Pathology - Fibroadenoma

Pathology - Fibroadenoma
Definition • A benign fibroepithelial tumor of the breast.
Epidemiology: Prevalent. • Predominantly affects young women aged 20 to 30 years.

Aetiology • The majority of experts consider them to be neoplastic proliferations of fibroblasts inside the specialized connective tissue of the intralobular stroma.

Pathogenesis • The proliferating neoplastic fibroblasts inside the intralobular stroma entrap and compress terminal duct lobular units and interlobular stroma, resulting in the formation of a well-defined nodular mass.
Macroscopy • Well-defined, movable breast masses often measuring 3 cm or less. • The cut surface is generally solid, whorled, and grey-white in hue.

Cytopathology • Aspirates exhibit cellularity, featuring numerous branching sheets of cohesive, bland ductal epithelial cells alongside a substantial presence of naked bipolar nuclei in the background. • Fragments of stromal material may also be observed.

Histopathology • Histological examination reveals a well-circumscribed multinodular tumor distinct from the adjacent breast tissue. Each nodule comprises an enlarged myxoid intralobular stromal compartment populated by inconspicuous spindled fibroblastic cells. The terminal duct lobular unit is constricted into narrow channels. • Narrow strands of interlobular stroma exist between each nodule of the fibroadenoma. • Mature lesions frequently exhibit fibrosis and calcification.
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Prognosis: • Benign lesions exhibiting no potential for malignant behavior. Surgical excision through straightforward 'shelling out' is nearly invariably curative with minimal likelihood of recurrence.

Phyllodes tumors
Phyllodes tumors are a category of potentially aggressive fibroepithelial neoplasms. These are rare tumors that often manifest as a progressively enlarging breast lump in women over 50 years of age. Some are believed to originate from pre-existing fibroadenomas. Macroscopically, the tumors typically present as big, fleshy, lobulated masses exhibiting regions of cystic alteration. Histologically, these are fibroepithelial tumors characterized by the excessive proliferation of neoplastic stromal cells, resulting in a disordered and heterogeneous morphology of the epithelial component. The stroma exhibits variability in cellularity and the composition of the extracellular matrix. Substantial stromal nodules extending into cystic cavities generate distinctive 'leaf-like' projections. All phyllodes tumors possess the potential for local recurrence and are typically managed with extensive local resection. In actuality, the majority do not reappear, even after uncomplicated enucleation. Phyllodes tumors may acquire the ability to spread, however this occurrence is exceedingly rare.