Definition/General
Introduction:
Multiple fibroadenomas is a condition where three to five or more fibroadenomas are present in a single breast
It is a benign condition.
Origin:
They arise from the terminal duct-lobular unit (TDLU).
Classification:
It is a clinical finding rather than a specific pathological subtype.
Epidemiology:
It is seen in 10-20% of patients with fibroadenomas
It is more common in younger women.
Clinical Features
Presentation:
Presents as multiple, painless, firm, mobile, well-circumscribed masses in one or both breasts.
Symptoms:
Multiple painless, mobile lumps are the most common symptom.
Risk Factors:
Hormonally responsive.
Screening:
On mammography and ultrasound, they appear as multiple, well-circumscribed masses.
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Gross Description
Appearance:
Multiple, well-circumscribed, encapsulated, firm, gray-white masses.
Characteristics:
The cut surface is whorled.
Size Location:
Size is variable.
Multifocality:
Defined by its multiplicity.
Microscopic Description
Histological Features:
The histology is identical to that of a conventional fibroadenoma.
Cellular Characteristics:
The epithelial and stromal cells are benign.
Architectural Patterns:
Can be intracanalicular, pericanalicular, or mixed.
Grading Criteria:
This is a benign lesion.
Immunohistochemistry
Positive Markers:
The IHC profile is similar to that of a conventional fibroadenoma.
Negative Markers:
Not typically required for diagnosis.
Diagnostic Utility:
IHC is not usually necessary for diagnosis.
Molecular Subtypes:
Molecular subtyping is not relevant for this benign condition.
Molecular/Genetic
Genetic Mutations:
Recurrent mutations in the MED12 gene are common.
Molecular Markers:
No specific molecular markers are routinely used for diagnosis.
Prognostic Significance:
Multiple fibroadenomas are not associated with a significantly increased risk of breast cancer, unless they are complex.
Therapeutic Targets:
Treatment is usually conservative (observation)
Excision may be performed for large or symptomatic lesions.
Differential Diagnosis
Similar Entities:
Multiple cysts
Metastases.
Distinguishing Features:
Cysts are fluid-filled on ultrasound
Metastases are typically more irregular and have a different clinical history.
Diagnostic Challenges:
The main challenge is to ensure that all the lesions are benign fibroadenomas.
Rare Variants:
There are no specific rare variants.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Final Diagnosis
Final diagnosis: [complete diagnosis]