complex fibroadenoma pathology outlines

The complex fibroadenoma comprises 14.1-40.4% of . Fibroadenoma. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). J Natl Cancer Inst. Ann Surg Oncol. 2022 Apr 3;23(7):3989. doi: 10.3390/ijms23073989. 1.5 - 2 times increased risk. 1999 Aug;16(3):235-47. Well circumscribed tumor with bulging cut surface, Fibroadenoma with atypical ductal hyperplasia, Sign up for our What's New in Pathology e-newsletter, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). Sclerosing adenosis and risk of breast cancer. The sections show a lesion with a pale mildly cellular stroma, and bland glandular elements. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). ; Chen, YY. Bookshelf National Library of Medicine LM DDx. Cardeosa G. Clinical breast imaging, a patient focused teaching file. Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer WD Jr, Rados MS, Schuyler PA. N Engl J Med. However, we cannot answer medical or research questions or give advice. Semin Diagn Pathol. Epub 2021 Sep 10. Risk appears to be slightly higher in those patients with a positive family history of breast cancer. This patient had atypical lobular hyperplasia at core needle biopsy. There are numerous reports that the general risk of developing cancer in the breast parenchyma is elevated among women with complex fibroadenomas; these women are 3.1-3.7 times more likely to develop breast cancer than women in the general population (compared with a relative risk of 1.9 times in women with non-complex fibroadenomas). Long-term risk of breast cancer in women with fibroadenoma. 2020 Dec;53(3):439-441. doi: 10.1055/s-0040-1716187. Maiorano, E.; Albrizio, M. (Dec 1995). Contributed by Gary Tozbikian, M.D. There are no clear cut mammographic or sonographic features that distinguish complex from simple fibroadenomas. .style2 {font-family: Arial, Helvetica, sans-serif} 2021 Jan 10;13(1):e12611. Epub 2020 Aug 26. da Silva EM, Beca F, Sebastiao APM, Murray MP, Silveira C, Da Cruz Paula A, Pareja F, Wen HY, D'Alfonso TM, Edelweiss M, Weigelt B, Brogi E, Reis-Filho JS, Zhang H. J Clin Pathol. The study included women aged 18-85 years from the Mayo Clinic Benign Breast Disease Cohort who underwent excisional breast biopsy from 1967 through 1991. FOIA 2001 May;115(5):736-42. (a) In a 42 year old woman with a right axillary palpable lump, the mammogram shows a well-defined, gently lobulated, oval nodule in the right axilla (white arrow).Accessory breast tissue is also seen (red arrow). The purpose of this study is to examine the breast cancer risk overall among women with simple fibroadenoma or complex fibroadenoma and to examine the association of complex fibroadenoma with breast cancer through stratification of other breast cancer risks. Value of scoring system in classification of proliferative breast disease on fine needle aspiration cytology. Before official website and that any information you provide is encrypted Int J Environ Res Public Health. Chapter 5 looks at special problems in breast cancer including bilateral breast cancer, cancer of the male breast, the unknown primary presenting with axillary lymphadenopathy, Paget's disease of the nipple-areola complex and phyllodes tumour of the breast. Age-related lobular involution and risk of breast cancer. Dehner LP, Hill DA, Deschryver K. Pathology of the breast in children, adolescents, and young adults. We evaluated the clinical and imaging presentations of complex fibroadenomas; compared pathology at core and excisional biopsy; and contrasted age, pathology, and size of complex and simple fibroadenomas using the Student's t test. Excision of breast fibroepithelial lesions: when is it still necessary?-A 10-year review of a regional centre. Cancer. This page was last edited on 5 January 2021, at 19:25. Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of epithelial (ductal) cells along with myoepithelial components, having a malignant potentiality. Complex fibroadenomas are often smaller than simple fibroadenomas (1.3 cm compared with 2.5 cm in simple fibroadenomas). //--> No leaf-like architecture is present. Background: To determine the cytomorphological features of complex type fibroadenoma (CFA), we reviewed fine needle aspiration (FNA) cytology with correlation to its histopathology findings, and compared them with non-complex type fibroadenoma (NCFA). 