1
|
Faulds TT, Bruckner J, Mousa M, Bhanu S, Chin M, Cendrowski K. Giant phyllodes tumor of the breast: A case report. Radiol Case Rep 2024; 19:818-824. [PMID: 38111558 PMCID: PMC10726342 DOI: 10.1016/j.radcr.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Phyllodes tumors of the breast are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors. They tend to affect middle-aged women, who present with a rapidly growing, palpable mass. Here we present a case of a 34-year-old female surrogate mother without any reported personal or family history of breast cancer who presented with a rapidly growing left breast mass, pathologically proven to be a phyllodes tumor. The patient was a G7P7 surrogate mother who received estrogen and progesterone injections for her twin surrogate pregnancy starting 4 months before embryo implantation, after which, she discovered a large palpable mass in the left breast at approximately week 7 gestational age. At the initial presentation, the patient was at week 23 gestational age. She underwent C-section delivery of the twins at this time and obtained further work-up of the mass. She had a core needle biopsy which yielded a benign fibroepithelial tumor. Due to the size of her breast mass and atypical morphology, including extension to the nipple, and skin ulceration, the patient subsequently underwent left mastectomy. At the time of mastectomy, which was 8 months after the initial work-up, the mass had grown to measure approximately 12 × 10 cm on physical examination and took up most of her left breast. It was completely resected and was pathologically determined to be a borderline phyllodes tumor. Only a few cases have been reported about the development of phyllodes tumor during pregnancy in the literature, and we believe this is the first case report of phyllodes tumor related to a surrogate pregnancy. Although the relationship between exogenous hormones and fibroepithelial tumors is not well understood, the case poses the clinical question if screening mammograms should be offered to patients undergoing exogenous hormonal therapy, regardless of age to establish a baseline and monitor for the development (if any) or growth of these tumors.
Collapse
Affiliation(s)
- Tam Truong Faulds
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Jacob Bruckner
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Mousa
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Shiv Bhanu
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Chin
- Riverside Community Hospital, Riverside, CA, USA
| | | |
Collapse
|
2
|
Lian J, Gao L, Yao R, Zhou Y, Sun Q. Case Report: A 13-year-old adolescent diagnosed as malignant phyllodes tumor combined with rhabdomyosarcoma differentiation. Front Oncol 2023; 13:1233208. [PMID: 37841438 PMCID: PMC10569689 DOI: 10.3389/fonc.2023.1233208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Phyllodes tumor (PT) is an infrequent type of breast neoplasm, constituting a mere 0.5%-1.5% of the entirety of breast tumors. The malignant phyllodes tumor (MPT) comprises only 15% of all phyllodes tumors, and its transformation into rhabdomyosarcoma (RMS) is exceedingly rare in clinical practice. Given its insensitivity to chemotherapy and radiotherapy, treatment options for MPT patients are limited, leaving complete surgical resection as the only option. Therefore, it is imperative to investigate the effective utilization of the heterogeneous differentiation characteristics of MPT to expand treatment alternatives for these patients. In this case report, we represent a 13-year-old adolescent diagnosed with giant breast MPT with RMS differentiation and pulmonary metastasis. The initial step in the treatment process involved radical surgical resection, followed by the administration of four cycles of VDC/IC chemotherapy, which is widely recognized as the standard chemotherapy for RMS. Regrettably, the delay in initiating chemotherapy resulted in minimal observable changes in the size of the pulmonary metastatic nodule. Additionally, a comprehensive literature review on the characterization of MPT with heterogeneous differentiation was conducted to enhance comprehension of the diagnosis and treatment of this uncommon disease in clinical practice. Meanwhile, this case also reminds the doctors that when we diagnose a patient as MPT, it is crucial to consider its heterogenous nature and promptly initiate adjuvant treatment. By targeting the differentiation element of MPT, it becomes feasible to overcome the previously perceived limitation of surgical intervention as the sole treatment option.
Collapse
Affiliation(s)
| | | | | | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
3
|
Chen C, Huang X, Xu Y, Sun Q. Rethinking on the management strategy of malignant phyllodes tumor of the breast: An analysis based on the SEER database. Medicine (Baltimore) 2023; 102:e33326. [PMID: 36961178 PMCID: PMC10036047 DOI: 10.1097/md.0000000000033326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
Malignant phyllodes tumor of the breast (MPTB) is a rare breast neoplasm that has a high recurrence rate and its optimal treatment strategies remain controversial. Our study used the most up-to-date database to determine prognostic factors that predict cancer-specific survival (CSS) and to evaluate the effects of different treatment strategies for MPTB. We performed a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Women who were diagnosed with MPTB from 2000 to 2019 were included. Kaplan-Meier method and Cox proportional hazards regressions were used to evaluate the prognostic power of variables on CSS. A total of 1902 women with MPTB were included in the study, with a median follow-up duration of 87.5 months. Age was found not to independently predict CSS in patients with tumors larger than 10 cm (P = .235). Mastectomy was performed on a total of 898 (47.2%) patients including 210 women (23.4%) undergoing radiotherapy after surgery. Mastectomy showed worse CSS when compared with breast-conserving surgery in patients with tumors smaller than 10 cm. Patients undergoing radiotherapy were not inferior to non-radiotherapy patients on CSS when patients were stratified by tumor size. Breast-conserving surgery showed survival benefits for patients with small tumors (T1 and T2). Patients with radiotherapy were not inferior to non-radiotherapy patients on CSS. Treatment of patients with MPTB should be carefully selected based on different tumor sizes.
Collapse
Affiliation(s)
- Chang Chen
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Huang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
EL Qasseh R, Antaky R, Touimi benjeloune A, Benhassou M, Ennachit M, El keroumi M. Secondary epidural and para-vertebral localization of a phyllodes sarcoma of the breast, case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
5
|
Wu PS, Lin C, Yang PS, Chang YC, Ko WC, Lam HB. Clinical features, prognostic factors, and treatment outcomes in 611 patients with phyllodes tumors of the breast: The experience of a single institution in Taiwan. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Sanjay S, Ketul P, Mohit S, Jahnavi G, Ajay YK, Abhishek J, Shashank JP. Study of clinicopathological factors and their impact on survival in phyllodes tumour of breast at tertiary care cancer centre in India. Cancer Treat Res Commun 2021; 29:100482. [PMID: 34757273 DOI: 10.1016/j.ctarc.2021.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Phyllodes tumour is a rare breast neoplasm having three histological types i. e benign, borderline and malignant. Surgical excision is the mainstay of treatment, but quantification of adequate margin required during excision is still a matter of debate. Role of adjuvant radiotherapy also remains controversial. AIMS Study of prognostic factors in patients with phyllodes tumour of breast and their effect on survival. SETTING AND DESIGN A retrospective analysis. MATERIAL AND METHODS From the year 2016 to 2019 we included 54 patients in this study and assessment of clinical and histopathological features, requirement of adjuvant radiotherapy and their effect on DFS (disease free survival) and OS (overall survival) was done. Log-rank test was used for univariate analysis and multivariate analysis was done by using Cox propotion hazard ratio method. STATISTICAL ANALYSIS Descriptive statistics was used for calculating proportion and median value. Survival analysis was done by using Kaplan Meier method. P value of <0.05 was considered statistically significant. RESULTS Mitotic count and presence of heterologous component had significant effect on overall survival (OS) and disease free survival (DFS) on multivariate analysis. No effect of adjuvant radiotherapy and the type of surgery (breast conservation surgery v/s mastectomy) was found on survival (OS, DFS). CONCLUSION Surgery with adequate margins should be the treatment of choice for tumours with borderline and malignant histological type Histological features like high mitotic count and stromal overgrowth are known prognostic factors, however, heterologous component is also an important prognostic factor and should be studied in large randomized trials. Role of adjuvant radiotherapy remains controversial.
