Fibroadenomatosis (fibroadenomatoid mastopathy): a benign breast lesion with composite pathologic features

A benign breast lesion with the composite histologic features of a fibroadenoma and fibrocystic changes has been referred to previously as fibroadenomatosis or fibroadenomatoid mastopathy; this lesion is distinct from the typical well circumscribed fibroadenoma that may have fibrocystic changes. The purpose of our study was to ascertain the frequency of this change among 200 consecutive breast biopsies and excisions with a coded pathologic diagnosis of fibroadenoma and/or "fibrocystic disease"; we identified these changes in 23 (11.5%) specimens. The lesion was characterized by microscopic fibroadenomatoid foci intermingled with dilated ducts, epitheliosis, and adenosis. It is suggested that fibroadenomatosis is yet another pattern in the complex morphologic spectrum known as benign proliferative breast disease. From our experience, this particular lesion was often appreciated as a unique finding, but the appropriate diagnostic designation was in question. The natural history of fibroadenomatosis is essentially unknown. It may represent a morphologic stage in the development of fibroadenoma(s).     

Carcinoma arising within mammary fibroadenomas. A study of six patients

We report six cases of carcinomas arising within fibroadenomas. Fibroadenoma is a benign neoplasm occurring in young women. Its association with carcinomas is unfrequent and particularly reported in older women. Few data are available on the histologic features of fibroadenomas harboring malignant lesions. In this study, most cases of fibroadenomas showed cysts, sclerosing adenosis, epithelial calcifications or papillary apocrine changes. These fibroadenomas are classified as complex and are a long-term risk factor for breast cancer. The complex fibroadenoma may be specific of fibroadenoma associated with carcinoma.     

Benign breast lesions.

A review of 52 unselected cases of benign breast masses operated on at the University College Hospital Ibadan, showed that fibroadenoma was the most common benign lesion found, followed by fibrocystic disease of the breast. Fibroadenoma is most common in the second and third decades of life, usually in nulliparous young women, whereas fibrocystic disease is most common in the fifth decade, usually in parous women. Benign breast lesions are more common in the left breast than the right, and the most common location is the upper outer quadrant.     

Correlation between non-toxic goitre and benign mastopathia. The result of a survey in 477 middle-aged women

A survey of thyroid and breast diseases was performed in 477 women representative of a middle-aged female population in Malm?, Sweden. Fifty-four women (11.3%) were found to have palpable goitre; 45 of these were unaware of their disorder. All goitres were considered to be benign. One woman with goitre had a mild thyrotoxicosis; the goitres in the other 53 women were atoxic. Seventy-six women (16.0%) had been subjected to surgical breast biopsy 1-25 years before the present survey (median 9 years). The histological diagnoses were: cancer 1, fibroadenoma 8, cystic disease 48, fibrosis 9, and miscellaneous 10. A correlation between atoxic goitre and histologically verified benign breast disease was found (p less than 0.05). The correlation was explained solely by an association between goitre and fibrosis of the breast (p less than 0.001). This study shows a correlation between fibrosis of the breast and atoxic goitre in middle-aged women. The correlation is considered to be a true one, and a possible explanation is briefly discussed.     

Rapidly-growing nodular pseudoangiomatous stromal hyperplasia of the breast: case report

