Fibroepithelial tumor: Difference between revisions

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m Mikael Häggström moved page Fibroadenoma to Fibroepithelial tumor: Generalized
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Generalized
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==Microscopic evaluation==
==Microscopic evaluation==
[[File:Micrograph of a fibroadenoma.jpg|thumb|200px]]
[[File:Micrograph of a fibroadenoma.jpg|thumb|200px]]
===Characteristics===
===Characteristics of fibroadenoma===
Proliferation of both stromal and epithelial components,<ref group="notes">The proliferation of two histological components is called "biplasia", from ''Latin'' bis (“twice”) and -plasia (“formation”), or "biphasic proliferation"</ref> arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts). Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.<ref name="WHO">{{cite book |editor=Tavassoli, F.A. |editor2=Devilee, P. |title=World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs |publisher=IARC Press |location=Lyon |year=2003 |isbn=978-92-832-2412-9 |url=}}</ref><ref name="POW">{{cite web|title=Breast nonmalignant, Fibroepithelial neoplasms, Fibroadenoma|url=http://www.pathologyoutlines.com/topic/breastfibroadenoma.html|accessdate=2019-11-04|author=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}} Revised: 31 October 2019</ref><ref name="Rosen">{{cite book |author=Rosen, PP. |title=Rosen's Breast Pathology |isbn=978-0-7817-7137-5 |edition=3rd|year=2009 }}</ref> 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.<ref name="titleFibroadenoma of the breast">{{cite web |url=http://www.pathologyatlas.ro/fibroadenoma-breast-pathology.php |title=Fibroadenoma of the breast |access-date=2007-12-15 }}</ref>
Proliferation of both stromal and epithelial components,<ref group="notes">The proliferation of two histological components is called "biplasia", from ''Latin'' bis (“twice”) and -plasia (“formation”), or "biphasic proliferation"</ref> arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts). Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.<ref name="WHO">{{cite book |editor=Tavassoli, F.A. |editor2=Devilee, P. |title=World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs |publisher=IARC Press |location=Lyon |year=2003 |isbn=978-92-832-2412-9 |url=}}</ref><ref name="POW">{{cite web|title=Breast nonmalignant, Fibroepithelial neoplasms, Fibroadenoma|url=http://www.pathologyoutlines.com/topic/breastfibroadenoma.html|accessdate=2019-11-04|author=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}} Revised: 31 October 2019</ref><ref name="Rosen">{{cite book |author=Rosen, PP. |title=Rosen's Breast Pathology |isbn=978-0-7817-7137-5 |edition=3rd|year=2009 }}</ref> 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.<ref name="titleFibroadenoma of the breast">{{cite web |url=http://www.pathologyatlas.ro/fibroadenoma-breast-pathology.php |title=Fibroadenoma of the breast |access-date=2007-12-15 }}</ref>


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</gallery>
</gallery>


==Further workup==
===Further workup===
Exclude breast cancer, which may be present in a fibroadenoma:<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/breast/fibroadenoma/printable.html|title=Fibroadenoma of the Breast|author=Richard L Kempson MD, Robert V Rouse MD|website=Stanford University School of Medicine}} May 27, 2006</ref>
Exclude another breast cancer, which may be present in a fibroepithelial tumor:<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/breast/fibroadenoma/printable.html|title=Fibroadenoma of the Breast|author=Richard L Kempson MD, Robert V Rouse MD|website=Stanford University School of Medicine}} May 27, 2006</ref>
{{Breast cancer types}}
{{Breast cancer types}}
===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'''.
Example report of fibroadenoma:
{|class=wikitable
| Right breast, lumpectomy:<br>
Fibroadenoma.<br>
Negative for atypia or malignancy.
|}
{{Bottom}}
{{Bottom}}

Revision as of 14:28, 22 April 2022

Author: Mikael Häggström [note 1]

Gross examination

As per:

or mastectomy.

Microscopic evaluation

File:Micrograph of a fibroadenoma.jpg

Characteristics of fibroadenoma

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). 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]

Further workup

Exclude another breast cancer, which may be present in a fibroepithelial tumor:[5]

Breast cancer types

File:Pie chart of incidence and prognosis of histopathologic breast cancer types.png
Breast cancer types, with relative incidences and prognoses.
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.[6] File:Histopathology of invasive ductal carcinoma of the breast.jpg
Ductal carcinoma in situ (DCIS) Malignant epithelial cells confined to the ductal system of the breast, without invasion through the basement membrane.[7] File:DCIS - Intraductal carcinoma of the breast.jpg
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. File:Classic Invasive Lobular Carcinoma of the Breast (6813147194).jpg
Lobular carcinoma in situ (LCIS)
  • Monomorphic, loosely cohesive, slightly enlarged and evenly spaced cells that fill acini.[8]

Cells have indistinct cell borders, pale cytoplasm, and uniform small nuclei with evenly distributed chromatin and inconspicuous nucleoli.[8]

File:Histopathology of lobular carcinoma in situ.jpg
Mucinous carcinoma Extracellular mucin areas around tumor cells. File:Histopathology of mucinous invasive ductal carcinoma of the breast.jpg
Medullary carcinoma Seemingly fused tumor cells (syncytial pattern), and a prominent lymphoid infiltrate. File:Histopathology of medullary breast carcinoma.jpg
Solid papillary carcinoma Larger tumor nests with fibrovascular cores. File:Histopathology of solid papillary carcinoma.jpg

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.

Example report of fibroadenoma:

Right breast, lumpectomy:

Fibroadenoma.
Negative for atypia or malignancy.

Notes

  1. ↑ The proliferation of two histological components is called "biplasia", from Latin bis (“twice”) and -plasia (“formation”), or "biphasic proliferation"
  1. ↑ 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

  1. ↑ 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. 
  2. ↑ 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
  3. ↑ Rosen, PP. (2009). Rosen's Breast Pathology (3rd ed.). ISBN 978-0-7817-7137-5. 
  4. ↑ . Fibroadenoma of the breast.
  5. ↑ Richard L Kempson MD, Robert V Rouse MD. Fibroadenoma of the Breast. Stanford University School of Medicine. May 27, 2006
  6. ↑ Peter Abdelmessieh. Breast Cancer Histology. Medscape. Retrieved on 2019-10-04. Updated: May 24, 2018
  7. ↑ 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:10.5858/arpa.2012-0078-RA. ISSN 0003-9985. 
  8. ↑ 8.0 8.1 Sucheta Srivastava. Breast - Noninvasive lobular neoplasia - LCIS classic. Topic Completed: 1 September 2017. Minor changes: 21 June 2020

Image sources


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