Difference between revisions of "Breast pathology"

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Breast pathology (view source)

Revision as of 18:32, 24 March 2012

197 bytes added ,  18:32, 24 March 2012
→‎Phyllodes tumour: re-work
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==Phyllodes tumour==
==Phyllodes tumour==
 
*Previously ''cystosarcoma phyllodes''.


===General===
===General===
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===Gross===
===Gross===
*Clefts/leaf-like structures.
*Clefts/leaf-like structures.
*Friable - esp. vis-a-vis a [[fibroadenoma]].
*Friable - especially vis-à-vis a [[fibroadenoma]].


Image:
Image:
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*[http://en.wikipedia.org/wiki/File:Phyllodes_tumour_-_low_mag.jpg Phyllodes tumour - low mag. (WC)].
*[http://en.wikipedia.org/wiki/File:Phyllodes_tumour_-_low_mag.jpg Phyllodes tumour - low mag. (WC)].


====Malignant phyllodes?====
====Grading====
Features of malignancy:<ref name=pmid17932112>{{cite journal |author=Taira N, Takabatake D, Aogi K, ''et al'' |title=Phyllodes tumor of the breast: stromal overgrowth and histological classification are useful prognosis-predictive factors for local recurrence in patients with a positive surgical margin |journal=Jpn. J. Clin. Oncol. |volume=37 |issue=10 |pages=730-6 |year=2007 |month=October |pmid=17932112 |doi=10.1093/jjco/hym099 |url=http://jjco.oxfordjournals.org/cgi/reprint/37/10/730}}</ref>
Phyllodes tumours are graded:
*Stromal cellular atypia.
*Benign.
*Mitotic activity in 10 [[HPF]]s.
*Borderline.
**"HPF" is not adequately defined - see [[HPFitis]]. The authors should be spanked.
*Malignant.
*Stromal overgrowth -- epithelial elements absent in one low power field (x40).<ref name=pmid17932112/>
**"LPF" is not adequately defined - see [[LPFitis]]. The authors should be spanked.


 
Grading phyllodes tumours - based on WMSP:<ref name=Ref_WMSP263>{{Ref WMSP|263}}</ref>
A comparison between benign and malignant phyllodes - adapted from Taira et al.<ref name=pmid17932112/>
{| class="wikitable"
{| class="wikitable"
| || '''Benign''' || '''Malignant'''
| Feature
| Benign phyllodes
| Borderline phyllodes
| Malignant phyllodes
|-
| Circumscription
| Well
| Well
| Poor
|-
| Stromal overgrowth †
| none
| none
| may be present
|-
|-
|Stromal overgrowth || no || yes
| Nuclear atypia
| mild
| mild-to-moderate
| moderate-to-marked
|-
|-
|Mitoses || >4/10 [[HPF]] || >=10/10 HPF
| Mitoses per 10 [[HPF]]s ‡
| < 5
| 5-10
| >10
|-
|-
|Atypia of stromal cells || <= moderate || marked
| Heterologous elements
| +/- benign
| +/- benign
| +/- malignant
|-
| DDx
| [[fibroadenoma]]
| benign phyllodes, malignant phyllodes
| [[metaplastic breast carcinoma]], sarcoma
|-
|-
|}
|}


See also: [[Phyllodes tumour vs. fibroadenoma]].
Notes:
* † Stromal overgrowth = epithelial elements absent in one low power field (LPF), defined as x40;<ref name=pmid17932112>{{cite journal |author=Taira N, Takabatake D, Aogi K, ''et al'' |title=Phyllodes tumor of the breast: stromal overgrowth and histological classification are useful prognosis-predictive factors for local recurrence in patients with a positive surgical margin |journal=Jpn. J. Clin. Oncol. |volume=37 |issue=10 |pages=730-6 |year=2007 |month=October |pmid=17932112 |doi=10.1093/jjco/hym099 |url=http://jjco.oxfordjournals.org/cgi/reprint/37/10/730}}</ref> ''LPF'' is not adequately defined - see [[LPFitis]].  
* ‡ ''HPF'' is not adequately defined - see [[HPFitis]].


==Pseudoangiomatous stromal hyperplasia==
==Pseudoangiomatous stromal hyperplasia==
Michael
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