3 Giant (juvenile or cellular) fibroadenoma is a . Essentials in Bone and Soft-Tissue Pathology - Jasvir S. Khurana 2010-03-10 Essentials in Bone and Soft-Tissue Pathology is a concise and well-illustrated handbook that captures the salient points of the most common problems in bone and soft-tissue . Molecular pathology. Only one malignancy, an invasive lobular carcinoma, was found in 63 complex fibroadenomas (1.6%). hall county inmate list FOIA 8600 Rockville Pike Would you like email updates of new search results? juvenile, complex, myxoid, cellular, tubular adenoma of the breast. Breast Cancer Res Treat. A benign gland has two cell layers - myoepithelial and epithelial. Breast, right, 2:00 zone 2, ultrasound guided core biopsy: Well developed leaf-like architecture, with accompanied increased stromal cellularity, Prominent mitotic activity 3/10 high power fields or the finding of 3 or more characteristic histologic features (stromal overgrowth, fat infiltration, stromal fragmentation, subepithelial stromal condensation, Indian J Plast Surg. May be either adult or juvenile type. Robert V Rouse MD rouse@stanford.edu. {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, Rock P, Bell D, et al. 2. The purpose of this study is to examine the breast cancer risk overall among women with simple fibroadenoma or complex fibroadenoma and to examine the association of complex fibroadenoma with breast cancer through stratification of other breast cancer risks. Fibroadenoma - slit-like spaces (webpathology.com), Fibroadenoma - lobulated appearance (webpathology.com), Tubular adenoma of the breast (webpathology.com), http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970216-9, http://www.imagingpathways.health.wa.gov.au/includes/dipmenu/image/image.html, http://www.breastpathology.info/fibro_variants.html#juvenile, http://www.breastpathology.info/fibro_variants.html#complex, https://librepathology.org/w/index.php?title=Fibroadenoma&oldid=51069, Attribution-NonCommercial-ShareAlike 4.0 International, abundant (intralobular) stroma usu. 2004 Feb;21(1):48-56. Mousa-Doust D, Dingee CK, Chen L, Bazzarelli A, Kuusk U, Pao JS, Warburton R, McKevitt EC. This website is intended for pathologists and laboratory personnel but not for patients. Visual survey of surgical pathology with 11,912 high-quality images of benign and malignant neoplasms & related entities. The study included women aged 18-85 years from the Mayo Clinic Benign Breast Disease . Most common benign tumor of the female breast. Carcinoma Breast-Like Giant Complex Fibroadenoma: A Clinical Masquerade. Unable to load your collection due to an error, Unable to load your delegates due to an error. Biphasic lesions of the breast. and Debra Zynger, M.D. incidental finding on histologic examination), Amorphous or pleomorphic clustered microcalcifications; architectural distortion or circumscribed to spiculated mass on mammogram (, Associated with increased mammographic breast density (, Heterogeneous echogenicity, irregular and ill defined mass, focal acoustic shadowing may be seen on ultrasound (, Small (< 1 cm) mass with benign kinetics on MRI (, As a single feature, increased risk of cancer of 1.5 - 2x, as seen with proliferative, 2x higher risk of breast cancer with increased, Does not provide further risk stratification in the presence of other proliferative disease / atypical hyperplasias (, Can mimic malignancy clinically and radiologically, 46 year old woman with sclerosing adenosis with mammogram and cytology mimicking malignancy (, 73 year old woman with sclerosing adenosis and coexisting ductal carcinoma in situ (, 82 year old woman with sclerosing adenosis in sentinel axillary lymph nodes (, Presence of sclerosing adenosis alone in a core biopsy does not require surgical excision, Coexisting atypia will typically prompt surgical consultation, Variable depending on extent of involvement and calcifications, May be indistinguishable from surrounding breast tissue, Multinodular, ill defined, cuts with increased resistance due to fibrosis, Gritty due to frequent calcifications but no chalky yellow white foci or streaks as seen in, Circumscribed to ill defined white, fibrotic mass if nodular adenosis / adenosis tumor, Low power: increase in glandular elements plus stromal fibrosis / sclerosis that distorts and compresses glands, Maintains lobular architecture at low power with rounded and well defined nodules, Centrally is more cellular with distorted and compressed