Limits...
A diagnostic dilemma in breast pathology--benign fibroadenoma with multinucleated stromal giant cells.

Heneghan HM, Martin ST, Casey M, Tobbia I, Benani F, Barry KM - Diagn Pathol (2008)

Bottom Line: The presence of this unusual cell type in the stroma does not alter the prognosis of otherwise benign lesion.We encountered two such cases at our institution in a six month period recently.We present their histories along with relevant radiological, microscopic and immunohistochemical features, followed by a discussion of this unusual pathological entity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Mayo General Hospital, Ireland. helenheneghan@hotmail.com

ABSTRACT
Fibroadenomas are common benign breast tumours that display a characteristic pathological morphology, although several epithelial and stromal variations exist. A very rare histological finding is the presence of multinucleated giant cells throughout the stroma of a benign fibroadenoma. Cells of this type, which are more commonly found incidentally within the interlobular stroma of breast tissue, are benign and should not be mistaken for malignant cells on microscopic examination. Unfortunately a lack of awareness of this pathological entity can lead to diagnostic confusion amongst pathologists resulting in the multinucleate giant cells being mistaken for highly mitotic cells and consequently the fibroadenoma being mistaken for a malignant lesion. This may have serious implications for the subsequent management of the patient. The presence of this unusual cell type in the stroma does not alter the prognosis of otherwise benign lesion. We encountered two such cases at our institution in a six month period recently. We present their histories along with relevant radiological, microscopic and immunohistochemical features, followed by a discussion of this unusual pathological entity.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemical stains on core breast biopsy tissue. a. Case 1: Pancytokeratin. b. Case 1: SMA. c. Case 1: Vimentin (arrow marks multinucleated giant cells in stroma). d. Case 2: Pancytokeratin. e. Case 2: SMA. f. Case 2: Vimentin (arrow marks multinucleated giant cells in stroma).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2526983&req=5

Figure 3: Immunohistochemical stains on core breast biopsy tissue. a. Case 1: Pancytokeratin. b. Case 1: SMA. c. Case 1: Vimentin (arrow marks multinucleated giant cells in stroma). d. Case 2: Pancytokeratin. e. Case 2: SMA. f. Case 2: Vimentin (arrow marks multinucleated giant cells in stroma).

Mentions: A 42 year old female was referred to the Breast Clinic for assessment of a palpable right breast lump. She had detected the breast lump six weeks previously during routine self examination and did not complain of any mastalgia, nipple discharge, skin changes or systemic symptoms. She had no personal or family history of breast cancer and had never used the oral contraceptive pill (OCP) or hormone replacement therapy. Clinical examination revealed a non-tender, mobile 2 cm solid mass in the upper outer quadrant of the right breast. Mammography and Ultrasonography confirmed the presence of a 2 cm solid mass in the right upper quadrant (Figures 1a, 1b). Core biopsy demonstrated fibroadipose tissue with stromal calcification. Given the clinical and pathological findings the patient opted for surgical excision of the lesion. Gross examination of the specimen revealed a well circumscribed firm nodule measuring 2.5 × 2.0 cm. The cut surface was firm and tan-gray in colour, with a whorled appearance. Microscopically the tumour shows a benign epithelial component with elongated, branching ducts and cellular stroma. The stroma was composed of cells with giant nuclei some of which are multi-nucleated. Mitosis of these cells was not seen (Figures 2a, 2b, 2c). The stromal cells stained negative for the Estrogen and Progesterone receptors (ER, PR respectively) Pancytokeratin (AE1/3 & CAM 5.2), Muscle Specific Actin, S100 and desmin, and stained positive for Vimentin; a general mesenchymal marker and suggestive of cells of myofibroblastic origin (Figures 3a, 3b, 3c). The conclusive diagnosis was that of a fully excised benign fibroadenoma, with multinucleated giant cells throughout its stroma. She made an uneventful postoperative recovery and follow-up has shown no recurrence of the lesion.


