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Liu BL, Mehrotra M, Kowtha L, Guan M, Houldsworth J, Baskovich B, Harigopal M. Fibroepithelial Neoplasm with Hybrid Features of Benign Phyllodes Tumor, Juvenile Papillomatosis, and Juvenile Fibroadenoma: A Case Report. Int J Surg Pathol 2024:10668969241256112. [PMID: 38839253 DOI: 10.1177/10668969241256112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Phyllodes tumor is an uncommon breast fibroepithelial neoplasm mainly found in middle-aged patients, presenting a morphologic continuum from benign to malignant. Juvenile papillomatosis represents a rare benign proliferative breast tumor primarily affecting young individuals and carries a potential elevated risk of subsequent breast cancer development. Juvenile fibroadenoma is a well-circumscribed biphasic neoplasm that often occurs in adolescent girls, characterized by a pericanalicular growth pattern with usual-type epithelial hyperplasia and gynaecomastia-like micropapillary proliferation. Herein, we present an unusual example of a 26-year-old woman with a left breast outer lower quadrant palpable mass. Ultrasonography identified a 5.9 cm lobulated hypoechoic solid mass with scattered small cysts. The preoperative biopsy initially diagnosed a fibroepithelial lesion, considering giant cellular fibroadenoma and phyllodes tumor in the differential. Subsequent complete excision revealed areas of benign phyllodes tumor features closely admixed with distinctive elements such as prominent multiple cysts exhibiting apocrine and papillary apocrine metaplasia, duct papillomatosis, and duct stasis characteristic of juvenile papillomatosis, and hyperplastic ductal epithelium with micropapillary projections demonstrating a pericanalicular growth pattern indicative of juvenile fibroadenoma. The diagnosis was conclusively established as a fibroepithelial lesion with combined features of benign phyllodes tumor, juvenile papillomatosis, and juvenile fibroadenoma. Further investigation uncovered a family history of breast cancer. Molecular analysis revealed a pattern of unique and overlapping mutations within these distinct histopathological areas. This unusual presentation with hybrid features within a single tumor is described for the first time in the literature along with the molecular signature of the individual components.
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Affiliation(s)
- Bella Lingjia Liu
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Meenakshi Mehrotra
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lakshmi Kowtha
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Michelle Guan
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jane Houldsworth
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Brett Baskovich
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Malini Harigopal
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Jorns JM, Farooq A, Puzyrenko A, Jarzembowski J, Thike AA, Nasir NDM, Ng CCY, Liu W, Lee JY, Lim AH, Guan P, Teh BT, Tan PH. Giant juvenile fibroadenomas with and without prominent pseudoangiomatous stromal hyperplasia (PASH)-like change: clinicopathological and molecular characteristics. Histopathology 2023; 83:357-365. [PMID: 37140543 DOI: 10.1111/his.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Abstract
AIMS Juvenile fibroadenomas (JFA) are biphasic fibroepithelial lesions (FEL) usually occurring in adolescent female patients. Giant (G) JFA, like other FEL, may exhibit prominent pseudoangiomatous stromal hyperplasia (PASH)-like change. We sought to determine clinicopathological and molecular characteristics of GJFA with and without PASH. METHODS AND RESULTS Archives were searched for cases of GJFA (1985-2020). All were stained for androgen receptor (AR), beta-catenin, CD34 and progesterone receptor (PR). Cases were sequenced using a custom 16-gene panel - MED12 (exons 1 and 2), TERT promoter (-124C>T and -146Ctable>T), SETD2, KMT2D, RARA (exons 5-9), FLNA, NF1, PIK3CA (exons 10, 11 and 21), EGFR, RB1, BCOR, TP53, PTEN, ERBB4, IGF1R and MAP3K1. Twenty-seven GJFA from 21 female patients aged 10.1-25.2 years were identified. Size ranged from 5.2 to 21 cm. Two patients had multiple, bilateral and later recurrent GJFA. Thirteen (48%) cases showed prominent PASH-like stroma. All were positive for stromal CD34, negative for AR and beta-catenin and one case showed focal PR expression. Sequencing showed MAP3K1 and SETD2 mutations in 17 samples, with KMT2D, TP53 and BCOR aberrations in 10 (45%), 10 (45%) and seven (32%) cases, respectively. Tumours with a PASH-like pattern had higher prevalence of SETD2 (P = 0.004) and TP53 (P = 0.029) mutations, while those without PASH had more RB1 mutations (P = 0.043). MED12 mutation was identified in one case. TERT promoter mutation was observed in four (18%), including two recurrences. CONCLUSIONS Gene mutations along more advanced phases of the proposed FEL pathogenetic pathway in GJFA are unusual, and suggest a mechanism for more aggressive growth in these tumours.