ductules; peripherally has more open or dilated ductules, Often has microcalcifications, due to calcification of entrapped secretions, Preservation of luminal epithelium and peripheral myoepithelium (2 cell layer) with surrounding basement membrane, Myoepithelial cells may vary from being prominent to indistinct on routine H&E staining, Myoepithelial cells are readily apparent via immunohistochemistry, even if difficult to identify on H&E, Rarely penetrates walls of blood vessels or perineural spaces, Epithelium may be involved by proliferative, atypical lesions or in situ carcinoma, If involved by atypia or in situ carcinoma, If florid and overtly non-lobulocentric / (pseudo) infiltrative into fat or stroma, Conspicuous myoepithelial cells with attenuated epithelial cells can appear like stands of single cells and mimic invasive lobular carcinoma, Atypical apocrine metaplasia: nuclear atypia / rare mitosis (, Moderate to markedly cellular, with small to large groups of benign epithelial cells in acinar sheets / cohesive groups / tubules and scattered individual epithelial cells, Also small foci of dense hyalinized stroma (, Tubules may have an angular configuration (, Fibrocystic changes including sclerosing adenosis with microcalcifications, Haphazardly distributed glands (lacks lobulocentric pattern), Lacks myoepithelium but has intact basement membrane, Nodular growth may mimic nodular adenosis / adenosis tumor, Uniform, closely packed tubules (lacks significant distortion by fibrosis), May be difficult to morphologically distinguish from florid sclerosing adenosis with marked distortion and/or involvement by atypia or, More widely spaced tubules with single epithelial layer. Most present in adults between menarche and menopause. government site. 2006 Oct;17(5):233-8. doi: 10.1111/j.1365-2303.2006.00333.x. Contributed by Andrey Bychkov, M.D., Ph.D. Fibroadenomatoid changes (sclerosing lobular hyperplasia, fibroadenomatoid mastopathy), Benign biphasic tumor composed of a proliferation of both glandular epithelial and stromal components of the terminal duct lobular unit, Most common breast tumor in adolescent and young women, Benign biphasic tumor comprised of glandular epithelium and specialized interlobular stroma of the terminal ductal lobular unit (, Can show a spectrum of histologic appearances; generally uniform in stromal cellularity and distribution of glandular and stromal elements within a given lesion (an important distinction from phyllodes tumor), Fibroadenomas with hypercellular stroma and prominent intracanalicular pattern can show morphologic overlap with benign phyllodes tumors, especially in needle biopsy specimens, Fibroadenoma, usual type fibroadenoma, adult type fibroadenoma, Most common benign tumor of the female breast, Can occur at any age, median age of 25 years (, Juvenile fibroadenoma generally occurs in younger and adolescent patients < 20 years; reported in children at a very young age (, Complex fibroadenoma reported in older patients with median age between 35 - 47 years (, Increased relative risk (1.5 - 2.0) of subsequent breast cancer; relative risk is higher (3.1) in complex fibroadenomas; no increased risk for juvenile fibroadenoma (, Can occur in axilla accessory breast tissue, Increased risk associated with cyclosporine immunosuppression (, Often presents as painless, firm, mobile, slow growing mass, Usually solitary, can be multiple and bilateral, Usually less than 3 cm in diameter but may grow to large size (, Histologic examination of involved tissue, Sonographically seen usually as a round or oval mass, smooth margins with hypo or isoechoic features (, Can be associated with calcifications, especially in postmenopausal patients, 16 year old girl with 28 cm left breast mass (, 17 year old girl with recurrent juvenile fibroadenoma (, 18 year old woman with mass in axilla accessory breast tissue (, 35 year old woman with left breast mass (, 37 year old woman with increased uptake of breast mass on PET scan (, 44 year old woman with bilateral breast masses (, Management depends on patient risk factors and patient preference, Conservative management with close clinical followup, especially if concordant radiology findings (, Local surgical excision, especially if symptomatic (, If atypia / neoplasia is found within a fibroadenoma, the surgical and systemic therapeutic management is specific and appropriate to the primary