ABSTRACT
Objective:
To investigate the pathological features and the clinicopathological significance of TERT
detection in those
tumors that were difficult to
diagnosis.
Methods:
A total of 93 cases of fibroepithelial
tumors without definite
diagnosis were collected from the Affiliated
Hospital of Qigndao
University between 2013 and 2021. The clinical details such as
patients' age and
tumor size were collected. All slides were re-reviewed and the pathologic
parameters, including stromal cellularity,
stromal cell atypia,
stromal cell mitoses, and stromal overgrowth were re-interpreted. Sanger sequencing was used to detect TERT promoter status, and
immunohistochemistry was performed to detect TERT
protein expression. The relationship between TERT promoter
mutation as well as
protein expression levels and the clinicopathological
parameters were also analyzed.
Results:
The
patients' ages ranged from 30 to 71 years (mean of 46 years); the
tumor size ranged from 1.2 to 8.0 cm (mean 3.8 cm). These
tumors showed the following morphologic features leafy structures in the background of
fibroadenoma, or moderately to severely abundant
stromal cells. The interpretations of
tumor border status were ambiguous in some cases. The
incidence of TERT promoter
mutation was high in
patients of age≥50 years,
tumor size≥4 cm, and stromal overgrowth at ×4 or ×10 objective, and these clinicopathologic features were in favor of
diagnosis of
phyllodes tumors. TERT
protein expression levels was not associated with the above clinicopathologic
parameters and its promoter
mutation status.
Conclusions:
The diagnostic difficulty for the
breast fibroepithelial
tumors is due to the difficulty in recognition of the leafy structures or in those cases with abundant
stromal cells. A comprehensive evaluation combined with morphologic characteristics and molecular
parameters such as TERT promoter may be helpful for the correct
diagnosis and better evaluating
recurrence risk.