I notoced there are some cases of fibroepithelial lesions (biphasic tumor)in our website. I send this case to open the discussion.

Fibroepithelial tumors including fibroadenoma (FA) and phyllodes tumors (PT). The definition and classification of PT are not very agreeable among pathologists. However, they are most common classified as bengin, borderline, or malignant suggested by WHO. Some pathologists use terms of benign, low grade maligant and high grade malignant. These two systems are very similar, borderlin equal to low grade malignant.

Hope you can give your diagnosis and mention why. I assume people may have different oppinions. It is ok.  We just discuss the case.

 Fibroepithelial lesion show focal leaf-like structures, sclerosing adenosis, cystic dilation, no marked increased cellularity, no obvious cytologic atypia.

We should know the marges and mitotic figures.

 Well well done. Excellent summary. Thank  笃 (du) 行者 . Hope more people can involve the website more actively. We can think the web as a  free stage. Every one can come here to share, show, or discuss the cases. When you prepare a summary you need to review the book and you learn in the same time. Often I need to review the books or papers to answer the questions. By the way I learn a lot from the book and from all of your discussion.

Thank  笃行者 again. People whoever read your summary can know the main points quickly.

cz

 Dr. Yang,

You are right. I cannot make the dx of phyllodes if it were the primary lesion for the second case. The dx of recurrent phyllodes was based on the pt's phyllodes history, the same location, and irregular border. The criteria are made by people, they often cannot be used for all cases. Individual case should be considered or treated individually in practical pathologic diagnosis.

 Thank 笃行者 .

I forget how to call the word 笃 even though you told me before. Please teacher me again. I will remember this time. cz

 Dr. Qianxun,

Thank you very much for your comment. For phyllodes tumors we count mitosis very carefully. Personally I never use ki67 stain for diagnosis of phyllodes. Could you describe the proliferative index more details for distinguishing benign from borderlin phyllodes? Thanks, cz

 I am showing you another fibroepithelial lesion.

Case 2:

50 y/f right breast lesion 1.7 cm. excisionaly biopsy specimen.

Fig 1. 20x

Other fig 100x

No mitosis is noticed.

Your diagnosis?

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 Most of people here have an agreenment for this case. The tumor demonstrates leaf-like structures, dense stroma with a little heterologeneous distribution and mild cytologic atypia, and a little increased cellularity, pushing margin with focal irregularity. Mitotic firures are rare (0-1/10 high power fields). Clearly it should be a phyllodes tumor, but not fibroadenoma, even though the tumor is small. Considering all the facts I diagnosed benign phyllodes finally.

Welcome you to share your different oppinion. 

 I mentioned above. 40 years with 1.2 cm demarcated breast mass.

Dood discusssion. Good point to ask the number of mitosis. Metotic figures are rare, 0-1/10 HPF.

 40 y/f with breast mass, 1.2 cm.

Key:

F1-2: 20x

F3. 40x

F4-5: 100x

F6: 400x

F7: 600x

I will go to Boston for USCAP meeting tomorrow and will be back next weekend.