Multinucleated Stromal Giant Cells in a Benign Fibroadenoma: Do Not Make a Mountain Out of a Molehill! (original) (raw)
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Diagnostic Pathology, 2008
Fibroadenomas are common benign breast tumours that display a characteristic pathological morphology, although several epithelial and stromal variations exist. A very rare histological finding is the presence of multinucleated giant cells throughout the stroma of a benign fibroadenoma. Cells of this type, which are more commonly found incidentally within the interlobular stroma of breast tissue, are benign and should not be mistaken for malignant cells on microscopic examination. Unfortunately a lack of awareness of this pathological entity can lead to diagnostic confusion amongst pathologists resulting in the multinucleate giant cells being mistaken for highly mitotic cells and consequently the fibroadenoma being mistaken for a malignant lesion. This may have serious implications for the subsequent management of the patient. The presence of this unusual cell type in the stroma does not alter the prognosis of otherwise benign lesion. We encountered two such cases at our institution in a six month period recently. We present their histories along with relevant radiological, microscopic and immunohistochemical features, followed by a discussion of this unusual pathological entity.
Diagnostic Pathology, 2008
Fibroadenomas are common benign breast tumours that display a characteristic pathological morphology, although several epithelial and stromal variations exist. A very rare histological finding is the presence of multinucleated giant cells throughout the stroma of a benign fibroadenoma. Cells of this type, which are more commonly found incidentally within the interlobular stroma of breast tissue, are benign and should not be mistaken for malignant cells on microscopic examination. Unfortunately a lack of awareness of this pathological entity can lead to diagnostic confusion amongst pathologists resulting in the multinucleate giant cells being mistaken for highly mitotic cells and consequently the fibroadenoma being mistaken for a malignant lesion. This may have serious implications for the subsequent management of the patient. The presence of this unusual cell type in the stroma does not alter the prognosis of otherwise benign lesion. We encountered two such cases at our institution in a six month period recently. We present their histories along with relevant radiological, microscopic and immunohistochemical features, followed by a discussion of this unusual pathological entity.
Giant fibroadenoma of the breast: a benign breast mass mimicking malignancy
International Surgery Journal, 2021
Fibroadenoma of the breast is a common benign lesion in women under 30 years of age. They consist of proliferating epithelial and stromal tissue, resembling phyllodes tumors, and are considered hyperplastic lesions rather than true neoplasms. Giant fibroadenomas are a rare subtype of fibroadenomas classified when it its size is greater than 5 cm and/or weighs more than 500 g. They usually occur in adolescent women or older females during pregnancy or lactation. Giant fibroadenomas are fast-growing masses that can cause dilated veins and occasionally skin ulceration, masquerading as a malignant breast neoplasm. We report a case of a 37-year-old woman with a giant fibroadenoma and discuss the challenges we faced in her diagnosis and management. CASE REPORT
Unusual Variants of Fibroadenoma Breast
Journal of Evolution of medical and Dental Sciences, 2013
UNUSUAL VARIANTS OF FIBROADENOMA BREAST DIAGNOSED ON CYTOLOGY Fibroadenomas are common benign breast tumours that display a characteristic morphology, although several epithelial and stromal variations exist which may pose a diagnostic difficulty. We are discussing a case series of four cases of benign fibroadenoma with morphological variations as observed on cytology smears in the department of Pathology, KGMU, Lucknow, UP. Juvenile fibroadenoma constitutes only 4% of the total fibroadenomas with incidence of 0.5% per year. Another very rare histological finding is the presence of multinucleated giant cells throughout the stroma of a benign fibroadenoma, more commonly found incidentally within the interlobular stroma of breast tissue. Similarly apocrine metaplasia has been found to be 28% in a case series (Arno Kuijper et.al) of 396 cases of fibroadenoma. It is important to identify these variants as they may be misinterpreted as malignancy.
The Journal of Pathology, 1986
A rare form of infiltrating ductal carcinoma of the breast containing numerous benign stromal multinucleated giant cells (MNGC) is described. Giant cell tumours of the breast are usually the result of stromal metaplasia or fusion of malignant cells or occur as extraskeletal giant cell tumours. Benign multinucleated cells in breast carcinoma, however, are a very unusual phenomenon and have been said to arise from the fusion of mononuclear cells, in response to increased vascularity. The present investigation by light and electron microscopy, in part, supports an origin for the multinucleated giant cells from mononuclear cells, but immunohistochemistry surprisingly failed to confirm this observation. Also, the formation of the multinucleated giant cells did not show any direct relationship with tumour vascularity .
