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
Quiz #1
Tiger?
Quiz #2
Lynx ?
Quiz #3
Lynx cub ?
Fibradenoma vs. Malignant PT
Cellular FAvs.
Benign PT(excision)
Cellular FA
vs.
Benign PT
(needle biopsy)
Cellular FA
vs.
Benign PT
(needle biopsy)
??Cellular FA
Benign PT Borderline PT
Malignant PT Benign PT
• 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
• “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
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
Summary of pathologic findings on CNB
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
Increased stromal cellularity : Benign (or Borderline) PT > CFA
Gregor et al. Seminars in Diagnostic Pathology 2017
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
Stromal overgrowth : Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014
Stromal overgrowth : Benign (or Borderline) PT > CFA
Benign PT
Stromal fragmentation : Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014Benjamin et al. Surgical Pathology. 2018
Stromal fragmentation : Benign (or Borderline) PT > CFA
FA
Adipocyte infiltration: Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014
Timothy et al. Anatomic Pathology 2005
Stromal heterogeneity : Benign (or Borderline) PT > CFA
Saba et al. AJCP 2014
same case, PT
Saba et al. AJCP 2014
Gregor et al. Seminars in Diagnostic Pathology 2017
Subepithelial condensation : Benign (or Borderline) PT > CFA
Stromal cell atypia: Benign (or Borderline) PT > CFA
FABenign PT
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
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
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
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.
Take home messages - Lynx?
Oral presentation 4 (April 27. Sat. AM 9:18),
TNXBCD36COPZ1MYL12AHSPA5HSPA8XRCC6FLNACFL1SERPINH1PGDTUBA1BHDLBPMDC1
Title: PROTEOMIC LANDSCAPE OF FIBROEPITHELIAL TUMOR OF BREAST
Thank you for your attention