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 -
|TA/SA type( n = 15)||TAMECS( n= 9)||JFA type( n=8)|
|Age < 11 years||3||0||0|
|Age 12- 18 years||7||7||5|
|Age 19-24 years||5||2||3|
|Bilateral Breast affected||9||4||6|
|Size < 5cm||10||4||3|
|Size 5- 10 cm||4||3||5|
|Size > 11 cm||1||3||0|
|Recurrences as phyllodes tumor||3||3||4|