Collapse
Affiliation(s)
- Singh Sanjay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Puj Ketul
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Sharma Mohit
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Gandhi Jahnavi
- Department of Pathology, Gujarat Cancer & Research Institute Ahmedabad, Gujarat 380016, India.
| | - Yadav Kumar Ajay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Jain Abhishek
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - J Pandya Shashank
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| |
Collapse
|
7
|
Outcomes of systemic therapy in metastatic phyllodes tumor of the breast. Breast Cancer Res Treat 2021; 186:871-882. [PMID: 33575859 DOI: 10.1007/s10549-021-06116-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/21/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Metastatic phyllodes tumors of the breast (MPT) are rare breast neoplasms, limiting development of standardized treatment approaches. We sought to characterize the largest group of MPT thus far reported, evaluating systemic therapy outcomes. METHODS Adult patients diagnosed with MPT between 1993 and 2015 and followed at MD Anderson Cancer Center were selected for retrospective chart review. Systemic therapy was sorted into: adriamycin/ifosfamide (AI), other anthracycline regimens, other ifosfamide regimens, gemcitabine-based regimens, and other. Given one patient may have received more than one regimen, we assumed that the effects of each regimen were independent from previous therapy. Median overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Log-rank test was performed to evaluate the difference in OS between patient characteristics groups, and the differences in PFS between the five chemotherapy regimens. RESULTS We identified 50 MPT patients, with 31 patients receiving 61 systemic regimens. Median OS was 10.7 months (95% CI: 8.67, 16.5). AI had a PFS of 9.10 months (95% CI: 5.03, 14.2), other ifosfamide regimens had a PFS of 5.10 months (95% CI: 0.67, 12.1), other anthracycline regimens had a PFS of 3.65 months (95% CI: 1.17, 7.90), gemcitabine-based regimens had a PFS of 2.80 months (95% CI: 1.83, 4.60), and other regimens had a PFS of 1.67 months (95% CI: 1.13, 7.77). CONCLUSION MPT patients are a unique population with limited characterization to date. Our study demonstrates activity of multiple sarcoma-directed chemotherapy regimens, with ifosfamide-containing regimens having the longest PFS.
Collapse
|
8
|
Makar GS, Makar M, Ghobrial J, Bush K, Gruner RA, Holdbrook T. Malignant Phyllodes Tumor in an Adolescent Female: A Rare Case Report and Review of the Literature. Case Rep Oncol Med 2020; 2020:1989452. [PMID: 32181035 PMCID: PMC7064852 DOI: 10.1155/2020/1989452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/13/2020] [Indexed: 11/30/2022] Open
Abstract
Primary breast neoplasms are rare in adolescent females, most of which are benign. Phyllodes tumors constitute a remarkably small subset of breast neoplasms (0.3-0.9%) with malignant phyllodes tumors being even more uncommon. Malignant phyllodes tumors tend to progress rapidly though only 1.5% metastasize. They are also associated with a higher rate of recurrence than their benign counterparts, underlying the importance of adequate surgical margins. It is therefore imperative to be able to identify these tumors early allowing for prompt resection and close follow-up. Here, we present the rare case of a 17-year-old female presenting with a rapidly enlarging breast mass, which was ultimately found to be a malignant phyllodes tumor. We further performed a review of the literature to highlight only 22 other cases reported in adolescent females.
Collapse
Affiliation(s)
- Gabriel S. Makar
- Cooper Medical School of Rowan University, 401 Broadway Ave, Camden, NJ 08103, USA
| | - Michael Makar
- Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Pl, New Brunswick, NJ 08901, USA
| | - Joanna Ghobrial
- AT Still University School of Osteopathic Medicine, 5850 E Still Cir, Mesa, AZ 85206, USA
| | - Kathryn Bush
- Cooper Medical School of Rowan University, 401 Broadway Ave, Camden, NJ 08103, USA
| | - Ryan Allen Gruner
- Cooper University Hospital, Department of Surgery, 1 Cooper Plaza, Camden, NJ 08103, USA
| | - Thomas Holdbrook
- Cooper University Hospital, Department of Pathology, 1 Cooper Plaza, Camden, NJ 08103, USA
| |
Collapse
|
9
|
Lee HJ, Lim HS, Ki SY, Lee JE, Lee JS, Park MH. Cutaneous Scalp Metastases of Malignant Phyllodes Tumor of the Breast. J Breast Cancer 2020; 23:320-325. [PMID: 32595994 PMCID: PMC7311367 DOI: 10.4048/jbc.2020.23.e18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/22/2020] [Indexed: 02/02/2023] Open
Abstract
Phyllodes tumor (PT) of the breast is a relatively rare fibroepithelial tumor that accounts for < 1% of primary breast neoplasms. PT is classified histologically as benign, borderline, or malignant, and a malignant PT has greater potential to metastasize than benign PT. Although almost all other organs can be affected, common metastatic sites are the lung and bone via the hematogenous route. There have been several studies reporting cutaneous and soft tissue metastases of PT, though the incidence is rare. Herein, we report a very rare case of scalp metastasis of malignant PT that was diagnosed via skin biopsy and surgical excision.
Collapse
Affiliation(s)
- Hyo-Jae Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - So Yeon Ki
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| |
Collapse
|
10
|
Yahaya JJ, Odida M. Primary Osteosarcoma of the Breast with Extensive Chondroid Matrix in a Teenager Female Patient: The Paradoxical Diagnosis in Breast Mastopathy. Int Med Case Rep J 2020; 13:11-17. [PMID: 32021493 PMCID: PMC6959500 DOI: 10.2147/imcrj.s233674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose Non-epithelial tumors of the breast are extremely rare and have an incidence of less than 1%. The most common non-epithelial breast tumor is the phyllodes tumor (PT), which accounts for 61%. Primary osteosarcomas of the breast contribute up to only 12.5% of all breast sarcomas. In young females, osteosarcomas are extremely rare, especially in those without a previous history of primary bone osteosarcoma. A case of a 16-year old female with primary osteosarcoma of the breast (POB) with extensive chondroid matrix involving the left breast is herein presented. Case Report This report describes a 16-year old female with neither a previous history of bone osteosarcoma nor family history of breast cancer who was diagnosed with a primary chondroblastic osteosarcoma of the left breast. The mass was shining, warm, firm, and slightly fixed. The excisional biopsy showed a large tumor measuring 11x9x7 cm which was encapsulated, grayish-white, and nodular. Conclusion Primary osteosarcomas of the breast carry a poor prognosis by being triple negative and because of being the rarest tumors, they pose a challenge in managing the patients due to lack of established treatment modalities.
