Podcast
Questions and Answers
Which histological pattern in fibroadenomas is characterized by the stroma expanding and compressing the ducts into slit-like spaces?
Which histological pattern in fibroadenomas is characterized by the stroma expanding and compressing the ducts into slit-like spaces?
- Well-circumscribed pattern
- Intracanalicular pattern (correct)
- Pericanalicular pattern
- Leaf-like projection
A young woman presents with a palpable, painless, and unilateral solid breast mass. Which of the following is the MOST likely diagnosis?
A young woman presents with a palpable, painless, and unilateral solid breast mass. Which of the following is the MOST likely diagnosis?
- Metaplastic carcinoma
- Invasive ductal carcinoma
- Phyllodes tumor
- Fibroadenoma (correct)
Which molecular alteration is MOST frequently observed in stromal cells of fibroadenomas?
Which molecular alteration is MOST frequently observed in stromal cells of fibroadenomas?
- EGFR mutation
- ERBB4 mutation
- MED12 mutation (correct)
- TP53 mutation
A breast lesion demonstrates a biphasic appearance composed of spindled stromal cells and benign epithelial cells with exaggerated intracanalicular growth forming "leaf-like" projections. Which diagnosis is MOST likely?
A breast lesion demonstrates a biphasic appearance composed of spindled stromal cells and benign epithelial cells with exaggerated intracanalicular growth forming "leaf-like" projections. Which diagnosis is MOST likely?
Which of the following immunohistochemical markers is typically POSITIVE in the stromal cells of a fibroadenoma?
Which of the following immunohistochemical markers is typically POSITIVE in the stromal cells of a fibroadenoma?
Which of the following features is LEAST likely to be associated with a fibroadenoma?
Which of the following features is LEAST likely to be associated with a fibroadenoma?
Which genetic syndrome is associated with an increased incidence of phyllodes tumors?
Which genetic syndrome is associated with an increased incidence of phyllodes tumors?
A pathologist examines a breast lesion and notes increased stromal cellularity ranging from pauci-cellular to hypercellular. Which of the following tumors is MOST likely to exhibit this characteristic?
A pathologist examines a breast lesion and notes increased stromal cellularity ranging from pauci-cellular to hypercellular. Which of the following tumors is MOST likely to exhibit this characteristic?
A patient presents with a large breast mass exhibiting rapid growth. Histological examination reveals a predominantly pericanalicular growth pattern. Which variant of fibroadenoma is MOST likely?
A patient presents with a large breast mass exhibiting rapid growth. Histological examination reveals a predominantly pericanalicular growth pattern. Which variant of fibroadenoma is MOST likely?
A pathologist reports the presence of heterologous elements in a phyllodes tumor. This finding suggests an increased likelihood of what?
A pathologist reports the presence of heterologous elements in a phyllodes tumor. This finding suggests an increased likelihood of what?
Flashcards
Fibroadenoma
Fibroadenoma
Benign neoplasm of the Terminal Duct Lobular Unit (TDLU) with biphasic proliferation
Intracanalicular pattern
Intracanalicular pattern
Stroma compresses ducts into slit-like spaces
Pericanalicular pattern
Pericanalicular pattern
Stroma grows around open ducts
Juvenile Fibroadenoma
Juvenile Fibroadenoma
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Phyllodes Tumor
Phyllodes Tumor
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TDLU
TDLU
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TERT promoter, ERBB4, TP53, EGFR, PIK3CA, RB1 mutations
TERT promoter, ERBB4, TP53, EGFR, PIK3CA, RB1 mutations
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Phyllodes Tumor: Risk
Phyllodes Tumor: Risk
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Study Notes
Fibroepithelial Lesions
Fibroadenoma: Morphology
- Benign neoplasm arising in the Terminal Duct Lobular Unit (TDLU).
- Shows biphasic proliferation of both epithelial and stromal cells.
- Intracanalicular pattern: display expansion of stroma that compresses ducts into slit-like spaces
- Pericanalicular pattern: characterized by stroma growing around open ducts
- Absence of stromal overgrowth, cytologic atypia, significant mitotic activity, or well-developed fronds
Fibroadenoma: Other High Yield Points
- Most common benign solid breast mass in young women.
- Most are slow growing, painless, and unilateral masses.
- Fibroadenomas do not typically recur after complete surgical excision.
- Juvenile Fibroadenoma: Usually large with rapid growth and predominantly have pericanalicular growth patterns
Fibroadenoma: Immunohistochemistry
- Stromal cells are positive for CD34, PR, FR-beta, Beta catenin (nuclear)
- Epithelial cells are positive for CK7, CKAE1/AE3, ER-alpha
Fibroadenoma: Genetics
- Approximately 60-65% harbor a MED12 mutation in stromal cells.
- Myxoid fibroadenomas typically lack this mutation
Phyllodes Tumor: Morphology
- Biphasic tumor composed of spindled stromal cells and benign epithelial cells.
- Stromal cellularity is variable, ranging from paucicellular to hypercellular
- Prominent intracanalicular growth pattern is observed.
- Has exaggerated intracanalicular growth, leading to "Leaf-like" projections into variably dilated lumina
Phyllodes Tumor: Other High Yield Points
- Increased incidence in patients with Li-Fraumeni syndrome
- Presents as a palpable painless breast mass
- May contain heterologous elements that are malignant
Phyllodes Tumor: Molecular
- MED12 and RARA mutations are seen in benign phyllodes tumors
- TERT promoter, ERBB4, TP53, EGFR, PIK3CA, and RB1 mutations are seen in borderline and malignant phyllodes tumors
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