52 Questions
What is the estimated percentage of women in the United States having breast fibroadenomas?
10%
Which gene mutation is found in up to 65% of fibroadenoma cases?
MED12
What is the main clinical presentation of fibroadenomas?
Solitary, painless small nodule
Which type of stroma gives rise to fibroadenomas?
Intralobular stroma
What are the two main histological features of fibroadenomas?
Intracanalicular and pericanalicular
When may fibroadenomas grow rapidly?
During hormone replacement therapy
What is the estimated increased risk of breast cancer in fibroadenoma cases compared to the general population?
1.3 to 2.1 times
Which type of neoplasm are fibroadenomas classified as?
Benign neoplasms
What is the source of fibroadenomas in the breast?
Intralobular stroma
What is the primary event in the formation of fibroadenomas?
Stromal cell proliferation
What is the main composition of fibroadenomas?
Both epithelial and stromal components
Which of the following is a specific pathologic feature of complex fibroadenoma?
Papillary apocrine hyperplasia
What is the association between size and complexity of fibroadenomas?
Size does not determine if a fibroadenoma is complex or not
What is considered very rare in relation to malignant transformations in fibroadenomas?
Malignant transformations in the epithelial components
How do fibroadenomas typically appear on mammograms?
Smooth-margined oval or round masses
What is the growth pattern of most fibroadenomas over 12 months?
Grow to 2 to 3 cm and then remain unchanged for several years
How are fibroadenomas usually diagnosed in the male breast?
Clinically as gynecomastia
What is the composition of phyllodes tumor?
Benign epithelial elements and a cellular spindle-cell stroma
What percentage of all fibroepithelial tumors of the breast do phyllodes tumors account for?
2.5%
What percentage of phyllodes tumors are benign and behave similarly to benign fibroadenomas?
70%
What gene mutation has been identified in about 70% of phyllodes tumors?
MED12 gene
Which type of fibroadenoma harbors specific pathologic features like sclerosing adenosis, papillary apocrine hyperplasia, cystic change, or epithelial calcification?
Complex fibroadenoma
What does size determine in relation to the classification of fibroadenomas?
None of the above
What is the association between simple fibroadenomas and the risk of breast cancer?
No correlation
What is the increased risk of breast cancer associated with complex fibroadenomas compared to the general population?
1.3 to 2.1 times
How rare are malignant transformations in the epithelial components of fibroadenomas considered to be?
Extremely rare
What is the typical ultrasound appearance of fibroadenomas?
Solid, well-circumscribed, and hypoechoic
What percentage of fibroadenomas show regression or complete resolution after reaching a size of 2 to 3 cm and remaining unchanged for several years?
50%
Are fibroadenomas common or uncommon in the male breast?
Uncommon
How rare are phyllodes tumors compared to fibroadenomas in the context of all breast malignancies?
Less common
What is the estimated median age at presentation for phyllodes tumors?
42-45 years
What is the gross appearance of phyllodes tumors?
Round to oval, well-circumscribed with a grayish white appearance
What is the characteristic microscopic architecture of phyllodes tumors?
Leaf-like architecture with elongated cleft-like spaces
What is a specific histological feature of malignant phyllodes tumors?
Marked stromal cellularity and atypia
What is the typical mammography appearance of a phyllodes tumor?
Large, rounded, well-circumscribed mass with smooth margins
What is the mutational spectrum of MED12 gene mutations in phyllodes tumors similar to?
Fibroadenomas
What is the behavior of benign phyllodes tumors similar to?
Benign fibroadenomas
What is the typical ultrasound appearance of phyllodes tumors?
Lobulated with smooth margins, and hypoechoic
What is the distinguishing feature of borderline phyllodes tumors?
Moderately high mitotic rate
What is the typical radiological appearance of Pseudoangiomatous stromal hyperplasia (PASH)?
Well-circumscribed hypoechoic mass, not associated with calcification
Which of the following is a characteristic histological feature of Pseudoangiomatous stromal hyperplasia (PASH)?
Empty interanastamosing angulated and slit-like spaces
Which markers are expressed by the spindle cells in Pseudoangiomatous stromal hyperplasia (PASH)?
CD34, vimentin, smooth muscle actin, desmin
Which type of breast tumor presents predominantly as a painless, palpable, firm or hard mass, which may be accompanied by skin dimpling and nipple retraction?
Fibromatosis
What is the characteristic gross appearance of myofibroblastoma of the breast?
Well-circumscribed tumor with a bulging gray to white, whorled cut surface
What is the typical ultrasound appearance of fibromatosis?
Well-defined hypoechoic lesion
Which breast tumor is thought to arise from cells of the mammary stroma with myofibroblastic and myoid differentiation?
Myofibroblastoma
What is the imaging study that may reveal a stellate lesion that mimics carcinoma in fibromatosis?
Mammography
What is a specific histological feature of fibromatosis?
Bland spindle-shaped or oval cells arranged in broad sheets or fascicles
Which breast tumor is encountered mainly in older men and postmenopausal women aged between 40 and 87 years?
Myofibroblastoma
What is the behavior of fibromatosis on mammography?
May not reveal any abnormality
What is the typical presentation of non-epithelial primary breast malignancies?
Painless, palpable, firm or hard mass with skin dimpling and nipple retraction
Which of the following is a characteristic microscopic architecture of phyllodes tumors?
Papillary architecture with fibrovascular cores
Study Notes
Complex Fibroadenoma and Phyllodes Tumor: Key Points
- Complex fibroadenoma harbors specific pathologic features like sclerosing adenosis, papillary apocrine hyperplasia, cystic change, or epithelial calcification.
- Size does not determine if a fibroadenoma is complex or not.
- Simple fibroadenomas do not correlate with an increased risk of breast cancer.
- Complex fibroadenomas are associated with a modest 1.3 to 2.1 increased risk of breast cancer compared to the general population.
- Malignant transformations in the epithelial components of fibroadenomas are considered very rare.
- Fibroadenomas typically appear as smooth-margined oval or round masses on mammograms and as solid, well-circumscribed, and hypoechoic on ultrasound.
- Most fibroadenomas grow over 12 months to reach a size of 2 to 3 cm and then remain unchanged for several years. After this period, regression or complete resolution is noted in 50% of cases.
- Fibroadenomas are very uncommon in the male breast and are usually diagnosed clinically as gynecomastia.
- Phyllodes tumor is an uncommon biphasic tumor composed of benign epithelial elements and a cellular spindle-cell stroma.
- Phyllodes tumors are rarer than fibroadenomas, accounting for 2.5% of all fibroepithelial tumors of the breast and less than 0.5% of all breast malignancies.
- Phyllodes tumors are capable of a diverse range of biologic behavior; about 70% are benign and behave similarly to benign fibroadenomas, while 5% are malignant and undergo mainly hematogenous spread.
- Somatic mutations of the MED12 gene have been identified in about 70% of phyllodes tumors, similar to fibroadenomas, supporting an underlying commonality in pathogenesis.
Test your knowledge about fibroadenoma of the breast and its characteristics with this informative quiz. Explore topics such as pathogenesis, clinical presentation, histological features, classification, risk of breast cancer, complex fibroadenoma, phyllodes tumor, and more.
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