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Khaoula M, Sirine B, Sana M, Eya A, Ghada S, Karima M. Primary breast sarcoma: Case report and literature review. Int J Surg Case Rep 2024; 119:109587. [PMID: 38749389 PMCID: PMC11109321 DOI: 10.1016/j.ijscr.2024.109587] [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: 02/26/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Primary breast sarcoma (PBS), excluding phyllodes tumors, is an extremely rare and heterogeneous group of cancers, accounting for <1 % of all breast cancers. PBS is typically diagnosed in the fifth or sixth decades of life. There are no pathognomonic clinical or radiological features. Diagnosis is generally established through a microbiopsy. For young women, the diagnosis can be confused with a benign pathology. CLINICAL PRESENTATION Our patient was 27 years old, with no family or personal history of breast cancer, which was initially brought to the emergency department with a breast abscess. The clinical diagnosis of abscessed mastitis was made. The patient underwent tissue excision with evacuation of blood clots and necrotic tissue. Histopathological examination revealed a primary breast sarcoma. An MRI showed locally advanced retro-glandular tumor. An abdominal and pelvic CT scan performed showed no evidence of secondary locations. Therefore, the patient was referred for neoadjuvant radiotherapy and chemotherapy. After the third course of chemotherapy, the patient died following cardiogenic shock. DISCUSSION The PBS in younger women is extremely rare. The etiopathogenesis remains undetermined. The clinical and radiological characteristics of PBS mimic breast adenocarcinoma. Mastectomy is the treatment of choice but in the case of locally advanced tumor, the use of neoadjuvant chemotherapy can be indicated. PBS presents a significantly poorer prognosis. CONCLUSION Breast sarcomas are rare malignant tumors for which treatment protocols are not well-established. Further research efforts are needed to improve the understanding and treatment of PBS.
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Affiliation(s)
- Magdoud Khaoula
- Emergency Department, Maternity And Neonatology Center, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - Bayar Sirine
- Department of Gynecology, Maternity and Neonatology Center, Tunis, Tunisia
| | - Menjli Sana
- Department of Gynecology, Maternity and Neonatology Center, Tunis, Tunisia
| | - Azouz Eya
- Department of Radiology, Rabta Hospital, Tunis, Tunisia
| | - Sahraoui Ghada
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; Department of Histology, Salah Azaiez Instate, Tunisia
| | - Mrad Karima
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia; Department of Histology, Salah Azaiez Instate, Tunisia
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Bouguerra F, Belajouza SK, Mziou E, Zanzouri R, Chahdoura H, Tbessi S, Bouzid N, Mrad ST. Primary breast sarcomas: A 13 case-series study treated in university hospital in central Tunisia over a 25-year period. Breast Dis 2024; 43:51-59. [PMID: 38552108 DOI: 10.3233/bd-230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
AIM To retrospectively study the therapeutic modalities of primary breast sarcomas in view of the data of a local Tunisian experience. METHODS It is a monocentric, descriptive, retrospective study including 13 cases of primary breast sarcoma treated over a period of 25 years (1995-2020) in the oncological radiotherapy department of a university hospital in Sousse, Tunisia. RESULTS In our study, 13 cases of non-metastatic breast sarcomas that has been identified, divided into ten cases of phyllodes sarcomas and three cases of non-phyllodes sarcomas.Surgically, all our patients had a mastectomy. Among them, seven underwent a lymph node procedure: five underwent axillary lymph node dissection, and two others had primary axillary lymph node biopsy. For the adjuvant treatment, all the patients included in our study received radiotherapy and seven received chemotherapy. Local recurrence occurred on the operative scar in one patient after completion of radiation therapy. Metastatic relapse was described in five patients. The time to onset of metastases varied between two months and five years. Nevertheless, a complete remission was noted in 6 patients with a follow-up varying from four years to 20 years. Two patients were lost to follow-up. CONCLUSION Breast sarcomas remain a very rare entity of aggressive tumors.The therapeutic approach is poorly codified. For this reason, the therapeutic decision should always be discussed in a multidisciplinary assessment.
