Paediatric fibroepithelial lesions revisited: pathological insights

To review the clinicopathological features of fibroepithelial neoplasms of the breast diagnosed by the paediatric pathology service in a children's hospital.

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.

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.

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.