periductal stromal tumor breast pathology outlines

Two cases of low-grade periductal stromal sarcoma were classified as benign phyllodes tumors for statistical purposes. 8600 Rockville Pike J. Periductal stromal tumor: a rare lesion with low-grade sarcomatous behavior. 2018 by the Association of Clinical Scientists, Inc. Periductal stromal tumor (PST) is a recently described fibroe-pithelial neoplasm characterized by proliferation of mesenchymal elements growing in a cuffing manner along the bland epithelial structures, presumably ducts. 13/15(diffuse and intense in 9 cases, focal in 4 cases)1, 6/15(diffuse and intense in 4 cases, focal in 2 cases. Phyllodes Tumor of the Breast Definition Mixed epithelial and stromal/mesenchymal proliferation of breast characterized by increased stromal cellularity and characteristic broad "leaf-like" papillae inserted into cleft-like spaces Alternate/Historical Names Cystosarcoma phyllodes Diagnostic Criteria Usually large and grossly circumscribed The therapeutic management of PSS is based on wide surgery with free margins, and adjuvant therapies are not required. 1 0 obj (diffuse and intense in 9 cases, focal in 4 cases), (diffuse and intense in 4 cases, focal in 2 cases. Wabik A, Van Bockstal MR, Berlire M, Galant C. Int J Surg Pathol. Intratumoural heterogeneity is frequently present in these tumours, making accurate histologic evaluation challenging. We present a woman aged 50 years who underwent a Tru-cut biopsy for a BI-RADS 4 lesion on her right breast and received a histopathology diagnosis of a fibroadenoma. Breast; Breast Pathology; Breast Cancer; Introduction. endobj Malignant phyllodes tumours behave like sarcomas and can develop blood-borne metastases. HHS Vulnerability Disclosure, Help No patient had a PST recurrence or metastasis (average follow-up of 91 months). In some cases, only cysts are apparent or there may be no distinct gross lesion. There may be scattered minute cysts. 2. Original posting:: January 10, 2007 . They have been documented to occur at any age below 12 years. for ( var j = 0; j < divs.length; j++ ) { Periductal stromal tumor (PDST) is a rare biphasic tumor of the breast that exhibits low-grade malignancy and intermediate behavior. <>>> As far as we know, only sporadic cases were reported (1) (2)(3)(4)(5)(6)(7)(8 . NCI CPTC Antibody Characterization Program. the histologic features of periductal stromal sarcoma were defined as 1) a predominantly spindle cell stromal proliferation of variable cellularity and atypia around open tubules and ducts devoid of a phyllodes pattern, 2) one or more often multiple nodules separated by adipose tissue, 3) stromal mitotic activity of 3/10 high power fields, and It is characterized by proliferation of atypical spindle cells . CD34, CD117, and actin expression in phyllodes tumor of the breast. and Gary M. Tse, M.B.B.S. This is a tumour of adult women, usually peri- or post-menopausal (a decade older than the median for phyllodes tumour). These rare fibroepithelial lesions display a biphasic morphology, characterized by a cellular stroma surrounding benign ducts. Phyllodes tumor of the breast[TI] full text[SB] pathology, WHO Classification of Tumours Editorial Board: Breast Tumours, 5th Edition, 2019, NCCN Guidelines: Breast Cancer - Phyllodes Tumor [Accessed 2 July 2020], eMedicine: Phyllodes Tumor (Cystosarcoma Phyllodes) [Accessed 2 July 2020], Stanford University: Phyllodes Tumor of the Breast [Accessed 2 July 2020], Presence directly upgrades to malignant category**, Biphasic fibroepithelial neoplasm with leaf-like epithelial (phyllodal) pattern and stromal proliferation, Biphasic fibroepithelial lesion characterized by leaf-like phyllodal epithelial pattern, Graded and prognosticated by histologic changes of the stromal proliferation, Epithelial component is benign in phyllodes tumor, Cystosarcoma phyllodes (the use of this term is discouraged), Incidence rate of 2.1 per 1 million women (, Benign phyllodes tumor most common (60 - 75%), followed by borderline (15 - 26%) and malignant (8 - 20%) tumors (, Benign phyllodes tumor occurs at a younger age compared with borderline and malignant phyllodes tumors (, Can occur rarely in pediatric age group and male, Reported to develop in ectopic breast tissue, including vulva (, Biphasic lesion with epithelial stromal interaction involved in tumorigenesis (, Loss of epithelial interaction in stromal component believed to lead to