1
|
Al-Arnawoot B, Scaranelo A, Fleming R, Kulkarni S, Menezes RJ, McCready D, Done S, Freitas V. Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical-sonography features helping to differentiate fibroadenomas and phyllodes tumor? J Surg Oncol 2020; 122:382-387. [PMID: 32396665 DOI: 10.1002/jso.25977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the role of clinico-sonographic features of breast cellular fibroepithelial lesions (CFELs) diagnosed on core needle biopsy (CNB) in the differentiation between fibroadenoma (FA) and phyllodes. MATERIALS AND METHODS Results of consecutive women with a CNB showing CFEL from 2005 to 2010 were retrospectively reviewed. Clinical and sonographic findings were compared with surgical outcomes. Chi-square and Fisher's exact tests were used followed by a regression model for statistical analysis. RESULTS A total of 131 women with 134 CFEL were included in the study; 89 (66%) were FAs and 45 (34%) were phyllodes (32 benign; 13 malignant). Significant predictors of increased risk of phyllodes tumor were patient age equal to or greater than 50 years (P = .021) and lesion size less than 2 cm at sonography (P = .043). No other imaging or clinical features were able to differentiate FA from phyllodes tumors. CONCLUSION CFEL with a larger size in older women is associated with the surgical pathological result of phyllodes tumor and management should be tailored accordingly. Younger patients with small size nodules might be approached less aggressively, depending on a personalized discussion with the surgeons, taking into account the results obtained in this study.
Collapse
Affiliation(s)
- Basma Al-Arnawoot
- Department of Diagnostic Imaging, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Anabel Scaranelo
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Rachel Fleming
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Ravi J Menezes
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - David McCready
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Susan Done
- Laboratory Medicine Program, University Health Network-Toronto General Hospital Site, University of Toronto, Toronto, Ontario, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Lee S, Mercado CL, Cangiarella JF, Chhor CM. Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision. Clin Imaging 2018; 50:31-36. [DOI: 10.1016/j.clinimag.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/23/2017] [Accepted: 12/12/2017] [Indexed: 11/16/2022]
|
3
|
Maran-Gonzalez A. [Diagnostic challenges on breast needle core biopsies. Case 1: Low grade fibroepithelial neoplasm]. Ann Pathol 2017; 37:359-367. [PMID: 28943202 DOI: 10.1016/j.annpat.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Aurélie Maran-Gonzalez
- Service d'anatomie pathologique, ICM val d'Aurelle, Parc Euromédecine, 208, rue des Apothicaires, 34298 Montpellier cedex 5, France.
| |
Collapse
|
4
|
Abstract
Fibroepithelial lesions of the breast comprise a morphologically and biologically heterogeneous group of biphasic tumors with epithelial and stromal components that demonstrate widely variable clinical behavior. Fibroadenomas are common benign tumors with a number of histologic variants, most of which pose no diagnostic challenge. Cellular and juvenile fibroadenomas can have overlapping features with phyllodes tumors and should be recognized. Phyllodes tumors constitute a spectrum of lesions with varying clinical behavior and are graded as benign, borderline or malignant based on a set of histologic features according to recommendations by the World Health Organization (WHO). Recent developments have significantly expanded our understanding of the pathogenesis of fibroepithelial lesions, highlighting fibroadenomas as true neoplasms and underscoring a commonality with phyllodes tumors in the form of recurrent MED12 exon 2 mutations. In addition, sequencing studies have elucidated pathways associated with phyllodes tumor progression. Accurate diagnosis and grading of phyllodes tumors are important for patient management and prognosis, as grade broadly correlates with increasing local recurrence risk, and essentially only malignant tumors metastasize. However, classification of fibroepithelial lesions in many cases remains challenging on both core biopsy and excision specimens. A commonly encountered problem at the benign end of the spectrum is the distinction of benign phyllodes tumor from cellular fibroadenoma, which is largely due to the subjective nature of histologic features used in diagnosis and histologic overlap between lesions. Grading is further complicated by the requirement to integrate multiple subjective and ill-defined parameters. On the opposite end of the histologic spectrum, malignant phyllodes tumors must be distinguished from more common metaplastic carcinomas and from primary or metastatic sarcomas, which can be especially difficult in core biopsies. Immunohistochemistry can be useful in the differential diagnosis but should be interpreted with attention to caveats. This review provides an overview and update on the spectrum of fibroepithelial lesions, with special emphasis on common problems and practical issues in diagnosis.
Collapse
Affiliation(s)
- Gregor Krings
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.