atypical / neoplastic lesion, Firm, well circumscribed, ovoid mass with bosselated surface, lobulations bulge above the cut surface, slit-like spaces, May have mucoid or fibrotic appearance; can be calcified, Biphasic tumor, proliferation of both glandular and stromal elements, 2 recognized growth patterns (of no clinical significance, both patterns may occur within a single lesion), Intracanalicular: glands are compressed into linear branching structures by proliferating stroma, Pericanalicular: glands retain open lumens but are separated by expanded stroma, Glandular elements have intact myoepithelial cell layer, Often associated with usual type ductal hyperplasia, apocrine metaplasia, cyst formation or squamous metaplasia, Rare mitotic activity can be observed in the glandular component, has no clinical significance, Generally uniform cellularity within a given lesion, Collagen and bland spindle shaped stromal cells with ovoid or elongated nuclei, Usually no mitotic activity; rare mitotic activity may be present in young or pregnant patients (, Stroma may show myxoid change or hyalinization, Rarely benign heterologous stromal elements (adipose, smooth muscle, osteochondroid metaplasia), Fibroadenomas may be involved by mammary neoplasia (e.g. Contain proliferative epithelium which outside and inside a fibroadenoma is associated with an increased risk of malignancy. "Radiologic evaluation of breast disorders related to pregnancy and lactation.". 2001 May;115(5):736-42. doi: 10.1309/F523-FMJV-W886-3J38. Glandular elements have at least two cell layers - epithelial and myoepithelial. emailE=('rouse' + '@' + 'stan' + 'ford.edu') One definition of "cellular" is: "stromal cells are touching one another". SIR for noncomplex fibroadenoma was 1.49 (95% CI 1.26-1.74); for complex fibroadenoma, it was 2.27 (95% CI 1.63-3.10) (test for heterogeneity in SIR, P = .02). N Engl J Med. Can occur at any age, median age of 25 years ( J R Coll Surg Edinb 1988;33:16 ) Juvenile fibroadenoma generally occurs in younger and adolescent patients < 20 years; reported in children at a very young age ( Am J Surg Pathol . "Fibroepithelial lesions with cellular stroma on breast core needle biopsy: are there predictors of outcome on surgical excision?". May be either adult or juvenile type. "Tubular adenoma of the breast: an immunohistochemical study of ten cases.". and transmitted securely. Clipboard, Search History, and several other advanced features are temporarily unavailable. Become a Gold Supporter and see no third-party ads. Careers. 1996 Nov;29(5):411-9. . Complex fibroadenomas may increase the risk of breast cancer. The border is well-circumscribed where seen. No calcifications are evident. Pane K, Quintavalle C, Nuzzo S, Ingenito F, Roscigno G, Affinito A, Scognamiglio I, Pattanayak B, Gallo E, Accardo A, Thomas G, Minic Z, Berezovski MV, Franzese M, Condorelli G. Int J Mol Sci. Stanton SE, Gad E, Ramos E, Corulli L, Annis J, Childs J, Katayama H, Hanash S, Marks J, Disis ML. pathology researchers that rely upon this methodology to perform tissue analysis in research. Semin Diagn Pathol. (Sep 2005). Oncoplastic Approach to Giant Benign Breast Tumors Presenting as Unilateral Macromastia. This site needs JavaScript to work properly. Incidence and management of complex fibroadenomas. ; Clotet, M.; Torrubia, S.; Gomez, A.; Guerrero, R.; de las Heras, P.; Lerma, E. (Oct 2007). This site needs JavaScript to work properly. May be hyalinized (dark pink) if infarcted. Stroma is generally more sparse than in conventional fibroadenoma. (b) Ultrasound shows a well-defined oval nodule in the right axilla which was confirmed to be a fibroadenoma on core biopsy. Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K, Vierkant RA, Maloney SD, Pankratz VS, Hillman DW, Suman VJ, Johnson J, Blake C, Tlsty T, Vachon CM, Melton LJ 3rd, Visscher DW. abundant (intralobular) stroma usu. Grossly, the fibroadenomas are small, well-demarcated, . Epub 2021 Jul 12 doi: 10.1371/journal.pone.0253764. Fibroadenomas may demonstrate estrogen and progesterone sensitivity and may grow during pregnancy. Results: Fibroadenoma was identified in 2136 women [noncomplex, 1835 (85.9%); complex, 301 (14.1%)]. . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). More frequent in young and black patients. 