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Affiliation(s)
- Fadoua Bouguerra
- Radiotherapy Oncology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Samia Kanoun Belajouza
- Radiotherapy Oncology Department, Farhat Hached University Hospital, Sousse, Tunisia
- Ibn El Jazzar Faculty of Medicine, Sousse, Tunisia
| | - Emna Mziou
- Prevention and Care Safety Department, Sahloul University Hospital, Sousse, Tunisia
| | - Rym Zanzouri
- Radiotherapy Oncology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Hayfa Chahdoura
- Radiotherapy Oncology Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Sabrine Tbessi
- Radiotherapy Oncology Department, Farhat Hached University Hospital, Sousse, Tunisia
- Ibn El Jazzar Faculty of Medicine, Sousse, Tunisia
| | - Nadia Bouzid
- Radiotherapy Oncology Department, Farhat Hached University Hospital, Sousse, Tunisia
- Ibn El Jazzar Faculty of Medicine, Sousse, Tunisia
| | - Sameh Tebra Mrad
- Radiotherapy Oncology Department, Farhat Hached University Hospital, Sousse, Tunisia
- Ibn El Jazzar Faculty of Medicine, Sousse, Tunisia
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Țigăran AE, Abu-Baker A, Ion DE, Peligrad T, Gheoca-Mutu DE, Avino A, Anghel AW, Balcangiu-Stroescu AE, Toma A, Răducu L. Extremely Rare Type of Breast Cancer-Dedifferentiated Breast Liposarcoma-Diagnosis and Treatment. J Pers Med 2023; 13:1451. [PMID: 37888062 PMCID: PMC10608349 DOI: 10.3390/jpm13101451] [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: 09/07/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Primary liposarcoma of the breast is an uncommon soft tissue malignant tumor, comprising only 0.003% of all malignant breast tumors. The main differential diagnosis of this mass consists of malignant phyllodes tumor and metaplastic breast carcinoma. The objective of this paper is to report a case of dedifferentiated breast liposarcoma, therapeutic approach and outcome. We present a case of a 79-year-old woman complaining of a large mass in her left breast which had increased in size over the last 6 months. Physical examination revealed an enlarged left breast, and a total body CT scan showed a large tumor in contact with the musculature of the anterior thoracic wall, with no metastatic lesions. The histopathology report of a fine needle biopsy described a high-grade sarcoma. The Oncological Tumor Board recommended neoadjuvant radiotherapy sessions and reevaluation by MRI and CT scans. The patient underwent radical mastectomy with latissimus dorsi myo-cutaneous flap reconstruction. The final histopathology diagnosis was a grade 3 dedifferentiated liposarcoma (FNCLCC), with certain response to radiotherapy and positive MDM2, CDK4 markers. The postoperative period was uneventful; 12 months after surgery, the follow-up CT scan showed multiple pulmonary lesions with metastatic characteristics. Liposarcoma is a very rare type of breast cancer, and the most important treatment for breast sarcoma is surgery, the role of axillary lymph node removal, chemotherapy and radiotherapy still being controversial. Considering such cases are scarce and the development of surgical guidelines is difficult, reporting any new case is crucial.
