differential diagnosis between fibroadenoma and phyllodes ...gbcc.kr/upload/edu seesion 7_ryu han...
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Differential diagnosis between fibroadenoma and phyllodes tumor on core needle biopsy
Department of Pathology
Seoul National Univ. Hospital
Han Suk Ryu M.D., Ph.D.
[Education Session 7] April 26 (Fri), GBCC 2019
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Quiz #1
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Tiger?
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Quiz #2
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Lynx ?
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Quiz #3
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Lynx cub ?
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Fibradenoma vs. Malignant PT
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Cellular FAvs.
Benign PT(excision)
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Cellular FA
vs.
Benign PT
(needle biopsy)
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Cellular FA
vs.
Benign PT
(needle biopsy)
??Cellular FA
Benign PT Borderline PT
Malignant PT Benign PT
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• The sensitivity of FNAC, CNB (core needle biopsy) and imaging for diagnosing phyllodes tumours was 40%, 63% and 65% respectively.
Ward et al. International Journal of Surgery 2012
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• “Precise distinction may be extremely challenging in an individual case.”
• “An unanimously accepted criterion drawing does not exist.”
• “Even among experienced pathologists, it may be no easy task to achievediagnostic consensus on core biopsy material...”,
Benjamin et al. Surgical Pathology. 2018
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15% - 17% 10% - 17%Recurrence rate
FibroadenomaBorderline PT: 35%Malignant PT : 8%
Recurrent tumor
Fibroadenoma Benign PT
Clinical differences between FA and benign PT
Benjamin et al. Surgical Pathology. 2018
Initial diagnosis is cirtical
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Summary of pathologic findings on CNB
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Text mining with recent studies (Cellular fibradenoma (CFA) vs. Benign PT)
IHC (2)Stromal component (10)
Cellular component (3) 6 1
# of Publication
A AA A
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Increased stromal cellularity : Benign (or Borderline) PT > CFA
Gregor et al. Seminars in Diagnostic Pathology 2017
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Increased stromal cellularity : Benign (or Borderline) PT > CFA
Gregor et al. Seminars in Diagnostic Pathology 2017
Cellular FABenign to borderline PT
Benign PTSaba et al. AJCP 2014
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Stromal overgrowth : Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014
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Stromal overgrowth : Benign (or Borderline) PT > CFA
Benign PT
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Stromal fragmentation : Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014Benjamin et al. Surgical Pathology. 2018
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Stromal fragmentation : Benign (or Borderline) PT > CFA
FA
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Adipocyte infiltration: Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014
Timothy et al. Anatomic Pathology 2005
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Stromal heterogeneity : Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014
same case, PT
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Saba et al. AJCP 2014
Gregor et al. Seminars in Diagnostic Pathology 2017
Subepithelial condensation : Benign (or Borderline) PT > CFA
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Stromal cell atypia: Benign (or Borderline) PT > CFA
FABenign PT
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Immunohistochemistry
Cellular FA PT
Topoisomerase IIa Lower Higher
Ki67 Lower Higher
CD34 Higher Lower
Ana Richelia Jara-Lazaro et al. Histopathology 2010
Timothy et al. Anatomic Pathology 2005
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Fibroepithelial lesions in young patients
Simple or cellular fibroadenoma Juvenile fibroadenoma Benign PT
Growth Slow
Stromal cellularity -/+ + +
Tumor size smaller Larger Larger
Pericanalicular pattern - + with lobular architecture +
Leaf-like fronds + - +
Epithelial hyperplasia - + +/-
Stromal mitosis 1.3/10HPF 1.8/10HPF 3.1/10HPF
Nuclear atypia No No Yes
Stromal uniformity + + -
Timothy et al. Journal of clinical pathology. 2015Benjamin et al. Surgical Pathology. 2018
Ross et al. Breast J. 2017
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Fibroepithelial lesions in young patients
Simple or cellular fibroadenoma Juvenile fibroadenoma Benign PT
Growth Slow
Stromal cellularity -/+ + +
Tumor size smaller Larger Larger
Pericanalicular pattern - + with lobular architecture +
Leaf-like fronds + - +
Epithelial hyperplasia - + +/-
Stromal mitosis 1.3/10HPF 1.8/10HPF 3.1/10HPF
Nuclear atypia No No Yes
Stromal uniformity + + -
Timothy et al. Journal of clinical pathology. 2015Benjamin et al. Surgical Pathology. 2018
Ross et al. Breast J. 2017
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Take home messages
• Cellular fibroadenoma and benign PT are clinical different.
• Cellular FibroEpithelial Lesions (CFELs) including Cellular fibrodenoma andindolent PT is challenging on needle biopsy sample.
• Seven morphologic variables including increased stromal cellularity helppathologists make a differential diagnosis.
• IHC might be valuable in some cases.
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Take home messages - Lynx?
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Oral presentation 4 (April 27. Sat. AM 9:18),
TNXBCD36COPZ1MYL12AHSPA5HSPA8XRCC6FLNACFL1SERPINH1PGDTUBA1BHDLBPMDC1
Title: PROTEOMIC LANDSCAPE OF FIBROEPITHELIAL TUMOR OF BREAST
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Thank you for your attention