Collapse
Affiliation(s)
- James Joseph Yahaya
- Department of Pathology, Makerere College of Health Sciences (MakCHS), Kampala, Uganda.,Department of Biomedical Sciences, College of Health Sciences (CHS), the University of Dodoma, Dodoma, Tanzania
| | - Michael Odida
- Department of Pathology, Makerere College of Health Sciences (MakCHS), Kampala, Uganda
| |
Collapse
|
11
|
Kataria K, Dhar A, Ranjan P, Kumar A, Islam S, Srivastava A. Radical Mastectomy SANS Axillary Lymph Node Dissection for Large Phyllodes Tumor: a Guarantee Against Recurrence. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1852-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
12
|
Narla SL, Stephen P, Kurian A, Annapurneswari S. Well-differentiated liposarcoma of the breast arising in a background of malignant phyllodes tumor in a pregnant woman: A rare case report and review of literature. INDIAN J PATHOL MICR 2019; 61:577-579. [PMID: 30303154 DOI: 10.4103/ijpm.ijpm_238_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pure mesenchymal sarcomas and phyllodes tumor with sarcomatous differentiation of the breast are rare tumors. Primary breast sarcomas are a heterogenous group of neoplasms which include malignant fibrous histiocytoma, fibrosarcoma, angiosarcoma, leiomyosarcoma, osteosarcoma, rhabdomyosarcoma, and liposarcoma. Sarcomatous differentiation in phyllodes tumor is seen in the form of angiosarcoma, chondrosarcoma, leiomyosarcoma, osteosarcoma, rhabdomyosarcoma, and liposarcoma. Here, we report a case of a 28-year-old pregnant woman with a breast lump during her second trimester which drastically increased in size in the postpartum period. Wide local excision revealed a malignant phyllodes tumor with liposarcomatous differentiation. Later, the patient underwent completion mastectomy which showed residual tumor.
Collapse
Affiliation(s)
- Swetha Lakshmi Narla
- Department of Histopathology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - Punitha Stephen
- Department of Histopathology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - Ann Kurian
- Department of Histopathology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| | - S Annapurneswari
- Department of Histopathology, Apollo Cancer Institutes, Chennai, Tamil Nadu, India
| |
Collapse
|
13
|
Lu Y, Chen Y, Zhu L, Cartwright P, Song E, Jacobs L, Chen K. Local Recurrence of Benign, Borderline, and Malignant Phyllodes Tumors of the Breast: A Systematic Review and Meta-analysis. Ann Surg Oncol 2019; 26:1263-1275. [PMID: 30617873 DOI: 10.1245/s10434-018-07134-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to investigate local recurrence (LR) rates among the three grades (benign, borderline, and malignant) of phyllodes tumors (PTs). The study also assessed various risk factors for LR. METHODS Electronic articles published between 1 January 1995 and 31 May 2018, were searched and critically appraised. The authors independently reviewed the abstracts and extracted data for LR rates and LR risk factors. RESULTS The review incorporated 54 studies with 9234 individual cases. The pooled LR rates were 8% for benign, 13% for borderline, and 18% for malignant PTs. The risk of LR was significantly increased by borderline versus benign PTs (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.68-2.38) and malignant versus borderline PTs (OR 1.28; 95% CI 1.05-1.55). The significant risk factors for LR were mitoses, tumor border (infiltrating vs. pushing), stromal cellularity (moderate/severe vs. mild), stromal atypia (severe vs. mild/absent), stromal overgrowth (severe vs. mild/absent), and tumor necrosis (positive vs. negative). Age and tumor size were not associated with LR risk. The subgroup analysis showed that breast-conserving surgery versus mastectomy and positive versus negative surgical margins were significantly associated with an increased LR risk only in malignant PTs. CONCLUSIONS The risk of LR was significantly increased from benign to borderline to malignant PTs. Mitoses, tumor border, stromal cellularity, stromal atypia, stromal overgrowth, tumor necrosis, type of surgery, and surgical margin status may be risk factors for LR. Different management strategies could be considered for different PT grades.
Collapse
Affiliation(s)
- Yiwen Lu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanbo Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Paul Cartwright
- Departments of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China. .,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Lisa Jacobs
- Departments of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China. .,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
14
|
Abdul Hamid S, Rahmat K, Ramli MT, Fadzli F, Jamaris S, See MH, Teoh KH, Taib NAM. Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women. Medicine (Baltimore) 2018; 97:e11412. [PMID: 30075507 PMCID: PMC6081195 DOI: 10.1097/md.0000000000011412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Phyllodes tumor or cystosarcoma phyllodes is a rare fibroepithelial neoplasm which arises from the periductal stroma of the breast. They are classified as benign, borderline, and malignant based on the histologic features. However, all phyllodes tumor (PT) subtypes are regarded as having malignant potential and correct diagnosis is important for surgical management and optimal care. This study is a retrospective review of 76 women diagnosed as PT with highlights on the imaging characteristics, pathology, and surgical treatment over a 7-year period in a tertiary medical center of urban population in Malaysia. There were 45 benign, 16 borderline, and 15 malignant PT. The median age for benign PT was 43, borderline 48.5, and malignant 42 years. The Malay ethnic group constitute 52.6% of cases, with 27.6% and 18.4% in Chinese and Indian ethnic groups, respectively. On mammograms, most benign (64.3%) and 33.3% of malignant PT showed high-density lesions. Calcifications were only seen in 2 benign PT. On ultrasound, 86% of benign PT was well-circumscribed whilst 50.0% of malignant PT had irregular outline. Cystic spaces were seen in 40.0% of malignant and 9.5% of benign PT. 80% of malignant PT lesions were heterogenous. Malignant PT demonstrates tumor heterogeneity, cystic spaces, and posterior acoustic enhancement on ultrasound. Half of malignant PT showed regular borders on ultrasound and appear well circumscribed on mammogram. A total of 46 patients had wide local excision or excision biopsy whilst 30 underwent mastectomy as primary treatment. The majority of the borderline and malignant PTs in our study (75.0% and 85.7% respectively) and only 5 out of the 43 (11.6%) benign PT underwent mastectomy. There were 2 tumor recurrence in the benign PT group and 1 case in the borderline and malignant group respectively.