2014 Feb;144(1):205-12. doi: 10.1007/s10549-014-2862-5. font-weight: bold; We consider the term merely descriptive. This website is intended for pathologists and laboratory personnel but not for patients. Pseudoangiomatous stromal hyperplasia [TI] free full text[sb], WHO Classification of Tumours Editorial Board: Breast Tumours (Medicine), 5th Edition, 2019, Schnitt: Biopsy Interpretation of the Breast (Biopsy Interpretation Series), 3rd Edition, 2017, Stanford University: Pseudoangiomatous Stromal Hyperplasia [Accessed 5 March 2020], Benign myofibroblastic proliferation simulating a vascular lesion, Usually an incidental finding but may produce palpable or mammographic mass, Complex interanastomosing spaces in dense collagenous, keloid-like stroma, Some of these spaces have spindle shaped myofibroblasts at their margins that simulate endothelial cells, Spindle cells are positive for ER, PR and CD34 but negative for other vascular markers, e.g. 1994 Sep;118(9):912-6. Systematic review of fibroadenoma as a risk factor for breast cancer. . doi: 10.7759/cureus.12611. Radiology of fibroadenoma. More frequent in young and black patients. Giant fibroadenoma. Patients with complex lesions were 18.5 years older (median age, 47 years; range, 21-69 years) than patients with noncomplex fibroadenomas (median age, 28.5 years; range, 12-86 years) (p < 0.001). Usual ductal hyperplasia is associated with a slight increase in risk (1.5 - 2 times) for subsequent breast cancer. No leaf-like architecture is present. 2006 Jul;49(3):334-40. government site. Although no significant difference was noted in patients' age and tumor size between CFA and NCFA, 5 CFA cases (33.3 %) were accompanied by the presence of carcinoma in the same breast or the contralateral breast while no NCFA cases had carcinoma in the breast. HHS Vulnerability Disclosure, Help Conclusion: Approximately 16% of fibroadenomas are complex. An official website of the United States government. official website and that any information you provide is encrypted The .gov means its official. Please enable it to take advantage of the complete set of features! Breast Cancer Res Treat. Epub 2020 Dec 29. O'Malley, Frances P.; Pinder, Sarah E. (2006). Complex fibroadenoma is a sub type of fibroadenomaharboring one or more of the following features: Complex fibroadenomas tend to occur in older patients (median age, 47 years) compared with simple fibroadenomas (median age, 28.5 years). Robert V Rouse MD rouse@stanford.edu. The https:// ensures that you are connecting to the Focally, the lesion approaches the inked margin; partial lesion transection cannot be excluded. The .gov means its official. It increases in size during pregnancy and tends to regress with age. Epub 2014 Feb 8. Findings can confirm benign nature of disease but are nonspecific, resembling fibroadenoma or phyllodes tumor (Indian J Pathol Microbiol 2005;48:260) Finding plump spindled mesenchymal cells is suggestive (Diagn Cytopathol 2005;32:345) IHC can aid in visualizing the myoepithelial layer. The border is well-circumscribed where seen. Unable to process the form. HHS Vulnerability Disclosure, Help 2008;190 (1): 214-8. Complex fibroadenoma with sclerosing adenosis (crowded, Complex fibroadenoma with sclerosing adenosis (crowded glands in a fibrotic stroma) (hematoxylin-eosin; original magnification, MeSH In this review, the pathology of the fibroadenoma and phyllodes tumour is revisited, with emphasis on diagnostic and management implications. The immunostains used in breast pathology for the . Disclaimer. In particular, these mutations are restricted to the stromal component. Webpathology.com: A Collection of Surgical Pathology Images . } Arch Pathol Lab Med. FNA smears from CFA cases showed discohesiveness, enlarged nuclei, prominent nucleoli, and fewer myoepithelial cells more often than NCFA. Analyses were performed overall, within subgroups of involution status, with other demographic characteristics (age, year of biopsy, indication for biopsy, and family history), and with histologic characteristics, including overall impression [nonproliferative disease, proliferative disease without atypia (PDWA), or atypical hyperplasia]. Left breast, at 5 o'clock and 4 cm from the nipple, ultrasound core needle biopsy: Breast tissue with pseudoangiomatous stromal hyperplasia, Hemorrhagic, soft, interanastomosing vascular channels containing red blood cells with invasion into breast parenchyma, Papillary endothelial growth and hyperchromatic endothelial cells, Neoplastic clonal tumors