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Affiliation(s)
- Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
| | - Abdalah Abu-Baker
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Discipline of Anatomy, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Discipline of Plastic Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Andrei-Wilhelm Anghel
- Department of Radiotherapy, Elias University Emergency Hospital, 011461 Bucharest, Romania;
- Department of Radiotherapy, MedEuropa, 022343 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Anca Toma
- Department of Anatomic Pathology, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania;
| | - Laura Răducu
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Discipline of Plastic Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania
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Liu N, Kang Y, Qu N, Kong C, Han Y. Clinical perspectives and outcomes of the giant breast phyllodes tumor and sarcoma: a real-world retrospective study. BMC Cancer 2023; 23:801. [PMID: 37635229 PMCID: PMC10463853 DOI: 10.1186/s12885-023-11279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Giant breast malignant phyllodes tumor or sarcoma (GBPS) are rare entities with diameter larger than 10 cm and variously histological pleomorphisms. This disease poses a significant threat to the quality of life of individuals, and its prognosis remains unclear. This study aimed to explore the differential diagnosis, treatment, and prognosis of GBPS in a real-world retrospective cohort. METHODS We collected GBPS (diameter > 10 cm, n = 10) and BPS (diameter ≤ 10 cm, n = 126) from patients diagnosed with sarcoma or malignant phyllodes tumor between 2008 and 2022. We analyzed clinical characteristics, histological status, treatment, and local recurrence using the Fisher's exact test between GBPS (diameter > 10 cm) and BPS (diameter ≤ 10 cm) cohort. We described overall survival (OS) and disease-free survival (DFS) using Kaplan-Meier curves and identified risk factors for local recurrence using logistic regression. The tumor size, age at diagnosis, and differential immunohistochemistry markers of breast sarcoma or phyllodes tumor to determine the prognosis of GBPS. RESULTS In our retrospective analysis of breast malignancies, we identified 10 cases of GBPS and 126 cases of BPS, corresponding to a GBPS prevalence of 0.17% (10/6000). The median age was 38.5 years (inter-quartile range, IQR: 28.25-48.5 years). During the follow-up of period (median: 80.5 months, IQR: 36.75-122 months), the local recurrence (LR) rate was 40% and 20.6%, respectively. Clinical characteristics of young age (HR:2.799, 95%CI -00.09276-0.017, p < 0.05) and cytological characteristics of marked stromal atypia (HR:0.88, 95% CI 0.39-1.40, p < 0.05) were risk factors for the poor prognosis of GBPS by COX regression model analysis. The Kaplan-Meier curves of GBPS 5-year disease-free survival (DFS) and overall survival (OS) were 31.5 months and 40 months, respectively, and were not associated with adjuvant radiation or chemotherapy. CONCLUSION We recommend mastectomy with a clear surgical margin as the preferred treatment for GBPS. Age and stromal atypia are significantly associated with recurrence. Adjuvant radiation therapy is advised; however, there was no improvement in overall survival. There is no consensus on the effectiveness of adjuvant chemotherapy and genetic methods, highlighting the need for further research into this aggressive tumor. We recommend a multidisciplinary approach involving a dedicated team for the management of GBPS.
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Affiliation(s)
- Naiquan Liu
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Ye Kang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Ningxin Qu
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Chenhui Kong
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Ye Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Žatecký J, Coufal O, Fabian P, Holánek M, Sehnálková E, Burkoň P. Primary Breast Sarcoma: A Two-Centre Analysis and Review of Literature. Breast Care (Basel) 2023; 18:262-269. [PMID: 37900556 PMCID: PMC10601702 DOI: 10.1159/000530934] [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: 08/23/2022] [Accepted: 04/28/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Primary breast sarcoma is a very rare malignant type of breast tumours with an incidence of 0.1% of all primary breast malignancies. Methods We present a retrospective analysis of the case series from two hospitals in the Czech Republic with a review of the diagnostic and treatment approach to primary breast sarcomas with an analysis of published prognostic factors. Results Eleven patients were included in the study, 9 women and 2 men. Statistical evaluation revealed that tumour size (p = 0.1964), grade (p = 0.1667), margin distance (p = 0.5403), mitotic activity (p = 0.8577), or age (p = 0.7822) were not prognostic factors in our cohort. Conclusion The analysis did not prove any of the factors, such as age, tumour size, grade, or mitotic activity, to be statistically significant prognostic factors. Based on the literature review, the most common published prognostic factors are tumour size, margin status, and grade, but the results are ambiguous.