Collapse
Affiliation(s)
- Shamsiah Abdul Hamid
- Department of Biomedical Imaging Department, University Malaya Research Imaging Centre, Kuala Lumpur
- Medical Imaging Unit, Faculty of Medicine University Teknologi MARA, Sungai Buloh Campus, Selangor
| | - Kartini Rahmat
- Department of Biomedical Imaging Department, University Malaya Research Imaging Centre, Kuala Lumpur
| | - Marlina Tanty Ramli
- Department of Biomedical Imaging Department, University Malaya Research Imaging Centre, Kuala Lumpur
- Medical Imaging Unit, Faculty of Medicine University Teknologi MARA, Sungai Buloh Campus, Selangor
| | - Farhana Fadzli
- Department of Biomedical Imaging Department, University Malaya Research Imaging Centre, Kuala Lumpur
| | | | | | - Kean Hooi Teoh
- Department of Pathology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | |
Collapse
|
15
|
Isimbaldi G, Sironi M, Declich P, Galli C, Assi A. A Case of Malignant Phyllodes Tumor with Muscular and Fatty Differentiations. TUMORI JOURNAL 2018; 78:351-2. [PMID: 1494810 DOI: 10.1177/030089169207800514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 50-year-old female underwent surgical removal of a mammary phyllodes tumor, whose peculiar histologic feature was the coexistence of areas of liposarcoma and leiomyosarcoma. The morphologic differential diagnosis is briefly discussed.
Collapse
Affiliation(s)
- G Isimbaldi
- U.O. di Anatomia ed Istologia Patologica e Citodiagnostica, Ospedale Civile di Legnano, Milano, Italy
| | | | | | | | | |
Collapse
|
16
|
Grove A, Deibjerg Kristensen L. Intraductal Carcinoma within a Phyllodes Tumor of the Breast: A Case Report. TUMORI JOURNAL 2018; 72:187-90. [PMID: 3010519 DOI: 10.1177/030089168607200212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The first reported case in the world literature of a ductal carcinoma in situ located within a phyllodes tumor of the breast is presented. Previously reported cases of carcinoma in phyllodes tumors are reviewed, and the relationship between carcinoma arising in fibroadenomas and phyllodes tumors is discussed.
Collapse
|
17
|
de Rosa G, Ferrara G, Goglia P, Ghicas C, Zeppa P. In Situ and Microinvasive Carcinoma with Squamoid Differentiation Arising in a Phyllodes Tumor: Report of a Case. TUMORI JOURNAL 2018; 75:514-7. [PMID: 2557696 DOI: 10.1177/030089168907500525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of in situ and invasive ductal carcinoma with areas of squamoid differentiation arising in a phyllodes tumor is reported. This last aspect has never been described before and is discussed reviewing the previously reported cases in the literature.
Collapse
Affiliation(s)
- G de Rosa
- Surgical Pathology Service, University of Naples, Italy
| | | | | | | | | |
Collapse
|
18
|
Lui SA, Oh HB, Wang S, Chan CW. Ductal carcinoma in-situ arising within benign phyllodes tumours. Ann R Coll Surg Engl 2018; 100:e97-e102. [PMID: 29484937 PMCID: PMC5958862 DOI: 10.1308/rcsann.2018.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/11/2022] Open
Abstract
Ductal carcinoma in situ arising within a benign phyllodes tumour is a rare neoplasm of the breast. We present a case of a 19-year-old woman who had a right breast lump for six months with the above diagnosis together with a mini-review of the literature. Ultrasound revealed a 5-cm breast lump and core biopsy revealed ductal carcinoma in situ. She underwent wide local excision of the breast lump with clear margins. Final histology confirmed ductal carcinoma in situ within a fibroepithelial lesion consistent with a benign phyllodes tumour. To our knowledge, this is the youngest case of ductal carcinoma in situ arising in a phyllodes tumour to have been reported so far.
Collapse
MESH Headings
- Adult
- Antineoplastic Agents, Hormonal/therapeutic use
- BRCA1 Protein/genetics
- BRCA2 Protein/genetics
- Biopsy, Large-Core Needle/methods
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Chemotherapy, Adjuvant
- Female
- Humans
- Mastectomy, Segmental
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- PTEN Phosphohydrolase/genetics
- Phyllodes Tumor/diagnostic imaging
- Phyllodes Tumor/pathology
- Phyllodes Tumor/therapy
- Sentinel Lymph Node Biopsy/methods
- Tamoxifen/therapeutic use
- Ultrasonography, Interventional
- Ultrasonography, Mammary
- Young Adult
Collapse
Affiliation(s)
- S-A Lui
- Division of Breast Surgery, Department of Surgery, National University Health System, Singapore
| | - HB Oh
- Division of Breast Surgery, Department of Surgery, National University Health System, Singapore
| | - S Wang
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - CW Chan
- Division of Breast Surgery, Department of Surgery, National University Health System, Singapore
| |
Collapse
|
19
|
Cellular fibroepithelial lesions of the breast: A long term follow up study. Ann Diagn Pathol 2018; 35:85-91. [PMID: 30029048 DOI: 10.1016/j.anndiagpath.2018.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
Some fibroepithelial lesions (FEL) of the breast are difficult to classify as cellular fibroadenoma (CFA) or benign phyllodes tumor (BPT) due to overlapping histologic features. This indeterminate group is histologically characterized by prominent stromal cellularity, mild atypia, and mitotic activity. The local recurrence potential of cellular FEL (CFEL) has been insufficiently studied. The objective of this study was to evaluate the histologic features, characterize the long-term follow-up and recurrence rate of CFEL, and compare this data with the recurrence rate of definitive BPT. Ninety CFEL that were <4 cm were recovered from the benign breast disease cohort. The control group comprised of 10 randomly selected patients with BPT. Cases were classified based on a combination of mitotic activity, intracanalicular growth, stromal atypia, stromal prominence, and fat infiltration. None of the CFEL was widely excised. Of the 90 CFEL cases, there were 22 BPT-like, 35 CFA, and 33 indeterminate. The mean age of the patients was 40.1 years. The mean tumor size was 2.4 cm. All patients had at least two years of follow-up (median 27). None of the patients with BPT-like CFEL showed ipsilateral recurrence. Five of the 35 patients with CFA had recurrent ipsilateral CFA. This occurred within 1 to 11 years after the initial diagnosis. One of 33 patients with indeterminate type had a recurrent ipsilateral lesion five years after the initial diagnosis with histologic features of CFA. None of the patients in control group had any recurrence. In conclusion, as a group, CFEL have a low proclivity for recurrence, even when enucleated with close or positive margins. The presence of histologic features of BPT did not correlate with an increased potential for recurrence.
