Bajrovic, Jasmina

Ibisevic, Nermina

Saranovic, Ena

Skenderi, Faruk

Spiritovic, Dijana

Vranic, Semir

Acta Medica Academica

Qatar University Institutional Repository

218Copyright © 2021 by the Academy of Sciences and Arts of Bosnia and Herzegovina.Images in Clinical MedicineActa Medica Academica 2021;50(1):218-220DOI: 10.5644/ama2006-124.337A Giant, Complex Fibroepithelial Tumor of the Breast: Borderline Phyllodes Tumor Combined with Tubular Adenoma − a Rare Clinical Presentation of a Fibroepithelial Tumor of the BreastNermina Ibisevic1, Jasmina Bajrovic2, Ena Saranovic1, Dijana Spiritovic1, Faruk Skenderi1, Semir Vranic3, 4, a1Department of Pathology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina, 2Department of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina, 3College of Medicine, QU Health, Qatar University, Doha, Qatar, 4Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, QatarCorrespondence: semir.vranic@gmail.com or svranic@qu.edu.qa; Tel.: + 974 4403 7873; Fax.: + 974 4403 2250 Received: 5 February 2021; Accepted: 12 February 2021Key Words: Breast  Fibroepithelial Tumors  Phyllodes Tumor  Tubular Adenoma.A 65-year-old woman with a negative family histo-ry of breast cancer presented with a palpable mass in the left breast’s central portion. Mammography revealed an oval heteroechogenic, partly solid, partly cystic, sharply demarcated mass, measur-ing 100×90 mm in greatest diameter, classified as BI-RADS 4c, according to ACR BI-RADS Atlas Fifth Edition (Figure 1A-B). Breast MRI showed a lobulated mass with smooth margins appearing hypointense on T1WI and high signal intensity on T2WI (Figure 1C-D). A core needle biopsy revealed a cellular neoplasm, composed of small, closely packed tubules with spindle cell interven-ing stroma without prominent atypia and mitotic activity, classified as B3 category according to the UK National Coordinating Committee for Breast Screening Pathology (Figure 2A). The multidis-ciplinary tumor board discussed the case and recommended a wide surgical excision. With the patient’s approval, a left mastectomy was recom-mended and performed. The axillary clearance was not performed. The 100×90 mm tumor was grossly well-circumscribed, grayish-white, and predominantly solid, with a smaller cystic com-ponent, without necrosis and hemorrhage (Fig-ure 2B). Histopathologic examination revealed a well-circumscribed tumor with two distinct com-ponents (tubular adenoma and phyllodes tumor) with the transition to one another (Figure 2C). The larger portion of the tumor was composed of closely packed small round to oval tubules with lit-tle intervening spindle cell stroma consistent with tubular adenoma. The smaller component showed a biphasic fibroepithelial tumor with leaf-like pro-jections with moderately cellular stroma (Figure 2D-E). The stromal cells exhibited mild to moder-ate atypia, and their mitotic activity was up to six mitoses/10 hpf (Figure 2F). Stromal overgrowth was absent, while the malignant heterologous el-ements were not observed despite the exhaustive tumor sampling (25 paraffin blocks). The final diagnosis was a complex fibroepithelial tumor composed of borderline phyllodes and tubular ad-enoma. Clinical ScienceaORCID: http://orcid.org/0000-0001-9743-7265219Nermina Ibisevic et al: Tubular Adenoma and Borderline Phyllodes TumorFigure 1A-D. Mammograms on the standard view (MLO and CC) revealed a round, dense mass partially surrounded by a clear halo, without any calcifications (A-B); Axial T1W1 MRI scans revealed a hypointense mass with some hyperintense foci of hemorrhage (C); Sagittal post-gadolinium subtraction image also showed intense enhancement (D).220Acta Medica Academica 2021;50(1):218-220Ethical ApprovalThe local institutional review board has the policy not to review the case studies. All the procedures reported in the current manuscript were performed according to the Declaration of Helsinki.Conflict of Interest: The authors declare that they have no conflict of interest.Figure 2A-F. A core biopsy specimen revealed predominantly tubular adenoma component with some spindle cell inter-vening stroma (Hematoxylin and Eosin, 10×) (A); A gross specimen revealed a large, (10×9 cm), well-demarcated solid mass without hemorrhage and necrosis (B); Microscopic examination revealed two distinct fibroepithelial tumors: tubular adenoma and phyllodes tumor with the abrupt transition one to another (Hematoxylin and Eosin, 10×) (C); Leaf-like pro-jections, a hallmark of phyllodes tumor of the breast, were easily identified in the phyllodes part of the mass (Hematoxylin and Eosin, 10×) (D); The stromal component exhibited moderate cellularity without stromal overgrowth (Hematoxylin and Eosin, 10×) (E); The stromal cells showed moderate atypia with up to six mitotic figures/10 hpf (Hematoxylin and Eosin, 20×) (F).

A Giant, Complex Fibroepithelial Tumor of the Breast: Borderline Phyllodes Tumor Combined with Tubular Adenoma - a Rare Clinical Presentation of a Fibroepithelial Tumor of the Breast

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A Giant, Complex Fibroepithelial Tumor of the Breast: Borderline Phyllodes Tumor Combined with Tubular Adenoma - a Rare Clinical Presentation of a Fibroepithelial Tumor of the Breast

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