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- B1770Breast fibroepithelial lesions (cqz 15)
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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.
标签：乳腺纤维腺瘤 叶状肿瘤
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zhang197510 离线
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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
For case #1 (09-3-7)
Phyllodes tumor, histologically benign.
Comment: small encapsulated lesion, low stromal cellularity , No mitosis (less than 0-4 mitotic figures/10 HPF) seen on the pictures althought scattered stromal cells showed mild muclear atypia.
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About case 2: Patient had history of phyllodes tumor several years ago (outside hospital). So this is local recurrence of benign phyllodes. It is difficult to predict the prognosis for phyllodes. The major concern is local recurrence. Distant metastases are rare.Complete excision with wide free margin is the main treatment. One large review study indicated the chance of local recurrence was 21%, 46%, and 65% for the patients with benign, borderline, and malignant phyllodes.
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alading1999 离线
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本帖最后由 于 2009-03-21 18:05:00 编辑
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FA和PT的鉴别，不足之处，请专家指导，谢谢！
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- 广州金域病理
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本帖最后由 于 2009-03-14 11:05:00 编辑
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.
