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Li W, Ou Q, Li Y, Yuan LY. Malignant phyllodes tumor of the breast with predominant osteosarcoma and chondrosarcomatous differentiation: a rare case report and review of literature. Front Oncol 2024; 14:1372710. [PMID: 38706594 PMCID: PMC11066275 DOI: 10.3389/fonc.2024.1372710] [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: 01/18/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Phyllodes tumors (PTs), which account for less than 1% of mammary gland tumors, composed of both epithelial and stromal components. If a malignant heterologous component is encountered, PT is considered malignant. Malignant phyllodes tumors (MPTs) only account for 8% to 20% of PTs. We report a case of MPT with osteosarcoma and chondrosarcoma differentiation and review the literature to discuss the differential diagnosis and therapy. Case presentation A 59-year-old Chinese woman come to our hospital because of a palpable mass she had had for 1 months in the left breast. Preoperative core needle biopsy (CNB) was performed on the left breast mass on January 11, 2023. Pathological diagnosis was malignant tumor, the specific type was not clear. Mastectomy and sentinel lymph node biopsy of the left breast was performed. No metastasis was found in 3 sentinel lymph nodes identified by carbon nanoparticles and methylene blue double staining. Heterologous osteosarcoma and chondrosarcomatous differentiation of phyllodes tumor were observed. Immunohistochemistry: spindle tumor cells ER(-), PR(-), HER-2(-), CK-pan(-), CK7(-), CK8(-), SOX10(-), S100(-), and MDM2(-), CK5/6(-), P63(-), P40(-) were all negative. CD34:(+), SATB2(+), P53(90% strong), CD68 (+), Ki-67(LI: about 60%). No ductal carcinoma in situ was found in the breast. Fluorescence in situ hybridization (FISH) indicated USP6 was negatively expressed on formalin-fixed, paraffin-embedded (FFPE) tissue sections. Conclusion MPTs are rare, and heterologous differentiation in MPTs is exceedingly rare. It could be diagnosed by pathology when metaplastic carcinoma, primary osteosarcoma, or myositis ossificans were excluded. This case could help clinicians to improve the prognosis and treatment of this disease.
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Affiliation(s)
- Wenfang Li
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qin Ou
- Department of Pathology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, Hebei, China
| | - Yingdong Li
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Linlin Yuan Yuan
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Lerwill MF, Lee AHS, Tan PH. Fibroepithelial tumours of the breast-a review. Virchows Arch 2021; 480:45-63. [PMID: 34505197 DOI: 10.1007/s00428-021-03175-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/08/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
Fibroepithelial tumours of the breast are biphasic neoplasms composed of both epithelial and stromal elements, including the common fibroadenoma and the infrequent phyllodes tumour. The admixture of epithelium and stroma in the fibroadenoma shows intra- and pericanalicular patterns, and may display a variety of histological changes. Fibroadenoma variants include the cellular, juvenile, myxoid and complex forms. The cellular fibroadenoma may be difficult to distinguish from the benign phyllodes tumour. Stromal mitotic activity can be increased in fibroadenomas in the young and pregnant patients. Phyllodes tumours, neoplasms with the potential for recurrence, show an exaggerated intracanalicular growth pattern with broad stromal fronded architecture and stromal hypercellularity. They are graded into benign, borderline and malignant forms based on histological assessment of stromal features of hypercellularity, atypia, mitotic activity, overgrowth and the nature of the tumour borders. Classification of phyllodes tumours is imperfect, compounded by tumour heterogeneity with overlapping microscopic features among the different grades, especially in the borderline category. Malignant phyllodes tumours can metastasise and cause death. Determining which phyllodes tumours may behave aggressively has been difficult. The discovery of MED12 mutations in the pathogenesis of fibroepithelial tumours, together with other gene abnormalities in the progression pathway, has allowed refinements in diagnosis and prognosis.
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Affiliation(s)
- Melinda F Lerwill
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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3
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Tan BY, Md Nasir ND, Chang HY, Ng CCY, Guan P, Nagarajan S, Rajasegaran V, Lee JY, Lim JQ, Thike AA, Teh BT, Tan PH. Morphologic and genetic heterogeneity in breast fibroepithelial lesions-a comprehensive mapping study. Mod Pathol 2020; 33:1732-1745. [PMID: 32322022 DOI: 10.1038/s41379-020-0533-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 02/01/2023]
Abstract
Breast fibroepithelial lesions (FELs) encompass the common fibroadenoma (FA) and relatively rare phyllodes tumour (PT); the latter entity is usually classified as benign, borderline or malignant. Intratumoural heterogeneity is frequently present in these tumours, making accurate histologic evaluation challenging. Despite their rarity, PTs are an important clinical problem due to their propensity for recurrence and, in the case of malignant PT, metastasis. Surgical excision is the mainstay of management. Recent work has uncovered myriad genetic alterations in breast FELs. In this study, exome sequencing was performed on seven cases of morphologically heterogeneous breast FELs, including FAs, PTs of all grades, and a case of metaplastic spindle cell carcinoma arising in PT, in order to elucidate their intratumoural genetic repertoire. Gene mutations identified encompassed cell signalling, tumour suppressor, DNA repair and cell cycle regulating pathways. Mutations common to multiple tumour regions generally showed higher variant allele frequency. Frequent mutations included MED12, TP53, RARA and PIK3CA. Histological observations of increased cellular density and pleomorphism correlated with mutational burden. Phylogenetic analyses revealed disparate pathways of possible tumour progression. In summary, histological heterogeneity correlated with genetic changes in breast FELs.
