2008;190 (1): 214-8. Fine-needle aspiration of gray zone lesions of the breast: fibroadenoma versus ductal carcinoma. Mousa-Doust D, Dingee CK, Chen L, Bazzarelli A, Kuusk U, Pao JS, Warburton R, McKevitt EC. Histopathology of fibroadenoma of the breast. The site is secure. +/-"Stromal overgrowth" = large area where there is a 'loss of glands'. We found that 15 cases fulfilled the diagnostic criteria of CFA, in which 7 (46.7 %) had an FNA diagnosis of "suspicious for malignancy" or "indeterminate" while only 2 NCFA cases had that of "indeterminate" (p = 0.004). 1 It is encountered in women usually before the age of 30 (commonly between 10-18 years of age), 2 although its occurrence in postmenopausal women, especially those receiving estrogen replacement therapy has been documented. sharing sensitive information, make sure youre on a federal interlobular stromal mucopolysaccharides (, Lacks glandular elements (versus myxoid fibroadenoma), Stromal condensation around glandular structures, Stromal mitotic activity (7 - 8/10 high power fields), Most common benign tumor arising in the breast. The mediator complex subunit 12 (MED12) gene is the most common gene involved in the pathogenesis of fibroadenoma. Am J Clin Pathol. Complex fibroadenoma is a sub type of fibroadenoma harbouring one or more of the following features: epithelial calcifications papillary apocrine metaplasia sclerosing adenosis and cysts larger than 3 mm. The myoepithelial layer is hard to see at times. Epub 2014 Feb 8. 2015 Aug;4(4):312-21. doi: 10.3978/j.issn.2227-684X.2015.06.04. Arch Pathol Lab Med. Epithelial component often not compressed - as in fibroadenoma. Breast, right, 2:00 zone 2, ultrasound guided core biopsy: Well developed leaf-like architecture, with accompanied increased stromal cellularity, Prominent mitotic activity 3/10 high power fields or the finding of 3 or more characteristic histologic features (stromal overgrowth, fat infiltration, stromal fragmentation, subepithelial stromal condensation,
A simple fibroadenoma does not raise your risk for breast cancer. Disclaimer. Complex fibroadenomas are smaller and appear at an older age. PMID: 11345838 (Free), Long-term risk of breast cancer in women with fibroadenoma. Powell CM, Cranor ML, Rosen PP. HHS Vulnerability Disclosure, Help Contributed by Andrey Bychkov, M.D., Ph.D. Fibroadenomatoid changes (sclerosing lobular hyperplasia, fibroadenomatoid mastopathy), Benign biphasic tumor composed of a proliferation of both glandular epithelial and stromal components of the terminal duct lobular unit, Most common breast tumor in adolescent and young women, Benign biphasic tumor comprised of glandular epithelium and specialized interlobular stroma of the terminal ductal lobular unit (, Can show a spectrum of histologic appearances; generally uniform in stromal cellularity and distribution of glandular and stromal elements within a given lesion (an important distinction from phyllodes tumor), Fibroadenomas with hypercellular stroma and prominent intracanalicular pattern can show morphologic overlap with benign phyllodes tumors, especially in needle biopsy specimens, Fibroadenoma, usual type fibroadenoma, adult type fibroadenoma, Most common benign tumor of the female breast, Can occur at any age, median age of 25 years (, Juvenile fibroadenoma generally occurs in younger and adolescent patients < 20 years; reported in children at a very young age (, Complex fibroadenoma reported in older patients with median age between 35 - 47 years (, Increased relative risk (1.5 - 2.0) of subsequent breast cancer; relative risk is higher (3.1) in complex fibroadenomas; no increased risk for juvenile fibroadenoma (, Can occur in axilla accessory breast tissue, Increased risk associated with cyclosporine immunosuppression (, Often presents as painless, firm, mobile, slow growing mass, Usually solitary, can be multiple and bilateral, Usually less than 3 cm in diameter but may grow to large size (, Histologic examination of involved tissue, Sonographically seen usually as a round or oval mass, smooth margins with hypo or isoechoic features (, Can be associated with calcifications, especially in postmenopausal patients, 16 year old girl with 28 cm left breast mass (, 17 year old girl with recurrent juvenile fibroadenoma (, 18 year old woman with mass in axilla accessory breast tissue (, 35 year old woman with left breast mass (, 37 year old woman with increased uptake of breast