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. 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. The myoepithelial layer is hard to see at times. An official website of the United States government. Visual survey of surgical pathology with 11,912 high-quality images of benign and malignant neoplasms & related entities. Simple: Most fibroadenomas are the simple type; they are more common in younger people.There's usually just one mass in your breast, with a definite border and very uniform cells. It is usually single, but in 20% of cases there are multiple lesions in the same breast or bilaterally. An official website of the United States government. HHS Vulnerability Disclosure, Help Sosin M, Pulcrano M, Feldman ED, Patel KM, Nahabedian MY, Weissler JM, Rodriguez ED. Careers. Fibroadenomas are benign while phyllodes tumor range from benign, indolent neoplasms to malignant tumors capable of distant metastasis. official website and that any information you provide is encrypted The purpose of this study is to examine the breast cancer risk overall among women with simple fibroadenoma or complex fibroadenoma and to examine the association of complex fibroadenoma with breast cancer through stratification of other breast cancer risks. .style2 {font-family: Arial, Helvetica, sans-serif} We sought to evaluate the incidence of complex fibroadenoma on biopsy and to propose decision criteria for managing patients with these breast lesions. white/pale +/-hyalinization, typically paucicellular, compression of glandular elements with perserved myoepithelial cells. ; Chen, YY. Stanford University School of Medicine. biopsy specimens (, Disordered but morphologically normal appearing ducts and lobules, Prominent pericanalicular adenosis-like epithelial proliferation with little intervening stroma, Generally does not form a clinically dominant mass, Individual lobule or few groups of lobules with collagenized interlobular stroma and loss of Robert V Rouse MD Fibroadenoma is the most common benign tumor of the female breast. PMC PMC 2022 May 17;19(10):6093. doi: 10.3390/ijerph19106093. Clipboard, Search History, and several other advanced features are temporarily unavailable. LM DDx. Int J Environ Res Public Health. May be either adult or juvenile type. Powell CM, Cranor ML, Rosen PP. This website is intended for pathologists and laboratory personnel but not for patients. 2015 May 15;121(10):1548-55. doi: 10.1002/cncr.29243. An official website of the United States government. If it grows to 5 cm or . The study included women aged 18-85 years from the Mayo Clinic Benign Breast Disease Cohort who underwent excisional breast biopsy from 1967 through 1991. 8600 Rockville Pike The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). 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. 2022 Apr 3;23(7):3989. doi: 10.3390/ijms23073989. Up to 66% of fibroadenomas harbor mutations in the exon (exon 2) of the mediator complex subunit 12 (MED12) gene. Findings can confirm benign nature of disease but are nonspecific, resembling fibroadenoma or phyllodes tumor (Indian J Pathol Microbiol 2005;48:260) Finding plump spindled mesenchymal cells is suggestive (Diagn Cytopathol 2005;32:345) Bethesda, MD 20894, Web Policies Background Fibroepithelial lesions of the breast include fibroadenoma (FA) and phyllodes tumor (PT). In particular, these mutations are restricted to the stromal component. Raganoonan C, Fairbairn JK, Williams S, Hughes LE. The border is well-circumscribed where seen. 2022 Feb;75(2):133-136. doi: 10.1136/jclinpath-2020-207062. 2020 Dec;53(3):439-441. doi: 10.1055/s-0040-1716187. It is a rare benign rapidly growing breast mass in adolescent females. No calcifications are evident. sharing sensitive information, make sure youre on a federal Complex Breast Fibroadenoma; Complex Fibroadenoma; Complex Fibroadenoma of Breast; Complex Fibroadenoma of the Breast: Definition. 1996 Nov;29(5):411-9. Epidemiology. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). sharing sensitive information, make sure youre on a federal The https:// ensures that you are connecting to the Clinically , fibroadenomas presents as solitary, freely mobile lump in the breast. 2006 Nov 15;98(22):1600-7. doi: 10.1093/jnci/djj439. Stanford University School of Medicine phyllodes tumour, sarcoma, pseudoangiomatous . sharing sensitive information, make sure youre on a federal Compression of glandular elements - very commonly seen. Aust N Z J Surg. ~50% of these tend to be lobular carcinoma in situ (LCIS), ~20% infiltrating lobular carcinoma, ~20%ductal carcinoma in situ (DCIS), and the remaining 10% are infiltrating ductal carcinoma. Well circumscribed tumor with bulging cut surface, Fibroadenoma with atypical ductal hyperplasia, 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). A benign gland has two cell layers - myoepithelial and epithelial. Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Cureus. No cytologic atypia is present. Conclusion: 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. Arch Pathol Lab Med. Complex fibroadenomas tend to occur in older patients (median age, 47 years) compared with simple fibroadenomas (median age, 28.5 years). Mastopathic fibroadenoma of the breast: a pitfall of aspiration cytology. "Radiologic evaluation of breast disorders related to pregnancy and lactation.". 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.
