 8 Monate später, welches eine Veränderung in der Größe und eine leichte Änderung der Elastizität zeigt; Mu = Thoraxmuskel; Knochen = Rippe.

Fig. 3 Contrast-enhanced ultrasound of the respective fibroadenoma 12 months after stopping cyclosporine; almost no vascularity could be shown (size of the lesion: 27 × 7 mm).

Abb. 3 Kontrastverstärkter Ultraschall 12 Monate nach Beendigung der Cyclosporin-Therapie: eine Vaskularisation ist nahezu nicht mehr erkennbar (Größe der Läsion 27 × 7 mm).