mass on PET scan (, 44 year old woman with bilateral breast masses (, Management depends on patient risk factors and patient preference, Conservative management with close clinical followup, especially if concordant radiology findings (, Local surgical excision, especially if symptomatic (, If atypia / neoplasia is found within a fibroadenoma, the surgical and systemic therapeutic management is specific and appropriate to the primary atypical / neoplastic lesion, Firm, well circumscribed, ovoid mass with bosselated surface, lobulations bulge above the cut surface, slit-like spaces, May have mucoid or fibrotic appearance; can be calcified, Biphasic tumor, proliferation of both glandular and stromal elements, 2 recognized growth patterns (of no clinical significance, both patterns may occur within a single lesion), Intracanalicular: glands are compressed into linear branching structures by proliferating stroma, Pericanalicular: glands retain open lumens but are separated by expanded stroma, Glandular elements have intact myoepithelial cell layer, Often associated with usual type ductal hyperplasia, apocrine metaplasia, cyst formation or squamous metaplasia, Rare mitotic activity can be observed in the glandular component, has no clinical significance, Generally uniform cellularity within a given lesion, Collagen and bland spindle shaped stromal cells with ovoid or elongated nuclei, Usually no mitotic activity; rare mitotic activity may be present in young or pregnant patients (, Stroma may show myxoid change or hyalinization, Rarely benign heterologous stromal elements (adipose, smooth muscle, osteochondroid metaplasia), Fibroadenomas may be involved by mammary neoplasia (e.g. Approximately 16% of fibroadenomas are complex. Background: To determine the cytomorphological features of complex type fibroadenoma (CFA), we reviewed fine needle aspiration (FNA) cytology with correlation to its histopathology findings, and compared them with non-complex type fibroadenoma (NCFA). Stroma is generally more sparse than in conventional fibroadenoma. Florid usual ductal hyperplasia in radial scar, Sign up for our What's New in Pathology e-newsletter, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). 8600 Rockville Pike H&E stain. In this review, the pathology of the fibroadenoma and phyllodes tumour is revisited, with emphasis on diagnostic and management implications. Fibroadenoma is the most common benign tumor of the female breast. document.write('')
Epidemiology. Cancer. sharing sensitive information, make sure youre on a federal This website is intended for pathologists and laboratory personnel but not for patients. Int J Environ Res Public Health. epithelial calcifications ; Clotet, M.; Torrubia, S.; Gomez, A.; Guerrero, R.; de las Heras, P.; Lerma, E. (Oct 2007). Results: Carcinoma Breast-Like Giant Complex Fibroadenoma: A Clinical Masquerade. Epub 2022 May 31. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. ; Menet, E.; Tardivon, A.; Cherel, P.; Vanel, D. (Apr 2005). Results: RSS2.0, bland-looking mammary spinlde cell tumors, molecular classification of mammary carcinoma. 2014 Feb;144(1):205-12. doi: 10.1007/s10549-014-2862-5. Clipboard, Search History, and several other advanced features are temporarily unavailable. radial scar or papilloma) that is identified on imaging, May show enhancement on magnetic resonance imaging (, Associated with 1.5 - 2 times increased risk for subsequent breast cancer (, Risk may be slightly higher for patients with a positive family history of breast cancer (, Indicator of general breast cancer risk rather than direct precursor lesion, 30 year old woman with immature-like usual ductal hyperplasia in a fibroadenoma (, 75 year old woman with malignant phyllodes tumor with liposarcomatous differentiation and intraductal hyperplasia (, Usual ductal hyperplasia within gynecomastia-like changes of the female breast (, Proliferation of cells of luminal and myoepithelial lineages, occasionally with intermixed apocrine cells, Mild variation in cellular and nuclear size and shape, Relatively small ovoid nuclei with frequent elongated or asymmetrically tapered (pear shaped) forms, Lightly granular euchromatic chromatin and small nucleoli, Frequent longitudinal nuclear grooves (coffee bean-like) and occasional nuclear pseudoinclusions, Many examples demonstrate cellular maturation, where the cells shrink as they progress from a basal location to the center of