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Breast-nonmalignant

Benign tumors / changes

Pleomorphic adenoma of breast

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 8 October 2012, last major update April 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Tumor with benign epithelial and stromal components similar to counterpart elsewhere, but rare in breast

 

Terminology

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● Also called mixed tumor, chondroid syringoma (in skin)

 

Epidemiology

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● Rare in humans in breast (<100 cases reported, usually postmenopausal women)

 

Sites

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Etiology

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● May derive from a single cell with divergent differentiation and not really be “mixed”

 

Clinical features

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Prognostic factors

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Case reports

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● 55 year old woman (Pathol Res Pract 2005;201:333)

● 59 year old woman with 10 year history of breast mass (Archives 2003;127:474)

● 81 year old woman (Arch Pathol Lab Med 2003;127:e233)

● With two recurrences (Breast J 2007;13:418)

 

Treatment

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● Wide excision with clear margins to avoid recurrence (Hum Pathol 1991;22:1206)

● Excellent prognosis

 

Clinical images

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Gross description (Macroscopy)

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● Circumscribed, single or multiple yellow-white firm nodules, 1-4 cm

● Often subareolar

 

Gross images

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Micro description (Histopathology)

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● Similar to counterpart in salivary glands or skin (Am J Surg Pathol 1990;14:913)

● Fibrous pseudocapsule surrounds benign glandular epithelial and myoepithelial cells in chondromyxoid or osseous stroma

● Epithelial cells are arranged in tubules, islands, cords or sheets, are cuboidal or columnar with bland nuclear features and minimal mitotic figures

● Myoepithelial cells are polygonal or stellate with clear to eosinophilic cytoplasm and small nuclei

 

Micro images

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Fibrosis, dilated ducts and chondroid metaplasia

 

Virtual Slides

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Videos

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Cytology description

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Cytology images

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Fig 1/2: FNA shows hypercellular smears with cohesive fragments of proliferative epithelium with papillary architecture and background of myxoid stroma

Fig 3: Epithelial cells have scant fragile cytoplasm with round hyperchromatic nuclei and stromal cells in mucinous background

Fig 4: Tissue sections show encapsulated nodule in subcutis composed of chords and nests of tubuloglandular structures within myxohyaline stroma

 

Positive stains

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Epithelial cells:

● Keratin, CEA, EMA

● Variable vimentin

 

Myoepithelial cells:

● Vimentin, S100, keratin, muscle specific actin, calponin, p63

 

Negative stains

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Electron microscopy descriptions

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● Intermediate filaments with dense bodies and intercellular junctions

 

Electron microscopy images

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Molecular / cytogenetics description

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● May have similar rearrangements as salivary gland tumor of 8q12 (PLAG1 gene, Cancer Genet Cytogenet 2007;177:1), 12q15 (HMGI-C), and 6p21 (HMGI-Y) (Pathol Res Pract 2005;201:333)

 

Molecular / cytogenetics images

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Differential Diagnosis

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Fibroadenoma

Metaplastic carcinoma: malignant epithelial component present

Mucinous / colloid carcinoma

Intraductal papilloma with chondro-osseous differentiation

Ductal adenoma

Phyllodes tumor

 

Additional references

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Stanford University

 

End of Breast-nonmalignant > Benign tumors / changes > Pleomorphic adenoma

 

 

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