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Presented by Hind Nassar, M.D.. and prepared by ChanJuan Shi, M.D., Ph.D.
Case 3: The patient is a 42 y old woman with a breast mass.
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1. Question
Week 387: Case 3
The patient is a 42 y old woman with a breast mass.images/nassar033009-3a.jpg
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images/nassar033009-3d.jpgCorrect
Answer: Phyllodes tumor, borderline
Histology: see below
Discussion: This is a fibroepithelial lesion of the breast, which consists of fibroadenoma and phyllodes tumor. The latter is classified into benign, borderline or malignant depending on the circumscription of the lesion, stromal cellularity, stromal overgrowth (defined as stromal proliferation seen on 4x), mitoses, stromal atypia, the presence of heterologous elements. Benign phyllodes tumor usually has a pushing border (can be focally irregular), moderate stromal cellularity, no stromal atypia, rare or absent mitoses. It is difficult to differentiate benign phyllodes from fibroadenoma in some cases. Malignant phyllodes tumor is characterized by infiltrative growth, high stromal cellularity, marked stromal atypia, mitoses >10/10 HPF, stromal overgrowth and in some cases, heterologous elements (such as liposarcoma). Tumors with some of these criteria but not all, such as our case are classified as borderline phyllodes tumors. The rate of recurrence in phyllodes tumor is very low in cases where the tumor was treated with wide local excision.
Incorrect
Answer: Phyllodes tumor, borderline
Histology: see below
Discussion: This is a fibroepithelial lesion of the breast, which consists of fibroadenoma and phyllodes tumor. The latter is classified into benign, borderline or malignant depending on the circumscription of the lesion, stromal cellularity, stromal overgrowth (defined as stromal proliferation seen on 4x), mitoses, stromal atypia, the presence of heterologous elements. Benign phyllodes tumor usually has a pushing border (can be focally irregular), moderate stromal cellularity, no stromal atypia, rare or absent mitoses. It is difficult to differentiate benign phyllodes from fibroadenoma in some cases. Malignant phyllodes tumor is characterized by infiltrative growth, high stromal cellularity, marked stromal atypia, mitoses >10/10 HPF, stromal overgrowth and in some cases, heterologous elements (such as liposarcoma). Tumors with some of these criteria but not all, such as our case are classified as borderline phyllodes tumors. The rate of recurrence in phyllodes tumor is very low in cases where the tumor was treated with wide local excision.