Pseudoangiomatous stromal hyperplasia is a benign proliferative lesion of the mammary stroma that rarely presents as a localized mass. Pseudoangiomatous stromal hyperplasia is characterized by a dense, collagenous proliferation of the mammary stroma, associated with capillary-like spaces. Pseudoangiomatous stromal hyperplasia can be mistaken with fibroadenoma on radiological examination or with low-grade angiosarcoma on histological examination. Its main importance is its distinction from angiosarcoma. The presented case was a 40-year-old woman who was admitted with a rapidly growing breast tumor. Physical examination revealed an elastic-firm, well-defined, mobile and painless mass in her right breast. Mammograms revealed a 6.7 x 3.7 cm, lobulated, well-circumscribed mass in her right breast but no calcification. Sonographic examination showed a well-defined and homogenous mass, not including any cyst. Based on these findings, a provisional diagnosis of fibroadenoma was made. Considering the rapid growth history of the mass, tumor excision was performed. The excised tumor was well demarcated and had a smooth external surface. Histological examination revealed the tumor to be composed of markedly increased fibrous stroma and scattered epithelial components (cystic dilatation of the ducts, blunt duct adenosis). The fibrous stroma contained numerous anastomosing slit-like spaces. Isolated spindle cells appeared intermittently at the margins of the spaces resembled endothelial cells. Immunohistochemical staining showed that the spindle cells were positive for CD34 and negative for Factor VIII-related antigen. The lesion was diagnosed as nodular pseudoangiomatous stromal hyperplasia.     

Concurrent fibroadenoma and intraductal papilloma – A recurring complex lesion in a premenarcheal girl

Breast diseases are rare in childhood and adolescence, most lesions being fibroadenomas and papillomas. We report the case of an 11-year old girl with a complex breast lesion with hybrid features of fibroadenoma and intraductal papilloma with an early recurrence. Microscopically, the lesion was composed of dilated ducts showing intraluminal papillary projections with small to broad fibrovascular stalks. The typical leaf-like appearance of fibroadenoma was determined by the presence at the periphery of ducts compressed and distorted by the prominent stromal component. Despite its florid epithelial hyperplasia and mild cytological atypia (more evident in the relapse), immunohistochemical staining for p63 and smooth muscle actin highlighted a continuum outer myoepithelial layer, confirming the non-invasive appearance of the lesion. Two pathogenetic links have been hypothesized: one is based on the morphological continuum between these two entities, which may represent different evolutive stages in the same lesion; the other is based on epithelial/mesenchymal interactions. The possible malignant transformation of such complex lesion is also discussed, along with its differential diagnoses.     

Differential diagnosis of benign epithelial proliferations and carcinomas of the breast using antibodies to cytokeratins

The immunohistochemical reactivity on frozen sections of diverse benign and malignant epithelial proliferations of human breast tissue from 156 patients was examined using antibodies to different cytokeratins. Antibodies recognizing cytokeratins 18 and 19 reacted with luminal epithelial cells but not with myoepithelial cells of normal mammary gland, cystic disease, adenosis, papilloma, and fibroadenoma or with a subpopulation of proliferating cells in sclerosing adenosis and epitheliosis. These antibodies reacted with the tumor cells of all in situ and invasive carcinomas. KA1 antibody, which by one- and two-dimensional gel electrophoresis and immunoblotting was shown to bind preferentially to cytokeratin 14 in a complex with cytokeratin 5, reacted with the nonproliferating myoepithelium of normal gland, cystic disease, adenosis, papilloma, fibroadenoma, and in situ carcinoma; it also reacted with a subpopulation of proliferating cells in sclerosing adenosis and epitheliosis (papillomatosis) but was negative with the tumor cells of all preinvasive and most invasive carcinomas. In adenotic and epitheliotic proliferations, groups of cells were identified that reacted strongly with KA1 antibody in addition to antibodies to cytokeratins 18 and 19. The data are discussed with respect to epithelial cell heterogeneity in the breast. We show that by using such antibodies, benign epithelial proliferations are clearly distinguished from carcinomas.     

