hi everyone welcome to this short tutorial from pathology made simple at ilo pathology this is the part 3 of breast pathology series which i am covering for the undergraduate students the medical students in this part let's learn about the stromal tumors of breast the benign stomal tumors of the breast which includes fibroadenoma and phyllous tumor this is what we'll be discussing in the next you know five to ten minutes we will talk about the stroma of the breast and then we will discuss the tumors of intra lobular and inter globular stroma so when i was discussing about the normal anatomy i think we did discuss about the two major structures two types of epithelial cells and the two types of stroma right and the stroma are the interlobular stroma and the intra lobular stroma so this was the illustration which i had showed right so the stroma which is present within the lobule is called as intra lobular stroma and the stroma in between the labels are called is called as inter globular stroma okay another illustration showing intra lobular stroma within the lobule in between two lobules you find inter globular stroma the tumors which arise from intra lobular stroma are the phyllods tumor and fibroadenoma okay they are also referred to as biphasic tumors that's because they also include a non-neoplastic epithelial component because you know you have a stroma and then this is epithelial component which is tightly intermingled right so the tumor do include a part of non-neoplastic epithelial component and that's the reason why they are referred to as biphasic tumors see the growth factors from the stromal cells they help in proliferation of these epithelial component in these tumors okay so the epithelial component grow by the growth factors which are released by the stromal cells in the intra-globular stroma most often majority of the cases there will be mutations in med12 gene the tumors which arise from the interlobular stroma are lipoma angiosarcoma myofibroblastoma and fibrous tumors the angel sarcoma being the malignant tumor so let's learn about these two tumors fibroadenoma and phyllous tumor fibroadenoma is the most common benign tumor of female breast it can occur at any age but most patients know they are young and in their reproductive age group two thirds of fibroadenoma patients do have harbor i mean they do have mutations in the mdm12 gene clinically fibroid enormous presence as solitary freely mobile lump in the breast and because of their high mobility they are also referred to as mouse in the breast or breast mouse they can be multiple and bilateral they are the hormone sensitive tumors which means they grow during pregnancy and the regress after menopause so grossly these are well circumscribed tumors often measuring around three to four centimeters rarely they grow beyond up to 10 centimeters in diameter the cut surface is very characteristic it bulges above the surrounding tissue and it is firm grayish white in color and glistening sometimes you do find slit like spaces so microscopically it contains a mixture of epithelial and stomal tissue that's why it's called fibroadenoma the stromal component is usually predominant that is made up of fibrous tissue i mean this is arising from the intralobular stroma whereas the epithelial component is composed of the ducts which are lined by regular double layered epithelium okay based on the growth of the fibrous component because fibrous component is predominant right so based on the growth of fibrous component the microscope is divided into two patterns one is intra canolicular pattern and two is pericannolic pattern intra i mean is actually a misnomer the fibrous pattern the fibrous growth do not grow inside the you know ducts it is called interactive molecular bitter because you know the proliferation of fibrous trauma is so much that it compresses the ducts into slit like spaces okay so that's why it's called as intra molecular pattern whereas perique molecular pattern the ducts retain their patency they are usually round and regular they're glandular which are not compressed and you find the connective tissue proliferation around these ducts okay so there are two patterns one is intracanalicular pattern another is pericanolicular pattern so what are the different types of fibroadenoma they are juvenile fibroadenoma this is a variant and usually seen in young and adolescent women with history of rapid growth in this case of these cases of fibroadenoma there is epithelial and stromal hyperplasia another one is a complex fibroadenoma which is a fibroderma with fibrocystic like changes which is what we studied in part one right fibrocystic like changes you find within the fibroadenoma with the presence of aboriginal and chains sclerosing adinosis and cyst formation why it is important to know this type of hybrid enormous these fibroid normals do have a slightly higher risk of subsequent malignancy another one is a giant fibroadenoma as the name says the tumor reaches massive size that's around 10 centimeter in diameter some of the authors classified this type as juvenile type of hybridinoma now can fibroadenomas turn malignant simple fibroneromas you know the regular fibroid normals do have a very slightly increased risk it's often it's almost negligible whereas the risk of subsequent malignancy is higher in complex fibroadenomas uh whenever you encounter a fibroadenoma in older women or fibromyalgia with a family history of breast cancers so you should be careful and because these are the individuals who might have no subsequent chances of developing into malignancies so the next tumor the next biphasic tumor or the stromal tumor which arises from the intralobular stroma is phyllous tumor it arises from intraoblastoma but it is less common as compared to fibroadenoma they are benign and malignant the benign ones majority of them have mdm2 mdm12 mutation just like the fibrodinomas whereas the malignant ones apart from the mdm12 mutation it also has additional mutations for example t e rt gene this is a gene which encodes telomerase so you can find additional mutations when the phylloud tumor is malignant and these tumors are variably sized some are very large tumors grossly the larger tumors have bulbous protrusions because of the presence of nodules of proliferating stroma and the proliferating stroma is covered by the epithelium and the protrusions can extend into a cystic like spacer cavity okay the characteristic feature is a world pattern with the cleft like spaces that resemble leaf birds and the name phyllods is derived from the greek you know which means leaf like on the cut surface and even a microscopy this pattern is seen that is leaf-like pattern malignant fillers on other hand very poorly circumscribed and locally invasive with infiltrative borders now microscopically the growth pattern typically shows exaggerated intra molecular growth pattern so we we learned about microscopy of fibronomia right that is an interactive molecular and pericunnicular pattern this fellowes tumor microscopy is an exaggerated intracanalicular growth pattern with leaf life projections into the dilated lumens let us understand this okay and these tumors have as compared to fibroadenomas these have higher in contrast to fibroadenomas these have higher cellularity of the stroma higher mitotic rate nuclear pleuomorphism the stromal overgrowth and infiltrative borders so i i have just placed you placed in front of you these two images right one is that of a fibroadenoma another is that of a lord's tumor so this is a classical intracanalicular type of fibrodynamia imagine see imagine a case of this particular lesion which has a massive stromal hyper growth it sort of develops into this histological pattern which means there is a hypercellular stroma with compression of these epithelial spaces this is epithelial component and what you see most of the places is the stomal component okay and how do you grade falloads tumor depending on the appearance of stomal component phyllous tumor are divided into low grade or benign fallout tumor and high grade which is also referred to as a malignant phyllous tumor where the stromal component is malignant so highly pleuomorphism you know mitotic activity and all those things you find in high grade phyllous tumor tumors in between low grade and borderline are referred to as borderline phyllox tumor now the prognosis philos tumor are likely to recur if they are not excised with wider margins generally mastectomy is the treatment of choice for affluence tumor if the blood tumor are larger so lymphatic spread in fellowes is uncommon high grade lesions you know they require they are the ones which frequently recur and they also develop hematogenous metastasis and remember whenever you have metastasis in these cases the metastatic deposits contain only the stromal component till now we studied tumors of intralobular stroma right now let us just quickly see what are the tumors of inter-globular stroma they can be classified as benign and malignant benign tumors include myofibroblastoma the lipomas and fibromatosis whereas the malignant the only important malignant stomal tumor of the breast is angiosarcoma that means this is a malignant tumor of blood vessels so that completes this part three of breast pathology series for undergraduates in this we learned about the stromal tumors particularly the tumors of intra lobular stoma the fibroid nominee fellowes tumor and just a list of tumors of interlobular trauma so thank you for watching hit the like button if you have liked this do comment if you have any questions do subscribe and don't forget to share if you find this video useful thank you