Collapse
|
20
|
Moo TA, Alabdulkareem H, Tam A, Fontanet C, Lu Y, Landers A, D’Alfonso T, Simmons R. Association Between Recurrence and Re-Excision for Close and Positive Margins Versus Observation in Patients with Benign Phyllodes Tumors. Ann Surg Oncol 2017; 24:3088-3092. [DOI: 10.1245/s10434-017-5955-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Indexed: 01/21/2023]
|
21
|
Yoshiba S, Saotome T, Mikogami T, Shirota T. Metastasis of Mammary Gland Malignant Phyllodes Tumor to the Mandibular Region: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2016; 75:440.e1-440.e9. [PMID: 27765548 DOI: 10.1016/j.joms.2016.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022]
Abstract
Phyllodes tumor is a rare breast tumor described by Müller (1938) as a lesion comprising leaflike stromal fibrous components and narrow cysts. The frequency of distant metastasis from this entity is reportedly approximately 20%, and no effective therapy has been established, so the prognosis is poor. This report describes the case of a 60-year-old woman with a history of left lung resection who showed metastasis of a mammary gland malignant phyllodes tumor to the oral cavity. Intraoral examination showed an elastic, hard mass measuring 28 × 27 mm in the gingiva around the left mandibular second molar. Biopsy examination showed growth of giant cells and roughly circular cells showing positivity for S-100, p63, and vimentin on immunohistochemical staining. The authors diagnosed metastasis of the mammary gland malignant phyllodes tumor to the left mandible and performed cyber knife irradiation (44 Gy in 5 fractions) of the left mandible. The mass in the oral cavity disappeared after cyber knife irradiation, but the patient died of direct invasion to the spine.
Collapse
Affiliation(s)
- Sayaka Yoshiba
- Assistant Professor, Showa University Northern Yokohama Hospital, Dentistry and Oral Surgery, Kanagawa; Department of Oral and Maxillofacial Surgery, Showa University School of Dentistry, Tokyo, Japan.
| | - Takashi Saotome
- Department Head, Department of Medical Oncology, Matsudo City Hospital, Chiba, Japan
| | - Tetsuya Mikogami
- Lecturer, Department of Clinico-Diagnostic Pathology, Showa University Northern Yokohama Hospital, Diagnostic Pathology, Kanagawa, Japan
| | - Tatsuo Shirota
- Professor, Department of Oral and Maxillofacial Surgery, Showa University School of Dentistry, Tokyo, Japan
| |
Collapse
|
22
|
Ng W, Poon C, Alagaratnam T, Leung E, Yip P, So M. Prognostic Value of Proliferating Cell Nuclear Antigen in Phyllodes Tumor of the Breast. Int J Surg Pathol 2016. [DOI: 10.1177/106689699400200207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The proliferating cell nuclear antigen (PCNA), a nuclear protein essential for cellular DNA synthesis, has been used to assess cellular proliferation in many tumors. To evaluate the potential value of PCNA in predicting the outcome of phyllodes tumor of the breast, we retrospectively studied 17 tumors diagnosed during the period 1985-1991. PC 10, a monoclonal antibody that recognizes PCNA, was applied to for malin-fixed, paraffin-embedded sections. The PCNA index ranged from 0.2% to 66.3%. The tumors were stratified into high (>9.8%, n = 4) or low (≤9.8%, n = 13) PCNA index groups. No significant correlation between high PCNA index and the clinicopath ologic parameters with the exception of infiltrative margin was sound. However, the difference in recurrence-free survival between the two groups was significant (log rank test P < .01). The Cox's regression analysis showed that high PCNA index was an important prognostic factor for tumor recurrence. PCNA staining could be used as an objective prognostic factor for the local recurrence of phyllodes tumor of the breast. Int J Surg Pathol 2(2):125-132, 1994
Collapse
Affiliation(s)
- W.F. Ng
- Department of Pathology, Uni versity of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | | | - P.S.F. Yip
- The Institute of Pathology, Sai Ying Pun Polyclinic, Hong Kong
| | - M.K.P. So
- The Institute of Pathology, Sai Ying Pun Polyclinic, Hong Kong
| |
Collapse
|
23
|
Seijo L, Sidhu J, Mizrachy B, Shafir M, Tartter P, Bleiweiss IJ. Malignant Phyllodes Tumor of the Breast. Int J Surg Pathol 2016. [DOI: 10.1177/106689699500300103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phyllodes tumors of the breast are rare lesions that historically have been presumed to be related to fibroadenomata, largely by virtue of the entities' histologic similarities. We report four cases of malignant phyllodes tumors (cystosarcoma phyllodes) of the breast, three showing liposarcomatous differentiation and one showing chondrosarcomatous and osteosarcomatous differentiation, each of which had demonstrable histologic continuity with benign fibroadenomata; one patient had a prior and concurrent history of multiple bilateral fibroadenomata. We postulate that fibroadenomata and phyllodes tumors (benign, borderline, and malignant) may constitute a spectrum of one stromal disease analogous to mammary epithelial hyperplasia, atypical hyperplasia, in situ, and invasive carcinoma. Int J Surg Pathol 3(1):17-22, 1995
Collapse
Affiliation(s)
- Laura Seijo
- Department of Pathology, The Mount Sinai Medical Center
| | - Jagmohan Sidhu
- Department of Hematology, Division of Cytopathology, The State University of New York Health Sciences Center, Syracuse, New York
| | - Benjamin Mizrachy
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
| | - Michail Shafir
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
| | - Paul Tartter
- Department of Surgery, The Mount Sinai Medical Center, New York, New York
| | | |
Collapse
|
24
|
Lien HC, Huang CS, Yang YW, Jeng YM. MED12 exon 2 mutation as a highly sensitive and specific marker in distinguishing phyllodes tumours from other spindle neoplasms of the breast. APMIS 2016; 124:356-64. [DOI: 10.1111/apm.12516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/17/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Huang-Chun Lien
- Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Pathology; National Taiwan University; Taipei Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery; National Taiwan University Hospital; Taipei Taiwan
| | - Ya-Wen Yang
- Department of Surgery; National Taiwan University Hospital; Taipei Taiwan
| | - Yung-Ming Jeng
- Department of Pathology; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Pathology; National Taiwan University; Taipei Taiwan
| |
Collapse
|
25
|
Lyle PL, Bridge JA, Simpson JF, Cates JM, Sanders ME. Liposarcomatous differentiation in malignant phyllodes tumours is unassociated withMDM2orCDK4amplification. Histopathology 2016; 68:1040-5. [DOI: 10.1111/his.12898] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Pamela L Lyle
- Department of Pathology; Bay Pines VA Health Care System; St Petersburg FL USA
| | - Julia A Bridge
- Departments of Pathology and Microbiology, Pediatrics and Orthopaedic Surgery; Nebraska Medical Center; Omaha NE USA
| | | | - Justin M Cates
- Department of Pathology, Immunology and Microbiology; Vanderbilt University Medical Center; Nashville TN USA
| | - Melinda E Sanders
- Department of Pathology, Immunology and Microbiology; Vanderbilt University Medical Center; Nashville TN USA
| |
Collapse
|
26
|
Lien HC, Huang CS, Yang YW, Jeng YM. Mutational analysis of MED12 exon 2 in a spectrum of fibroepithelial tumours of the breast: implications for pathogenesis and histogenesis. Histopathology 2015; 68:433-41. [PMID: 26109290 DOI: 10.1111/his.12764] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/19/2015] [Indexed: 01/31/2023]
Abstract
AIMS Fibroadenomas (FAs) and phyllodes tumours (PTs) are fibroepithelial tumours. Mutations in MED12 exon 2 have been reported in FAs. This study investigated the MED12 mutations in a spectrum of fibroepithelial tumours. METHODS AND RESULTS Using direct sequencing, we analysed MED12 exon 2 mutations on 121 samples, including PTs and FAs and variants. We found MED12 mutations in 71.4% of PTs. No significant difference in the mutation frequency was observed between benign, borderline and malignant PTs, and a general lack of correlation existed between mutations and pathological factors associated with PT grading. The mutation patterns were similar between PTs and FAs, with codon 44 being involved most frequently. MED12 mutations were identified in 47.1, 52.6 and 50.0% of complex FAs, juvenile FAs and tubular adenomas (TAs), respectively, and the frequency and mutation patterns were similar between these FA variants and usual FAs. CONCLUSIONS The high frequency and similar patterns of MED12 mutations in FAs and various grades of PTs implies that the MED12 mutation is a common and early pathological event in these fibroepithelial tumours. The similar frequency and patterns of the MED12 mutation between FAs and variants suggests that FA variants are bona fide FAs, with identical pathogenesis involving MED12 mutations.