Aggressive Giant Fibroepithelial Lesion with Unusual Vascular Stroma—A Case Report
Modern Pathology - MODERN PATHOL, 2003
The stroma of fibroadenoma and phyllodes tumor usually consists of fibroblastic proliferation. Rarely the stroma contains bundles of smooth muscle. Pseudoangiomatous hyperplasia of the mammary stroma has been described in fibroadenomas. However, true benign vascular stroma has not been reported. We report a case of a 34-year-old Chinese woman who presented with a large mass occupying the entire left breast. Left mastectomy was performed and showed a large, well-circumscribed, lobulated, rubbery-firm tumor measuring 13 × 10 × 6 cm. Microscopic examination revealed a fibroepithelial tumor formed by an organoid pattern of ductal structures with a very striking stromal appearance composed of extensive vascular proliferation and that demonstrated strong immunoreactivity for CD31, CD34, and Factor VIII. Ultrastructural examination revealed intercellular junctions, basal lamina, pinocytotic vesicles, and Weibel-Palade bodies in the cells lining the vascular spaces, confirming their endothe...
Giant fibroadenoma of the breast: A rare case in a mature woman
International Journal of Surgery Case Reports, 2019
INTRODUCTION: Fibroadenomas are common benign lesions of the breast that are usually found young patients. Giant fibroadenomas are uncommon benign lesions, defined as fibroadenomas of >5 cm in size, which are usually found in patients of less than 20 years of age. PRESENTATION OF CASE: A 39-year-old premenopausal woman presented with a right breast tumor that had rapidly increased in size and which showed ulceration and bleeding. Needle biopsy showed mixed connective tissue and an epithelial tumor without a leaf-like pattern, but indeterminate. Total mastectomy and skin grafting were performed. Histopathology confirmed the diagnosis of giant fibroadenoma. DISCUSSION: In comparison to all previous reports on patients with giant fibroadenoma, this patient was relatively old and the etiology was unknown. Although rare, an appropriate therapeutic strategy should be decided according to the results of a histopathological examination. CONCLUSION: Early treatment could allow breast preserving surgery and patients should be recommended to undergo reexamination with awareness of progression.
Cureus, 2018
Fibroadenoma, being a very common benign tumor of the breast in young females, does not pose any threat and, thus, can be treated with lumpectomy. Breast cancer arising within a fibroadenoma is a rare phenomenon, but detecting these neoplasms is of utmost importance for complete treatment and follow-up. These lesions are an incidental finding in a lumpectomy specimen done for fibroadenoma breast. A 28-year-old female presented with multiple bilateral lumps for eight years. The lumps were mobile, non-tender, and slowly growing, with no nipple discharge, no axillary lymphadenopathy, and no family history. The diagnosis of a benign lesion suggestive of fibroadenoma was given on ultrasonography (USG) and fine-needle aspiration cytology (FNAC). The patient underwent lumpectomy and the excised tissues were subjected to histopathological examination. Grossly, multiple, well-circumscribed, encapsulated masses, with the largest measuring 4x2.5x2 cm were noted. All masses showed homogenous grey-white areas with slit-like spaces. On microscopy, predominant areas were consistent with fibroadenoma, with few foci showing the features of ductal carcinoma in situ (DCIS) with nests of cells having pleomorphic nuclei, prominent nucleoli with atypical mitosis, a cribriform pattern, and comedo necrosis. This highlights the rare association of fibroadenoma and carcinoma in situ, thus, a careful and extensive sampling of the tissue is required to prevent the false negative diagnosis by pathologists.
Breast fibroadenoma with pseudoangiomatous (PASH-like) stroma
Breast Disease, 2017
Pseudoangiomatous stromal hyperplasia (PASH) is a breast stromal change, histologically characterized by anastomosing, slit-like spaces lined by slender myofibroblasts and surrounded by dense collagenous stroma. Mass forming cases clinically and radiologically simulate fibroadenoma. A middle aged women presented with unpalpable breast nodule discovered on ultrasound examination. The ultrasound characteristics were typical for fibroadenoma, while fine-needle aspiration cytology was inconclusive. The histological examination of the lumpectomy specimen showed fibroadenoma with peculiar stromal alteration consistent with pseudoangiomatous stromal hyperplasia. The presented case of fibroadenoma with pseudoangiomatous hyperplasia within its stroma demonstrates the relationship between these two entities not only clinically and radiologically, but also histologically.