![]() ![]() Features studied in the epithelial component were: number of clusters per 10 fields on a scanner (> 5 or 5 or 80% of field) margins of stromal fragments (rounded/frayed/irregular) cellularity in stromal fragments under high power (mild/ moderate/marked) nature of the fragments (fibromyxoid/hyaline) traversing blood vessel (present or absent) and shape of the nucleus in stromal fragments under high power (spindle/oval).įor the dispersed cell population, the cellularity was expressed as mild, moderate or marked, and cell type as oval or spindle. The cytomorphology of the epithelial and stromal fragments, and the dispersed cell population in the background were studied. Overall cellularity of the smears was recorded as low, moderate or marked. Air-dried and alcohol-fixed smears were made and stained with Giemsa and Papanicolaou stains respectively. In all cases, FNA was performed with a 23–25-gauge needle. Only those cases were included in the study where the histopathological follow-up of the case was available for use as the gold standard for further analysis and comparison. We retrospectively reviewed 24 cases of phyllodes tumor and 46 cases of fibroadenoma (70 cases) diagnosed at our center. Our study was done to evaluate the cytological features of phyllodes tumor with specific reference to certain cytological features that can help in differentiating it from fibroadenoma. However, the diagnosis of low-grade phyllodes tumor and its distinction from fibroadenoma on cytology is difficult due to overlapping features between the two lesions. The cytodiagnosis of a high-grade malignant phyllodes tumor is not difficult as established in studies. The preoperative diagnosis of PT is important for correct surgical planning to avoid a repeat surgery (at least 1 cm margin with wide local excision, has traditionally been the treatment of choice for phyllodes tumor). There has been a close molecular relationship between fibroadenoma and phyllodes tumor demonstrated by the MED12 mutations apart from the morphological resemblance (dimorphic pattern of epithelial and stromal components). Presence of well-developed stromal fronds or exaggerated intracanalicular pattern of growth along with increased stromal cellularity on histology favour phyllodes tumor. The distinction of phyllodes tumors from cellular/juvenile fibroadenomas is particularly challenging as the latter may show a cellular stroma. Phyllodes tumor resembles intracanalicular fibroadenoma at the benign end of the spectrum while malignant phyllodes tumor can be mistaken for primary breast sarcoma or sarcomatous carcinoma. PT can display locally destructive growth and even metastasize. They are characterized by a diverse range of biological behavior. Phyllodes tumors account for < 0.5% of all breast malignancies. Presence of large, opened out, folded epithelial sheets, frayed and irregular stromal contours with spindle nuclei, background spindle cells and atypia can help distinguish PT from FA.įibroepithelial lesions of the breast include fibroadenoma (FA) and phyllodes tumor (PT). Median epithelial: stromal ratio was 3.4 and 2.6 for FA and PT, respectively. The GEE regression model achieved 78.9% diagnostic accuracy ( p < 0.001) in identifying PT based on cytological features. Univariate analysis and regression models based on generalized estimating equations revealed that large opened out, folded epithelial sheets, frayed and irregular stromal fragment contours, spindle stromal cell nuclei, spindle cell nuclei in the background and background cell atypia are significant cytological predictors of PT. Median age and tumor size for FA and PT were 23.0 and 39.0 years, and 2.0 and 5.0 cm, respectively. ResultsĤ6 FA and 24 PT were specimens were reviewed. epithelial component, stromal component and background cellularity were assessed. MethodsĪ retrospective review was performed of patients who had histopathology follow up of FA or PT and on whom a pre-operative fine needle aspiration was performed. Our study was to determine the select cytologic features that can accurately distinguish FA from PT. Fibroadenomas are benign while phyllodes tumor range from benign, indolent neoplasms to malignant tumors capable of distant metastasis. Fibroepithelial lesions of the breast include fibroadenoma (FA) and phyllodes tumor (PT). ![]()
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