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Case 9 Clinical history This 24 year old female presented to the Breast Clinic with a large, rapidly growing mass in the right breast, causing distortion and thinning of the overlying skin. Clinically the lesion was felt to be suspicious of malignancy, possibly a sarcoma. Imaging was not performed. FNAC showed benign cells only - C2. The mass was excised. Histological appearances - A-C The section shows a large fibroepithelial lesion composed of deep epithelial clefts and stroma. The clefts have a normal bilaminar structure whilst the stroma is of relatively low cellularity with focal sclerosis. Differential diagnosis Juvenile fibroadenoma Hamartoma Phyllodes tumour The overall pattern is that of a fibroadenoma with an intracanalicular pattern, but the presence of deep clefts with a leaf-like pattern raises the possibility of phyllodes tumour. However, the latter diagnosis is ruled out by the lack of a cellular stroma and the regularity of the stromal nuclei. Hamartoma can also be excluded because of the lack of ducto-lobular structures. Final diagnosis Juvenile fibroadenoma |