From the Classic to the Novel and Unusual Variants

pathology.ucsf.edu

From the Classic to the Novel and Unusual Variants

5/13/10

Tavassoli

Fibroepithelial Tumors:

From the Classic to the

Novel and Unusual Variants

F. A. Tavassoli, MD

Professor of Pathology and Reproductive Sciences

Yale University School of Medicine

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Fibroepithelial Tumors

• Fibroadenoma

• Phyllodes Tumor*

• Periductal Stromal Sarcoma

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Phyllodes Tumor

Definition: A group of circumscribed

biphasic tumors, basically analogues of

fibroadenomas, characterized by a double

layer of E/ME cells lining clefts and

surrounded by an overgrowth of a

hypercellular mesenchymal component

typically organized in leaf-like processes.

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Phyllodes Tumors

WHO 2003

Alternative Terms

• Benign

• Borderline

• High Grade

• Low grade

• NOS

• High grade

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LEAF-LIKE

PROCESSES

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Prognostic Factors

• Tumor size

• Histopathology

• Operative procedure

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Relationship of Tumor Size to

Prognosis

Recurrence

Dead of Tumor

Size (cm) No. No. (%) No. (%)

0-3.9 18 2 (11) 0 -

4-5.9 23 10 (43) 5 (22)

6-9.9 20 7 (35) 4 (20)

10-13.9 12 5 (42) 4 (33)

14+ 12 3 (25) 2 (17)

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Histopathology

• Margin

• Cytologic Atypia

• Mitotic Activity

• Sarcomatous Overgrowth

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Relationship of Contour to

Prognosis

Recurrence

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Dead of Tumor

Margin

No. of

Cases

No. (%) No. (%)

Pushing 39 6 (15) 1 (2.5)

Infiltrating 26 10 (38) 9 (35)

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Relationship of Cellular Atypia

to Prognosis

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Recurrence

Dead of Tumor

Degree of No of Pts. No. (%) No. (%)

Atypia

1+ 30 8 (27) 2 (7)

2+ 33 12 (36) 8 (24)

3+ 20 8 (40) 5 (25)

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Relationship of Mitotic Activity

to Prognosis

Mit. Fig.

Per 10 HPF

Recurrence Dead of Tumor

No. of Pts. No. (%) No. (%)

0-2 23 4 (17) 0 -

3-4 11 2 (18) 2 (18)

5-12 25 9 (36) 4 (16)

13-20 19 8 (42) 5 (26)

20+ 9 5 (56) 4 (44)

Total

87

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Prognostic Factors

Histopathology

• Atypia

• Mitotic Activity

• Contour

• Sarcomatous Overgrowth

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Benign/Low Grade PT

• Pushing margins

• Less than 5 MF/10 HPF

• No atypia or mild atypia

• No sarcomatous overgrowth

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High Grade PT

• Infiltrating margins

• Moderate or severe atypia

• 5 or more MF/10 HPP

• Sarcomatous overgrowth

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FA

PT

Leaf-like Processes - +

Age < 15 yrs + -

Adipose Tissue - +

Squamous Metaplasia - +

Chondroid Metaplasia - +

Osseous Metaplasia - +

Infiltrating Margins - +

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Biphasic Tumors

AFIP-1963-1997

♦ Fibroadenoma 105

- youngest patient- 11 years old

♦ Phyllodes Tumor

102

- youngest patient- 10 years old

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Periductal Stromal Sarcoma

• An infiltrative hypercellular spindle cell

proliferation around ducts with open

lumens. PSS is generally a low grade

tumor.

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Periductal Stromal Sarcoma

n=20

Age Range 37 to 89 yrs; (mean 55.3m)

Presentation

Tumor Size

Follow-Up

Mass (20/20)

0.2 to 6.0 cm (mean 2.97 cm)

1 to 72 months ( mean 25.3 m)

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Periductal Stromal Sarcoma

Therapy: Complete excision with a

margin of uninvolved breast tissue.

Follow-up is particularly important

because the distribution and irregular

growth pattern of the lesion make

complete excision often difficult.

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