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Affiliation(s)
| | - Nur Diyana Md Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | - Cedric Chuan Young Ng
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Peiyong Guan
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore.,Quantitative Biology and Medicine Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Sanjanaa Nagarajan
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Jing Yi Lee
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Quan Lim
- Lymphoma Genomic Translational Laboratory, National Cancer Centre Singapore, Singapore, Singapore
| | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Bin Tean Teh
- Duke-NUS Medical School, Singapore, Singapore. .,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore.
| | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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Zhang T, Feng L, Lian J, Ren WL. Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report. World J Clin Cases 2020; 8:3591-3600. [PMID: 32913869 PMCID: PMC7457108 DOI: 10.12998/wjcc.v8.i16.3591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Phyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.
CASE SUMMARY A 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.
CONCLUSION This case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.
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Affiliation(s)
- Ting Zhang
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Liang Feng
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Jie Lian
- Department of Pathology, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Wei-Li Ren
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
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Johnson ED, Gulbahce E, McNally J, Buys SS. Malignant Phyllodes Tumor Presenting in Bone, Brain, Lungs, and Lymph Nodes. Case Rep Oncol 2017; 9:861-868. [PMID: 28203179 PMCID: PMC5260605 DOI: 10.1159/000453660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Phyllodes tumors (PTs) are rare fibroepithelial tumors of the breast which are classified as benign, borderline, or malignant. Malignant PTs account for <1% of malignant breast tumors, and borderline tumors have potential to progress to malignant tumors. Metastatic recurrences are most commonly documented in bone and lungs. We report an extremely rare presentation of recurrent malignant PTs involving the brain, lung, lymph nodes, and bone. Case A 66-year-old female presented with a large breast mass. Biopsy identified malignant PT, treated by mastectomy. One year later she presented with acute back pain; imaging showed pathological L4 spinal compression fracture. Core biopsy confirmed PT. Staging identified additional metastases in the lymph nodes, brain, and lung. Discussion PTs are rare and fast-growing tumors that originate from periductal stromal tissues and are composed of both epithelial and stromal components. Histologically, they are classified as benign, borderline, or malignant. The prognosis of the malignant type is poorly defined, with local recurrence occurring in 10–40% and metastases in 10%. Chemotherapy and radiotherapy are generally ineffective in this tumor type. The most common metastatic sites for malignant cases are the lung and bones, but in rare instances, PTs may metastasize elsewhere. Conclusion We report a rare presentation of recurrent malignant PT presenting as pathological fracture of the lumbar spine with impingement on the spinal column, along with cerebellar, nodal, and pulmonary metastases. Only 1 similar case has been previously reported.
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Affiliation(s)
- Eric D Johnson
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Evin Gulbahce
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph McNally
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Saundra S Buys
- Huntsman Cancer Institute at the University of Utah School of Medicine, Salt Lake City, UT, USA
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Konstantinova AM, Vanecek T, Martinek P, Kyrpychova L, Spagnolo DV, Stewart CJR, Portelli F, Michal M, Kazakov DV. Molecular alterations in lesions of anogenital mammary-like glands and their mammary counterparts including hidradenoma papilliferum, intraductal papilloma, fibroadenoma and phyllodes tumor. Ann Diagn Pathol 2017. [PMID: 28648934 DOI: 10.1016/j.anndiagpath.2017.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Lesions affecting anogenital mammary-like glands (AGMLG) are histopathologically very similar to those seen in the breast but whether this morphological similarity is also reflected at the genetic level is unknown. To compare the underlying molecular mechanisms in lesions of AGMLG and their mammary counterparts, we analyzed the mutational profile of 16 anogenital neoplasms including 5 hidradenomas papilliferum (HP), 1 lesion with features of HP and fibroadenoma (FA), 7 FA, 3 phyllodes tumors (PhT)) and 18 analogous breast lesions (6 intraductal papillomas (IDP), 9 FA, and 3 PhT) by high-coverage next generation sequencing (NGS) using a panel comprising 50 cancer-related genes. Additionally, all cases were analyzed for the presence of a mutation in the MED12 gene. All detected mutations with allele frequencies over 20% were independently validated by Sanger sequencing (concordance: 100%). Mutations in PIK3CA, AKT1, MET, ABL1 and TP53 genes were found in lesions of AGMLG and also their mammary counterparts. The PI3K-AKT cascade plays a role in tumors arising at both sites. It appears that some histopathologically similar anogenital and breast lesions develop along similar molecular pathways.
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Affiliation(s)
- Anastasia M Konstantinova
- Department of Pathology, Clinical research and practical center for specialized oncological care, Saint-Petersburg, Russia; Department of Pathology, Medical Faculty, Saint-Petersburg State University, Russia; Department of Pathology, Medico-Social Institute, St.-Petersburg, Russia
| | - Tomas Vanecek
- Departments of Pathology, Charles University, Medical Faculty and Charles University Hospital, Pilsen, Czech Republic; Department of Molecular Genetics, Bioptical Laboratory Ltd., Pilsen, Czech Republiс
| | - Petr Martinek
- Departments of Pathology, Charles University, Medical Faculty and Charles University Hospital, Pilsen, Czech Republic; Department of Molecular Genetics, Bioptical Laboratory Ltd., Pilsen, Czech Republiс
| | - Liubov Kyrpychova
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Dominic V Spagnolo
- PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia; University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, WA, Australia
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | | | - Michal Michal
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic; Bioptical Laboratory, Pilsen, Czech Republic.
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