1 / 45

DS Ross, 1 DD Giri, 1 MM Akram, 1 JP Catalano, 1 KJ Van Zee, 2 E Brogi 1

Fibroepithelial Lesions in the Breast of Adolescent Females: A Clinicopathological Profile of 53 Cases. DS Ross, 1 DD Giri, 1 MM Akram, 1 JP Catalano, 1 KJ Van Zee, 2 E Brogi 1 1 Department of Pathology, Memorial Sloan-Kettering Cancer Center, NYC, NY

parson
Download Presentation

DS Ross, 1 DD Giri, 1 MM Akram, 1 JP Catalano, 1 KJ Van Zee, 2 E Brogi 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Fibroepithelial Lesions in the Breast of Adolescent Females:A Clinicopathological Profile of 53 Cases DS Ross,1 DD Giri,1 MM Akram,1 JP Catalano,1 KJ Van Zee,2 E Brogi1 1Department of Pathology, Memorial Sloan-Kettering Cancer Center, NYC, NY 2Department of Surgery, Memorial Sloan-Kettering Cancer Center, NYC, NY

  2. Background Fibroepithelial lesions (FELs): • Most common breast abnormality in adolescent females (< 18 years-old) • Referred to as: • Fetal fibroadenoma • Cellular fibroadenoma • Juvenile fibroadenoma • Giant fibroadenoma • Fibroadenoma variant • Tubular adenoma • Hamartoma • Cystosarcoma phyllodes • Phyllodes tumor

  3. Study Aims • Investigate the morphology and clinical behaviorof FELs in adolescents • Standardize the diagnostic terms used for FELs in adolescents based upon histologic criteria

  4. Study Design (1) • Search of MSKCC pathology database • Age < 18 years-old • Excision or mastectomy between 1992-2011 • Diagnosis of any fibroepithelial lesion • 7 FELs from a prior series were also included (1975-1983) Barrio AV et al. Ann Surg Oncol 2007

  5. Study Design (2) • 3 pathologists reviewed all available slides • Features noted: • Gross & microscopic size • Borders / margin status • Growth pattern • Stromal overgrowth • Stromal cellularity • Nuclear pleomorphism • Epithelial hyperplasia • Stromal cell mitoses • Smooth muscle actin-α (1A4, DAKO) staining performed on available tissue

  6. Study Design (3) • Patient information and clinical follow-up obtained from e-medical records • Age at presentation • Age at menarche • Race • Laterality • Family history

  7. Patient Population (1)

  8. Patient Population (1) *Information available for 26 patients **1 patient presented 12 mo prior to menarche

  9. Patient Population (2) *Pt undergoing US for ipsilateral FEL

  10. 53 Fibroepithelial Lesions

  11. Malignant Phyllodes Tumor (8%), Low Grade N=1,High Grade N=3 • Gross size*: 4 & 25cm • Infiltrative borders** • Stromal overgrowth • All high grade tumors *Gross size available for 2 cases **Borders assessable in 2 case

  12. Malignant Phyllodes Tumor (8%), Low Grade N=1,High Grade N=3 • Increased stromal cellularity • Moderate-marked stromal nuclear atypia • Mean mitotic count / 10 HPF: • Low grade: 10 • High grade: 17 (12-20)

  13. Benign Phyllodes Tumor, N=15 (28%) • Mean gross size*: 4 cm (1-13 cm) • Borders**: • Circumscribed: 11/14 (79%) • Infiltrative: 3/14 (21%) • Stromal overgrowth: 13% (2/15) • Growth pattern • Intracanalicular: 10/15 (67%) • Pericanalicular: 5/15 (33%) *Gross size available for 11 cases **Borders assessable in 14 cases

  14. Benign Phyllodes Tumor, N=15 (28%) • Increased stromal cellularity • Mild-moderate stromal nuclear atypia • Epithelial hyperplasia: 7/15 (47%) • Mean mitotic count / 10 HPF: 3.1 (1-7)

  15. Benign Phyllodes Tumor, N=15 (28%) • Increased stromal cellularity • Mild-moderate stromal nuclear atypia • Epithelial hyperplasia: 7/15 (47%) • Mean mitotic count / 10 HPF: 3.1 (1-7)

  16. Benign Phyllodes Tumor, N=15 (28%) • Increased stromal cellularity • Mild-moderate stromal nuclear atypia • Epithelial hyperplasia: 7/15(47%) • Mean mitotic count / 10 HPF: 3.1 (1-7)

  17. Usual Fibroadenoma, N=11 (21%) • Mean gross size: 2.6 cm (0.7-4.5 cm) • Circumscribed borders • Growth pattern • Intracanalicular: 10/11 (91%) • Pericanalicular: 1/11 (9%)

  18. Usual Fibroadenoma, N=11 (21%) • Increased stromal cellularity: 3/11(27%) • No stromal nuclear atypia • Epithelial hyperplasia: 2/11(18%) • Mean mitotic count / 10 HPF: 1.3 (0-6) • 6 mit / 10 HPF in pt pregnant 1y before; FA w/ focal lactational changes • Mean mitotic count w/o above pt is 0.8

  19. Usual Fibroadenoma, N=11 (21%) • Increased stromal cellularity: 3/11 (27%) • No stromal nuclear atypia • Epithelial hyperplasia: 2/11(18%) • Mean mitotic count / 10 HPF: 1.3 (0-6) • 6 mit / 10 HPF in pt pregnant 1y before; FA w/ focal lactational changes • Mean mitotic count w/o above pt is 0.8