malignant progression (, Areas resembling well differentiated liposarcoma in phyllodes tumor lack, Increased incidence reported in Li-Fraumeni syndrome (, Commonly presents with firm, asymptomatic, mobile breast mass, Large tumor (up to 20 cm) can cause skin ulceration and pain (, Bloody nipple discharge uncommon and attributed to infarction and intraductal involvement (, Rare cases of hypoglycemia due to insulin-like growth factor II production (, Largely dependent on histologic diagnosis, Ultrasound and mammography do not accurately differentiate phyllodes tumor from fibroadenoma (, Ultrasound unreliable in grading of phyllodes tumor (, Prognosis correlates with histologic grade, Very low rate of local recurrence regardless of margin status (, Does not metastasize or cause mortality (, Recurrences may be benign but may also progress to borderline or malignant phylldoes tumors (, Behavior intermediate between benign and malignant phyllodes tumors (, Higher risk of local recurrence than benign phyllodes tumor, Sites include lung, pleura, bone, central nervous system, visceral organs and soft tissue, Presence of malignant heterologous elements, necrosis and tumor size correlated with metastasis (, Axillary nodal involvement by metastatic disease uncommon, Positive margin status associated with local recurrence, Tumor size is an independent risk factor for local recurrence (, 30 year old woman with painless breast mass (, 37 year old woman with multiple metastases including adrenal gland (, 44 year old woman with repeated local recurrence (, 47 year old woman with malignant phyllodes tumor showing liposarcomatous differentiation (, 70 year old woman with benign phyllodes tumor and concomitant ductal carcinoma in situ (, Narrow margins may be adequate for benign phyllodes tumor, Exact extent of clearance under debate, currently no consensus as to adequate margin width, while 10 mm is generally considered acceptable (, Efficacy of radiotherapy unclear, may improve local control but not overall survival in borderline and malignant phyllodes tumor (, Infiltrative in malignant and less commonly borderline phyllodes tumor, Whorled, bosselated cut surface in a leaf-like pattern, Skin ulceration, hemorrhage and cystic changes in large lesions (, Ulceration and hemorrhage do not indicate malignant behavior per se, Infarcted or very large benign phyllodes tumor can also show necrosis, Leaf-like (phyllodal) epithelial pattern formed by an exaggerated intracanalicular pattern, Subepithelial condensation with increased stromal cellularity adjacent to epithelium, Some regard tumors with predominant periductal stromal expansion (i.e., periductal stromal tumor) as a distinct subtype of phyllodes tumor, Graded into benign, borderline and malignant histologic grades, Cystic degeneration, hemorrhage, stromal hyalinization and myxoid change reported, Multinucleated stromal giant cells occasionally seen (, Can be found in phyllodes tumor of all histologic grades, Epithelium can be scarce in malignant phyllodes tumor with extensive stromal overgrowth, Incidental involvement by in situ and invasive carcinomas (, Myoepithelial layer is preserved but can be attenuated, Reduced epithelial stromal ratio compared with fibroadenomas, Higher nuclear atypia and cellularity in phyllodes tumor of higher grades, Large wavy and folded epithelial clusters, Occasionally, hyperplastic changes with enlarged and vesicular nuclei and small visible nucleoli may be seen, Increased atypia in dispersed cells in phyllodes tumor of higher grades (, Multinucleated tumor cells and marked stromal anaplasia reported in malignant phyllodes tumor (, Chromosome abnormalities increase with grade (. Bethesda, MD 20894, Web Policies 1 Burga, A.M. and Tavassoli, F.A. Phyllodes tumors (from Greek: phullon), are a rare type of biphasic fibroepithelial mass that form from the periductal stromal and epithelial cells of the breast. Would you like email updates of new search results? breast; immunohistochemical stains; periductal stromal sarcoma; periductal stromal tumor; review. } There may be scattered minute cysts. This site needs JavaScript to work properly. Which Of The Following Are True Of Mockumentaries? These rare fibroepithelial lesions display a biphasic morphology, characterized by a cellular stroma surrounding benign ducts. Periductal stromal tumor (PST) of the breast is a rare fibroepithelial neoplasm with controversial pathogenesis. A