the proliferation, becoming small and nearly pyknotic, Eosinophilic, nonabundant cytoplasm with indistinct cell borders, Cohesive proliferation with haphazard, jumbled cell arrangement or streaming growth pattern, Fenestrated, solid and occasional micropapillary patterns, Irregular slit-like fenestrations are common, especially along periphery, Cells run parallel to the edges of secondary spaces and do not exhibit a polarized orientation (this contrasts with the cells of atypical ductal hyperplasia and ductal carcinoma in situ, which have apical-basal polarity and radially orient their apical poles toward the spaces), Typically focal in a background of conventional pattern usual ductal hyperplasia, Short stubby papillae of roughly uniform height, Cytologic features of usual ductal hyperplasia, Cellular maturation present, with tips of papillae formed by tight knots of mature cells, Larger immature basal hyperplastic cells predominate or are increased beyond their usual 1 - 2 cell layers and are instead several cell layers thick, Most often encountered in fibroepithelial lesions with cellular stroma, Florid usual ductal hyperplasia can rarely demonstrate central necrosis, Typically occurs within a radial scar / complex sclerosing lesion, nipple adenoma or juvenile papillomatosis, Florid usual ductal hyperplasia within radial scars / complex sclerosing lesions can occasionally have more active appearing nuclei with mild nuclear enlargement, Other cytologic and architectural features of usual ductal hyperplasia remain intact, Sample may be moderately to highly cellular, Sheets and cohesive clusters of bland ductal cells with regular spacing and associated myoepithelial cells (, Lack of significant nuclear overlap / crowding, Ductal cell nuclei with finely granular chromatin and inconspicuous small nucleoli, Naked myoepithelial cell nuclei in the background may be present, Activating mutations in the PI3K / AKT / mTOR pathway may play a role in pathogenesis (, Round to oval nuclei with homogeneous, fine and hyperchromatic chromatin; inconspicuous nucleoli; and smooth nuclear contours, Increased amounts of pale eosinophilic to amphophilic cytoplasm with conspicuous cell borders, Cellular polarization around luminal and secondary spaces, Atypical architectural patterns formed by polarized growth (cribriform spaces, Roman arches, trabecular bars, micropapillae), Moderate nuclear enlargement throughout the proliferation, Abnormal chromatin, which may be hyperchromatic, cleared and clumped or coarsely granular, Solid epithelial proliferation showing marked expansion of multiple circumscribed duct spaces (, Thin fibrovascular cores punctuate the proliferation, with cellular palisading around the cores, Myoepithelial cells often sparse or absent along fibrovascular cores, Nuclei may superficially resemble those in usual ductal hyperplasia but demonstrate greater populational uniformity, are slightly larger and have abnormal chromatin, Often positive for neuroendocrine markers (, No change in risk compared to control populations, HMWCK mosaic positive / ER diffusely positive, HMWCK mosaic positive / ER heterogeneously positive. Multinucleated stromal giant cells in mammary fibroepithelial neoplasms. Limite G, Esposito E, Sollazzo V, Ciancia G, Formisano C, Di Micco R, De Rosa D, Forestieri P. BMC Res Notes. The border is well-circumscribed where seen. Focally, the lesion approaches the inked margin; partial lesion transection cannot be excluded. Left breast, at 5 o'clock and 4 cm from the nipple, ultrasound core needle biopsy: Breast tissue with pseudoangiomatous stromal hyperplasia, Hemorrhagic, soft, interanastomosing vascular channels containing red blood cells with invasion into breast parenchyma, Papillary endothelial growth and hyperchromatic endothelial cells, Neoplastic clonal tumors with characteristic genetic change (del 13q14) (this can be demonstrated by loss of Rb protein immunohistochemistry in myofibroblastoma), Solid mass of spindle cells which surrounds and involves ducts and lobules, Tumor cells arranged in long fascicles without significant clefting, nuclear, CD34-, CD31-, nuclear beta catenin+, AE1 / AE3+. No cytologic atypia is present. No stromal overgrowth is seen. We consider the term merely descriptive. Analyses were performed overall, within subgroups of involution status, with other demographic characteristics (age, year of biopsy, indication for biopsy, and family