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Affiliation(s)
- Jan Žatecký
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Surgery, Silesian Hospital in Opava, Opava, Czech Republic
- The Institute of Paramedical Health Studies, Faculty of Public Policies, Silesian University, Opava, Czech Republic
| | - Oldřich Coufal
- Department of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Surgical Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pavel Fabian
- Department of Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Miloš Holánek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Sehnálková
- The Institute of Paramedical Health Studies, Faculty of Public Policies, Silesian University, Opava, Czech Republic
- Department of Pathology, Silesian Hospital in Opava, Opava, Czech Republic
| | - Petr Burkoň
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Li W, Fang K, Chen J, Deng J, Li D, Cao H. The application of clinical variable-based nomogram in predicting overall survival in malignant phyllodes tumors of the breast. Front Genet 2023; 14:1133495. [PMID: 37323673 PMCID: PMC10265739 DOI: 10.3389/fgene.2023.1133495] [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: 12/29/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background: We aimed to explore prognostic risk factors in patients with malignant phyllodes tumors (PTs) of the breast and construct a survival prediction model. Methods: The Surveillance, Epidemiology, and End Results database was used to collect information on patients with malignant breast PTs from 2004 to 2015. The patients were randomly divided into training and validation groups using R software. Univariate and multivariate Cox regression analyses were used to screen out independent risk factors. Then, a nomogram model was developed in the training group and validated in the validation group, and the prediction performance and concordance were evaluated. Results: The study included 508 patients with malignant PTs of the breast, including 356 in the training group and 152 in the validation group. Univariate and multivariate Cox proportional hazard regression analyses showed that age, tumor size, tumor stage, regional lymph node metastasis (N), distant metastasis (M) and tumor grade were independent risk factors for the 5-year survival rate of patients with breast PTs in the training group (p < 0.05). These factors were used to construct the nomogram prediction model. The results showed that the C-indices of the training and validation groups were 0.845 (95% confidence interval [CI] 0.802-0.888) and 0.784 (95% CI 0.688-0.880), respectively. The calibration curves of the two groups were close to the ideal 45° reference line and showed good performance and concordance. Receiver operating characteristic and decision curve analysis curves showed that the nomogram has better predictive accuracy than other clinical factors. Conclusion: The nomogram prediction model constructed in this study has good predictive value. It can effectively assess the survival rates of patients with malignant breast PTs, which will aid in the personalized management and treatment of clinical patients.
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Affiliation(s)
- Wei Li
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Kun Fang
- Department of Surgery, Yinchuan Maternal and Child Health Hospital, Yinchuan, China
| | - Jiaren Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jian Deng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Dan Li
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Hong Cao
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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Chu X, Wu M, Yang J, Fu Y, Wang X, Wang H, Xiao Y, Chen D, He J. Organoid models derived from patients with malignant phyllodes tumor of the breast. Breast Cancer Res Treat 2023:10.1007/s10549-023-06973-5. [PMID: 37204665 DOI: 10.1007/s10549-023-06973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Phyllodes tumor of the breast is a kind of rare neoplasm, which accounts for less than 1% of all breast tumors. Malignant phyllodes tumor (MPT) is the highest risk subtype of phyllodes tumor, and is characterized by the tendency of local recurrence and distant metastasis. The prediction of prognosis and the individual therapy for MPT is still challenging. It's urgent to develop a new reliable in vitro preclinical model in order to understand this disease better and to explore appropriate anticancer drugs for individual patients. METHODS Two surgically resected MPT specimens were processed for organoid establishment. MPT organoids were subsequently subjected to H&E staining, immunohistochemical analysis and drug screening, respectively. RESULTS We successfully established two organoid lines from different patients with MPT. The MPT organoids can well retain the histological features and capture the marker expression in original tumor tissues, including p63, vimentin, Bcl-2, CD34, c-Kit, and Ki-67, even after a long-term culture. The dose titration tests of eight typical chemotherapeutic drugs (paclitaxel, docetaxel, vincristine, doxorubicin, cisplatin, gemcitabine, cyclophosphamide, ifosfamide) on the two MPT organoid lines showed patient-specific drug responses and varying IC50 values. Of all the drugs, doxorubicin and gemcitabine showed the best anti-tumor effect on the two organoid lines. CONCLUSION Organoids derived from MPT may be a novel preclinical model for testing personalized therapies for patients with MPT.