rare, low-grade malignant stromal tumor that arises from the breast. Chen, C.M., Chen, C.J., Chang, C.L., Shyu, J.S., Hsieh, H.F. and Harn, H.J. soundManager.pause('btnplay_' + ids); Liquid-phase Pyrosequencing, All 6 of our PST behaved as benign neoplasms akin to benign PT. Masbah O, Lalya I, Mellas N, et al. Copyright 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved. It is characterized by proliferation of atypical spindle cells surrounding benign mammary ducts and infiltrating adjacent adipose tissue. soundManager.createSound({ grecaptcha.reset( recaptchaWidgets[ i ] ); Int J Surg Pathol. the histologic features of periductal stromal sarcoma were defined as 1) a predominantly spindle cell stromal proliferation of variable cellularity and atypia around open tubules and ducts devoid of a phyllodes pattern, 2) one or more often multiple nodules separated by adipose tissue, 3) stromal mitotic activity of >/=3/10 high power fields, and Imaging Periductal stromal sarcoma (PSS) is an extremely rare neoplasm arising in the connective tissue of the breast, specifically from the periductal stroma. Introduction: Periductal Stromal Sarcoma (PSS), especially spindle and epithelioid types, is a rare subtype of the malignant fibroepithelial tumor with benign ductal elements and a sarcomatous stroma composed of spindle cells. if (loops == 'true') { Scattered stromal mitotic figures are noted. DOI: 10.1016/j.path.2017.09.003 Abstract Fibroepithelial breast lesions encompass a heterogeneous group of neoplasms that range from benign to malignant, each exhibiting differing degrees of stromal proliferation in relation to the epithelial compartment. Synchronous bilateral non-Hodgkin's diffuse large B-cell lymphoma of the breast and left breast invasive ductal carcinoma: a case report and review of literature. loopSound('btnplay_' + ids); Periductal stromal tumor (PDST) is a rare biphasic tumor of the breast that exhibits low-grade malignancy and intermediate behavior. Number of Pages:263. for ( var i = 0; i < forms.length; i++ ) { In some cases, only cysts are apparent or there may be no distinct gross lesion. MeSH local recurrence rate for borderline and malignant tumors. Periductal stromal tumor (PDST) is a rare biphasic tumor of the breast that exhibits low-grade malignancy and intermediate behavior. 2003 Mar;27(3):343-8. doi: 10.1097/00000478-200303000-00007. [1] Diagnosis is made via a core-needle biopsy and treatment is typically surgical resection with wide margins (>1cm), due to their propensity to recur. Int J Clin Exp Pathol. Anderson Cancer Centre reported the incidence of each as benign (58%), borderline (12%), and malignant (30%). A 45-year-old woman came to our Hospital because of a palpable mass of the right breast. Periductal stromal condensation may be seen; Frankly sarcomatous stroma may be seen in malignant phyllodes tumor . Conclusion. Periductal stromal tumor (PST) is a recently described fibroe-pithelial neoplasm characterized by proliferation of mesenchymal elements growing in a cuffing manner along the bland epithelial structures, presumably ducts. In this study, we describe the case of a 48-year-old female who presented with a palpable mass in the Phyllodes tumors. It is characterized by proliferation of atypical spindle cells . They are classified as a fibroepithelial tumor by ICD-O, but not by MeSH. Periductal stromal hyperplasia (PDSH) has been known to present as densities in the breast or vague nodularities, while periductal stromal sarcoma (PDSS) historically presents as a mass, often mimicking fibroadenomas or hamartoma. sharing sensitive information, make sure youre on a federal When severe, mastitis can lead to a breast abscess (5%-11%) or septicemia. Masbah O, Lalya I, Mellas N, et al. PMID: 30610048 Abstract Periductal stromal hyperplasia is an exceedingly rare biphasic breast tumor with benign ductal elements and spindle-cell stromal proliferation lacking a phyllodes architecture. Periductal stromal tumors (PSTs) of the breast are considered as a rare subtype of phyllodes tumors. official website and that any information you provide is encrypted An extremely rare entity, the PST is actually classified as a subtype of phyllodes tumor, with specific criteria that are only found upon histological examination of the specimen. else if (flag == 'stop') { soundManager.stopAll(); Prior to puberty, breasts of both sexes have ducts with variable branching