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Affiliation(s)
- Julie M Jorns
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrii Puzyrenko
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jason Jarzembowski
- Department of Pathology, Children's Hospital of Wisconsin, Madison, WI, USA
| | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | | | | | - Wei Liu
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Jing Yi Lee
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Abner Herbert Lim
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Peiyong Guan
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Quantitative Biology and Medicine Programme, Duke-NUS Medical School, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Puay Hoon Tan
- Luma Medical Centre, Singapore
- KK Women's and Children's Hospital, Singapore
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pathology, University of Western Sydney, Sydney, NSW, Australia
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Mon KS, Tang P. Fibroepithelial Lesions of the Breast: Update on Molecular Profile With Focus on Pediatric Population. Arch Pathol Lab Med 2023; 147:38-45. [PMID: 35776911 DOI: 10.5858/arpa.2022-0011-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/31/2022]
Abstract
CONTEXT.— This review article derives from the breast pathology lecture at the Eighth Princeton Integrated Pathology Symposium (PIPS VIII). OBJECTIVE.— To provide a literature review and update on fibroepithelial lesions of the breast with molecular findings and findings regarding the pediatric population. DATA SOURCES.— The sources include extensive literature review, personal research, and experience. CONCLUSIONS.— Given significant differences in prognosis and management of fibroepithelial lesions, we aim to provide readers with pertinent definitions, pathomorphology, molecular findings, and management for each diagnosis, with insights on the pediatric population.
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Affiliation(s)
- Khin Su Mon
- From the Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Ping Tang
- From the Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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4
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Tsang JY, Shao Y, Poon IK, Ni YB, Kwan JS, Chow C, Shea KH, Tse GM. Analysis of recurrent molecular alterations in phyllodes tumour of breast: insights into prognosis and pathogenesis. Pathology 2022; 54:678-685. [PMID: 35691725 DOI: 10.1016/j.pathol.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
Phyllodes tumour (PT) of breast is a rare biphasic neoplasm. Recent next generation sequencing analyses had revealed novel genetic alterations in PT but lacked a further characterisation of their relationship to different PT features and outcome. Here, using targeted sequencing, we examined a panel of 90 recurrently altered or cancer related genes in 88 PT samples (including 49 benign, 25 borderline and 14 malignant PT). Twenty-three genes showed alterations in at least 8.0% of cases. Alterations were significantly higher with an increasing grade of PT (p=0.033), particularly for copy number alterations. The top ten alterations were TERT promoter (58.0%), MED12 (53.4%), RARA (22.8%), FLNA (19.3%), SETD2 (15.9%), SYNE1 (18.2%), PCLO (15.9%), KMT2D (14.3%), CDKN2A (15.9%) and DNAH11 (14.8%). Alterations in CDKN2A/B, EGFR, TP53, PIK3CA, PTEN and ARID1B (p≤0.039) were associated with a higher grade. Analysing alterations based on common pathways indicated a significant correlation of cell cycle pathway and epigenetic alterations with a higher PT grade (p=0.036 and 0.075 respectively). Interestingly, recurrences were not correlated with tumour grade, but related to the presence of RARA mutation (p=0.011) and the absence of alterations in epigenetic pathway (p=0.031). Analysis of synchronous pair of PT showed more differences in gene mutations with divergent MED12 mutation. By contrast, the recurrent samples showed similar genetic alterations as the primary tumours. In summary, we characterised genetic alterations in PTs of different grades and confirmed the recurrent alterations observed in earlier studies. In addition, current data implicated the roles of cell cycle, epigenetic and RARA changes in PT recurrence and tumourogenesis.
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Affiliation(s)
- Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Yan Shao
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Yun-Bi Ni
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Johnny S Kwan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Chit Chow
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Ka-Ho Shea
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, NT, Hong Kong, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China.