| | - Gregory R Bean
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
5
|
Liu SY, Joseph NM, Ravindranathan A, Stohr BA, Greenland NY, Vohra P, Hosfield E, Yeh I, Talevich E, Onodera C, Van Ziffle JA, Grenert JP, Bastian BC, Chen YY, Krings G. Genomic profiling of malignant phyllodes tumors reveals aberrations in FGFR1 and PI-3 kinase/RAS signaling pathways and provides insights into intratumoral heterogeneity. Mod Pathol 2016; 29:1012-27. [PMID: 27255162 DOI: 10.1038/modpathol.2016.97] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 12/16/2022]
Abstract
Malignant phyllodes tumors of the breast are poorly understood rare neoplasms with potential for aggressive behavior. Few efficacious treatment options exist for progressed or metastatic disease. The molecular features of malignant phyllodes tumors are poorly defined, and a deeper understanding of the genetics of these tumors may shed light on pathogenesis and progression and potentially identify novel treatment approaches. We sequenced 510 cancer-related genes in 10 malignant phyllodes tumors, including 5 tumors with liposarcomatous differentiation and 1 with myxoid chondrosarcoma-like differentiation. Intratumoral heterogeneity was assessed by sequencing two separate areas in 7 tumors, including non-heterologous and heterologous components of tumors with heterologous differentiation. Activating hotspot mutations in FGFR1 were identified in 2 tumors. Additional recurrently mutated genes included TERT promoter (6/10), TP53 (4/10), PIK3CA (3/10), MED12 (3/10), SETD2 (2/10) and KMT2D (2/10). Together, genomic aberrations in FGFR/EGFR PI-3 kinase and RAS pathways were identified in 8 (80%) tumors and included mutually exclusive and potentially actionable activating FGFR1, PIK3CA and BRAF V600E mutations, inactivating TSC2 mutation, EGFR amplification and PTEN loss. Seven (70%) malignant phyllodes tumors harbored TERT aberrations (six promoter mutations, one amplification). For comparison, TERT promoter mutations were identified by Sanger sequencing in 33% borderline (n=12) and no (0%, n=8) benign phyllodes tumors (P=0.391 and P=0.013 vs malignant tumors, respectively). Genetic features specific to liposarcoma, including CDK4/MDM2 amplification, were not identified. Copy number analysis revealed intratumoral heterogeneity and evidence for divergent tumor evolution in malignant phyllodes tumors with and without heterologous differentiation. Tumors with liposarcomatous differentiation revealed more chromosomal aberrations in non-heterologous components compared with liposarcomatous components. EGFR amplification was heterogeneous and present only in the non-heterologous component of one tumor with liposarcomatous differentiation. The results identify novel pathways involved in the pathogenesis of malignant phyllodes tumors, which significantly increase our understanding of tumor biology and have potential clinical impact.
Collapse
Affiliation(s)
- Su-Yang Liu
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Nancy M Joseph
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Ajay Ravindranathan
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Bradley A Stohr
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Nancy Y Greenland
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Poonam Vohra
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.,Department of Pathology, San Francisco General Hospital, San Francisco, CA, USA
| | | | - Iwei Yeh
- Department of Dermatology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Eric Talevich
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Courtney Onodera
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Jessica A Van Ziffle
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - James P Grenert
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Boris C Bastian
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.,Department of Dermatology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Gregor Krings
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
6
|
Bacchi CE, Wludarski SC, Lamovec J, Ben Dor D, Ober E, Salviato T, Zanconati F, De Maglio G, Pizzolitto S, Sioletic S, Falconieri G. Lipophyllodes of the breast. A reappraisal of fat-rich tumors of the breast based on 22 cases integrated by immunohistochemical study, molecular pathology insights, and clinical follow-up. Ann Diagn Pathol 2015; 21:1-6. [PMID: 27040923 DOI: 10.1016/j.anndiagpath.2015.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/08/2015] [Indexed: 11/28/2022]
Abstract
We have studied 22 cases of mammary lipophyllodes tumors (LPT), analyzing their clinicopathologic features along with available follow-up. All cases were tested for cytokeratins, S100 protein, and MDM2, and in selected cases for estrogen receptor, smooth muscle actin, bcl2, desmin, and myogenin. Patients were women aged 21 to 69 years (average, 45 years), and LPT size ranged from 1.6 to 30 cm (average, 9.7 cm). Microscopically, LPT segregated as follows: atypical lipoma-like tumor/well-differentiated liposarcoma (ALT/WDL), 8 cases; myxoid, 6; and pleomorphic/poorly differentiated/round cell, 8, including a case of dedifferentiated liposarcoma. Immunohistochemistry studies showed focal positive staining for S100 and CD34 in most ALT/WDL, and desmin and myogenin in 2 cases with evidence of rhabdomyoblastic differentiation. MDM2 positivity was focally seen in 1 case. Follow-up was available in 8 cases. Multiple recurrent tumors were seen in 2 patients, and metastatic disease to the lung was seen in 2 patients. In 4 patients with a follow-up between 2 and 15 years there was no evidence of recurrent or metastatic disease. Patients with ALT/WDL (2/2) were alive with no evidence of disease; 2 of 4 patients with myxoid liposarcoma component experienced tumor recurrence, whereas pleomorphic liposarcoma LPT pursued a less favorable course although only 1 patient died of the condition. Absence of MDM2 reactivity in most cases seems not as meaningful as in fatty tumors of somatic soft parts.
Collapse
Affiliation(s)
| | | | - Janez Lamovec
- Department of Pathology, Institute of Oncology, Ljubljana, Slovenia
| | - David Ben Dor
- Department of Pathology, The Barzilai Medical Center, Ashkelon, Israel
| | - Elisa Ober
- Department of Pathology, University of Trieste School of Medicine, Trieste, Italy
| | - Tiziana Salviato
- Department of Pathology, University of Trieste School of Medicine, Trieste, Italy
| | - Fabrizio Zanconati
- Department of Pathology, University of Trieste School of Medicine, Trieste, Italy
| | | | | | - Stefano Sioletic
- Department of Pathology, General University Hospital, Udine, Italy
| | - Giovanni Falconieri
- Department of Pathology, University of Trieste School of Medicine, Trieste, Italy.
| |
Collapse
|