complex fibroadenoma pathology outlines

2008;190 (1): 214-8. Fibroadenoma (FA) is the most common type of breast lesion in young female individuals. Careers. 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). 2022 May 17;19(10):6093. doi: 10.3390/ijerph19106093. Radiology of fibroadenoma. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). PMID: 8202095 (Free), 1996 - 2023 Humpath.com - Human pathology Med J Aust. A. Would you like email updates of new search results? Tumors >500 g or disproportionally large compared to rest of breast. 2004 Feb;21(1):48-56. Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer WD Jr, Rados MS, Schuyler PA. N Engl J Med. 2010 Dec;17(12):3269-77. doi: 10.1245/s10434-010-1170-5. The site is secure. 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. (Most fibroadenomas in adolescents are typical, adult type fibroadenomas and should be diagnosed as such) Giant fibroadenoma Tumors >500 g or disproportionally large compared to rest of breast; More frequent in young and black patients; We consider the term merely descriptive; May be either adult type or juvenile fibroadenomas CD31, Also called pseudoangiomatous hyperplasia of mammary stroma, PASH is an incidental microscopic finding in up to 23% of breast surgical resections (, Almost always women who are premenopausal, Myofibroblastic origin, postulated role of hormonal factors (, Usually asymptomatic and an incidental finding but may be detected by imaging (, Histologic examination of resected tissue, May produce a mammographically detected mass, Nonneoplastic but mass forming lesion may rarely recur, especially in younger patients, 11 year old girl with bilateral nodular lesions (, 12 year old girl with pseudoangiomatous stromal hyperplasia (, 30 year old woman with pseudoangiomatous stromal hyperplasia of the breast with foci of morphologic malignancy (, 37 year old woman with giant nodular pseudoangiomatous stromal hyperplasia of the breast presenting as a rapidly growing tumor (, 46 year old woman with bilateral marked breast enlargement (, 67 year old man with pseudoangiomatous stromal hyperplasia of breast (, Local excision needed only in symptomatic mass forming lesions, If diagnosed on core needle biopsy, no surgical excision required, provided the diagnosis is concordant with radiologic findings (, Usually unilateral, well circumscribed, smooth nodule, Cut surface is firm, gray-white, lacks the characteristic slit-like spaces of fibroadenoma, Spaces are usually empty but may contain rare erythrocytes, Cellular areas or plump spindle cells may obscure pseudoangiomatous structure, No mitotic figures, no necrosis, no atypia, Fascicular PASH: cellular variant, in which myofibroblasts aggregate into fascicles with reduced or absent clefting, resembles myofibroblastoma, Moderately cellular with cohesive clusters of bland ductal cells (occasionally with staghorn pattern), single naked nuclei, some spindle cells with moderate cytoplasm and fine chromatin, Occasional loose hypocellular stromal tissue fragments containing spindle cells and paired elongated nuclei in fibrillary matrix (, Findings can confirm benign nature of disease but are nonspecific, resembling fibroadenoma or phyllodes tumor (, Finding plump spindled mesenchymal cells is suggestive (, Spaces are not true vascular channels but due to disruption and separation of stromal collagen fibers. "Normal and pathological breast, the histological basis.". ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. . PMC Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). This patient had atypical lobular hyperplasia at core needle biopsy. Virchows Arch. Because of their high mobility, they are also referred to as mouse in the breast/breast mouse. Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY, Weissler JM, Rodriguez ED. Bethesda, MD 20894, Web Policies However, we cannot answer medical or research questions or give advice. Raganoonan C, Fairbairn JK, Williams S, Hughes LE. 1996 Nov;29(5):411-9. SIR for noncomplex fibroadenoma was 1.49 (95% CI 1.26-1.74); for complex fibroadenoma, it was 2.27 (95% CI 1.63-3.10) (test for heterogeneity in SIR, P = .02). 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. As the name suggests, is typically found in younger patients. Percutaneous radiofrequency-assisted excision of fibroadenomas. The pictured lesion is sclerosing adenosis, a benign breast lesion characterized by expansion of glands (with preserved 2 cell layers: inner epithelial and outer myoepithelial cells) within the terminal duct lobular unit with distortion by fibrosis / sclerosis. FNA of CFA can lead to erroneous or indeterminate interpretation, due to proliferative and/or hyperplastic changes of ductal epithelium with or without atypia.

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