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5
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Seow DY, Tay TK, Tan PH. FIBROEPITHELIAL LESIONS OF THE BREAST: A REVIEW OF RECURRING DIAGNOSTIC ISSUES. Semin Diagn Pathol 2022; 39:333-343. [DOI: 10.1053/j.semdp.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
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6
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Lerwill MF, Lee AHS, Tan PH. Fibroepithelial tumours of the breast-a review. Virchows Arch 2021; 480:45-63. [PMID: 34505197 DOI: 10.1007/s00428-021-03175-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/08/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
Fibroepithelial tumours of the breast are biphasic neoplasms composed of both epithelial and stromal elements, including the common fibroadenoma and the infrequent phyllodes tumour. The admixture of epithelium and stroma in the fibroadenoma shows intra- and pericanalicular patterns, and may display a variety of histological changes. Fibroadenoma variants include the cellular, juvenile, myxoid and complex forms. The cellular fibroadenoma may be difficult to distinguish from the benign phyllodes tumour. Stromal mitotic activity can be increased in fibroadenomas in the young and pregnant patients. Phyllodes tumours, neoplasms with the potential for recurrence, show an exaggerated intracanalicular growth pattern with broad stromal fronded architecture and stromal hypercellularity. They are graded into benign, borderline and malignant forms based on histological assessment of stromal features of hypercellularity, atypia, mitotic activity, overgrowth and the nature of the tumour borders. Classification of phyllodes tumours is imperfect, compounded by tumour heterogeneity with overlapping microscopic features among the different grades, especially in the borderline category. Malignant phyllodes tumours can metastasise and cause death. Determining which phyllodes tumours may behave aggressively has been difficult. The discovery of MED12 mutations in the pathogenesis of fibroepithelial tumours, together with other gene abnormalities in the progression pathway, has allowed refinements in diagnosis and prognosis.
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Affiliation(s)
- Melinda F Lerwill
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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Li X, Febres-Aldana C, Zhang H, Zhang X, Uraizee I, Tang P. Updates on Lobular Neoplasms, Papillary, Adenomyoepithelial, and Fibroepithelial Lesions of the Breast. Arch Pathol Lab Med 2021; 146:930-939. [PMID: 34270716 DOI: 10.5858/arpa.2021-0091-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— This review article is a result of the breast pathology lectures given at the Sixth Chinese American Pathologists Association annual diagnostic pathology course in October 2020 (held virtually due to the coronavirus disease 2019). OBJECTIVE.— To update recent developments, in this review article, the authors wrote minireviews in the following 4 areas: lobular neoplasm, adenomyoepithelial lesions, papillary lesions, and fibroepithelial lesions. DATA SOURCES.— The sources include extensive literature review, personal research, and experience. CONCLUSIONS.— With the wide practice of screening mammography, these lesions are not uncommon in image-guided core biopsies and excisional specimens. Many recent developments have emerged in understanding these lesions. We aim to provide readers with concise updates for each of these lesions with a focus on recent updates in definitions, diagnostic criteria, management, and molecular profiles that are most relevant to the daily practice of pathology and patient management.
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Affiliation(s)
- Xiaoxian Li
- From the Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (Li)
| | - Christopher Febres-Aldana
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Febres-Aldana, H. Zhang)
| | - Hong Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Febres-Aldana, H. Zhang)
| | - Xinmin Zhang
- Department of Pathology, Cooper University Health Care, Camden, New York (X. Zhang)
| | - Imran Uraizee
- The Department of Pathology and Laboratory Medicine, Loyola University, Maywood, Illinois (Uraizee, Tang)
| | - Ping Tang
- The Department of Pathology and Laboratory Medicine, Loyola University, Maywood, Illinois (Uraizee, Tang)
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Ng CCY, Md Nasir ND, Loke BN, Tay TKY, Thike AA, Rajasegaran V, Liu W, Lee JY, Guan P, Lim AH, Chang KTE, Gudi MA, Madhukumar P, Tan BKT, Tan VKM, Wong CY, Yong WS, Ho GH, Ong KW, Yip GWC, Bay BH, Tan P, Teh BT, Tan PH. Genetic differences between benign phyllodes tumors and fibroadenomas revealed through targeted next generation sequencing. Mod Pathol 2021; 34:1320-1332. [PMID: 33727697 DOI: 10.1038/s41379-021-00787-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
Breast fibroepithelial lesions are biphasic tumors which comprise the common benign fibroadenomas (FAs) and the rarer phyllodes tumors (PTs). This study analyzed 262 (42%) conventional FAs, 45 (7%) cellular FAs, and 321 (51%) benign PTs contributed by the International Fibroepithelial Consortium, using a previously curated 16 gene panel. Benign PTs were found to possess a higher number of mutations, and higher rates of cancer driver gene alterations than both groups of FAs, in particular MED12, TERT promoter, RARA, FLNA, SETD2, RB1, and EGFR. Cases with MED12 mutations were also more likely to have TERT promoter, RARA, SETD2, and EGFR. There were no significant differences detected between conventional FAs and cellular FAs, except for PIK3CA and MAP3K1. TERT promoter alterations were most optimal in discriminating between FAs and benign PTs. Our study affirms the role of sequencing and key mutations that may assist in refining diagnoses of these lesions.
