Basics
- Definition: Fibroepithelial Breast Tumor
- 15% Risk for Recurrence (Local or Contralateral)
- Rare Hematogenous Spread
- Most Common Site of Mets: Lung
Presentation
- Smooth Multinodular Mass
- Firm & Mobile
- Generally Painless
- Often Large (Average 4-7 cm) – Generally Larger than Fibroadenomas
- Can Ulcerate
- Many (Up to 20%) Have Palpable Axillary Lymphadenopathy Although Most are Reactive
- Metastatic Lymph Node Involvement is Rare
Diagnosis
- Initial Evaluation: Imaging (Mammogram/US)
- Diagnosis: Core Needle Biopsy (CNB)
- Pathology: Stromal Hypercellularity with Leaf-Like Projections
- Vimentin & Actin Stain Positive
- May Be Difficult to Distinguish from Fibroadenoma
- Imaging for Both May Show Smooth Multinodular Mass
- Biopsy for Both May Show Cellular Fibroepithelial Lesion
- *See Breast: Breast Mass Evaluation
Histologic Classification
- Classifications:
- Indeterminate
- Benign
- Borderline
- Malignant
- Based On:
- Degree of Stromal Cellular Atypia
- Mitotic Activity
- Infiltrative Margins
- Presence of Stromal Overgrowth – The Most Consistently Associated with Aggressive/Metastatic Behavior
Treatment
- Primary Treatment (Borderline or Malignant): Wide Local Excision (WLE)
- Margin: ≥ 1 cm
- Mastectomy May Be Required if Large or Comprising the Majority of Breast Volume
- Does Not Require SLNB or XRT
- Consider Excisional Biopsy Alone (Without Intent of Obtaining Surgical Margins) for Indeterminate or Benign Phyllodes Tumors