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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] [What about the content of this article? (0)] [Affiliation(s)] [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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2
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Zhanghuang C, Hang Y, Ji F, Long N, Yao Z, Li L, Yang Z, Tang H, Zhang K, Wu C, Xie Y, Yan B. Congenital giant fibroepithelial polyp of the scrotum in an infant: the first case report from China. Front Pediatr 2023; 11:1191983. [PMID: 37492601 PMCID: PMC10364443 DOI: 10.3389/fped.2023.1191983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Giant fibroepithelial polyp (FP) of the scrotum in infants is a rare disease. We reported the first case of FP in China. The child was only 9 months and 12 days old and was admitted to the hospital due to rapid growth and rupture of the scrotal mass. The patient underwent scrotal exploration under general anesthesia, and the mass was cystic-solid with clear boundaries. The tumor did not invade the sarcolemma of the scrotum and testicular tissue. The intraoperative pathological frozen section tended to be benign, and the scrotum's tumor and subcutaneous pedicle tissue were removed entirely after 0.5 cm from the boundary of the mass. The operation was successful. The mass was confirmed as FP by postoperative pathology. 6 months after the operation, the incision healed well without recurrence. This case report has a detailed diagnosis and treatment process and adequate examination results. It can provide a reference for diagnosing and treating FP in infants and reduce the risk of misdiagnosis and mistreatment.
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Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
- Yunnan Key Laboratory of Children’s Major Disease Research, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Yu Hang
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Fengming Ji
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Na Long
- Department of Special Needs Ward, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Zhigang Yao
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Li Li
- Yunnan Key Laboratory of Children’s Major Disease Research, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Zhen Yang
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Haoyu Tang
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Kun Zhang
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Chengchuang Wu
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Bing Yan
- Department of Urology, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
- Department of Special Needs Ward, Kunming Children’s Hospital (Children’s Hospital Affiliated to Kunming Medical University), Kunming, China
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3
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Tan BY, Fox SB, Lakhani SR, Tan PH. Survey of recurrent diagnostic challenges in breast phyllodes tumours. Histopathology 2023; 82:95-105. [PMID: 36468287 DOI: 10.1111/his.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/15/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Breast phyllodes tumours (PTs) are graded as benign, borderline, or malignant by analysis of multiple histological features. PT grading is often inconsistent, likely due to variation in the weighting of grading criteria by pathologists. DESIGN The hierarchy of use of diagnostic criteria was identified using a 20-question survey. RESULTS In all, 213 pathologists from 29 countries responded. 54% reported 10-50 PT cases per year. Criteria considered key to PT diagnosis were: increased stromal cellularity (84.3%), stromal overgrowth (76.6%), increased stromal mitoses (67.8%), stromal atypia (61.5%), stromal fronding (59.0%), periductal stromal condensation (58.0%), irregular tumour borders (46.3%), and/or lesional heterogeneity (33.7%). The importance of grading parameters were: mitotic activity (55.5%), stromal overgrowth (54.0%), stromal atypia (51.9%), increased stromal cellularity (41.7%), and nature of the tumour border (38.9%). 49% would diagnose malignant PT without a full array of adverse features. 89% used the term "cellular fibroepithelial lesion (FEL)" for difficult cases; 45% would diagnose an FEL with stromal fronding (but lacking other PT features) as fibroadenoma (FA), 35% FEL, and 17% PT. 59% deemed clinico-radiological findings diagnostically significant; 68% considered age (≥40 years) important in determining if an FEL was a FA or PT. In FELs from young patients, increased stromal cellularity (83%), fronding (52%), and mitoses (41%) were more common. 34% regarded differentiating cellular FA from PT as a specific challenge; 54% had issues assigning a borderline PT grade. CONCLUSION Criteria for grading PT lie on a spectrum, leading to interpretive variability. The survey highlights the criteria most used by pathologists, which do not completely align with WHO recommendations.
