Distinction of phyllodes tumor from fibroadenoma: Cytologists′ perspective

Bandyopadhyay, Ranjana; Nag, Dipanwita; Mondal, Santosh Kumar; Mukhopadhyay, Sabyasachi; Roy, S. K.; Sinha, Sankar Narayan

doi:10.4103/0970-9371.70739

Cited by 28 publications

(57 citation statements)

References 10 publications

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“…Although Shabalova et al [7] showed that the epithelial clusters of phyllodes tumors have different patterns, including branched, staghorn-like, honeycomb arrangements, strips, and small groups, Mitra and Dey [8] stated that the epithelial component of phyllodes is broad and rounded; also, Giri [2] showed that the epithelial clusters of phyllodes tumors are elongated and wavy [2], but bonsai-like clusters have not been reported previously. According to previous studies, epithelial clusters are more abundant in fibroadenomas with a higher epithelial-to-stromal ratio [1-5]. …”

Section: Discussionmentioning

confidence: 99%

“…We also observed deposition of pinkish and amorphous material at the border of the stromal and epithelial fragments. Previous studies have demonstrated that the size and cellularity of stromal fragments as well as the presence of atypia in stromal cells is found more frequently in phyllodes tumors, showing well-defined borders compared to fibroadenomas [1-5]. It has been suggested that the degree of background cellularity, the composition of these cells, and the epithelium-to-stroma ratio may be useful features for differentiation [1].…”

Section: Discussionmentioning

confidence: 99%

“…Differentiation from their closely related mimicker “fibroadenoama” (another benign breast fibroepithelial lesion) is very important, and thus it is crucial to correctly diagnose fibroepithelial lesions as the diagnosis will dictate further treatment [1-6]. Fine-needle aspiration cytology is a simple, safe, and accurate method for the evaluation of breast lesions.…”

Section: Introductionmentioning

confidence: 99%

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Cytological Findings in Benign Phyllodes Tumors

Kumar

Mokhtari

2018

Acta Cytologica

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Objective: Phyllodes tumors are fibroepithelial breast lesions with many cytological and histopathological similarities to fibroadenomas. The aim of this study was to investigate cytological findings in benign phyllodes tumors. Study Design: Seventy-six histologically proven cases of benign phyllodes tumors were selected from 1982 to 2017. Cytological criteria, including cellularity, the number and shape of epithelial clusters, the shape and number of stromal fragments, and the presence of atypia, were evaluated. Results: Cytological slides were hypercellular and showed dimorphic populations of cells. The epithelial clusters were moderate in amount and had a bonsai-like configuration. The stromal fragments consisted of oval-to-spindle shaped cells with preservation of the cytoplasm. Some popcorn-like cells and intranuclear inclusions in stromal cells and deposition of pinkish and amorphous material at the border of the stromal fragments were also noted in the stromal cells. Conclusion: Stromal hypercellularity and large amounts of stromal fragments, the presence of bonsai-like epithelial clusters, and deposition of amorphous pinkish material at the border of the stromal fragments, as well as newly observed findings including the presence of intranuclear inclusions and popcorn-like nuclei in the stromal cells, can aid in the diagnosis of phyllodes tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cytological Findings in Benign Phyllodes Tumors

Kumar

Mokhtari

2018

Acta Cytologica

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“…The phyllodes tumor has to be identified from the common benign fibroadenoma, which is its nemesis and a clinical, radiological, and morphological mimicker. [4] A correct surgical planning with wide local excision and at least 1 cm margin is the needed treatment to avoid relook operation in cases of phyllodes. [5] The triple assessment is the desired approach for breast lumps, which combines the results of clinical examination, radiological imaging, fine-needle aspiration cytology (FNAC), and/or core needle biopsy, to ensure diagnostic accuracy in breast disease before surgery.…”

Section: Introductionmentioning

confidence: 99%

Missed diagnosis of phyllodes tumor and its implications: A case report

Chatura¹,

Sajjan²,

Preethi³

2018

JCRI

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Phyllodes tumor, a fibroepithelial neoplasm, is rare and accounts for <1% of breast tumors. It is often underdiagnosed by the pathologists and undertreated by the surgeons. The pathologist has a definite role in the pre-operative diagnosis of phyllodes which is essential for planning of surgery. A consistent differentiation of phyllodes tumor from cellular fibroadenoma is often difficult. Pre-operative diagnosis by fine-needle aspiration cytology or core needle biopsy is very important to avoid reoperation because of inadequate excision or to prevent unwarranted surgery. Its heterogeneity makes phyllodes tumor, a challenge for the pathologist and the clinician. We present the case of 45-year-old female with clinical differential diagnoses of phyllodes tumor or carcinoma of right breast lump. The lack of correlation between clinical and cytological diagnosis warranted a core biopsy which was not helpful. Intraoperative frozen section was requested on the subsequent lumpectomy. Grossly, a multicystic lesion with fronds projecting into them and cysts with mucinous material was seen. Cellular imprint smears and frozen and routine histopathology sections confirmed the diagnosis of phyllodes tumor. This case aptly describes the saga of a missed pre-operative diagnosis of phyllodes tumor.

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“…13,26 Preoperative cytological examination is essential as it plays a pivotal role in clinching the diagnosis in most of the cases, as seen in our case. However, sometimes the features of fibroadenomas and benign or borderline phyllodes tumor overlap each other, thereby making the diagnosis difficult on FNAC 15,27 However, it is the histopathology which is considered to be the gold standard as it is not only required for the definite diagnosis but it also helps in differential diagnosis of giant breast masses, thereby allowing timely intervention and appropriate treatment in such cases.…”

mentioning

confidence: 99%