Division of Pathology, Singapore General Hospital, Academia, Diagnostics Tower Level 7, 20 College Road, Singapore, 169856, Singapore.
Mod Pathol. 2021 Jan;34(Suppl 1):15-37. doi: 10.1038/s41379-020-0583-3. Epub 2020 May 27.
Fibroepithelial lesions of the breast, comprising the fibroadenoma and phyllodes tumour, are a unique group of neoplasms that share histological characteristics but possess different clinical behaviour. The fibroadenoma is the commonest benign breast tumour in women, while the phyllodes tumour is rare and may be associated with recurrences, grade progression and even metastasis. The diagnosis of fibroadenoma is usually straightforward, with recognised histological variants such as the cellular, complex, juvenile and myxoid forms. The phyllodes tumour comprises benign, borderline and malignant varieties, graded using a constellation of histological parameters based on stromal characteristics of hypercellularity, atypia, mitoses, overgrowth and the nature of tumour borders. While phyllodes tumour grade correlates with clinical behaviour, interobserver variability in assessing multiple parameters that are potentially of different biological weightage leads to significant challenges in accurate grade determination and consequently therapy. Differential diagnostic considerations along the spectrum of fibroepithelial tumours can be problematic in routine practice. Recent discoveries of the molecular underpinnings of these tumours may have diagnostic, prognostic and therapeutic implications.
乳腺纤维上皮性病变包括纤维腺瘤和叶状肿瘤，是一组具有独特组织学特征但具有不同临床行为的肿瘤。纤维腺瘤是女性最常见的良性乳腺肿瘤，而叶状肿瘤则较为罕见，可能与复发、分级进展甚至转移有关。纤维腺瘤的诊断通常较为直接，存在一些公认的组织学变异型，如细胞型、复杂型、幼年型和黏液样型。叶状肿瘤包括良性、交界性和恶性，根据基于基质特征的细胞密度、异型性、有丝分裂、过度生长和肿瘤边界性质的一系列组织学参数进行分级。虽然叶状肿瘤的分级与临床行为相关，但评估多个潜在生物学权重不同的参数的观察者间变异性导致准确分级和治疗的确定存在显著挑战。在纤维上皮性肿瘤的范围内进行鉴别诊断在常规实践中可能存在问题。这些肿瘤的分子基础的最新发现可能具有诊断、预后和治疗意义。
