2003 Oct;12(5):302-7. doi: 10.1016/s0960-9776(03)00123-1. The pathology is in the stroma; so, the lesion is really a misnomer by the naming rules. Value of scoring system in classification of proliferative breast disease on fine needle aspiration cytology. Richard L Kempson MD. A benign gland has two cell layers - myoepithelial and epithelial. Flat epithelial atypia and risk of breast cancer: A Mayo cohort study. It is a rare benign rapidly growing breast mass in adolescent females. These tumors are usually benign, but they can come back and cause the breast to look abnormal if not totally removed. 2022 Jan;480(1):45-63. doi: 10.1007/s00428-021-03175-6. Usual ductal hyperplasia is associated with a slight increase in risk (1.5 - 2 times) for subsequent breast cancer. 2010 Dec;17(12):3269-77. doi: 10.1245/s10434-010-1170-5. 8600 Rockville Pike This website is intended for pathologists and laboratory personnel but not for patients. We consider the term merely descriptive. Careers. More frequent in young and black patients. No large cysts are seen. Clipboard, Search History, and several other advanced features are temporarily unavailable. We welcome suggestions or questions about using the website. (Sep 2005). Silverman JS, Tamsen A. Mammary fibroadenoma and some phyllodes tumour stroma are composed of CD34+ fibroblasts and factor XIIIa+ dendrophages. National Library of Medicine 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+. H&E stain. Degnim AC, Frost MH, Radisky DC, Anderson SS, Vierkant RA, Boughey JC, Pankratz VS, Ghosh K, Hartmann LC, Visscher DW. Accessibility 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. panel curtains ikea vmware sase pop postbox near me. "Normal and pathological breast, the histological basis.". stromal nuclear pleomorphism) is predictive of phyllodes tumor (versus fibroadenoma) in core 1994 Jul 7;331(1):10-5. Results: May be hyalinized (dark pink) if infarcted. Lippincott Williams & Wilkins. The immunostains used in breast pathology for the . Would you like email updates of new search results? Fibroadenoma is a very common benign neoplasm typically occurring in patients between the ages of 20 and 35 years. white/pale +/-hyalinization, typically paucicellular, compression of glandular elements with perserved myoepithelial cells, juvenile, complex, myxoid, cellular, tubular adenoma of the breast, well-circumscribed, rubbery, tan/white, +/-lobulated appearance, +/-short slit-like spaces, +/-calcifications. (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 We welcome suggestions or questions about using the website. ; Holden, JA. PMC and transmitted securely. Unable to load your collection due to an error, Unable to load your delegates due to an error. No apparent proliferative activity is present. The lesion was shelled-out. 2001 May;115(5):736-42. Contact | They fall under the broad group of adenomatous breast lesions. 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). Bookshelf PMID: 11345838 (Free), Long-term risk of breast cancer in women with fibroadenoma. Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer WD Jr, Rados MS, Schuyler PA. This is usual ductal hyperplasia. National Library of Medicine Histopathology of fibroadenoma of the breast. 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) No calcifications are evident. The border is well-circumscribed where seen. Jacobs, TW. ~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. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). 2022 Apr 3;23(7):3989. doi: 10.3390/ijms23073989. 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). 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). Complex fibroadenoma with sclerosing adenosis (crowded, Complex fibroadenoma with sclerosing adenosis (crowded glands in a fibrotic stroma) (hematoxylin-eosin; original magnification, MeSH It is important to recognize the disease entity and characteristic cytomorphological findings of CFA to reach accurate FNA diagnosis of breast lesions. Visscher DW, Nassar A, Degnim AC, Frost MH, Vierkant RA, Frank RD, Tarabishy Y, Radisky DC, Hartmann LC. doi: 10.7759/cureus.12611. Giant juvenile fibroadenoma: a systematic review with diagnostic and treatment recommendations. Background Fibroepithelial lesions of the breast include fibroadenoma (FA) and phyllodes tumor (PT). Semin Diagn Pathol. AJR Am J Roentgenol. Compression of glandular elements - very commonly seen. No stromal overgrowth is seen. Breast Cancer Res Treat. Nissan N, Bauer E, Moss Massasa EE, Sklair-Levy M. Insights Imaging. HHS Vulnerability Disclosure, Help Tumors >500 g or disproportionally large compared to rest of breast. Although no significant difference was noted in patients' age and tumor size between CFA and NCFA, 5 CFA cases (33.3 %) were accompanied by the presence of carcinoma in the same breast or the contralateral breast while no NCFA cases had carcinoma in the breast. This site needs JavaScript to work properly. Raganoonan C, Fairbairn JK, Williams S, Hughes LE. Musio F, Mozingo D, Otchy DP. Would you like email updates of new search results? 