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Presented by Dr. Pedram Argani and prepared by Dr. Harsimar Kaur
This is a 38 year old female with a breast mass that grew from 1cm to 4cm over the course of a year.
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1. Question
This is a 38 year old female with a breast mass that grew from 1cm to 4cm over the course of a year.
Correct
Answer: C
Histologic Description: This is a fibroepithelial neoplasm characterized by expanded stroma over which there is benign breast epithelium. The stroma varies in different areas, ranging from paucicellular hyalinized areas to highly cellular areas composed of pleomorphic cells with atypical mitoses. Some portions of the stroma demonstrate liposarcomatous differentiation characterized by atypical lipoblasts with lipid cytoplasmic vacuoles. In some portions of the tumor, mitotic rate was 3 per high power field, and there were 4x (low power) fields of pure atypical stroma without epithelium. These meet the diagnostic criteria for a malignant phyllodes tumor.
Differential Diagnosis: Fibroadenoma is biphasic neoplasm in which the stroma is uniformly distributed and lacks cytologic atypia. Benign phyllodes tumors typically have infiltrative borders, but lack significant mitotic activity, heterologous differentiation, or stromal overgrowth. While this tumor demonstrates liposarcomatous differentiation, it is not a pure liposarcoma as the sarcomatous component is a component of the biphasic phyllodes tumor. Interestingly, the liposarcomatous component of malignant phyllodes tumor does not typically share the genetic alterations (MDM2 amplification) that are associated with well differentiated liposarcoma.
Malignant phyllodes tumor have potential for aggressive local recurrence, particularly if not completely excised, and overall an approximately a 25% risk of distant metastases.
Incorrect
Answer: C
Histologic Description: This is a fibroepithelial neoplasm characterized by expanded stroma over which there is benign breast epithelium. The stroma varies in different areas, ranging from paucicellular hyalinized areas to highly cellular areas composed of pleomorphic cells with atypical mitoses. Some portions of the stroma demonstrate liposarcomatous differentiation characterized by atypical lipoblasts with lipid cytoplasmic vacuoles. In some portions of the tumor, mitotic rate was 3 per high power field, and there were 4x (low power) fields of pure atypical stroma without epithelium. These meet the diagnostic criteria for a malignant phyllodes tumor.
Differential Diagnosis: Fibroadenoma is biphasic neoplasm in which the stroma is uniformly distributed and lacks cytologic atypia. Benign phyllodes tumors typically have infiltrative borders, but lack significant mitotic activity, heterologous differentiation, or stromal overgrowth. While this tumor demonstrates liposarcomatous differentiation, it is not a pure liposarcoma as the sarcomatous component is a component of the biphasic phyllodes tumor. Interestingly, the liposarcomatous component of malignant phyllodes tumor does not typically share the genetic alterations (MDM2 amplification) that are associated with well differentiated liposarcoma.
Malignant phyllodes tumor have potential for aggressive local recurrence, particularly if not completely excised, and overall an approximately a 25% risk of distant metastases.