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Affiliation(s)
| | - Stephen B Fox
- Peter MacCallum Cancer Centre and University of Melbourne, Australia
| | - Sunil R Lakhani
- The University of Queensland and Pathology Queensland, Australia
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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4
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Muacevic A, Adler JR, Alattia L. Transformation of a Benign-Appearing Fibroepithelial Lesion to a Giant Malignant Phyllodes Tumor of the Breast. Cureus 2022; 14:e32881. [PMID: 36699789 PMCID: PMC9867914 DOI: 10.7759/cureus.32881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
This is a case of a woman who presented with a left breast mass that was initially diagnosed as fibroadenoma on core biopsy and, after three years without any surgical intervention, was found to be a malignant phyllodes tumor. Initially, a core needle biopsy of the mass showed probable fibroadenoma. Because of the initial benign seeming diagnosis and the need to treat her tongue cancer, the patient did not recognize the need for a recommended surgical consultation and excision. Three years later, she presented after the mass had enlarged to encompass nearly the whole left breast. Core needle biopsy revealed spindle cell proliferation with scattered benign-looking tubules. Due to the large size of the mass, she underwent a total mastectomy, and the final pathology demonstrated a malignant phyllodes tumor. This case demonstrates a case of progression of a benign-appearing fibroepithelial lesion to a malignant phyllodes tumor three years later.
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Kubelis-López DE, Figueroa-Morales AL, Reyna-Rodríguez IL, Garza-Rodríguez V, Ocampo-Candiani J, Gutiérrez-González A, García-Chairez LR, Piñeiro-Martínez A, Enrriquez-Avila JV, Alba-Rojas E. Giant congenital fibroepithelial polyp of the scrotum. Pediatr Dermatol 2021; 38:327-328. [PMID: 33222238 DOI: 10.1111/pde.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/07/2020] [Accepted: 10/20/2020] [Indexed: 10/22/2022]
Abstract
Fibroepithelial polyps are common tumors of mesodermal origin. However, only a few case reports of giant fibroepithelial polyps have been published, and they have mainly involved adults. This case report describes a 3-month-old boy with a pedunculated mass in the scrotum. To our knowledge, this is the first report of a giant congenital fibroepithelial polyp on this location.
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Affiliation(s)
- David Emmanuel Kubelis-López
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Ana Lizzeth Figueroa-Morales
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Irving Llibrán Reyna-Rodríguez
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Verónica Garza-Rodríguez
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Ocampo-Candiani
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Gutiérrez-González
- Urology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Luis Roberto García-Chairez
- Urology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Antonio Piñeiro-Martínez
- Urology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Joana Valeria Enrriquez-Avila
- Urology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Erika Alba-Rojas
- Dermatology Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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6
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Nguyen QD, Krider SO, Roberts JT, Posleman Monetto FE, He J. Fibroepithelial Lesion Initially Believed to Be Fibroadenoma, but Interval Growth Consistent With Phyllodes Tumor. Cureus 2020; 12:e10363. [PMID: 33062486 PMCID: PMC7549856 DOI: 10.7759/cureus.10363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Fibroepithelial lesions of the breast are commonly encountered tumors comprised of stromal and epithelial components. Fibroadenoma and phyllodes tumor are both fibroepithelial lesions, but their management differs. Phyllodes tumor requires surgical excision, whereas fibroadenoma requires no further workup. Both have many overlapping histological features making it difficult to distinguish between a benign fibroadenoma versus the more aggressive phyllodes tumor. This case details a breast mass that was initially believed to be a fibroadenoma, but interval growth at one year follow up resulted in surgical excision with final pathology revealing phyllodes tumor.
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Affiliation(s)
- Quan D Nguyen
- Radiology, University of Texas Medical Branch, Galveston, USA
| | - Samuel O Krider
- Diagnostic Radiology, University of Texas Medical Branch, Galveston, USA
| | - James T Roberts
- Diagnostic Radiology, University of Texas Medical Branch, Galveston, USA
| | | | - Jing He
- Pathology, University of Texas Medical Branch, Galveston, USA
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7
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Can B, Ozluk AY. Giant Fibroepithelial Polyps: Why do they Grow Excessively? Sisli Etfal Hastan Tip Bul 2020; 54:257-60. [PMID: 32617069 DOI: 10.14744/SEMB.2018.33603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 01/05/2023]
Abstract
Fibroepithelial polyps (acrochordon or skin tag) are benign tumors that usually occur in skin folds, such as the axilla, genital area or neck. They can be solitary or multiple. Their dimensions usually do not exceed 1-2 millimeters. Sometimes, they can reach huge dimensions. In the literature, a giant fibroepithelial polyp with a size of 42 centimeters has been reported. Although the etiology and the factors that cause excessive growth have not been elucidated, it is stated that obesity and insulin resistance might trigger growth. Lymphedematous fibroepithelial polyps described in recent years show that prolonged lymphatic stasis and chronic inflammation may lead to the growth of fibroepithelial polyps. We present a 21-year-old patient with a giant fibroepithelial polyp with a size of 14x6 centimeter, located in the midline on the anterior chest wall. To our knowledge, this is the first case in the literature, in this location, which makes our case unique. Herein, we presented our patient along with the review of current literature pertaining to the diagnosis and the treatment of fibroepithelial polyps (FEPs) and the factors leading to excessive growth.