2001 Feb 19;174(4):185-8. doi: 10.5694/j.1326-5377.2001.tb143215.x. Long-term risk of breast cancer in women with fibroadenoma. A. -->, Richard L Kempson MD The https:// ensures that you are connecting to the Women with complex fibroadenomas may therefore be managed with a conservative approach, similar to the approach now recommended for women with simple fibroadenomas. Epub 2020 Dec 29. Complex fibroadenomas were half the size (average, 1.3 cm; range, 0.5-2.6 cm) of noncomplex fibroadenomas (average, 2.5 cm; range, 0.5-7.5 cm) (p < 0.001). Richard L Kempson MD. sharing sensitive information, make sure youre on a federal Fibroadenoma was identified in 2136 women [noncomplex, 1835 (85.9%); complex, 301 (14.1%)]. In analyses stratified by involution status and PDWA, complex fibroadenoma was not an independent risk marker for breast cancer. An official website of the United States government. Jacobs. Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Cureus. 8600 Rockville Pike The sections show a lesion with a pale mildly cellular stroma, and bland glandular elements. Become a Gold Supporter and see no third-party ads. pathology researchers that rely upon this methodology to perform tissue analysis in research. As the name suggests, is typically found in younger patients. Ann Surg Oncol. No leaf-like architecture is present. P30 CA015083/CA/NCI NIH HHS/United States, P50 CA116201/CA/NCI NIH HHS/United States, R01 CA132879/CA/NCI NIH HHS/United States. IHC can aid in visualizing the myoepithelial layer. However, we cannot answer medical or research questions or give advice. Pane K, Quintavalle C, Nuzzo S, Ingenito F, Roscigno G, Affinito A, Scognamiglio I, Pattanayak B, Gallo E, Accardo A, Thomas G, Minic Z, Berezovski MV, Franzese M, Condorelli G. Int J Mol Sci. Schnitt: Biopsy Interpretation of the Breast, 3rd Edition, 2017, WHO Classification of Tumours Editorial Board: Breast Tumours, 5th Edition, 2019, Adenosis or lobulocentric processes with increase in glandular elements of terminal duct lobular unit (TDLU) with stromal fibrosis / sclerosis that distorts and compresses glands, Preserved 2 cell layer (inner epithelial and outer myoepithelial cells), Enlarged terminal duct lobular unit with distortion by stromal fibrosis / sclerosis, Coalescent foci of typical sclerosing adenosis, Rare; sclerosing adenosis with predominance of myoepithelial cells, presents as multifocal microscopic lesions (, Most frequent in third to fourth decades but occurs over a wide age range, Found in 12 - 28% of all benign and 5 - 7% of malignant biopsies (, Terminal duct lobular unit; otherwise, no specific location within the breast, Often an incidental finding or detected by screening, Can present as a palpable mass if nodular adenosis / adenosis tumor, Histologic examination of tissue with or without immunohistochemistry, Variable depending on the size / extent of breast involvement, If focal, may not be visualized (i.e. Check for errors and try again. Diagnosis in short. 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, Fibroadenoma - slit-like spaces (webpathology.com), Fibroadenoma - lobulated appearance (webpathology.com), Tubular adenoma of the breast (webpathology.com), http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970216-9, http://www.imagingpathways.health.wa.gov.au/includes/dipmenu/image/image.html, http://www.breastpathology.info/fibro_variants.html#juvenile, http://www.breastpathology.info/fibro_variants.html#complex, https://librepathology.org/w/index.php?title=Fibroadenoma&oldid=51069, Attribution-NonCommercial-ShareAlike 4.0 International, abundant (intralobular) stroma usu. FOIA ; Complex: Complex fibroadenomas are less common but become more common as people age.While they may have a definite border, it's what is inside this . Gland Surg. BCDnet: Parallel heterogeneous eight-class classification model of breast pathology. 