history), and with histologic characteristics, including overall impression [nonproliferative disease, proliferative disease without atypia (PDWA), or atypical hyperplasia]. More frequent in young and black patients. The https:// ensures that you are connecting to the Ann Surg Oncol. No large cysts are seen. The term fibroadenoma combines the words "fibroma," meaning a tumor made up of fibrous tissue, and "adenoma," a tumor of gland tissue. Complex Breast Fibroadenoma; Complex Fibroadenoma; Complex Fibroadenoma of Breast; Complex Fibroadenoma of the Breast: Definition. (b) Ultrasound shows a well-defined oval nodule in the right axilla which was confirmed to be a fibroadenoma on core biopsy. Gland Surg. 2015 May 15;121(10):1548-55. doi: 10.1002/cncr.29243. This model affords the opportunity for investigators to study the process of mammary carcinogenesis over a very short latency and to investigate early events in this process. Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Cureus. Benign breast disease and the risk of breast cancer. and transmitted securely. atypical ductal hyperplasia, atypical lobular hyperplasia) often as a result of spread from an adjacent lesion, Similar structure but with prominent myxoid stromal change composed of abundant pale, blue-gray extracellular matrix material, Cysts > 3 mm, sclerosing adenosis, epithelial microcalcifications or papillary apocrine metaplasia (, Increased epithelial hyperplasia with gynecomastoid-like micropapillary projections, Usual (adult type) fibroadenoma: biphasic population composed of abundant spindle stromal cells and naked nuclei, epithelium arranged in antler horn clusters or fenestrated honeycomb sheets (, Myxoid fibroadenoma: high cellularity with stroma and epithelium embedded in myxoid background (, Cellular variant of fibroadenoma shows higher rates of mutation in. ; Chen, YY. This site needs JavaScript to work properly. They fall under the broad group of adenomatous breast lesions. Usual ductal hyperplasia is associated with a slight increase in risk (1.5 - 2 times) for subsequent breast cancer. Management of fibroadenoma of the breast. Contain proliferative epithelium which outside and inside a fibroadenoma is associated with an increased risk of malignancy. 2022 May 17;19(10):6093. doi: 10.3390/ijerph19106093. Lerwill MF. Disclaimer. official website and that any information you provide is encrypted Only one malignancy, an invasive lobular carcinoma, was found in 63 complex fibroadenomas (1.6%). Most common benign tumor of the female breast. Site Map In the male breast, fibroepithelial tumors are very rare, . FOIA Aust N Z J Surg. Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Cureus. Webpathology.com: A Collection of Surgical Pathology Images . At a mean follow-up of 2 years, we found a low incidence of malignancy in complex fibroadenomas. To determine the cytomorphological features of complex type fibroadenoma (CFA), we reviewed fine needle aspiration (FNA) cytology with correlation to its histopathology findings, and compared them with non-complex type fibroadenoma (NCFA). 1999 Aug;16(3):235-47. Subtypes. However, we cannot answer medical or research questions or give advice. N Engl J Med. Stanton SE, Gad E, Ramos E, Corulli L, Annis J, Childs J, Katayama H, Hanash S, Marks J, Disis ML. Materials and methods: Board review style answer #1. May be either adult or juvenile type. We evaluated the clinical and imaging presentations of complex fibroadenomas; com-pared pathology at core and exci sional biopsy; and cont rasted age, pathology, and size of com- Printed from Surgical Pathology Criteria: Stroma compresses ducts into slit-like spaces, Myoepithelial cells and myofibroblasts not prominent, May be hyalinized, especially in older patients, Ducts lined by epithelial and myoepithelial cells, May be seen at least focally in half of cases, "Complex fibroadenoma" has been applied if any of the following are present, Invasive carcinoma is present in adjacent breast in half of patients with in situ carcinoma in a fibroadenoma, Mean age of cases with carcinoma is in 40's, Tumors >500 g or disproportionally large compared to rest of breast, More frequent in young and black patients, Smooth muscle actin typically negative to focal/weak, Complex fibroadenoma (approximately 3 times risk), Atypical ductal hyperplasia (no family history), Atypical ductal hyperplasia, if history of carcinoma in primary relatives, Rosen