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 2 Department of Surgery, Memorial Sloan-Kettering Cancer Center, NYC, NY
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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 - PowerPoint PPT Presentation
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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, NY2Department of Surgery, Memorial Sloan-Kettering Cancer Center, NYC, NY
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
• “…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
Juvenile Fibroadenoma, Variant Pattern (N=8/23)
Problems in Breast Pathology, Azzopardi, 1979 Case from our series
Mean Mitotic Count: 1.8 (0-7) Mean Mitotic Count: 3.1 (1-7)
Juvenile Fibroadenoma Benign Phyllodes Tumor
Original Diagnosis
Usual
FA
Cellula
r FA
Juve
nile F
A
FEL (w/ d
escri
ption
)
Benign
PT
LG M
align
ant P
T
Malign
ant P
T
Tubula
r Ade
noma
Adeno
sis0
5
10
15
20
25
14
810
2
13
13
1 1
Original
FEL
N
Reclassification
Usual
FA
Cellula
r FA
Juve
nile F
A
FEL (w/ d
escri
ption
)
Benign
PT
LG M
align
ant P
T
Malign
ant P
T
Tubula
r Ade
noma
Adeno
sis0
5
10
15
20
25
14
810
2
13
13
1 1
11
0
23
0
15
13
0 0
OriginalReclassified
FEL
N
Follow-Up
• 37 patients (41 FELs)– Mean follow-up: 40 months
• From less than a month to 278 months
2 Recurrent Cases
Months to Recur.
Gross Size (cm)
Borders Increased Stromal
Cellularity
Mitotic count per 10 HPF
Stromal atypia
BPT 12.2 8.5 Infiltrative Yes 4 Mild
LGMPT 18 N/A Infiltrative Yes 10 Moderate
• Information for index FEL
1992-2011: 46 Consecutive Fibroepithelial Lesions
Usual Fibroadenoma24%, N=11
Juvenile Fibroadenoma46%, N=21
Benign Phyllodes
Tumor26%, N=12
Malignant Phyllodes Tumor4%, N=2
Conclusions
• FEL in adolescents– Benign in two-thirds of cases
• Juvenile FA 46%, Usual FA 24%
Conclusions
• FEL in adolescents– Benign in two-thirds of cases
• Juvenile FA 46%, Usual FA 24%– Frequent stromal mitoses
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
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)
References1. Amerson, J.R., Cystosarcoma phyllodes in adolescent females. A report of seven
patients. Ann Surg, 1970. 171(6): p. 849-56. 2. Ashikari, R., J.H. Farrow, and J. O'Hara, Fibroadenomas in the breast of juveniles. Surg
Gynecol Obstet, 1971. 132(2): p. 259-62.3. Azzopardi, J.G., A. Ahmed, and R.R. Millis, Problems in breast pathology. Major
problems in pathology1979, Phildelphia: Saunders. xvi, 466 p.4. 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. 2961-70.5. Ewing, J., Neoplastic Diseases, 2nd ed.1927, Philidelphia: W. B. Saunders.6. Hertel, B.F., C. Zaloudek, and R.L. Kempson, Breast adenomas. Cancer, 1976. 37(6): p.
2891-905.7. Koerner, F.C.. Diagnostic Problems in Breast Pathology. 2009, Philadelphia: Saunders. 8. Mies, C. and P.P. Rosen, Juvenile fibroadenoma with atypical epithelial hyperplasia. Am
J Surg Pathol, 1987. 11(3): p. 184-90.9. Pike, A.M. and H.A. Oberman, Juvenile (cellular) adenofibromas. A clinicopathologic
study. Am J Surg Pathol, 1985. 9(10): p. 730-6.10. Rosen, P.P., Rosen's breast pathology. 3rd ed 2008, Philadelphia: Lippincott Williams &
Wilkins.11. Tavassoli, F.A., Pathology of the breast. 2nd ed1999, Stamford, Conn.: Appleton &
Lange. xi, 874 12. Wulsin, J.H., Large breast tumors in adolescent females. Ann Surg, 1960. 152: p. 151-9.