[278] Phyllodes Tumor in Young Women – Focus on Tubular Adenomatous Tumors with Propensity for Phyllodes like Recurrences

Tanuja Shet, Bharati Ramnani, Shweta Sethi. Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

Background: The diagnosis of Phyllodes tumor in women < 20 years poses a problem for most pathologist. There are tumors that straddle between Fibroadenoma variant (Juvenile fibroadenoma) and phyllodes tumor, where histopathology criteria for diagnosis are not well defined.
Design: A retrospective review of all non-conventional firboepithelial neoplasms or juvenile fibroadenomas or phyllodes tumor in women < 24 years from 2003 to 2011 was conducted. Many of fibroepithelial neoplasms in younger women were found to have a tubular or adenomyoepithelioma like epithelial compoenent and hence a review classifcation was devised.
Results: Of the 41 cases, 7 were diagnosed as phyllodes tumor upfront while remaining 35 were an interesting spectrum of lesions that were classified as 1) Tubular adenoma and sclerosing adenosis type (TA/SA) characterized by multiple capsulated nodules resembling adenosis with cellular intervening stroma.2) Tubular adenomyoepithelioma with cellular stroma(TAMECS) where the epithelial component resembled an adenomyoepithelioma with myoepithelial proliferation but the intervening stroma was cellular. 3) Juvenile fibroadenoma (JFA) like with TDLU like structure and fair amounts of paucicellular stroma. A summary of differences is given -

Clinical differences in three groups
 TA/SA type( n = 15)TAMECS( n= 9)JFA type( n=8)
Age < 11 years300
Age 12- 18 years775
Age 19-24 years523
Bilateral Breast affected946
Multiple tumors1123
Size < 5cm1043
Size 5- 10 cm435
Size > 11 cm130
Recurrences964
Recurrences as phyllodes tumor334
    


Ten of the 35 patients developed phyllodes tumors. A thorough histologic evaluation revealed that MIB1 >10% and stromal overgrowth at 20X magnification served to predict likelihood of development of phyllodes tumor in this group. Stromal cellularity, tumor size CD10 and CD 34 did not predict these recurrences. One patient was put on imatinib and had 50% reduction in her bilateral breast lumps but patient died due to acute liver failure. In the last two patients MRI was used to choose excision of the most cellular tumor. One patient with metastatic phyllodes tumor succumbed to the disease.
Conclusions: The histopathology criteria for defining phyllodes tumor in young women needs to be redefined. The tumors described above represent a distinct group with propensity for multiplicity and phyllodes like recurrences and a relook of all fibroepithelial neoplasms in children with these findings is required.
Category: Breast

Monday, March 4, 2013 1:00 PM

Poster Session II # 46, Monday Afternoon

 

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