1999 Aug;16(3):235-47. Milanese TR, Hartmann LC, Sellers TA, Frost MH, Vierkant RA, Maloney SD, Pankratz VS, Degnim AC, Vachon CM, Reynolds CA, Thompson RA, Melton LJ 3rd, Goode EL, Visscher DW. FOIA Over time, a fibroadenoma may grow in size or even shrink and disappear. and Debra Zynger, M.D. Breast. phyllodes tumour, sarcoma, pseudoangiomatous . {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, Rock P, Bell D, et al. Multiple, giant fibroadenoma. 2021 May 11;7(1):50. doi: 10.1038/s41523-021-00257-1. Fibroepithelial tumours of the breast-a review. Breast disease: a primer on diagnosis and management. | Log in | Stanford CA 94305-5342, Relative risk for development of invasive breast carcinoma, , Circumscribed breast mass composed of benign stromal and epithelial cells, Atypical ductal or lobular hyperplasia may be present, Carcinoma, in situ or invasive, may be present, Lacks significant stromal hypercellularity, Elevated stromal mitotic rate, usually >4-5 per 10 hpf, abnormal forms may be found, May contain poorly circumscribed areas of fibrocystic change, Lobules typically present (may be atrophic), Frequent intracanalicular or tubular glandular proliferation. Up to 66% of fibroadenomas harbor mutations in the exon (exon 2) of the mediator complex subunit 12 (MED12) gene. Franklin County, North Carolina . Federal government websites often end in .gov or .mil. 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. Department of Pathology. Other names for these tumors include phylloides tumor and cystosarcoma phyllodes. 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 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 A study of 11 patients. 2022 Jul;194(2):307-314. doi: 10.1007/s10549-022-06631-2. government site. On gross pathology, a rubbery, tan colored, and Fibroadenoma is the commonest solid benign lesion that can exist as a solitary mass or multiple masses in the breasts. Epub 2014 Feb 8. 3 Giant (juvenile or cellular) fibroadenoma is a . Unable to load your collection due to an error, Unable to load your delegates due to an error. PMC Kuijper A, Mommers EC, van der Wall E, van Diest PJ. 1991 Jul;57(7):438-41. font-family: Arial, Helvetica, sans-serif; Disclaimer. However, we cannot answer medical or research questions or give advice. 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. The term fibroadenoma combines the words "fibroma," meaning a tumor made up of fibrous tissue, and "adenoma," a tumor of gland tissue. Clipboard, Search History, and several other advanced features are temporarily unavailable. Mousa-Doust D, Dingee CK, Chen L, Bazzarelli A, Kuusk U, Pao JS, Warburton R, McKevitt EC. Bethesda, MD 20894, Web Policies Breast Cancer Res Treat. official website and that any information you provide is encrypted Conventional fibroadenomas (FAs) are underpinned by recurrent MED12 mutations in the stromal components of the lesions. hampton beach homes for sale 919-497-6028. cannery row nashville wedding dundee1234@aol.com Epub 2021 Sep 10. Background: . Most common benign tumor of the female breast. It should be distinguished from other benign masses of the breast by proper evaluation and management. "Tubular adenoma of the breast: an immunohistochemical study of ten cases.". A simple fibroadenoma does not raise your risk for breast cancer. Board review style answer #1. Complex fibroadenomas were diagnosed in 63 of 401 fibroadenomas (15.7%) found at consecutive percutaneous needle or excisional surgical bi-opsy. Contain proliferative epithelium which outside and inside a fibroadenoma is associated with an increased risk of malignancy. 2021 Jan 10;13(1):e12611. Stroma is generally more sparse than in conventional fibroadenoma. emailE=('rouse' + '@' + 'stan' + 'ford.edu') Int J Environ Res Public Health. 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. Essentials in Bone and Soft-Tissue Pathology - Jasvir S. Khurana 2010-03-10 Essentials in Bone and Soft-Tissue Pathology is a concise and well-illustrated handbook that captures the salient points of the most common problems in bone and soft-tissue . Calcifications, mediolateral oblique view, 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). Conclusion: Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K, Vierkant RA, Maloney SD, Pankratz VS, Hillman DW, Suman VJ, Johnson J, Blake C, Tlsty T, Vachon CM, Melton LJ 3rd, Visscher DW. Benign breast disease and the risk of breast cancer. 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. From excisional biopsy or resected specimens of fibroadenoma (FA) cases treated at our institution from 2004 to 2013, we chose 46 patients who underwent FNA before a diagnosis of FA was established. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. 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.