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8
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Kolia AK, Kalles V, Zografos CG, Chamzin A, Michalopoulos NV. Giant phyllodes tumor occupying the whole breast in a young female: feasibility of mastectomy and immediate reconstruction. J Surg Case Rep 2020; 2020:rjz410. [PMID: 32280449 PMCID: PMC7135843 DOI: 10.1093/jscr/rjz410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/10/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022] Open
Abstract
Giant phyllodes tumors are rare fibroepithelial breast neoplasms typically >10 cm by definition. The best investigation for preoperative diagnosis is core biopsy, although it is often difficult for the pathologist to distinguish fibroadenomas from phyllodes tumors and determine the level of malignant potential. The wide excision is the appropriate therapy for phyllodes tumors taking into consideration that mastectomy may be required for huge phyllodes tumors. In the modern era of breast tissue expanders and breast implants, immediate breast reconstruction is feasible. We present a case report of a patient with a giant phyllodes tumor of 24 cm diameter who underwent mastectomy and immediate breast reconstruction with breast tissue expander.
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Affiliation(s)
- Aikaterini K Kolia
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Vasileios Kalles
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Constantinos G Zografos
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Alexandros Chamzin
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Nikolaos V Michalopoulos
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
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9
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Fisher K, Rojas K, Zelkowitz C, Borgen P, Kiss L, Zeng J. Beta-HCG-producing phyllodes tumor. Breast J 2019; 26:547-549. [PMID: 31605427 DOI: 10.1111/tbj.13562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kristy Fisher
- School of Medicine, St George's University, True Blue, Grenada, West Indies
| | | | | | | | - Larry Kiss
- Maimonides Medical Center, Brooklyn, New York
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10
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Khattab RA, Rowe JJ, Booth CN, Sneige N, Fong N, Pantanowitz L, Oshilaja O, Brainard JA, Downs-Kelly EP, Dawson A, Sturgis CD. Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses. Diagn Cytopathol 2019; 47:1100-1118. [PMID: 31343114 DOI: 10.1002/dc.24288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/06/2022]
Abstract
The Uniform Approach to Breast Fine Needle Aspiration Biopsy was put forward by a learned group of breast physicians in 1997. This landmark manuscript focused predominantly on diagnosis and reporting of mammary epithelial lesions. Today, most American practitioners turn initially to core biopsy rather than aspiration biopsy for the first line diagnosis of solid breast lesions; however, recent efforts from the International Academy of Cytology have produced a system called the Standardized Reporting of Breast Fine Needle Aspiration Biopsy Cytology (colloquially labeled in 2017 as the "Yokohama System"), suggesting a new interest in breast fine needle aspiration (FNA), especially in resource limited settings or clinical practice settings with experienced breast cytopathologists. Fibroepithelial lesions of the breast comprise a heterogeneous group of biphasic tumors with epithelial and stromal elements. Mesenchymal lesions of the breast include a variety of neoplasms of fibroblastic, myofibroblastic, endothelial, neural, adipocytic, muscular, and osteo-cartilaginous derivations. The cytology of mesenchymal breast lesions is infrequently described in the literature and is mainly limited to case reports and small series. This illustrated review highlights the cytologic features of fibroepithelial and mesenchymal mammary proliferations and discusses differential diagnoses and histomorphologic correlates.
