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Fibroepithelial Lesions of the Breast

  • Danielle Fortuna
  • Adam Toll
  • Juan P. Palazzo
Chapter

Abstract

Fibroepithelial lesions of the breast are a group of biphasic neoplasms, lesions characterized by proliferation of both mesenchymal and epithelial elements. On the whole, these lesions constitute one of the most commonly encountered neoplasms in routine practice and span the spectrum of biological significance from benign to malignant. Prototypic examples of these neoplasms include the fibroadenoma (FA) and phyllodes tumor (PT), with the phyllodes tumor requiring further subtyping into benign, borderline/intermediate, and malignant in accordance with the World Health Organization (WHO) recommendations [1]. These specific lesions within this group have diverse clinical behavior, natural history, and therapeutic implications, despite showing considerable morphologic overlap at times. Since many of the initial diagnoses are rendered in core biopsies, this can potentially compound a diagnostic challenge, and clinical-pathological correlation is imperative. Here, we present a review of fibroepithelial lesions with an emphasis on morphology and distinguishing features. Hamartomas, also considered a fibroepithelial lesion, is discussed below under the differential diagnosis section of fibroadenoma.

Keywords

Fibroepithelial lesion Fibroadenoma Phyllodes Hamartoma Breast fibroepithelial lesions Fibroadenoma Phyllodes tumor Differential diagnosis 