Collapse
Affiliation(s)
- Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Wen Yang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Jeng
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
27
|
Phyllodes tumors in African American women. Am J Surg 2015; 210:74-9. [DOI: 10.1016/j.amjsurg.2014.09.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/30/2014] [Accepted: 09/08/2014] [Indexed: 11/22/2022]
|
28
|
Augustyn A, Sahoo S, Wooldridge RD. Large Malignant Phyllodes Tumor of the Breast with Metastases to the Lungs. Rare Tumors 2015; 7:5684. [PMID: 26266007 PMCID: PMC4508638 DOI: 10.4081/rt.2015.5684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 11/24/2022] Open
Abstract
Phyllodes tumors of the breast account for less than 0.5% of breast cancers and present most commonly in women 45 to 49 years old. The importance in managing fibroepithelial lesions lies in distinguishing fibroadenomas, which are benign, from phyllodes tumors, which can be malignant and require complete surgical excision. We report the case of a 56-year-old female who presented with a rapidly enlarging mass in her right breast 18 cm in maximum dimension that completely effaced the breast and distorted the nipple. The patient underwent a successful total mastectomy after core biopsy revealed a diagnosis of phyllodes tumor. Surgical resection is the primary treatment modality; neoadjuvant and adjuvant therapies remain controversial. Here, we report the case of a large malignant phyllodes tumor metastatic to the lungs, review the literature, and discuss diagnostic modalities and adjunct nonsurgical therapies.
Collapse
Affiliation(s)
- Alexander Augustyn
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Sunati Sahoo
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Rachel D Wooldridge
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center , Dallas, TX, USA
| |
Collapse
|
29
|
Lightner AL, Shurell E, Dawson N, Omidvar Y, Foster N. A Single-center Experience and Review of the Literature: 64 Cases of Phyllodes Tumors to Better Understand Risk Factors and Disease Management. Am Surg 2015. [DOI: 10.1177/000313481508100336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phyllodes tumors of the breast are rare fibroepithelial tumors that are characterized as benign, borderline, or malignant based on cellular characteristics such as stromal overgrowth and number of mitoses. Currently, there is a lack of consensus on risk factors and management of patients with phyllodes tumors, which has led to variation in treatment patterns as well as patient outcomes across many institutions. This study seeks to understand the clinicopathologic features, risk factors for local and metastatic recurrence, and clinical outcomes of patients with phyllodes tumors to better define optimal treatment patterns.
Collapse
Affiliation(s)
- Amy L. Lightner
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Elizabeth Shurell
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Nicole Dawson
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Yasaman Omidvar
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Nova Foster
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| |
Collapse
|
30
|
Yom CK, Han W, Kim SW, Park SY, Park IA, Noh DY. Reappraisal of Conventional Risk Stratification for Local Recurrence Based on Clinical Outcomes in 285 Resected Phyllodes Tumors of the Breast. Ann Surg Oncol 2015; 22:2912-8. [DOI: 10.1245/s10434-015-4395-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Indexed: 11/18/2022]
|
31
|
Roberts N, Runk DM. Aggressive malignant phyllodes tumor. Int J Surg Case Rep 2015; 8C:161-5. [PMID: 25697402 PMCID: PMC4353966 DOI: 10.1016/j.ijscr.2014.12.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/31/2014] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumor of breast could be either benign or malignant variety and they can grow into very large sizes and distort the breast. WHO classifies tumors into benign, borderline and malignant and it is the best methods to predict the local recurrence, distant metastasis or bath after resection. Borderline and malignant disease should have close follow up; as some of these tumors can rapidly change and metastasize.
Introduction Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3–0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount. Presentation of case We present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31 cm in diameter and weighed over 10 kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office. Conclusion Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.
Collapse
Affiliation(s)
- Nathan Roberts
- Jewish Hospital Department of Surgery, 4777 E. Galbraith Road, Cincinnati, OH 45236, USA.
| | - Dianne M Runk
- Jewish Hospital Department of Surgery, 4777 E. Galbraith Road, Cincinnati, OH 45236, USA
| |
Collapse
|
32
|
Giant malignant phyllodes tumour of breast. Case Rep Oncol Med 2014; 2014:956856. [PMID: 25548696 PMCID: PMC4273467 DOI: 10.1155/2014/956856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/05/2014] [Indexed: 11/17/2022] Open
Abstract
The term phyllodes tumour includes lesions ranging from completely benign tumours to malignant sarcomas. Clinically phyllodes tumours are smooth, rounded, and usually painless multinodular lesions indistinguishable from fibroadenomas. Percentage of phyllodes tumour classified as malignant ranges from 23% to 50%. We report a case of second largest phyllodes tumour in a 35-year-old lady who presented with swelling of right breast since 6 months, initially small in size, that progressed gradually to present size. Examination revealed mass in the right breast measuring 36×32 cms with lobulated firm surface and weighing 10 kgs. Fine needle aspiration cytology was reported as borderline phyllodes; however core biopsy examination showed biphasic neoplasm with malignant stromal component. Simple mastectomy was done and specimen was sent for histopathological examination which confirmed the core biopsy report. Postoperatively the patient received chemotherapy and radiotherapy. The patient is on follow-up for a year and has not shown any evidence of metastasis or recurrence.