with characteristic genetic change (del 13q14) (this can be demonstrated by loss of Rb protein immunohistochemistry in myofibroblastoma), Solid mass of spindle cells which surrounds and involves ducts and lobules, Tumor cells arranged in long fascicles without significant clefting, nuclear, CD34-, CD31-, nuclear beta catenin+, AE1 / AE3+. Am J Clin Pathol. white/pale +/-hyalinization, typically paucicellular, compression of glandular elements with perserved myoepithelial cells. .style1 { Jacobs. We further re-assessed detailed characteristics of each FNA smears to identify cytomorphological features of CFA. Unauthorized use of these marks is strictly prohibited. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). 2015 May 15;121(10):1548-55. doi: 10.1002/cncr.29243. Complex fibroadenomas were diagnosed in 63 of 401 fibroadenomas (15.7%) found at consecutive percutaneous needle or excisional surgical biopsy. Results: Pathology. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. No cytologic atypia is present. Up to 66% of fibroadenomas harbor mutations in the exon (exon 2) of the mediator complex subunit 12 (MED12) gene. Grossly, the typical fibroadenoma is a sharply demarcated . Giant fibroadenoma. Epidemiology. 2005 Jul 21;353(3):229-37. doi: 10.1056/NEJMoa044383. Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Cureus. Aust N Z J Surg. Stanford University School of Medicine. ; Holden, JA. National Library of Medicine Fibroadenoma is the most common benign tumor of the female breast. Materials and methods: Adipocytokines and Insulin Resistance: Their Role as Benign Breast Disease and Breast Cancer Risk Factors in a High-Prevalence Overweight-Obesity Group of Women over 40 Years Old. Kuijper A, Mommers EC, van der Wall E, van Diest PJ. Women with complex fibroadenomas may therefore be managed with a conservative approach, similar to the approach now recommended for women with simple fibroadenomas. BCDnet: Parallel heterogeneous eight-class classification model of breast pathology. Clipboard, Search History, and several other advanced features are temporarily unavailable. CD31, Also called pseudoangiomatous hyperplasia of mammary stroma, PASH is an incidental microscopic finding in up to 23% of breast surgical resections (, Almost always women who are premenopausal, Myofibroblastic origin, postulated role of hormonal factors (, Usually asymptomatic and an incidental finding but may be detected by imaging (, Histologic examination of resected tissue, May produce a mammographically detected mass, Nonneoplastic but mass forming lesion may rarely recur, especially in younger patients, 11 year old girl with bilateral nodular lesions (, 12 year old girl with pseudoangiomatous stromal hyperplasia (, 30 year old woman with pseudoangiomatous stromal hyperplasia of the breast with foci of morphologic malignancy (, 37 year old woman with giant nodular pseudoangiomatous stromal hyperplasia of the breast presenting as a rapidly growing tumor (, 46 year old woman with bilateral marked breast enlargement (, 67 year old man with pseudoangiomatous stromal hyperplasia of breast (, Local excision needed only in symptomatic mass forming lesions, If diagnosed on core needle biopsy, no surgical excision required, provided the diagnosis is concordant with radiologic findings (, Usually unilateral, well circumscribed, smooth nodule, Cut surface is firm, gray-white, lacks the characteristic slit-like spaces of fibroadenoma, Spaces are usually empty but may contain rare erythrocytes, Cellular areas or plump spindle cells may obscure pseudoangiomatous structure, No mitotic figures, no necrosis, no atypia, Fascicular PASH: cellular variant, in which myofibroblasts aggregate into fascicles with reduced or absent clefting, resembles myofibroblastoma, Moderately cellular with cohesive clusters of bland ductal cells (occasionally with staghorn pattern), single naked nuclei, some spindle cells with moderate cytoplasm and fine chromatin, Occasional loose hypocellular stromal tissue fragments containing spindle cells and paired elongated nuclei in fibrillary matrix (, Findings can confirm benign nature of disease but are nonspecific, resembling fibroadenoma or phyllodes tumor (, Finding plump spindled mesenchymal cells is suggestive (, Spaces are not true vascular channels but due to disruption and separation of stromal collagen fibers.

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