大理州白族妇女乳腺包块117例病理分析

目的初步探讨大理州白族妇女乳腺包块最常见的病因。方法对云南大理学院病理教研室2008~2009年117例临床诊断为＂乳腺包块性质待查＂的患者,进行回顾性分析。结果大理州白族妇女最常见的病因为乳腺纤维腺瘤,占46.15%,乳腺纤维囊性变占21.38%,乳腺癌占20.5%。结论大理州白族妇女乳腺包块最常见的病因为乳腺纤维腺瘤,其次为乳腺增生性病变,乳腺癌亦占有相当高的比例。     

Benign chondrolipomatous tumor of the human female breast

A benign chondrolipomatous breast tumor occurred in a 66-year-old woman. The preoperative diagnosis, based on mammography and xeroradiography, was fibroadenoma. Grossly, the demarcated lesion resembled a fibroadenoma with islands of cartilage projecting from its cut surface. Histologically, it was composed of benign mature fibrous stroma, fat, breast ducts, and islands of mature cartilage. Most cartilage-containing tumors of the human breast are associated with primary mammary malignant neoplasms. A few of the benign cartilage-containing tumors reported in the literature are discussed. The last case was published in 1909.     

Fibroepithelial lesions of the breast with pleomorphic stromal giant cells: a clinicopathologic study of 4 cases and review of the literature

Pleomorphic stromal giant cells are occasionally found as an incidental finding in breast tissue but are only rarely seen in fibroepithelial lesions. In this report, we describe 4 fibroadenoma-like lesions of the breast with pleomorphic stromal giant cells. Two cases had focal stromal hypercellularity, one of which was with architectural features borderline between a fibroadenoma and a phyllodes tumor, but none was considered diagnostic of phyllodes tumor. One lesion had up to 4 mitotic figures per 10 high-power fields, including rare atypical mitotic figures. The remaining 3 cases lacked mitotic activity. Follow-up for 3 cases at 16 to 59 months revealed no evidence of tumor recurrence. The fourth case was lost to follow-up. It appears that the presence of pleomorphic stromal giant cells in an otherwise benign fibroepithelial lesion has no adverse clinical significance. The clinicopathologic features of each case are discussed, and a review of the literature is provided.     

Adenoid cystic carcinoma arising in a fibroadenoma

Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm, accounting for only 0.1 % of all breast carcinomas. An intriguing factor of ACC in the breast is its good prognosis compared to ACC in other locations, mainly in the minor salivary glands. The incidence of axillary lymph node involvement is also very low compared to that of other breast tumors, and distant metastases are uncommon. We report the case of a 65-year-old woman with a 2-year history of a well-circumscribed breast nodule sonographically thought to be a lymph node which was later excised because of rapid growth. Histologic examination showed an adenoid cystic carcinoma with squamous differentiation originating in a fibroadenoma. A review of the literature reveals no previous report of such a case.     

Tubular adenoma of breast

A recent classification of adenomas of the breast included tubular adenoma. This uncommon lesion can be distinguished from fibroadenoma by the predominance of epithelium and relative lack of stroma. This is, to our knowledge, the first report of a tubular adenoma studied by aspiration cytology as well as light and electron microscopy. A 4-cm, slightly tender mass was found in the upper outer quadrant of the breast of a 26-year-old woman. Aspiration cytology showed abundant epithelial fragments, similar to those seen in fibroadenoma, but without the spindle cell component often seen in aspirates of that lesion. Light microscopic study of the excised mass showed a well-demarcated tumor of tubular glands and scanty stroma. By electron microscopy, the epithelial stromal junction was intact. This contrasts with the findings in fibroadenoma, and confirms that this difference can distinguish these lesions.     

Aspiration biopsy of nodular pseudoangiomatous stromal hyperplasia of the breast: clinicopathologic correlates in 10 cases

Nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast is rare and often indistinguishable from fibroadenoma, clinically and on aspiration biopsy smears. We report our observations in 10 patients with PASH, evaluated by fine-needle aspiration (FNA) biopsy and core biopsy. We retrospectively reviewed the clinical, radiographic, cytologic, and histologic findings in 10 cases of pure nodular PASH. Ten patients with a presumed clinical and radiologic diagnosis of fibroadenoma underwent aspiration biopsy. The aspiration smears were diagnosed as fibroadenoma (4 cases), cellular fibroadenoma (1 case), schwannoma versus neurofibroma (1 case), fibrocystic change (3 cases; 2 with atypia), and "not specific for a lesion" (1 case). A diagnosis of PASH was not suspected in any case. A discrepant or imprecise cytologic diagnosis and/or the presence of dissociated spindle or epithelial cells, or cellular stromal fragments prompted a surgical excision in 7 of 10 patients (70%). The remaining 3 patients exhibited cytologic features of fibroadenoma and were diagnosed as such; however, surgical excision was recommended. Three patients underwent a subsequent core biopsy, with a diagnosis of PASH being made in 1 patient. FNA biopsy could not discriminate PASH from fibroadenoma in 4 of 10 patients (40%) or suggest a diagnosis of PASH in any case. On retrospective review, the finding of plump, spindle-shaped mesenchymal cells may be a cytologic clue to suggest a diagnosis of PASH.     

Expression of anaphase-promoting complex7 in fibroadenomas and phyllodes tumors of breast

The proteolytic destruction of cyclin B is an important event during cell division. Cyclin B proteolysis is triggered by the anaphase-promoting complex. Therefore, cell cycle dysregulation due to anaphase-promoting complex loss contributes to cell transformation and human carcinogenesis. This study investigates anaphase-promoting complex7 expression in spindle cell breast tumors and also includes a comparison between the proliferation antigen Ki-67 and S-phase fraction. The average values of the anaphase-promoting complex7 and Ki-67 labeling indices increased in order from benign to malignant within the phyllodes tumor group, and the fibroadenoma and juvenile fibroadenoma exhibited lower levels of anaphase-promoting complex7 and Ki-67 expression than did the phyllodes tumor. The frequency of anaphase-promoting complex7-positive stromal cells correlated with Ki-67 expression in phyllodes tumor and in all of the examined breast tumors. The above results indicate that anaphase-promoting complex7 and Ki-67 are closely related to cell proliferation. In addition, phyllodes tumor can be differentiated from juvenile fibroadenoma with increased mitotic figures mimicking phyllodes tumor by anaphase-promoting complex7 and Ki-67 immunochemistry. Because anaphase-promoting complex7 is expressed at higher levels than is Ki-67, it may overcome the limitations of the Ki-67 labeling index with regard to the differentiation of benign phyllodes tumor from fibroadenoma.     

Immunohistochemical identification of actomyosin-containing (myoepithelial) cells in non-neoplastic and neoplastic tissues.

Actomyosin-containing cells in both non-neoplastic and neoplastic tissues of the salivary gland, lung, breast and some other organs were studied by immunofluorescent microscopy using antiactomyosin rabbit serum. In the breast, myoepithelial-like cells with positive immunofluorescence in the cytoplasm were observed not only in sclerosing adenosis and fibroadenoma but also in scirrhous and medullary-tubular duct carcinomas. No positive cells were observed in medullary carcinomas with lymphoid infiltration. The actomyosin positive cells were also seen at the outer layer of tubules of "mixed tumors" and of cell nests in adenoid cystic carcinoma and in myoepithelioma of the salivary gland, but not in the metaplastic squamous cells or in the cells of myxomatous and chondroid areas of "mixed tumor". In carcinoma of the lung, actomyosin-positive cells were observed in adenoid cystic carcinomas and adenocarcinoma of the bronchial gland type, but they were not seen in squamous cell carcinomas or papillary adenocarcinomas. It was concluded that the actomysoin-containing cells with structural appearances of myoepithelial cells in a variety of tumors were neoplastic myoepithelial cells.     

