Fibroadenoma/benign phyllodes: a cytologic diagnostic challenge

Background: To study and compare cytomorphological features of histologically proven cases of benign phyllodes and cellular fibroadenoma.Methods: Smears of histologically-proven cases of benign phyllodes and cellular fibroadenoma in one year, were reviewed. The cellular fibroadenoma had epithelial and/or stromal hypercellularity. The stromal and epithelial components as well as the background cells were qualitatively and quantitatively analyzed.Results: Number, cellularity and type of stromal fragments varied significantly in two groups. Higher number, intermediate to large-sized and hypercellular stromal fragments were commonly seen in phyllodes. Hypercellular (3+ cellularity) fragments were seen in 100% cases of phyllodes against 11.1% cases of fibroadenoma. Large-sized stromal fragments were found in 100% of phyllodes while in only 11.1% cases of fibroadenoma. The ratio of number of epithelial to stromal fragments was significantly high (58.5:1) in fibroadenoma against phyllodes (1.3:1). The epithelial architecture, atypia, apocrine metaplasia and presence of cystic macrophages did not very much in the two groups. The cellularity of the dispersed cells in background did not reveal significant difference though the type of cells varied; the proportion of long and short spindle cells was higher in PT group while proportion of oval cells was higher in FA group.Conclusion: The number, cellularity and nature of stromal fragments, ratio of epithelial to stromal fragments, cellularity and type of background cells are helpful in distinguishing benign phyllodes from cellular fibroadenoma. The identification of these features can improve the pickup rate of phyllodes tumor, thereby assisting proper management.

A comparative study with clinico-pathological correlation between ultrasonography, mammography and fine needle aspiration cytology in evaluation of breast lumps in coastal population of Karaikal

Background: Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women of age 40 to 44 year. It accounts for 33% of all female cancers and is responsible for 20% of the cancer-related deaths in women. However, the vast majority of the lesions that occur in the breast are benign. Aim of the study: To assess the effectiveness of FNAC, Ultrasonography, and Mammography in the evaluation of breast lumps by correlating to histopathology. Materials and Methods: Patients attending Surgery Outpatient Department with breast-related complaints during the period from November 2017 to April 2019 were assessed using Triple assessment. Each patient was subjected to clinical examination, mammography, FNAC, Ultrasonogram and HPE, and the results analyzed. Results: 40 patients were included in the study, with age ranging from 25 years to 60 years. The sensitivity, specificity, positive and negative predictive values of Clinical Examination w a s 87.5%, Balasundaram, A. Nilavazhagan. A comparative study with clinico-pathological correlation between ultrasonography, mammography and fine needle aspiration cytology in evaluation of breast lumps in coastal population of Karaikal. IAIM, 2019; 6(9): 21-27. Page 22 93.75%, 77.77%, 96.77%; FNAC was 87.5%, 100%, 100%, 96.96%; Mammogram was 87.5%, 90.62%, 70%, 96.6%; and SG was 62.5%, 93.75%, 71.42%, 90.90% respectively. Conclusion: In patients with a definite lump, Clinical examination and FNAC alone may be sufficient to rule out malignancy. A mammogram is needed in patients with no clinically palpable lump and to rule out multi-centric and multi-focal disease.

Evaluation of Satb1, Survivin, and Ki-67 as Possible Markers to Differentiate Phyllodes Tumour from Fibroadenoma

Aims Difficulties in diagnosis of phyllodes tumour are well known. Our aim was to observe whether the expressions of satb1, survivin, and ki-67 were helpful in differentiating fibroadenoma and phyllodes tumour. Settings and design Retrospective. Methods and material Paraffin embedded tissue samples from 60 female patients with phyllodes tumour and 60 female patients with fibroadenoma were studied. Expression of the gene products was studied and confirmed using immunohisto chemical and western blot analysis. Statistical analysis used The statistical analysis was performed using Fisher's exact test to find out the significant changes. Results Statistically significant difference was observed in Satb1, survivin expression between fibroadenoma and benign phyllodes cases. The difference between the Ki-67 expression in fibroadenoma and benign phyllodes cases was not statistically significant. Conclusions Our finding of strong stromal expression of satb1 and survivin in phyllodes as compared to fibroadenoma can be helpful for the development of additional diagnostic and prognostic indicators for otherwise difficult cases. Such immunochemical markers can be used to elucidate cellular basis of tumour behaviour. Validation of such immunochemical test in future will reduce diagnostic uncertainty in this rare tumour. In addition to that such parameters may serve as a therapeutic target that could increase effectiveness of chemotherapy or radiation therapy. A study with large number of samples along with clinical and follow-up data is required for confirmation.

Long-Term Follow-Up Result of Benign Phyllodes Tumor of the Breast Diagnosed and Excised by Ultrasound-Guided Vacuum-Assisted Breast Biopsy / 한국유방암학회지

PURPOSE: Percutaneous removal of benign breast tumors using ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible and safe method without serious complications. The aim of this study was to evaluate the efficacy and safety of the VABB in the treatment of benign phyllodes tumors, and to identify whether or not surgical re-excision is necessary for benign phyllodes tumors diagnosed and excised by VABB. METHODS: From January 2003 to December 2011, a total of 6,923 VABB were performed in 5,434 patients. Out of 6,923 lesions, 53 were benign phyllodes tumors. Among these, 31 lesions, with a follow-up period of longer than 24 months, were enrolled in this study. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. The mean follow-up period was 75.9+/-13.5 months (range, 24-94 months). RESULTS: The mean patient age at presentation was 31.6+/-9.4 years. The mean size of the lesion was 1.60+/-0.88 cm. The majority of lesions, 74.2% (23 cases), were palpable, and 25.8% (8 cases) were non-palpable. Twenty-two lesions (71.0%) were classified as Breast Imaging Reporting and Data System category 3, and nine lesions (29.0%) were classified as category 4a, by ultrasonography. During the follow-up period, local recurrence developed in one lesion, making the local recurrence rate 3.2%. CONCLUSION: If a benign phyllodes tumor is diagnosed, and sufficiently excised by VABB, observing the clinical course may be considered as an alternative to performing immediate wide local excision; this is the case despite the fact that it would need to be observed for a prolonged period of time.

Is Surgical Excision Necessary for a Benign Phyllodes Tumor of the Breast Diagnosed and Excised by Ultrasound-guided Vacuum-assisted Biopsy Device (Mammotome)?

PURPOSE: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. METHODS: From Jan. 2003 to Feb. 2007, a total of 2,751 US- guided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3- to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). RESULTS: The mean patient age was 31.4 years. The average size of the lesion was 1.5 cm (SD+0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. CONCLUSION: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 cm.