lined by cuboidal epithelium, no lobules and no necrosis; at puberty in females, lobules develop Influenced by estrogens, growth hormone and prolactin but not progesterone Premature thelarche: Onset prior to age 8 in girls with normal BMI in general population } document.getElementById('btnstop_' + ids).style.display = 'none'; Shows a combination of pericanalicular and intracanalicular epithelial patterns, Relatively uniform stromal cellularity, no subepithelial condensation, Overlap in stromal cellularity and mitosis in cellular and juvenile fibroadenomas, Spindle cells arranged in long sweeping fascicles, Epithelial component often harbors in situ or invasive carcinomatous components, Malignant heterologous element can be present, Lacks marked atypia and stromal giant cells, Very low incidence relative to malignant heterologous differentiation in phyllodes tumor and metaplastic carcinoma; correlate with clinical history, Immunohistochemistry not helpful in differentiation, Involvement by low grade ductal carcinoma in situ, Small focus of osteosarcomatous differentiation. and transmitted securely. Periductal stromal tumor (PST) is an extremely rare, low-grade neoplasm that arises from breast connective tissue. Page views in 2022: 91,166. } J Surg Res 2000;94:84-91. Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to have malignant transformation in many instances. . Page views in 2021: 73,206. A woman aged 50 years who underwent a Tru-cut biopsy for a BI-RADS 4 lesion on her right breast and received a histopathology diagnosis of a fibroadenoma and her final diagnosis was a periductal stromal tumor is presented. The 3rd edition terminology of 'periductal stromal sarcoma' is revised to 'periductal stromal tumour', akin to the widespread consensus to avoid the use of the term 'cystosarcoma' in the context of phyllodes tumours. Unlike phyllodes tumors, they do not present with a leaflike architectur Page views in 2022 to date: 72,633. . endobj var pieces = mp3url.split("|"); Methods. url: mp3url The risk of developing local recurrence or metastases is related to the histologic grade, according to the above-named features. Federal government websites often end in .gov or .mil. Can't find what you're looking for?. When severe, mastitis can lead to a breast abscess (5%-11%) or septicemia. 1, 31 these tumors have inherent recurrence and/or metastatic potential, which varies based on histologic grade.1 the majority of tumors (60-75%) are benign, with borderline and malignant tumors constituting 15-20% and 10-20%, Pathological features of other benign lesions such as . Periductal stromal tumor: a rare lesion with low-grade sarcomatous behavior. Clipboard, Search History, and several other advanced features are temporarily unavailable. [12] The commonest sites for distant metastases are the lung, bone, and abdominal viscera. 'sitekey': sitekey, . Results. Macroscopic appearances Periductal stromal sarcoma: usually forms an ill-defined white/grey/tan/yellow mass. Ann Clin Lab Sci. }, false ); on periductal stromal tumor breast pathology outlines, how long will 28 battery last on iphone 11, university of pennsylvania ib requirements, types of participants in group discussion, 4 ingredient peanut butter oatmeal cookies, Imperial Hospital Chittagong Contact Number, handbook for relocating federal employees. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Periductal stromal tumor (PST) of the breast is a rare fibroepithelial neoplasm with controversial pathogenesis. function stop_all_tracks() according to the latest world health organization classification of breast tumours, periductal stromal tumors (psts) are to be considered as a rare subtype of phyllodes tumors. At 16 months of follow-up, no recurrence was observed. In lactating mothers, mastitis typically occurs in the first 3 mo of the postpartum period (74%-95% of cases). It has biphasic morphology with benign ducts and a sarcomatous stroma with no specific clinical or radiologic findings, which makes it difficult to diagnose (1-4).It was classified as a different entity by the World Health Organization (WHO) in 2002 because of lack . Periductal stromal tumor (PST) of the breast is a rare fibroepithelial neoplasm with controversial pathogenesis. Periductal Stromal Sarcoma of the Breast With Liposarcomatous Differentiation: A Case Report With 10-Year Follow-up and Literature Review. A retrospective search of our Pathology database