IMMUNOHISTOCHEMICAL IDENTIFICATION OF ACTOMYOSIN-CONTAINING (MYOEPITHELIAL) CELLS IN NON-NEOPLASTIC AND NEOPLASTIC TISSUES

Actomyosin-containing cells in both non-neoplastic and neoplastic tissues of the salivary gland, lung, breast and some other organs were studied by immunofluorescent microscopy using antiactomyosin rabbit serum. In the breast, myoepithelial-like cells with positive immunofluorescence in the cytoplasm were observed not only in sclerosing adenosis and fibroadenoma but also in scirrhousgand medullary-tubular duct carcinomas. No positive cells were observed in medullary carcinomas with lymphoid infiltration. The actomyosin positive cells were also seen at the outer layer of tubules of "mixed tumors" and of cell nests in adenoid cystic carcinoma and in myoepithelioma of the salivary gland, but not in the metaplastic squamous cells or in the cells of myxomatous and chondroid areas of "mixed tumor". In carcinoma of the lung, actomyosin-positive cells were observed in adenoid cystic carcinomas and adenocarcinoma of the bronchial gland type, but they were not seen in squamous cell carcinomas or papillary adenocarcinomas.
It was concluded that the actomysoin-containing cells with structural appearances of myoepithelial cells in a variety of tumors were neoplastic myoepithelial cells.     

Benign breast disease: the relationship between its histological features and risk factors for breast cancer.

Associations between histologically defined proliferative, but benign, epithelial disorders of the breast and risk factors for breast carcinoma were examined in 568 patients whose breast biopsies were submitted consecutively to the laboratory. Some disorders were associated with multiparity. Blunt duct adenosis was associated with a family history of breast cancer. Apart from a positive association with fibroadenoma, use of oral contraceptives was not associated with any proliferative lesion. Proliferative epithelial lesion changes were not associated with other aspects of obstetric or gynecological history.     

Fine needle aspiration cytology of benign breast lumps: a review of experience with 651 cases

A detailed cytomorphologic study was done on fine needle aspiration smears from 651 benign breast lumps. Cytological categorization enabled the distinction of proliferative from non-proliferative and infective lesions in the majority of the cases. Lumpectomy provided the histological diagnosis in 584 cases, most of which were proliferative lesions. Gross cystic disease and fibroadenoma were the most common lesions encountered. Microcysts with apocrine change, sclerosing adenosis, proliferative disease without atypia, atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ were associated with the dominant lesion in many of the cases. In all these cases, retrospective analysis of the cytological smears was done in an attempt to identify cytological features which may indicate these lesions.     

Fine-needle aspiration cytology of juvenile papillomatosis of breast: A case report

The cytologic findings of juvenile papillomatosis (JP) have been rarely described. The clinical and cytologic findings were suggestive of a fibroadenoma, but due to the presence of 2 cc of clear fluid during the aspiration, fibrocystic change was in the differential diagnosis. Operation and subsequent examination of the mass identified a case of JP (so-called Swiss cheese disease of the breast). Because JP is a marker for breast carcinoma for the patients' families, and the patients may themselves be at increase risk for malignancy, it is important that this entity be considered in the differential diagnosis. The observations in this case indicate that it is difficult to diagnose JP only by cytology, but the combination of clinical findings—a well-circumscribed mass in a young patient with cystic fluid, but with a residual mass after aspiration due to the multicystic nature of JP—with the cytologic findings—sheets of hyperplatic breast epithelium with areas resembling fibroadenoma, macrophages, and apocrine cells—that appear to be sufficiently characteristic to suggest the diagnosis of JP.     

90例乳腺良性病变组织中ER和PR的表达

应用免疫组化方法对９０例良性乳腺病变组织进行ＥＲ、ＰＲ的检测。结果，ＥＲ阳性率为８４．４％，ＰＲ为８３．３％，与同期乳腺癌的ＥＲ和ＰＲ阳性率比较有非常显著性意义，ＥＲ阳性以纤维腺瘤，导管内乳头状瘤，囊性乳腺增生症最为常见，小叶内增生ＥＲ阳性相对减少，同时对乳腺组织间质存在前背景染色问题加以讨论。