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Affiliation(s)
- Cedric Chuan Young Ng
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Nur Diyana Md Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Benjamin Nathanael Loke
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Wei Liu
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Yi Lee
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Peiyong Guan
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore.,Quantitative Biology and Medicine Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Abner Herbert Lim
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mihir Ananta Gudi
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Preetha Madhukumar
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore.,Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Veronique Kiak Mien Tan
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chow Yin Wong
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Wei Sean Yong
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gay Hui Ho
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Kong Wee Ong
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | | | - George Wai Cheong Yip
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Boon Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Patrick Tan
- Duke-NUS Medical School, Singapore, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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9
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Tan PH. Fibroepithelial lesions revisited: implications for diagnosis and management. Mod Pathol 2021; 34:15-37. [PMID: 32461622 DOI: 10.1038/s41379-020-0583-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
Fibroepithelial lesions of the breast, comprising the fibroadenoma and phyllodes tumour, are a unique group of neoplasms that share histological characteristics but possess different clinical behaviour. The fibroadenoma is the commonest benign breast tumour in women, while the phyllodes tumour is rare and may be associated with recurrences, grade progression and even metastasis. The diagnosis of fibroadenoma is usually straightforward, with recognised histological variants such as the cellular, complex, juvenile and myxoid forms. The phyllodes tumour comprises benign, borderline and malignant varieties, graded using a constellation of histological parameters based on stromal characteristics of hypercellularity, atypia, mitoses, overgrowth and the nature of tumour borders. While phyllodes tumour grade correlates with clinical behaviour, interobserver variability in assessing multiple parameters that are potentially of different biological weightage leads to significant challenges in accurate grade determination and consequently therapy. Differential diagnostic considerations along the spectrum of fibroepithelial tumours can be problematic in routine practice. Recent discoveries of the molecular underpinnings of these tumours may have diagnostic, prognostic and therapeutic implications.
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Affiliation(s)
- Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Academia, Diagnostics Tower Level 7, 20 College Road, Singapore, 169856, Singapore.
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10
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Md Nasir ND, Ng CCY, Rajasegaran V, Wong SF, Liu W, Ng GXP, Lee JY, Guan P, Lim JQ, Thike AA, Koh VCY, Loke BN, Chang KTE, Gudi MA, Lian DWQ, Madhukumar P, Tan BKT, Tan VKM, Wong CY, Yong WS, Ho GH, Ong KW, Tan P, Teh BT, Tan PH, Rahman NA, Nahar Begum SMK, Cheah PL, Chen CJ, Dela Fuente E, Han A, Harada O, Kanomata N, Lee CS, Han Lee JY, Kamal M, Nishimura R, Ohi Y, Sawyer EJ, Teoh KH, Tsang AKH, Tsang JY, Tse GMK, Yamaguchi R. Genomic characterisation of breast fibroepithelial lesions in an international cohort. J Pathol 2019; 249:447-460. [DOI: 10.1002/path.5333] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/11/2019] [Accepted: 08/01/2019] [Indexed: 12/31/2022]
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11
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Pareja F, Da Cruz Paula A, Murray MP, Hoang T, Gularte-Mérida R, Brown D, da Silva EM, Sebastiao APM, Giri DD, Weigelt B, Reis-Filho JS, Brogi E. Recurrent MED12 exon 2 mutations in benign breast fibroepithelial lesions in adolescents and young adults. J Clin Pathol 2018; 72:258-262. [PMID: 30467240 DOI: 10.1136/jclinpath-2018-205570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022]
Abstract
AIMS Most benign breast fibroepithelial lesions (FEL) in adults harbour recurrent somatic MED12 exon 2 mutations and rare TERT promoter hotspot mutations. We sought to determine the frequency of MED12 exon 2 and TERT promoter hotspot mutations in fibroadenomas (FA) and benign phyllodes tumours (BePT) in adolescents and young adults. METHODS DNA from 21 consecutive FAs and eight consecutive BePTs in adolescents and young adults was subjected to Sanger sequencing of the exon 2 of MED12 and the TERT promoter hotspot locus. RESULTS We identified MED12 exon 2 mutations in 62% and 88% of FAs and BePTs, respectively, and no TERT promoter hotspot mutations. The majority of the MED12 exon 2 mutations identified were in-frame deletions (60%). CONCLUSIONS As in adults, benign FELs in juvenile patients harbour recurrent MED12 exon 2 mutations.
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Affiliation(s)
- Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arnaud Da Cruz Paula
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa P Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Timothy Hoang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rodrigo Gularte-Mérida
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David Brown
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edaise M da Silva
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ana Paula Martins Sebastiao
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Post-Graduate Program in Health Sciences, Pontifical Catholic University of Paraná, Curitiba, Brazil.,Department of Medical Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Dilip D Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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