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Affiliation(s)
- Ruba A Khattab
- Department of Pathology, University Hospitals of Case Western Reserve University, Cleveland, Ohio
| | - J Jordi Rowe
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Nour Sneige
- Department of Pathology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - Nancy Fong
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Andrea Dawson
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
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11
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Abstract
Background: Fibroepithelial polyps of the urinary tract are rare tumors, and their occurrence in the upper urinary tract is highly unusual. Case Report: This study reports a 9-year-old boy who presented to our clinic with complaints of unilateral flank pain and macroscopic hematuria. The direct urinary system graph did not show stone formation; therefore, magnetic resonance urography was performed. This revealed a filling defect in the left proximal ureter. On cystoscopy, a polyp was seen in the orifice of the left ureter, extending along the ureter. The polyp was resected by laser ablation and removed from the ureter. Histopathologic examination revealed a fibroepithelial polyp comprising fibrovascular stroma covered with transitional epithelium. Conclusion: Although extremely rare, a fibroepithelial polyp should be considered in the differential diagnosis when a young patient presents with flank pain and macroscopic hematuria. Endoscopic procedures may be the treatment of choice for polyps located in the upper ureter.
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Affiliation(s)
- Hakan Akdere
- Department of Urology, Trakya University School of Medicine, Edirne, Turkey
| | - Gökhan Çevik
- Department of Urology, Trakya University School of Medicine, Edirne, Turkey
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12
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Tay TKY, Guan P, Loke BN, Nasir NDM, Rajasegaran V, Thike AA, Lian D, Chang KTE, Teh BT, Ng CCY, Tan PH. Molecular insights into paediatric breast fibroepithelial tumours. Histopathology 2018; 73:809-818. [PMID: 29969836 DOI: 10.1111/his.13701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 07/01/2018] [Indexed: 12/13/2022]
Abstract
AIMS This study aims to examine the molecular genetics of paediatric breast fibroepithelial tumours through the targeted sequencing of 50 genes. METHODS AND RESULTS Formalin-fixed paraffin-embedded tissues of fibroepithelial tumours diagnosed in a cohort of patients aged 18 years and below were subjected to next generation sequencing using the Haloplex Target Enrichment System. Twenty-five conventional and 17 juvenile fibroadenomas were studied, with MED12 mutations found in 53.8 and 35% of the tumours, respectively. There was also one benign fibroepithelial neoplasm with hybrid features of juvenile papillomatosis and infarcted benign phyllodes tumour-like areas. Most tumours did not have mutations in well-known cancer driver genes, none harboured TERT promoter mutations, while 25.6% (11 of 43) showed no mutations. Metachronous and synchronous tumours were found to have mutational heterogeneity with some containing mutations in MED12; other genes or no mutations were detected at all. Four of eight giant fibroadenomas (size 5 cm or larger) had no mutations detected, suggesting that there are other molecular mechanisms driving their growth. Tumours with MED12 mutations incidentally had a significantly higher stromal mitotic count compared with those without. CONCLUSION While paediatric fibroepithelial lesions can have cellular stroma potentially raising concern for phyllodes tumour, their lack of TERT promoter and cancer driver mutations is reassuring. The absence of mutations in a significant proportion of tumours, especially the giant fibroadenomas, warrants investigation of pathogenetic mechanisms beyond those involving the 50 genes.
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Affiliation(s)
- Timothy K Y Tay
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Peiyong Guan
- Laboratory of Cancer Epigenome, National Cancer Centre, Singapore
| | - Benjamin N Loke
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Nur Diana M Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | | | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Derrick Lian
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre, Singapore
| | - Cedric C Y Ng
- Laboratory of Cancer Epigenome, National Cancer Centre, Singapore
| | - Puay-Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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13
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Arda MS, Ilhan H, Kara T, Arık D, Tokar B. Laparoscopic Approach to a Rare Cause of Ureteropelvic Junction Obstruction in a Child: Ureteral Polyp. European J Pediatr Surg Rep 2015; 3:78-81. [PMID: 26788453 PMCID: PMC4712053 DOI: 10.1055/s-0035-1555654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/30/2015] [Indexed: 11/25/2022] Open
Abstract
Fibroepithelial polyps are a rare underlying reason of ureteropelvic junction obstruction. In the past, open surgery was the only option. However, due to development of minimal invasive technics, treatment alternatives have been changed. Resection by laparoscopy or endoscopy, laser fulguration and/or percutaneous resection are recommended in children and adults. Here, we present a 10-year-old boy with severe left hydronephrosis due to fibroepithelial polyp close to the ureteropelvic junction and our laparoscopic approach.