PP, Oberman HA. Epub 2010 Jun 22. FOIA Can occur at any age, median age of 25 years ( J R Coll Surg Edinb 1988;33:16 ) Juvenile fibroadenoma generally occurs in younger and adolescent patients < 20 years; reported in children at a very young age ( Am J Surg Pathol . "Radiologic evaluation of breast disorders related to pregnancy and lactation.". Over time, a fibroadenoma may grow in size or even shrink and disappear. It increases in size during pregnancy and tends to regress with age. Tumors of the Mammary Gland, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 7, 1993. The injection of sexually immature female rats with 1-methyl-1-nitrosourea results in a rapid induction of premalignant and malignant mammary gland lesions within 35 days of carcinogen administration. It is important to recognize the disease entity and characteristic cytomorphological findings of CFA to reach accurate FNA diagnosis of breast lesions. The .gov means its official. Conclusion: Approximately 16% of fibroadenomas are complex. Complex fibroadenomas are a fibroadenoma subtype harboring one or more complex features. 2021 Jan 10;13(1):e12611. Four variants are described by the Washington Manual:[7], Considered a variant of fibroadenoma by many authorities:[8], Breast - Tubular Adenoma - low power (SKB), Breast - Tubular Adenoma - medium power (SKB), Breast - Tubular Adenoma - high power (SKB), Breast - Tubular Adenoma with lactational change (SKB). LM DDx. Our study was to determine the select cytologic features that can accurately distinguish FA from PT. Franklin County, North Carolina .
Complex fibroadenoma is a sub type of fibroadenomaharboring one or more of the following features: Complex fibroadenomas tend to occur in older patients (median age, 47 years) compared with simple fibroadenomas (median age, 28.5 years). Please enable it to take advantage of the complete set of features! 2020 Dec;53(3):439-441. doi: 10.1055/s-0040-1716187. Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Cureus. 8600 Rockville Pike The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Dehner LP, Hill DA, Deschryver K. Pathology of the breast in children, adolescents, and young adults. stromal nuclear pleomorphism) is predictive of phyllodes tumor (versus fibroadenoma) in core
Visual survey of surgical pathology with 11,912 high-quality images of benign and malignant neoplasms & related entities. MeSH Complex type; Fibroadenoma; Fine needle aspiration. There are no clear cut mammographic or sonographic features that distinguish complex from simple fibroadenomas. FNA of CFA can lead to erroneous or indeterminate interpretation, due to proliferative and/or hyperplastic changes of ductal epithelium with or without atypia. 1994 Jul 7;331(1):10-5. Cardeosa G. Clinical breast imaging, a patient focused teaching file. Systematic review of fibroadenoma as a risk factor for breast cancer. Musio F, Mozingo D, Otchy DP. There are numerous reports that the general risk of developing cancer in the breast parenchyma is elevated among women with complex fibroadenomas; these women are 3.1-3.7 times more likely to develop breast cancer than women in the general population (compared with a relative risk of 1.9 times in women with non-complex fibroadenomas). The luminal cell is epithelial. 2022 Apr 9;13(1):71. doi: 10.1186/s13244-022-01214-7. This patient had atypical lobular hyperplasia at core needle biopsy. Usual ductal hyperplasia[TIAB] free full text[SB], Benign intraductal proliferation of progenitor epithelial cells with varying degrees of solid or fenestrated growth, Streaming growth pattern with fenestrated spaces and lack of cellular polarity, Immunoreactive for high molecular weight cytokeratins, Associated with slight increase in subsequent breast cancer risk (1.5 - 2 times), Also called epithelial hyperplasia, intraductal hyperplasia, hyperplasia of usual type, ductal hyperplasia without atypia, epitheliosis, Most significant finding in 20% of benign breast biopsies (, Proliferation of CK5+ progenitor cells that can differentiate along glandular or myoepithelial lineages; glandular progenitor cells appear to predominate and show intermediate levels of differentiation (, Diagnosis by histologic examination of tissue removed via biopsy or surgical excision, No specific mammographic findings; occasional examples are associated with microcalcifications, Can involve an underlying lesion (e.g. Objective: Background Fibroepithelial lesions of the breast include fibroadenoma (FA) and phyllodes tumor (PT). Within this cohort, women who had fibroadenoma were compared to women who did not have fibroadenoma. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland.It derives its name from the architectural Pleomorphism (variable appearance) seen by light . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Women with complex fibroadenomas may therefore be managed with a conservative approach, similar to the approach now recommended . More frequent in young and black patients. 3 Giant (juvenile or cellular) fibroadenoma is a . incidental finding on histologic examination), Amorphous or pleomorphic clustered microcalcifications; architectural distortion or circumscribed to spiculated mass on mammogram (, Associated with increased mammographic breast density (, Heterogeneous echogenicity, irregular and ill defined mass, focal acoustic shadowing may be seen on ultrasound (, Small (< 1 cm) mass with benign kinetics on MRI (, As a single feature, increased risk of cancer of 1.5 - 2x, as seen with proliferative, 2x higher risk of breast cancer with increased, Does not provide further risk stratification in the presence of other proliferative disease / atypical hyperplasias (, Can mimic malignancy clinically and radiologically, 46 year old woman with sclerosing adenosis with mammogram and cytology mimicking malignancy (, 73 year old woman with sclerosing adenosis and coexisting ductal carcinoma in situ (, 82 year old woman with sclerosing adenosis in sentinel axillary lymph nodes (, Presence of sclerosing adenosis alone in a core biopsy does not require surgical excision, Coexisting atypia will typically prompt surgical consultation, Variable depending on extent of involvement and calcifications, May be indistinguishable from surrounding breast tissue, Multinodular, ill defined, cuts with increased resistance due to fibrosis, Gritty due to frequent calcifications but no chalky yellow white foci or streaks as seen in, Circumscribed to ill defined white, fibrotic mass if nodular adenosis / adenosis tumor, Low power: increase in glandular elements plus stromal fibrosis / sclerosis that distorts and compresses glands, Maintains lobular architecture at low power with rounded and well defined nodules, Centrally is more cellular with distorted and compressed ductules; peripherally has more open or dilated ductules, Often has microcalcifications, due to calcification of entrapped secretions, Preservation of luminal epithelium and peripheral myoepithelium (2 cell layer) with surrounding basement membrane, Myoepithelial cells may vary from being prominent to indistinct on routine H&E staining, Myoepithelial cells are readily apparent via immunohistochemistry, even if difficult to identify on H&E, Rarely penetrates walls of blood vessels or perineural spaces, Epithelium may be involved by proliferative, atypical lesions or in situ carcinoma, If involved by atypia or in situ carcinoma, If florid and overtly non-lobulocentric / (pseudo) infiltrative into fat or stroma, Conspicuous myoepithelial cells with attenuated epithelial cells can appear like stands of single cells and mimic invasive lobular carcinoma, Atypical apocrine metaplasia: nuclear atypia / rare mitosis (, Moderate to markedly cellular, with small to large groups of benign epithelial cells in acinar sheets / cohesive groups / tubules and scattered individual epithelial cells, Also small foci of dense hyalinized stroma (, Tubules may have an angular configuration (, Fibrocystic changes including sclerosing adenosis with microcalcifications, Haphazardly distributed glands (lacks lobulocentric pattern), Lacks myoepithelium but has intact basement membrane, Nodular growth may mimic nodular adenosis / adenosis tumor, Uniform, closely packed tubules (lacks significant distortion by fibrosis), May be difficult to morphologically distinguish from florid sclerosing adenosis with marked distortion and/or involvement by atypia or, More widely spaced tubules with single epithelial layer. Silverman JS, Tamsen A. Mammary fibroadenoma and some phyllodes tumour stroma are composed of CD34+ fibroblasts and factor XIIIa+ dendrophages. Chapter 5 looks at special problems in breast cancer including bilateral breast cancer, cancer of the male breast, the unknown primary presenting with axillary lymphadenopathy, Paget's disease of the nipple-areola complex and phyllodes tumour of the breast.