  20. Usual Fibroadenoma, N=11 (21%) • Increased stromal cellularity: 3/11 (27%) • No stromal nuclear atypia • Epithelial hyperplasia: 2/11 (18%) • Mean mitotic count / 10 HPF: 1.3 (0-6) • 6 mit / 10 HPF in pt pregnant 1y before; FA w/ focal lactational changes • Mean mitotic count w/o above pt is 0.8

  21. Juvenile Fibroadenoma, N=23 (43%) • Mean gross size*: 3.1 cm (0.5-7 cm) • Circumscribed borders • Growth pattern • Pericanalicular • Floridly glandular • Retention of lobular structure *Gross size available for 22 cases

  22. Juvenile Fibroadenoma, N=23 (43%) • Increased stromal cellularity: 14/23 (61%) • No stromal nuclear atypia • Epithelial hyperplasia: 7/23 (30%) • Mean mitotic count / 10 HPF: 1.8 (0-7)

  23. Juvenile Fibroadenoma, N=23 (43%) • Increased stromal cellularity: 14/23 (61%) • No stromal nuclear atypia • Epithelial hyperplasia: 7/23 (30%) • Mean mitotic count / 10 HPF: 1.8 (0-7)

  24. Juvenile Fibroadenoma, N=23 (43%) • Increased stromal cellularity: 14/23 (61%) • No stromal nuclear atypia • Epithelial hyperplasia: 7/23(30%) • Mean mitotic count / 10 HPF: 1.8 (0-7)

  25. Juvenile Fibroadenoma, N=23 (43%) SMAα

  26. Juvenile Fibroadenoma • A distinctive type of FA • Collagenized and cellular stroma • Pericanalicular growth pattern • Lobular arrangement • +/- Florid ductal hyperplasia

  27. Juvenile Fibroadenoma: Variation in Morphology

  28. Fibroadenoma Variant • Characterized by collagenous and cellular stroma • “…related to FAs in structure and composition but show sufficient difference to raise problems in precise dx and classification” • Differential dx often includes a phyllodes tumor Azzopardi, 1979

  29. Juvenile Fibroadenoma, Variant Pattern (N=8/23) Problems in Breast Pathology, Azzopardi, 1979 Case from our series

  30. Juvenile Fibroadenoma: Variant Pattern & Intratumoral Heterogeneity (N=4/23)

  31. Juvenile Fibroadenoma: Variant Pattern & Intratumoral Heterogeneity (N=4/23)

  32. Distinguishing Features Juvenile Fibroadenoma Benign Phyllodes Tumor

  33. Distinguishing Features Juvenile Fibroadenoma Benign Phyllodes Tumor

  34. Distinguishing Features Juvenile Fibroadenoma Benign Phyllodes Tumor Mean Mitotic Count: 1.8 (0-7) Mean Mitotic Count: 3.1 (1-7)

  35. Original Diagnosis

  36. Reclassification

  37. Follow-Up • 37 patients (41 FELs) • Mean follow-up: 40 months • From less than a month to 278 months

  38. 2 Recurrent Cases • Information for index FEL

  39. 1992-2011: 46 Consecutive Fibroepithelial Lesions

  40. Conclusions • FEL in adolescents • Benign in two-thirds of cases • Juvenile FA 46%, Usual FA 24%

  41. Conclusions • FEL in adolescents • Benign in two-thirds of cases • Juvenile FA 46%, Usual FA 24% • Frequent stromal mitoses

  42. Conclusions • FEL in adolescents • Benign in two-thirds of cases • Juvenile FA 46%, Usual FA 24% • Frequent stromal mitoses • Juvenile FA is the most common FEL • Distinctive morphology

  43. Conclusions • FEL in adolescents • Benign in two-thirds of cases • Juvenile FA 46%, Usual FA 24% • Frequent stromal mitoses • Juvenile FA is the most common FEL • Distinctive morphology • +/- Stromal expansion and intratumoral heterogeneity (fibroadenoma variant)

  44. References • Amerson, J.R., Cystosarcoma phyllodes in adolescent females. A report of seven patients. Ann Surg, 1970. 171(6): p. 849-56. • Ashikari, R., J.H. Farrow, and J. O'Hara, Fibroadenomas in the breast of juveniles. Surg Gynecol Obstet, 1971. 132(2): p. 259-62. • Azzopardi, J.G., A. Ahmed, and R.R. Millis, Problems in breast pathology. Major problems in pathology1979, Phildelphia: Saunders. xvi, 466 p. • Barrio, A.V., et al., Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol, 2007. 14(10): p. 2961-70. • Ewing, J., Neoplastic Diseases, 2nd ed.1927, Philidelphia: W. B. Saunders. • Hertel, B.F., C. Zaloudek, and R.L. Kempson, Breast adenomas. Cancer, 1976. 37(6): p. 2891-905. • Koerner, F.C.. Diagnostic Problems in Breast Pathology. 2009, Philadelphia: Saunders. • Mies, C. and P.P. Rosen, Juvenile fibroadenoma with atypical epithelial hyperplasia. Am J Surg Pathol, 1987. 11(3): p. 184-90. • Pike, A.M. and H.A. Oberman, Juvenile (cellular) adenofibromas. A clinicopathologic study. Am J Surg Pathol, 1985. 9(10): p. 730-6. • Rosen, P.P., Rosen's breast pathology. 3rd ed 2008, Philadelphia: Lippincott Williams & Wilkins. • Tavassoli, F.A., Pathology of the breast. 2nd ed1999, Stamford, Conn.: Appleton & Lange. xi, 874 • Wulsin, J.H., Large breast tumors in adolescent females. Ann Surg, 1960. 152: p. 151-9.

More Related