A diagnostic dilemma in breast pathology--benign fibroadenoma with multinucleated stromal giant cells.

Heneghan HM, Martin ST, Casey M, Tobbia I, Benani F, Barry KM - Diagn Pathol (2008)

Immunohistochemical stains on core breast biopsy tissue. a. Case 1: Pancytokeratin. b. Case 1: SMA. c. Case 1: Vimentin (arrow marks multinucleated giant cells in stroma). d. Case 2: Pancytokeratin. e. Case 2: SMA. f. Case 2: Vimentin (arrow marks multinucleated giant cells in stroma).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2526983&req=5

Figure 3: Immunohistochemical stains on core breast biopsy tissue. a. Case 1: Pancytokeratin. b. Case 1: SMA. c. Case 1: Vimentin (arrow marks multinucleated giant cells in stroma). d. Case 2: Pancytokeratin. e. Case 2: SMA. f. Case 2: Vimentin (arrow marks multinucleated giant cells in stroma).
Mentions: A 42 year old female was referred to the Breast Clinic for assessment of a palpable right breast lump. She had detected the breast lump six weeks previously during routine self examination and did not complain of any mastalgia, nipple discharge, skin changes or systemic symptoms. She had no personal or family history of breast cancer and had never used the oral contraceptive pill (OCP) or hormone replacement therapy. Clinical examination revealed a non-tender, mobile 2 cm solid mass in the upper outer quadrant of the right breast. Mammography and Ultrasonography confirmed the presence of a 2 cm solid mass in the right upper quadrant (Figures 1a, 1b). Core biopsy demonstrated fibroadipose tissue with stromal calcification. Given the clinical and pathological findings the patient opted for surgical excision of the lesion. Gross examination of the specimen revealed a well circumscribed firm nodule measuring 2.5 × 2.0 cm. The cut surface was firm and tan-gray in colour, with a whorled appearance. Microscopically the tumour shows a benign epithelial component with elongated, branching ducts and cellular stroma. The stroma was composed of cells with giant nuclei some of which are multi-nucleated. Mitosis of these cells was not seen (Figures 2a, 2b, 2c). The stromal cells stained negative for the Estrogen and Progesterone receptors (ER, PR respectively) Pancytokeratin (AE1/3 & CAM 5.2), Muscle Specific Actin, S100 and desmin, and stained positive for Vimentin; a general mesenchymal marker and suggestive of cells of myofibroblastic origin (Figures 3a, 3b, 3c). The conclusive diagnosis was that of a fully excised benign fibroadenoma, with multinucleated giant cells throughout its stroma. She made an uneventful postoperative recovery and follow-up has shown no recurrence of the lesion.

Bottom Line: The presence of this unusual cell type in the stroma does not alter the prognosis of otherwise benign lesion.We encountered two such cases at our institution in a six month period recently.We present their histories along with relevant radiological, microscopic and immunohistochemical features, followed by a discussion of this unusual pathological entity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Mayo General Hospital, Ireland. helenheneghan@hotmail.com

ABSTRACT
Fibroadenomas are common benign breast tumours that display a characteristic pathological morphology, although several epithelial and stromal variations exist. A very rare histological finding is the presence of multinucleated giant cells throughout the stroma of a benign fibroadenoma. Cells of this type, which are more commonly found incidentally within the interlobular stroma of breast tissue, are benign and should not be mistaken for malignant cells on microscopic examination. Unfortunately a lack of awareness of this pathological entity can lead to diagnostic confusion amongst pathologists resulting in the multinucleate giant cells being mistaken for highly mitotic cells and consequently the fibroadenoma being mistaken for a malignant lesion. This may have serious implications for the subsequent management of the patient. The presence of this unusual cell type in the stroma does not alter the prognosis of otherwise benign lesion. We encountered two such cases at our institution in a six month period recently. We present their histories along with relevant radiological, microscopic and immunohistochemical features, followed by a discussion of this unusual pathological entity.

No MeSH data available.


Related in: MedlinePlus