Fibrous Lesions of the Breast: Imaging-Pathologic Correlation

Abstract

Fibroepithelial lesions of the breast are commonly seen in clinical practice. The masses are composed of a combination of prominent stroma and varying glandular elements. Fibroadenomas, benign lesions that derive from the terminal duct lobular unit, are the most common and are often identified at clinical examination or mammography as circumscribed masses. Benign mesenchymal tumors include focal fibrosis, pseudoangiomatous stromal hyperplasia, and fibromatosis or desmoid tumor. Phyllodes tumor, which is similar to fibroadenoma but has increased cellularity in the stroma, is typically benign but has malignant potential. Diabetic fibrous mastopathy, a stromal proliferation found in patients with juvenile-onset insulin-dependent diabetes, is a reactive fibrous lesion. Most of these lesions manifest as masses at clinical and/or mammographic examination. Some (eg, fibroadenomas) may be associated with calcifications. Except for fibromatosis and phyllodes tumor, fibroepithelial lesions need not be excised if the diagnosis is confirmed by the results of histologic analysis at percutaneous biopsy. To correctly differentiate between fibrous breast lesions that are benign and those that should be resected, the physician must be familiar with the correlated radiologic-pathologic findings in the various lesion types.

Malignant Phyllodes Tumour of Breast: Case Report and Review of Literature

“…In ultrasound, they are generally characterized as a solid lobulated nodule of well-defined contours, and may be associated with cystic components. [9] Phyllodes tumors present rapid growth, however, when in smaller dimensions, it's difficult to differentiate them from fibroadenoma, including histopathologic aspects of fragments obtained through core biopsy, where the main criterion for differentiation of fibroadenoma is the higher stromal cellularity presented in phyllodes tumors. Problems occur when characterizing malignant forms due to their large cellularity and atypia which varies, making broader samples necessary for conclusive diagnosis, even in surgical specimens.…”

Rare Mammary Lesions: A Radiologic-Pathologic Correlation

“…4 On imaging, US images may show a hypoechoic circumscribed mass that resembles a fibroadenoma. 7 The most striking histologic finding is a complex pattern of empty anastomosing slitlike spaces within the stroma. These slitlike spaces resemble the vascular spaces in lesions such as low-grade angiosarcoma and may be mistaken for such (hence the name pseudoangiomatous), from which PASH must be histologically differentiated.…”

“…The prognosis is generally good, with a reported recurrence rate of approximately 10%. 7 Angiosarcoma is a malignancy of endovascular origin. Primary angiosarcoma can arise anywhere in the body.…”

Radiologic Imaging Findings of Bilateral Infiltrating Pseudoangiomatous Stromal Hyperplasia of the Breasts: A Case Report

“…PASH mainly occurred in young premenopausal women; in some cases, it also occurred in postmenonpausal women in hormonal replacement therapy. This suggests that the development of PASH may be related with hormonal stimulation (1,3,4,(7)(8)(9). It is found as an incidental finding of breast biopsy specimens, up to 25% and can occur as mass forming tumor.…”

“…The most common mammographic and ultrasound finding of PASH is a circumscribed mass without calcification and it is difficult to distinguish from the phyllodes tumor and fibroadenoma (1)(2)(3)(4)8). Up to our knowledge, PASH presenting as rapid bilateral breast enlargement, as seen in our case, is very rare.…”