FIBROEPITHELIAL LESIONS

Transcription

1 DEFINITIONS FIBROEPITHELIAL LESIONS Suzanne Moore FIBROADENOMA- A discrete benign tumour showing evidence of connective tissue and epithelial proliferation- WHO Fibrous stromal element of these tumours are the key to classification and behaviour Fibroadenoma-low cellularity and benign cytology Phyllodes- increased cellularity and atypia of the stroma 1

2 PATHOGENESIS Arise from the lobules of the breast Probably an aberration of normal lobular development Hyperplasia- all cellular components normal In Phyllodes tumours the stromal cells are monoclonal, not polyclonal RISK FACTORS ORAL CONTRACEPTIVE PILL/ HRT CYCLOSPORIN A GEOGRAPHICAL VARIATIONS 2

3 AGE OF DIAGNOSIS NATURAL HISTORY GROWTH PHASE- up to 1-3cm Conservative treatment of 201 patients 13% resolved 85% unchanged 2% increased in size 4. Dobie V, Walsh J, Lamb J, et. al.: Natural history of fibroadenoma of the breast. Mansel RE Recent Developments in the Study of Benign Breast Disease Parthenon London: pp

4 NATURAL HISTORY INCIDENCE- 10% 4

5 21/11/2016 Sharply rounded or lobulated tumour. White glistening bulging surface Irregular epithelial clefts st D is ea se Sy m po si um PATHOLOGY Be ni gn Br ea PATHOLOGY 5

6 VARIATIONS PREGNANCY INFARCTION SCLEROSING ADENOSIS MYXOID JUVENILE TUBULAR ADENOMA FIBROADENOMATOID HYPERPLASIA CLINICAL FEATURES 6

7 GIANT FIBROADENOMAS MULTIPLE FIBROADENOMAS HAVING 3-4 CONCURRENTLY- NORMAL MULTIPLE FIBROADENOMAS - AS A DISTINCT ENTITY >5 MAY BE MORE COMMON IN ASIAN WOMEN 7

8 21/11/2016 MAMMOGRAPHY m po si um NOT IF <35 POPCORN st D is ea se Sy CALCIFICATIONS Be ni gn Br ea ULTRASOUND 8

9 INVESTIGATIONS CYTOLOGY CORE BIOPSY 9

10 CANCER AND FIBROADENOMA Cancer is rare arising within a fibroadenoma- often LCIS or DCIS May occur adjacent to a fibroadenoma and grow into it Fibroadenoma and subsequent cancer risk Epidemiologically relative risk of developing cancer is around Not clear whether excising the lesion changes the risk. FHx breast cancer and complex FA- RR- 3-4x. Risk not enough to change clinical management. MANAGEMENT CONSERVATIVE TREATMENT much more common SAFETY of CONSERVATION based on triple assessment. INFORMED DECISION AIM TO EXCLUDE CANCER, TREAT SYMPTOMS 10

11 MANAGEMENT CORE BIOPSY FOR DIAGNOSIS EXCISE IF >4CM IF < 4CM- EXCISION IF PATIENT REQUEST OR OBSERVATION- 6 MONTHS REPEAT US IF UNCHANGED OR SMALLER- DISCHARGE THEN SIGNIFICANT ENLARGEMENT- EXCISE EXCEPTIONS SCREEN DETECTED- NEED FOLLOW UP MULTIPLE LESIONS THE VERY YOUNG 11

12 MANAGEMENT SURGICAL LARGE TUMOURS SUBMAMMARY INCISION 12

13 RECURRENCE AFTER SURGERY INCOMPLETE REMOVAL SAME PROCESS LARGE SERIES- 23 NEW FAS FOLLOWING EXCISION-7 OPPOSITE BREAST, 16 RECURRENT TUMOURS IN THE SAME BREAST- 9 AT THE SAME SITE, 7 ELSEWHERE PHYLLODES TUMOUR 13

14 DIAGNOSIS EPITHELIAL AND STROMAL ELEMENTS STROMAL CELLULARITY, HYPERCHROMATISM IRREGULARITY MITOSIS PHYLLODES TUMOURS ARISE FROM FIBROADENOMAS MOST COMMON RARE BEFORE 20 ONE PHYLLODES TUMOUR PER 40 FIBROADENOMAS 14

15 LARGE MASS IN THE BREAST IMAGING 15

16 ULTRASOUND PATHOLOGY 16

17 BEHAVIOUR TENDENCY FOR LOCAL RECURRENCE BENIGN BORDERLINE MALIGNANT RECURRENCE RATE 11% 18% 28% MORTALITY 0.3% 6.6% 20% BEHAVIOUR HIGHER GRADE OF RECURRENCES LOW RATE OF LYMPH NODES METASTASES 17

18 TREATMENT COMPLETE EXCISION TO PREVENT RECURRENCE BENIGN LESIONS- EXCISION WITH NARROW MARGIN LARGER OR RECURRENT LESIONS-10MM MARGIN, QUDRANTECTOMY OR MASTECTOMY EXCISION MARGINS 18