Juvenile Fibroadenoma

  • Is a fibroepithelial lesion with rapid growth in an adolescent:
    • The histologic features of:
      • Increased stromal cellularity with pericanalicular architecture:
        • Nodular stroma around non-compressed open duct-like structures)
      • So-called gynecomastoid hyperplasia:
        • Are characteristic of juvenile fibroadenomas
    • Gynecomastoid hyperplasia:
      • Refers to non-atypical epithelial proliferation with tufted architecture
  • Phyllodes tumors:
    • Comprise only about 5% of pediatric fibroepithelial neoplasms:
      • Can be difficult to distinguish from juvenile fibroadenomas
    • In the pediatric population:
      • Both juvenile fibroadenomas and phyllodes tumors:
        • May have increased stromal cellularity and rudimentary or focal leaf-like architecture
      • Tan et al:
        • Did not find that focal leaf-like architecture or stromal hypercellularity:
          • Correlated with recurrence in pediatric fibroepithelial lesions
      • Yet other studies suggested that:
        • Tumors with greater than two mitotic figures per 10 high power fields:
          • Have a greater recurrence rate
Histology section shows prominent pericanalicular growth pattern, mild stromal hypercellularity and epithelial proliferation, and a low mitotic rate, without leaf-like architecture.
  • Some have used the terms “juvenile” and “giant” fibroadenoma synonymously:
    • While others have used “giant”:
      • To describe particularly large fibroadenomas (> 5 cm)
  • References:
    • Tan PH, Tse G, Lee A, et al. Fibroepithelial tumours. In: Lakhani SR, Ellis IO, Schnit SJ, Tan PH, van de Vijver MJ,. eds. WHO Classification of Tumours of the Breast. Lyon: IARC Press, 2012:142-143.
    • Schnitt SJ, Collins L. Biopsy Interpretation of the Breast. 3rd edition. Philadelphia, PA: Wolters Kluwer, 2018: 180-193.
    • Tay TK, Chang KT, Thike AA, Tan PH. Paediatric fibroepithelial lesions revisited: pathological insights. J Clin Pathol. 2015;68(8):633-641.
    • Krings G, Bean GR, Chen YY. Fibroepithelial lesions; The WHO spectrum. Semin Diagn Pathol. 2017;34(5):438-452.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #JuvenileFibroadenomas #Fibroadenomas #Teacher #BreastCancer Miami #Mexico

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