Difference between revisions of "Fibroepithelial tumor"
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If, even after [[consultation]], it is not clear whether a tumor is a fibroadenoma or phyllodes tumor, then it can be reported as a '''cellular fibroepithelial lesion''' or a '''fibroepithelial neoplasm'''. | If, even after [[consultation]], it is not clear whether a tumor is a fibroadenoma or phyllodes tumor, then it can be reported as a '''cellular fibroepithelial lesion''' or a '''fibroepithelial neoplasm'''. | ||
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| + | A phyllodes tumor warrants a comment whether margins are positive or negative for tumor, whereas fibroadenoma does not need such comment. | ||
Example report of fibroadenoma: | Example report of fibroadenoma: | ||
Revision as of 08:17, 5 May 2022
Author:
Mikael Häggström [note 1]
Contents
Gross examination
As per:
or mastectomy.
Microscopic evaluation
Characteristics of fibroepithelial tumor
Biplastic, having proliferation of both stromal and epithelial components,[notes 1] arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts).
Characteristics of fibroadenoma
Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.[1][2][3] Furthermore, the epithelial proliferation appears in a single terminal ductal unit and has duct-like spaces surrounded by a fibroblastic stroma. The basement membrane is intact.[4]
In fibroadenomas, glands may vary from relatively normal to completely compressed (at right in image), and possibly dilated.
Fibroadenoma with proliferation of the (variably eosinophilic) intralobular stroma, compressing and distorting the epithelium.
Characteristics of phyllodes tumor
In contrast to fibroadenomas, phyllodes tumors display a leaf-like architecture, and an increased stromal cellularity.[5] In needle biopsy specimens, phyllodes tumors can be diagnosed in a fibroepithelial tumor if there is prominent mitotic activity of ≥3 per 10 high power fields, or the finding of 3 or more of the following characteristic histologic features:[5]
- Stromal overgrowth
- Fat infiltration
- Stromal fragmentation
- Subepithelial stromal condensation
- Stromal nuclear pleomorphism
Further workup
After diagnosing a fibroepithelial tumor, still exclude another type of breast cancer, which may arise within it:[6]
Breast cancer types
| Cancer type | Histopathology | Image |
|---|---|---|
| Invasive ductal carcinoma (IDC) | Carcinomatous cells are seen below the basement membrane of lactiferous ducts. Otherwise, there are no specific histologic characteristics, essentially making it a diagnosis of exclusion.[7] | 
|
| Ductal carcinoma in situ (DCIS) | Malignant epithelial cells confined to the ductal system of the breast, without invasion through the basement membrane.[8] | 
|
| Invasive lobular carcinoma (ILC) | The "classic" pattern is round or ovoid cells with little cytoplasm in a single-file infiltrating pattern, sometimes concentrically giving a targetoid pattern. | .jpg)
|
| Lobular carcinoma in situ (LCIS) |
Cells have indistinct cell borders, pale cytoplasm, and uniform small nuclei with evenly distributed chromatin and inconspicuous nucleoli.[9] |
|
| Mucinous carcinoma | Extracellular mucin areas around tumor cells. | 
|
| Medullary carcinoma | Seemingly fused tumor cells (syncytial pattern), and a prominent lymphoid infiltrate. | 
|
| Solid papillary carcinoma | Larger tumor nests with fibrovascular cores. | 
|
Microscopic report
If, even after consultation, it is not clear whether a tumor is a fibroadenoma or phyllodes tumor, then it can be reported as a cellular fibroepithelial lesion or a fibroepithelial neoplasm.
A phyllodes tumor warrants a comment whether margins are positive or negative for tumor, whereas fibroadenoma does not need such comment.
Example report of fibroadenoma:
| Right breast, lumpectomy: Fibroadenoma. |
Notes
- ↑ The proliferation of two histological components is called "biplasia", from Latin bis (“twice”) and -plasia (“formation”), or "biphasic proliferation" (although the latter may refer to proliferation that has two chronological phases).
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ Tavassoli, F.A., ed (2003). World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs . Lyon: IARC Press. ISBN 978-92-832-2412-9.
- ↑ Jaya Ruth Asirvatham, M.B.B.S., Carlos C. Diez Freire, M.D., Cansu Karakas, M.D., Belinda Lategan, M.D., Nat Pernick, M.D., Emily S. Reisenbichler, M.D., Monika Roychowdhury, M.D., Mary Ann Gimenez Sanders, M.D, Ph.D., Gary Tozbikian, M.D., Hind Warzecha, M.D. Senior Authors: Julie M. Jorns, M.D., Shahla Masood. Breast nonmalignant, Fibroepithelial neoplasms, Fibroadenoma. Retrieved on 2019-11-04. Revised: 31 October 2019
- ↑ Rosen, PP. (2009). Rosen's Breast Pathology (3rd ed.). ISBN 978-0-7817-7137-5.
- ↑ . Fibroadenoma of the breast.
- ↑ 5.0 5.1 Gary Tozbikian, M.D.. Breast - Fibroepithelial tumors - Fibroadenoma. Last author update: 19 July 2021. Last staff update: 22 July 2021
- ↑ Richard L Kempson MD, Robert V Rouse MD. Fibroadenoma of the Breast. Stanford University School of Medicine. May 27, 2006
- ↑ Peter Abdelmessieh. Breast Cancer Histology. Medscape. Retrieved on 2019-10-04. Updated: May 24, 2018
- ↑ Siziopikou, Kalliopi P. (2013). "Ductal Carcinoma In Situ of the Breast: Current Concepts and Future Directions ". Archives of Pathology & Laboratory Medicine 137 (4): 462–466. doi:. ISSN 0003-9985.
- ↑ 9.0 9.1 Sucheta Srivastava. Breast - Noninvasive lobular neoplasia - LCIS classic. Topic Completed: 1 September 2017. Minor changes: 21 June 2020
Image sources