Collapse
|
33
|
|
34
|
Yasir S, Gamez R, Jenkins S, Visscher DW, Nassar A. Significant histologic features differentiating cellular fibroadenoma from phyllodes tumor on core needle biopsy specimens. Am J Clin Pathol 2014; 142:362-9. [PMID: 25125627 DOI: 10.1309/ajcpzuz96resgpup] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Cellular fibroepithelial lesions (CFELs) are a heterogeneous group of tumors encompassing cellular fibroadenoma (CFA) and phyllodes tumor (PT). Distinction between the two is challenging on core needle biopsy (CNB) specimens. The objective of this study was to evaluate histologic features that can help distinguish PT from CFA on CNB specimens. METHODS Records of all patients diagnosed with CFELs on CNB specimens with follow-up excision between January 2002 and December 2012 were retrieved. Histopathologic stromal features were evaluated on CNB specimens, including mitoses per 10 high-power fields (hpf), overgrowth, increased cellularity, fragmentation, adipose tissue infiltration, heterogeneity, subepithelial condensation, and nuclear pleomorphism. RESULTS Twenty-seven (42.2%) of 64 were diagnosed as PT (24 benign PTs and three borderline PTs) and 37 (57.8%) as CFA on excision. All features except for increased stromal cellularity were statistically significant. The average number of histologic features seen in PT and CFA was 3.9 and 1.4, respectively (odds ratio [OR], 7.27; 95% confidence interval [CI], 2.44-21.69; P = .0004). The average number of mitoses per 10 hpf was 3.0 for PT compared with 0.8 for CFA (OR, 2.14; 95% CI, 1.18-3.86; P = .01). CONCLUSIONS The presence of mitoses (three or more) and/or total histologic features of three or more on CNB specimens were the most helpful features in predicting PT on excision.
Collapse
Affiliation(s)
- Saba Yasir
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Roberto Gamez
- Department of Pathology and Laboratory Medicine, Loyola University, Chicago, IL
| | - Sarah Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Daniel W. Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
35
|
Tudor ECG, Cutress ML, McNeill SA. Seminal vesicle phyllodes tumour treated by transperitoneal laparoscopic resection. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813507255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
36
|
Spitaleri G, Toesca A, Botteri E, Bottiglieri L, Rotmensz N, Boselli S, Sangalli C, Catania C, Toffalorio F, Noberasco C, Delmonte A, Luini A, Veronesi P, Colleoni M, Viale G, Zurrida S, Goldhirsch A, Veronesi U, De Pas T. Breast phyllodes tumor: A review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol 2013; 88:427-36. [DOI: 10.1016/j.critrevonc.2013.06.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/03/2013] [Accepted: 06/12/2013] [Indexed: 11/12/2022] Open
|
37
|
Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat 2013; 141:353-63. [DOI: 10.1007/s10549-013-2684-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
|
38
|
A case of large phyllodes tumor causing "rupture" of the breast: a unique presentation. Case Rep Oncol Med 2013; 2013:871292. [PMID: 23762692 PMCID: PMC3666329 DOI: 10.1155/2013/871292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/28/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. Phyllodes tumors are rare fibroepithelial tumors which constitute less than 1% of all known breast neoplasms. The importance of recognizing these tumors lies in the need to differentiate them from fibroadenomas and other benign breast lesions to avoid inappropriate surgical management. We report a case of large phyllodes tumor which caused rupture of the breast and presented as an external fungating breast mass, a presentation which is exceedingly rare. Case Presentation. A 32-year-old female presented with a 1-year history of a mass in her right breast and eruption of the mass through the skin for the last 3 months. On physical examination, an ulcerated, irregular, and nodular mass measuring 9 × 8 cms was found hanging in the lower and outer quadrant of the right breast. Ultrasonography revealed an exophytic mass with heterogeneous echotexture and vascularity. Under general anesthesia, the tumor was excised. The resected specimen was 9.5 × 8.5 × 4.5 cm in size and the tumor was not invasive to the surrounding tissues. Histological examination confirmed a benign case of Phyllodes tumor. Conclusion. Clinicians should be aware of the myriad ways in which Phyllodes can present. A rapidly growing breast mass in a female should raise strong suspicion for Phyllodes. It is necessary to differentiate it from fibroadenomas to avoid inappropriate surgical management which may lead to local recurrence.
Collapse
|
39
|
Sawalhi S, Al-Shatti M. Phyllodes tumor of the breast: a retrospective study of the impact of histopathological factors in local recurrence and distant metastasis. Ann Saudi Med 2013; 33:162-8. [PMID: 23563006 PMCID: PMC6078618 DOI: 10.5144/0256-4947.2013.162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The challenging issue for the breast surgeons is local recurrence of phyllodes tumor. The histological criteria to predict local recurrence has been a controversial issue. The objective of this study was to determine pathological parameters and surgical margins that influence outcome of local recurrence and distant metastasis in phyllodes tumor (PT). DESIGN AND SETTING Retrospective review between January 2003 to August 2008 at King Hussein Cancer Center-Jordan. PATIENTS AND METHODS Forty-two female patients diagnosed as having PT were classified to benign, borderline and malignant. The medical records were reviewed in relation to the surgical management, recurrence, follow-up, the histological features of the tumor and grading of tumors based on the following histological parameters: mitotic count, stromal cellularity, stromal overgrowth, cellular pleomorphism, nuclear grade, tumor necrosis, tumor margin, and surgical margin status. All patients underwent wide local excision of the tumor or mastectomy. RESULTS Forty-two patients with PT (16 benign, 9 borderline, 17 malignant PT) were followed up for 30 months. The mean age was 39.8 years, and the average tumor size was 6.6 cm. The recurrence rate of PT in our study was 21% at a mean time of 11 months. Nine patients had local recurrence; 2 benign, 6 malignant and 1 borderline. Cellular pleomorphism had correlation with recurrence rate (P=.045). We had six patients (14%) with distant metastasis. All had malignant PT. Metastasis in PT has a relationship with histological grade (P=.02). CONCLUSIONS We conclude that patients with moderate and severe cellular pleomorphism had higher local recurrence, while metastatic PT occur more in patients with high nuclear grade.
