Published: 2020-06-25

An audit and clinicopathological study of fibroepithelial lesions of the breast at a tertiary care centre and comparison with WHO grading

Deepti Yadav, Mukta Meel, Deepika Hemrajani, Aarti Mittal, Kusum Mathur


Background: Mammary fibroepithelial lesions encompass a wide spectrum of tumors ranging from an indolent fibroadenoma to potentially fatal malignant phyllodes tumor (PT). The criteria used for their classification based on morphological assessment are often challenging to apply and there is no consensus as to what constitutes an adequate resection margin. The aims of the study were to study histopathological spectrum of fibroepithelial lesions of breast at tertiary care centre, to stratify and classify various fibroepithelial lesions into fibroadenomas and PT, reclassify all confirmed cases of PT seen in the study period according to standard histopathological WHO criteria.

Methods: Records and slides of fibroepithelial lesions of the breast received at the department between January 2016 and August 2019 were retrieved and reviewed.

Results: A total 891 fibroepithelial lesions of breast were diagnosed during this duration. Out of these, 826 (92.7%) were fibroadenoma and its variants, 34 (3.8%) cases were of fibroadenomatoid mastopathy and 31(3.5%) were PT. Among all PT, 8 (25.8%) were borderline and 4 (12.9%) were malignant, rest (61.3%) were benign.

Conclusions: Fibroepithelial tumours of the breast are a heterogenous group of lesions ranging from fibroadenoma at the benign end of the spectrum to malignant PT. There are overlapping histologic features among various subtypes, and transformation and progression to a more malignant phenotype may also occur. Given the significant clinical differences within various subtypes, accurate pathologic classification is important for appropriate management. Although some immunohistochemical markers may be useful in this differential diagnosis, histomorphology still remains the gold standard.


Fibroadenoma, Fibroepithelial lesions, Phyllodes tumours

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Giri D. Fibro epithelial lesions. Arch Pathol Lab Med. 2009;133:713-21.

Geethamala K, Vani BR, Murthy VS, Rhada M. Fibroadenoma: A harbor for various histopathological changes. Clin Cancer Investig J. 2015;4:183-7.

Dyer NH, Bridger JE, Taylor RS. Cystosarcoma phylloides. Br J Surg. 1966;53:450 55.

Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: An analysis of 170 cases. Cancer. 1996;77:910 6.

Bumpers HL, Tadros T, Gabram Mendola S, Rizzo M, Martin M, Zaremba N, et al. Phyllodes tumors in African American women. Am J Surg. 2015;210:74 9.

Fattaneh A, Devilee P. WHO Classification of Tumors: Tumors of the Breast and Female Genital Organs. Lyon: IARC; 2003.

Tan PH, Jayabaskar T, Chuah KL, Lee HY, Tan Y, Hilmy M, et al. Phyllodes tumors of the breast: The role of pathologic parameters. Am J Clin Pathol. 2005;123:529 40.

Moffat CJ, Pinder SE, Dixon AR, Elston CW, Blamey RW, Ellis IO. Phyllodes tumours of the breast: A clinicopathological review of thirty two cases. Histopathology. 1995;27:205-18.

Tan PH, Tse G, Lee A, Simpson JF, Hanby AM. Fibroepithelial tumors. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. World Health Organization Classification of Tumors: Tumors of the Breast and Female Genital Organs. Lyon, France: IARC Press; 2012: 143-147.

Wani R, Sheikh S, Jehangeer AM, Bhat S, Niyaz I, Khursheed B. A three and a half years histopathological study of fibroepithelial breast lesions in a tertiary care hospital. Int J Current Res Rev. 2019;11:1-5.

Patil V, Khandelwal A, Kanchanmala G. Ghorpade. Histopathological Spectrum of Benign Breast Lesions. J Res Med Dent Sci. 2017;5:9-14.

Zhang Y, Kleer CG. Phyllodes Tumor of the Breast. Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates. Arch Pathol Lab Med. 2016;140:665-71.

Guillot E, Couturaud B, Reyal F, Curnier A, Ravinet J, Lae M, et al. Management of phyllodes breast tumours. Breast J. 2011;17:129-37.

Karim RZ, Gerega SK, Yang YH, Spillane A, Carmalt H, Scolyer RA, et al. Phyllodes tumours of the breast: A clinicopathological analysis of 65 cases from a single institution. Breast. 2009;18:65-70.

Barnes L, Pietruszka M. Rhabdomyosarcoma arising within a cystosarcoma phyllodes. Case report and review of the literature. Am J Surg Pathol. 1978;2:423 9.

Bode MK, Rissanen T, Apaja- Sarkkinen M. Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumour phyllodes. Acra Radiol. 2007;48:708-13.

El Hag IA, Aodah A, Kollur SM, Attallah A, Mohamed AA, Al Hussaini H. Cytological clues in the distinction between phyllodes tumor and fibroadenoma. Cancer Cytopathol. 2010;118:33-40.

Barrio AV, Clark BD, Goldberg JI, Hoque LW, Bernik SF, Flynn LW, et al. Clinicopathologic features and long term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14:2961-70.