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Published on: January 7, 2016
Paediatric fibroepithelial lesions revisited: pathological insights
Timothy Kwang Yong Tay1, Kenneth Tou En Chang2, Aye Aye Thike1
1Department of Pathology, Singapore General Hospital, Singapore.
Insights
Paediatric fibroepithelial breast neoplasms often show increased stromal cellularity and leaf-like fronds. Stromal mitoses are rare and may predict recurrence in these breast tumors.
Area of Science:
- Paediatric Pathology
- Surgical Pathology
- Oncology
Background:
- Fibroepithelial neoplasms are rare breast tumors in children.
- Understanding their clinicopathological features is crucial for diagnosis and management.
Purpose of the Study:
- To review the clinicopathological features of fibroepithelial neoplasms in paediatric patients.
- To identify potential predictors of recurrence.
Main Methods:
- Retrospective review of 68 fibroepithelial neoplasms diagnosed between 2002-2012.
- Analysis of tumour size, macroscopic and microscopic parameters, and clinical features.
- Statistical analysis to correlate features with recurrence.
Main Results:
- Fibroadenomas and juvenile fibroadenomas were the most common types.
- Most tumours had leaf-like fronds and moderate stromal cellularity.
- Positive surgical margins were frequent (79.4%), with 11.8% recurrence rate.
Conclusions:
- Increased stromal cellularity and leaf-like fronds are common in paediatric fibroepithelial tumours.
- Stromal mitoses were rare and may be a better predictor of recurrence than stromal cellularity.
- Further research is needed to refine prognostic factors.
Aim:
To review the clinicopathological features of fibroepithelial neoplasms of the breast diagnosed by the paediatric pathology service in a children's hospital.
Methods:
Files of the Department of Pathology and Laboratory Medicine, Kandang Kerbau Women's and Children's Hospital, were searched for breast fibroepithelial neoplasms diagnosed between January 2002 and December 2012. Tumour size and macroscopic findings were obtained from surgical pathology reports while clinical features were determined from clinical files. Histological slides were reviewed and microscopic parameters documented. Findings were tabulated and analysed using statistical methods.
Results:
68 fibroepithelial neoplasms from 53 female subjects were studied. There were 27 (39.7%) fibroadenomas, 32 (47.1%) juvenile fibroadenomas, 3 (4.4%) cellular fibroadenomas, 3 (4.4%) benign phyllodes tumours with the remaining 3 (4.4%) comprising benign fibroepithelial neoplasms with focal infarction and hybrid features. Half (50%) of the tumours possessed small leaf-like fronds and a majority had at least moderate stromal cellularity (83.8%). Most tumours had no discernible stromal mitoses with only 23.5% (16/68) having ≥1 mitoses per 10 high power fields. Many (79.4%) disclosed positive surgical margins. Recurrences occurred in 8 (11.8%) cases after excision.
Conclusions:
Most paediatric fibroepithelial tumours showed increased stromal cellularity which did not correlate with recurrence. Leaf-like fronds were commonly seen in paediatric fibroepithelial tumours apart from phyllodes tumours. Stromal mitoses were rare and may be a better criterion for predicting recurrence.
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