Collapse
Affiliation(s)
- Samer Sawalhi
- Department of Surgery- College of Medicine, Taibah University, Al-Madinah 30001, Saudi Arabia.
| | | |
Collapse
|
40
|
Ubiquitin carboxy-terminal hydrolase L1 may be involved in the development of mammary phyllodes tumors. Virchows Arch 2013; 462:155-61. [DOI: 10.1007/s00428-012-1366-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/03/2012] [Accepted: 12/21/2012] [Indexed: 12/22/2022]
|
41
|
Lin CC, Chang HW, Lin CY, Chiu CF, Yeh SP. The clinical features and prognosis of phyllodes tumors: a single institution experience in Taiwan. Int J Clin Oncol 2012; 18:614-20. [DOI: 10.1007/s10147-012-0442-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 06/17/2012] [Indexed: 10/28/2022]
|
42
|
Park HL, Kwon SH, Chang SY, Huh JY, Kim JY, Shim JY, Lee YH. Long-term follow-up result of benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum-assisted breast biopsy. J Breast Cancer 2012; 15:224-9. [PMID: 22807941 PMCID: PMC3395747 DOI: 10.4048/jbc.2012.15.2.224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/20/2012] [Indexed: 01/11/2023] Open
Abstract
Purpose Percutaneous removal of benign breast tumors using ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible and safe method without serious complications. The aim of this study was to evaluate the efficacy and safety of the VABB in the treatment of benign phyllodes tumors, and to identify whether or not surgical re-excision is necessary for benign phyllodes tumors diagnosed and excised by VABB. Methods From January 2003 to December 2011, a total of 6,923 VABB were performed in 5,434 patients. Out of 6,923 lesions, 53 were benign phyllodes tumors. Among these, 31 lesions, with a follow-up period of longer than 24 months, were enrolled in this study. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. The mean follow-up period was 75.9±13.5 months (range, 24-94 months). Results The mean patient age at presentation was 31.6±9.4 years. The mean size of the lesion was 1.60±0.88 cm. The majority of lesions, 74.2% (23 cases), were palpable, and 25.8% (8 cases) were non-palpable. Twenty-two lesions (71.0%) were classified as Breast Imaging Reporting and Data System category 3, and nine lesions (29.0%) were classified as category 4a, by ultrasonography. During the follow-up period, local recurrence developed in one lesion, making the local recurrence rate 3.2%. Conclusion If a benign phyllodes tumor is diagnosed, and sufficiently excised by VABB, observing the clinical course may be considered as an alternative to performing immediate wide local excision; this is the case despite the fact that it would need to be observed for a prolonged period of time.
Collapse
Affiliation(s)
- Hai-Lin Park
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
43
|
Schechet SA, Askenasy EP, Dhamne S, Scott BG. Anemia and jejunal intussusception: An unusual presentation for a metastatic phyllodes breast tumor. Int J Surg Case Rep 2012; 3:62-4. [PMID: 22288047 DOI: 10.1016/j.ijscr.2011.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 10/10/2011] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Phyllodes tumor of the breast is a rare cause of breast cancer, accounting for less than 0.5% of breast cancers. These tumors are classified as benign, borderline, or malignant, with malignant tumors compromising nearly 25% of cases. Metastases occur in 20% of malignant tumors, lungs, bones, liver and brain being the frequent sites of metastases. PRESENTATION OF CASE We present a case of a metastatic phyllodes tumor to the small bowel causing jejunal intussusception, symptomatic anemia, and small bowel obstruction. DISCUSSION Patients with phyllodes tumor of the breast can develop disease recurrence even years after initial treatment. Phyllodes tumor metastasizing to the small bowel is extremely rare, with only three known previously described case reports in the literature. CONCLUSION High risk patients, with a past medical history of phyllodes breast cancer, should be monitored closely. Even years after breast cancer treatment, these patients may present with gastrointestinal complaints such as obstruction or bleeding, and therefore metastatic disease to the small bowel should be considered on the differential with subsequent abdominal imaging obtained.
Collapse
Affiliation(s)
- Sidney A Schechet
- Baylor College of Medicine, Ben Taub General Hospital, Michael E. DeBakey Department of Surgery, 1504 Taub Loop, Houston, TX 77030, United States
| | | | | | | |
Collapse
|
44
|
Harden SV, Ball RY, Harnett AN. Angiosarcoma of the scalp presenting in association with borderline malignant phyllodes tumour of the breast. Sarcoma 2011; 7:173-6. [PMID: 18521383 PMCID: PMC2395529 DOI: 10.1080/13577140310001644823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumours and angiosarcoma are both rare mesenchymal tumours. There are no reports of their coexistence in the
literature except in families with germline p53 mutations. Here we report a case of an elderly woman who developed an
extensive angiosarcoma of the scalp nearly 4 years after surgical removal of a borderline malignant phyllodes tumour of the
breast. The scalp lesion was initially thought more likely to be a metastasis of her first rare tumour than a second equally rare
primary tumour, but histologically this was not the case. The case and the literature are discussed.
Collapse
Affiliation(s)
- Susan V Harden
- Department of Oncology Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY UK
| | | | | |
Collapse
|
45
|
Keratin 15, transcobalamin I and homeobox gene Hox-B13 expression in breast phyllodes tumors: novel markers in biological classification. Breast Cancer Res Treat 2011; 132:143-51. [DOI: 10.1007/s10549-011-1555-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/25/2011] [Indexed: 01/10/2023]
|
46
|
Guillot E, Couturaud B, Reyal F, Curnier A, Ravinet J, Laé M, Bollet M, Pierga JY, Salmon R, Fitoussi A. Management of Phyllodes Breast Tumors. Breast J 2011; 17:129-37. [DOI: 10.1111/j.1524-4741.2010.01045.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
Focus on haematogenous dissemination of the malignant cystosarcoma phylloides: institutional experience. Arch Gynecol Obstet 2010; 283:591-6. [DOI: 10.1007/s00404-010-1746-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/19/2010] [Indexed: 11/30/2022]
|
48
|
Kuo YJ, Ho DMT, Tsai YF, Hsu CY. Invasive ductal carcinoma arising in phyllodes tumor with isolated tumor cells in sentinel lymph node. J Chin Med Assoc 2010; 73:602-4. [PMID: 21093830 DOI: 10.1016/s1726-4901(10)70131-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 05/25/2010] [Indexed: 11/17/2022] Open
Abstract
Phyllodes tumor (PT) consists of stroma of variable grading and benign ductal epithelium. Although exceptional, carcinomas that arise from the epithelium in PTs do exist, and seem to behave less aggressively than the usually encountered breast carcinoma. To the best of our knowledge, among the invasive carcinomas that have arisen in PTs, only 1 has been proved to have metastatic carcinoma in the lymph nodes. Here, we describe the youngest woman to have invasive ductal carcinoma that arose in a borderline PT, with isolated carcinoma cells in the sentinel lymph node. Whether such a combined lesion carries a more indolent course is also discussed.
Collapse
Affiliation(s)
- Ying-Ju Kuo
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, and Department of Pathology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | | | | | | |
Collapse
|
49
|
Molecular classification of breast phyllodes tumors: validation of the histologic grading scheme and insights into malignant progression. Breast Cancer Res Treat 2010; 129:319-29. [DOI: 10.1007/s10549-010-1204-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 09/28/2010] [Indexed: 01/21/2023]
|
50
|
Malignant transformation of breast fibroadenoma to malignant phyllodes tumor: long-term outcome of 36 malignant phyllodes tumors. Breast Cancer 2009; 18:268-72. [DOI: 10.1007/s12282-009-0185-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|