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Affiliation(s)
- Mehmet Surhan Arda
- Department of Pediatric Surgery, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey
| | - Huseyin Ilhan
- Department of Pediatric Surgery, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey
| | - Taylan Kara
- Department of Radiology, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey
| | - Deniz Arık
- Department of Pathology, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey
| | - Baran Tokar
- Department of Pediatric Surgery, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey
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Casalini E, Cavazza A, Andreani A, Marchioni A, Montanari G, Cappiello FG, Mengoli MC, Corradini P, Agostini L, Serini R, Rossi G. Bronchial fibroepithelial polyp: a clinico-radiologic, bronchoscopic, histopathological and in-situ hybridisation study of 15 cases of a poorly recognised lesion. Clin Respir J 2015; 11:43-48. [PMID: 25832329 DOI: 10.1111/crj.12300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/02/2015] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Bronchial fibroepithelial polyp is an uncommon, poorly recognised lesion, lacking clear diagnostic criteria at histology, but possibly mimicking neoplastic growth on clinico-radiologic and histopathological grounds. The aim of this study was to define the clinico-pathological features, bronchoscopic appearance and treatment of bronchial fibroepithelial polyp. METHODS We collected the largest series of bronchial fibroepithelial polyps (15 consecutive cases), including clinico-pathological, bronchoscopic, radiologic and histological features. RESULTS Overall, there were 13 males and 2 females, with a mean age of 68 years at diagnosis. Eight patients were asymptomatic, whereas four presented with haemoptysis, two with fever, cough and pneumonia-like opacity, and one with dry recurrent cough. Mean size of the lesion was 6.5 mm (range, 2-20 mm) without any prevalence for segmental bronchi. Lesions larger than 10 mm were always symptomatic and visible at computed tomography scans. At bronchoscopy, the lesion appeared as a firm endobronchial nodule with hard consistency and glistening, whitish, smooth surface. A multilobulated and sepimentated surface was observed in the largest polyps. Whatever the size, histological features were quite similar in all cases, consisting in a polypoid lesion with a dense, collagenous, hypocellular stroma with some thin-walled, ectatic vessels and a regular respiratory mucosa on surface. In-situ hybridisation with human papillomavirus probe was negative in all the eight tested cases. CONCLUSION Despite the benign behaviour of bronchial fibroepithelial polyps, it is important to fix some robust diagnostic criteria in order to avoid misdiagnoses leading to unnecessary aggressive treatment. Differential diagnosis mainly includes inflammatory polyps, hamartomas and papillomas.
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Affiliation(s)
- Eleonora Casalini
- Department of Oncology and Haematology, Respiratory Diseases Clinic, University Hospital Policlinico of Modena, Modena, Italy
| | - Alberto Cavazza
- Department of Oncology and Advanced Technologies, Operative Unit of Pathologic Anatomy, Azienda Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia, Italy
| | | | - Alessandro Marchioni
- Department of Oncology and Haematology, Respiratory Diseases Clinic, University Hospital Policlinico of Modena, Modena, Italy
| | - Gloria Montanari
- Department of Oncology and Haematology, Respiratory Diseases Clinic, University Hospital Policlinico of Modena, Modena, Italy
| | | | - Maria Cecilia Mengoli
- Department of Diagnostic Laboratories, Section of Pathologic Anatomy, University Hospital Policlinico of Modena, Modena, Italy
| | - Paolo Corradini
- Department of Oncology and Haematology, Respiratory Diseases Clinic, University Hospital Policlinico of Modena, Modena, Italy
| | - Lorenzo Agostini
- Operative Unit of Pulmonology, Azienda Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia, Italy
| | - Roberto Serini
- Operative Unit of Pulmonology, Civic Hospital, Sassuolo, Italy
| | - Giulio Rossi
- Department of Diagnostic Laboratories, Section of Pathologic Anatomy, University Hospital Policlinico of Modena, Modena, Italy
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