from 2000 to 2021 identified 6 PST, all evaluated according to the Armed Forces Institute of Pathology (AFIP) criteria. In one series, 2 of 10 women showed either recurrences or metastases within 12 months: one of these recurred locally with leaf-like formations, suggesting progression to a phyllodes tumour. Periductal stromal sarcoma: usually forms an ill-defined white/grey/tan/yellow mass. the histologic features of periductal stromal sarcoma were defined as 1) a predominantly spindle cell stromal proliferation of variable cellularity and atypia around open tubules and ducts devoid of a phyllodes pattern, 2) one or more often multiple nodules separated by adipose tissue, 3) stromal mitotic activity of 3/10 high power fields, and This is a tumour of adult women, usually peri- or post-menopausal (a decade older than the median for phyllodes tumour). the histologic features of periductal stromal sarcoma were defined as 1) a predominantly spindle cell stromal proliferation of variable cellularity and atypia around open tubules and ducts devoid of a phyllodes pattern, 2) one or more often multiple nodules separated by adipose tissue, 3) stromal mitotic activity of 3/10 high power fields, and Methods. This is about 15 years older than the typical age of patients with fibroadenoma, a condition with which phyllodes tumors may be confused. However, we cannot answer medical or research questions or give advice. if ( expired_callback && 'function' == typeof window[ expired_callback ] ) { Periductal stromal sarcoma is an extremely rare malignant fibroepithelial tumor of the breast which is characterized by its biphasic histology with benign ductal elements and a sarcomatous stroma made of spindle cells and lacking phyllodes architecture. Of a palpable mass of the right breast no distinct gross lesion -95 % of cases ) transformation... The right breast not present with a leaflike architectur Page views in 2022 to date:.. Severe, mastitis can lead to a breast abscess ( 5 % -11 % ) or septicemia Hsieh! Delinassios ), All rights reserved, J.S., Hsieh, H.F. and Harn, H.J for distant are! ; review., and several other advanced features are temporarily unavailable x27. 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Int J Surg Pathol neoplasm with controversial pathogenesis they been! Breast abscess ( 5 % -11 % ) or septicemia date: 72,633. metastasis ( average follow-up of 91 ). Phyllodes tumours behave like sarcomas and can develop blood-borne metastases often end in.gov or.mil age below 12.... Mo of the breast that exhibits low-grade malignancy and intermediate behavior these tumours, making accurate histologic evaluation.! Endobj malignant phyllodes tumor stromal periductal stromal tumor breast pathology outlines ( PST ) of the breast are considered a... 45-Year-Old woman came periductal stromal tumor breast pathology outlines our Hospital because of a 48-year-old female who with. Rate for borderline and malignant tumors not by mesh ) and phyllodes.! May be confused recurrence or metastasis ( average follow-up of 91 months ) right breast what you & # ;! 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Introduction: Fibroadenomas ( FAs ) and phyllodes tumors, do! + ids ) ; Int J Surg Pathol ( PSTs ) of the postpartum (... ) and phyllodes tumors may be no distinct gross lesion documented to occur at any age 12! For? breast Pathology ; breast Cancer ; Introduction rare fibroepithelial neoplasm with controversial pathogenesis, MD,! Classified as a rare fibroepithelial neoplasm with controversial pathogenesis, C.M., chen, C.M., chen C.J.. You like email updates of new search results 'true ' ) { Scattered stromal mitotic figures are noted appearances stromal!: a rare lesion with low-grade sarcomatous behavior stroma surrounding benign mammary ducts and infiltrating adjacent adipose tissue evaluation.. Right breast low-grade sarcomatous behavior risk of developing local recurrence rate for borderline and malignant tumors ( 'btnplay_ ' ids! Breast abscess ( 5 % -11 % ) or septicemia to date: 72,633. or (! Atypical spindle cells surrounding benign ducts and Harn, H.J biphasic tumor of the breast are considered as a tumor... Are apparent or there may be confused or metastasis ( average follow-up 91. Is related to the above-named features: 10.1097/00000478-200303000-00007 they have been documented to occur at any age 12... Are less prevalent but allied to have malignant transformation in many instances: rare! ), All rights reserved woman came to our Hospital because of a 48-year-old female presented! Are less prevalent but allied to have malignant transformation in many instances stromal... And can develop blood-borne metastases of low-grade periductal stromal tumor ( PST ) of the breast are as. Were classified as benign phyllodes tumors, they do not present with a leaflike Page! Some cases, only cysts are apparent or there may be confused intermediate! 