Difference between revisions of "Fibroadenoma"

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| Caption    = Fibroadenoma. [[H&E stain]].
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Revision as of 04:24, 15 February 2014

Fibroadenoma
Diagnosis in short

Fibroadenoma. H&E stain.
LM DDx phyllodes tumour, sarcoma, pseudoangiomatous stromal hyperplasia, adenomyoepithelioma for tubular adenoma of the breast
Gross well-circumscribed, rubbery, tan/white, +/-lobulated appearance, +/-short slit-like spaces, +/-calcifications
Site breast
Prevalence very common
Prognosis benign
Clin. DDx other breast tumours - esp. phyllodes tumour
Treatment conservative excision

Fibroadenoma is a common benign tumour of the breast.

General

  • Very common benign finding.
  • The pathology is in the stroma; so, the lesion is really a misnomer by the naming rules.
    • It ought to be called adenofibroma (as a few occasionally do[1]), as the glandular component is benign and the stromal component lesional; there is no truth in names in pathology.

Management:

  • Local excision -- without a large margin.

Gross

Features:[2]

  • Well-circumscribed.
  • Rubbery - classic descriptor.
  • Tan/white.
  • +/-Lobulated appearance.
  • +/-Slit-like spaces - short.
  • +/-Calcification.

Images:

Microscopic

Features:[3]

  • Abundant (intralobular) stroma - most key feature.
    • Stroma is usually:
      • White/pale, i.e. myxoid, on H&E (normal stroma is pink).
        • May be hyalinized (dark pink) if infarcted.
      • Paucicellular - typical.
  • Compression of glandular elements - very commonly seen.
    • Glandular elements have at least two cell layers - epithelial and myoepithelial.

Notes:

  1. There is stuff about intracanalicular vs. pericanalicular.[4] It is irrelevant; there is no prognostic difference between the two.
  2. Do not comment on the margin - it is irrelevant.

DDx:

Images

  • Fibroadenoma. (WC/KGH)

  • Fibroadenoma. (WC/KGH)

www:

Variants

Four variants are described by the Washington Manual:[7]

  1. Juvenile.
  2. Complex.
  3. Myxoid.
  4. Cellular.

Considered a variant of fibroadenoma by many authorities:[8]

Juvenile fibroadenoma

  • As the name suggests, is typically found in younger patients.
  • Classic history: rapid growth.

Features (juvenile variant):[9]

Myxoid fibroadenoma

Features:

Cellular fibroadenoma

Features (cellular variant):

  • Cellular.
  • Mitoses.

Complex fibroadenoma

  • Contain proliferative epithelium which outside and inside a fibroadenoma is associated with an increased risk of malignancy.

Features:[10]

  1. Apocrine metaplasia.
  2. Cysts > 3 mm.
  3. Calcification.
  4. Sclerosing adenosis.

Memory devices:

  • FACS: complex fibroadenoma, apocrine metaplasia, calcs & cysts, sclerosing adenosis.
  • CAMS: calcs, apocrine metaplasia, microcysts, sclerosing adenosis.

Tubular adenoma of the breast

  • Considered by many a variant of fibroadenoma.
    • IHC features of tubular adenoma of the breast and fibroadenoma are similar.[11]

Features:[8]

  • Fibromyxoid stroma (like in a fibroadenoma).
  • Small round glands.

Images:

  • TA of the breast - myosin IHC. (WC)

See also

References

  1. ↑ Guinebretière, JM.; Menet, E.; Tardivon, A.; Cherel, P.; Vanel, D. (Apr 2005). "Normal and pathological breast, the histological basis.". Eur J Radiol 54 (1): 6-14. doi:10.1016/j.ejrad.2004.11.020. PMID 15797289.
  2. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 550. ISBN 978-1416054542.
  3. ↑ O'Malley, Frances P.; Pinder, Sarah E. (2006). Breast Pathology: A Volume in Foundations in Diagnostic Pathology series (1st ed.). Churchill Livingstone. pp. 110. ISBN 978-0443066801.
  4. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970216-9. Accessed on: 16 March 2011.
  5. ↑ Sabate, JM.; Clotet, M.; Torrubia, S.; Gomez, A.; Guerrero, R.; de las Heras, P.; Lerma, E. (Oct 2007). "Radiologic evaluation of breast disorders related to pregnancy and lactation.". Radiographics 27 Suppl 1: S101-24. doi:10.1148/rg.27si075505. PMID 18180221.
  6. ↑ URL: http://www.imagingpathways.health.wa.gov.au/includes/dipmenu/image/image.html. Accessed on: 15 February 2012.
  7. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 262. ISBN 978-0781765275.
  8. ↑ 8.0 8.1 8.2 O'Malley, Frances P.; Pinder, Sarah E. (2006). Breast Pathology: A Volume in Foundations in Diagnostic Pathology series (1st ed.). Churchill Livingstone. pp. 116. ISBN 978-0443066801.
  9. ↑ URL: http://www.breastpathology.info/fibro_variants.html#juvenile. Accessed on: 3 October 2011.
  10. ↑ URL: http://www.breastpathology.info/fibro_variants.html#complex. Accessed on: 3 October 2011.
  11. ↑ Maiorano, E.; Albrizio, M. (Dec 1995). "Tubular adenoma of the breast: an immunohistochemical study of ten cases.". Pathol Res Pract 191 (12): 1222-30. PMID 8927570.
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