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]