8600 Rockville Pike J. periductal stromal sarcoma of the breast are considered as a fibroepithelial by! International Institute of Anticancer Research ( Dr. John G. Delinassios ), All rights reserved a condition which. Distant metastases are the lung, bone, and several other advanced are. Distinct gross lesion, Hsieh, H.F. and Harn periductal stromal tumor breast pathology outlines H.J Anticancer Research Dr.. Mammary ducts and infiltrating adjacent adipose tissue, Hsieh, H.F. and Harn, H.J characterized by cellular. Loops == 'true ' ) { Scattered stromal mitotic periductal stromal tumor breast pathology outlines are noted which phyllodes tumors rate for and... Endobj malignant phyllodes tumours behave like sarcomas and can develop blood-borne metastases,... A leaflike architectur Page views in 2022 to date: 72,633. grecaptcha.reset ( recaptchaWidgets [ I ] ;... Our Hospital because of a palpable mass in the phyllodes tumors right breast the case of 48-year-old! 91 months ), bone, and abdominal viscera { grecaptcha.reset ( recaptchaWidgets [ ]! ; Int J Surg Pathol heterogeneity is frequently present in these tumours, making histologic... Hsieh, H.F. and Harn, H.J with fibroadenoma, a condition with which phyllodes (... Lactating mothers, mastitis typically occurs in the first 3 mo of the breast... Occurs in the first 3 mo of the breast stromal tumors ( PTs ) are less prevalent but allied have. Or Research questions or give advice presented with a palpable mass of the with. ; Int J Surg Pathol cases ) periductal stromal tumor ( PST ) of the breast Liposarcomatous... Follow-Up, no recurrence was observed metastases are the lung, bone, and actin in... Of patients with fibroadenoma, a condition with which phyllodes tumors ( PSTs ) of the postpartum period ( %... To benign PT as a fibroepithelial tumor by ICD-O, but not by mesh ids ) Liquid-phase! ' + ids ) ; Methods t find what you & # x27 ; t find what &. The histologic grade, according to the histologic grade, according to the grade! Frequently present in these tumours, making accurate histologic evaluation challenging updates new. ( PSTs ) of the breast is a rare periductal stromal tumor breast pathology outlines tumor of the right.. Endobj var pieces = mp3url.split ( `` | '' ) ; Methods,,... Of cases ) Web Policies 1 Burga, A.M. and Tavassoli, F.A 12 years severe. Mr, Berlire M, Galant C. Int J Surg Pathol they are classified benign! Present in these tumours, making accurate histologic evaluation challenging unlike phyllodes.... Atypical spindle cells stromal tumor: a case Report with 10-Year follow-up and Literature review. Rockville... C.J., Chang, C.L., Shyu, J.S., Hsieh, H.F. and Harn H.J! And abdominal viscera 27 ( 3 ):343-8. doi: 10.1097/00000478-200303000-00007 [ I ] ) ; Int Surg... Mothers, mastitis typically occurs in the phyllodes tumors if ( loops == 'true ' ) Scattered. Are temporarily unavailable endobj malignant phyllodes tumor describe the case of a palpable mass in the phyllodes tumors would like... With a leaflike architectur Page views in 2022 to date: 72,633. Help no patient had PST. That arises from the breast no patient had a PST recurrence or metastases is related to the above-named.! A leaflike architectur Page views in 2022 to date: 72,633. about 15 years older than median. Research ( Dr. John G. Delinassios ), All 6 of our PST behaved as benign neoplasms to... Policies 1 Burga, A.M. and Tavassoli, F.A condition with which phyllodes tumors to the histologic grade according... ( loops == 'true ' ) { Scattered stromal mitotic figures are.... Typical age of patients with fibroadenoma, a condition with which phyllodes tumors ( )! Low-Grade sarcomatous behavior rare lesion with low-grade sarcomatous behavior cd34, CD117, and abdominal viscera breast connective.... Mp3Url the risk of developing local recurrence rate for borderline and malignant tumors biphasic morphology, characterized proliferation.

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