References

  1. 1.
    Tan P, Tse G, Lee A, Simpson J, Hanby A. Fibroepithelial tumors. In: Lakhani S, Ellis I, Schnitt S, Tan P, van de Vijver M, editors. WHO classifications of tumors of the breast. 4th ed. Lyon: IARC Press; 2012. p. 142–7.Google Scholar
  2. 2.
    Darwish A, Nasr AO, El Hassan LA, Fahal AH. Cyclosporine-A therapy-induced multiple bilateral breast and accessory axillary breast fibroadenomas: a case report. J Med Case Rep. 2010;4:267.CrossRefGoogle Scholar
  3. 3.
    Weinstein SP, Orel SG, Collazzo L, Conant EF, Lawton TJ, Czerniecki B. Cyclosporin A-induced fibroadenomas of the breast: report of five cases. Radiology. 2001;220(2):465–8.CrossRefGoogle Scholar
  4. 4.
    Yang X, Kandil D, Cosar EF, Khan A. Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med. 2014;138(1):25–36.CrossRefGoogle Scholar
  5. 5.
    Cericatto R, Pozzobon A, Morsch DM, Menke CH, Brum IS, Spritzer PM. Estrogen receptor-alpha, bcl-2 and c-myc gene expression in fibroadenomas and adjacent normal breast: association with nodule size, hormonal and reproductive features. Steroids. 2005;70(3):153–60.CrossRefGoogle Scholar
  6. 6.
    Sapino A, Bosco M, Cassoni P, Castellano I, Arisio R, Cserni G, et al. Estrogen receptor-beta is expressed in stromal cells of fibroadenoma and phyllodes tumors of the breast. Mod Pathol. 2006;19(4):599–606.CrossRefGoogle Scholar
  7. 7.
    Goel NB, Knight TE, Pandey S, Riddick-Young M, de Paredes ES, Trivedi A. Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics. 2005;25(6):1547–59.CrossRefGoogle Scholar
  8. 8.
    Kuijper A, Mommers EC, van der Wall E, van Diest PJ. Histopathology of fibroadenoma of the breast. Am J Clin Pathol. 2001;115(5):736–42.CrossRefGoogle Scholar
  9. 9.
    Yasir S, Gamez R, Jenkins S, Visscher DW, Nassar A. Significant histologic features differentiating cellular fibroadenoma from phyllodes tumor on core needle biopsy specimens. Am J Clin Pathol. 2014;142(3):362–9.CrossRefGoogle Scholar
  10. 10.
    Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1):5–21.CrossRefGoogle Scholar
  11. 11.
    Diaz NM, Palmer JO, McDivitt RW. Carcinoma arising within fibroadenomas of the breast. A clinicopathologic study of 105 patients. Am J Clin Pathol. 1991;95(5):614–22.CrossRefGoogle Scholar
  12. 12.
    Sanders M, Brooks J, Palazzo J. Mesenchymal lesions of the breast. In: Palazzo JP, editor. Difficult diagnoses in breast pathology. New York, NY: Demos Medical; 2011. p. 172–95.Google Scholar
  13. 13.
    Guray M, Sahin AA. Benign breast diseases: classification, diagnosis, and management. Oncologist. 2006;11(5):435–49.CrossRefGoogle Scholar
  14. 14.
    Greenberg R, Skornick Y, Kaplan O. Management of breast fibroadenomas. J Gen Intern Med. 1998;13(9):640–5.CrossRefGoogle Scholar
  15. 15.
    Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer WD Jr, Rados MS, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. 1994;331(1):10–5.CrossRefGoogle Scholar
  16. 16.
    Abe M, Miyata S, Nishimura S, Iijima K, Makita M, Akiyama F, et al. Malignant transformation of breast fibroadenoma to malignant phyllodes tumor: long-term outcome of 36 malignant phyllodes tumors. Breast Cancer. 2011;18(4):268–72.CrossRefGoogle Scholar
  17. 17.
    Krishnamurthy S, Ashfaq R, Shin HJ, Sneige N. Distinction of phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer. 2000;90(6):342–9.CrossRefGoogle Scholar
  18. 18.
    Mishra SP, Tiwary SK, Mishra M, Khanna AK. Phyllodes tumor of breast: a review article. ISRN Surg. 2013;2013:361469.CrossRefGoogle Scholar
  19. 19.
    Jacobs TW, Chen YY, Guinee DG Jr, Holden JA, Cha I, Bauermeister DE, et al. Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision? Am J Clin Pathol. 2005;124(3):342–54.CrossRefGoogle Scholar
  20. 20.
    Mituś JW, Blecharz P, Walasek T, Reinfuss M, Jakubowicz J, Kulpa J. Treatment of patients with distant metastases from phyllodes tumor of the breast. World J Surg. 2016;40(2):323–8.CrossRefGoogle Scholar
  21. 21.
    Telli ML, Horst KC, Guardino AE, Dirbas FM, Carlson RW. Phyllodes tumors of the breast: natural history, diagnosis, and treatment. J Natl Compr Cancer Netw. 2007;5(3):324–30.CrossRefGoogle Scholar
  22. 22.
    Cowan ML, Argani P, Cimino-Mathews A. Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins. Mod Pathol. 2016;29(3):259–65.CrossRefGoogle Scholar
  23. 23.
    Jang JH, Choi MY, Lee SK, Kim S, Kim J, Lee J, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol. 2012;19(8):2612–7.CrossRefGoogle Scholar
  24. 24.
    Lee AH, Hodi Z, Ellis IO, Elston CW. Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 2007;51(3):336–44.CrossRefGoogle Scholar
  25. 25.
    Van Osdol AD, Landercasper J, Andersen JJ, Ellis RL, Gensch EM, Johnson JM, et al. Determining whether excision of all fibroepithelial lesions of the breast is needed to exclude phyllodes tumor: upgrade rate of fibroepithelial lesions of the breast to phyllodes tumor. JAMA Surg. 2014;149(10):1081–5.CrossRefGoogle Scholar
  26. 26.
    Lacroix-Triki M, Geyer FC, Lambros MB, Savage K, Ellis IO, Lee AH, et al. β-catenin/Wnt signalling pathway in fibromatosis, metaplastic carcinomas and phyllodes tumours of the breast. Mod Pathol. 2010;23(11):1438–48.CrossRefGoogle Scholar
  27. 27.
    Burga AM, Tavassoli FA. Periductal stromal tumor: a rare lesion with low-grade sarcomatous behavior. Am J Surg Pathol. 2003;27(3):343–8.CrossRefGoogle Scholar
  28. 28.
    Zhang Y, Kleer CG. Phyllodes tumor of the breast: histopathologic features, differential diagnosis, and molecular/genetic updates. Arch Pathol Lab Med. 2016;140(7):665–71.CrossRefGoogle Scholar
  29. 29.
    Liu H. Application of immunohistochemistry in breast pathology: a review and update. Arch Pathol Lab Med. 2014;138(12):1629–42.CrossRefGoogle Scholar
  30. 30.
    Tse GM, Lee CS, Kung FY, Scolyer RA, Law BK, Lau TS, et al. Hormonal receptors expression in epithelial cells of mammary phyllodes tumors correlates with pathologic grade of the tumor: a multicenter study of 143 cases. Am J Clin Pathol. 2002;118(4):522–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PathologyThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of PathologySt. Luke’s University Health NetworkBethlehemUSA
  3. 3.Department of PathologyThomas Jefferson University HospitalPhiladelphiaUSA

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