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Affiliation(s)
- Xinyu Chu
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Ming Wu
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Jianbo Yang
- Department of the Cancer Center, Fujian Medical University Union Hospital, Fuzhou, 350000, Fujian, China
- Department of Otolaryngology | The Immunotherapy Research Laboratory, University of Minnesota, Minneapolis, MN, 55421, USA
| | - Yang Fu
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Xuewei Wang
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Huan Wang
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yang Xiao
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Dong Chen
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
| | - Jinsong He
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China.
- Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
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Breast Sarcoma Incidence Rate: A National Study in Iran. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-120247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Breast sarcomas are a group of rare and non-epithelial malignancies that account for less than 1% of breast cancers. There are few epidemiologic studies on this type of cancer due to its rarity. Methods: In this study, the database of the Iran National Cancer Registry (INCR) from March 2009 to March 2014 was used to calculate the age-specific incidence rate for breast sarcoma in Iran. Moreover, age-standardized incidence rate (ASR) for pathologic subtypes, pathologic grades, and different regions of the country were determined. Results: Totally, 258 breast sarcoma patients were included in this study in Iran. The ASR of breast sarcoma was 1.17 (95% CI: 1.02, .32) and 0.60 (95% CI: 0.52, 0.67) per million person-years for women and the total population, respectively. ASR was 0.03 (95%CI: 0.01, 0.06) per million person-years for male patients. The highest age-specific incidence rate for malignant phyllodes was observed among patients aged 55 to 59 years (1.0; 95% CI: 0.5, 1.5), and for other sarcomas, it was found among those aged 70 to 74 years (0.9; 95% CI: 0.2, 1.6). The most prevalent pathologic grade of sarcoma was grade 3 with an ASR of 0.40 (95% CI: 0.34, 0.46) per million person-years. Conclusions: Compared to western countries, Iran has a lower incidence of breast sarcoma in women, a higher incidence rate in men, and older onset age. As in other countries, malignant phyllodes tumors and angiosarcomas are the most common subtypes. In addition, breast sarcoma incidence rates in different grades are similar across countries.
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Ji Y, Zhong Y, Zheng Y, Hu H, Min N, Wei Y, Geng R, Hong C, Guan Q, Li J, Wang Z, Zhang Y, Li X. Surgical management and prognosis of phyllodes tumors of the breast. Gland Surg 2022; 11:981-991. [PMID: 35800748 PMCID: PMC9253188 DOI: 10.21037/gs-21-877] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/15/2022] [Indexed: 02/28/2024]
Abstract
BACKGROUND Regardless of histological grade, phyllodes tumors (PTs) exhibit the potential of local recurrence. The National Comprehensive Cancer Network (NCCN) recommends wide local excision (WLE) with a 1 cm margin or more for borderline/malignant PTs but excisional biopsy for benign PTs. However, the treatment of benign PTs remains controversial and the clinicopathologic risk factors for the local recurrence is still unclear. METHODS We retrospectively analyzed 238 patients with PTs who underwent surgery at the Chinese PLA General Hospital from January 1, 2006 and April 30, 2020. We stratified our analysis according to histologic grade and explored the clinicopathologic factors to influence local recurrence (LR), including age, histologic grade, history of fibroadenoma, type of surgery [vacuum-assisted biopsy system (VABS), local excision (LE), wide local excision (WLE) and mastectomy]. RESULTS All 238 cases were categorized as benign (171, 71.8%), borderline (38, 16.0%), or malignant (29, 12.2%). The median follow-up was 50.2 months. In multivariate analysis, histologic grade (P<0.01) and history of fibroadenoma (P<0.01) were independent prognostic factors for LR. No difference existed in the recurrence rate of BPT treated with different surgical procedures (P=0.397), whereas a higher recurrence rate was found in VABS and LE subgroups than in WLE and mastectomy subgroups for borderline/malignant tumors (P<0.01). CONCLUSIONS No association found between surgical modalities and LR rate for BPT. We suggested a "wait-and-watch" policy for patients with unexpected benign subtypes, instead of unnecessary re-excision. In addition, VABS or LE can be treated for BPT with small mass, whereas WLE or even mastectomy should be conducted for borderline/malignant PTs with large mass.
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Affiliation(s)
- Yashuang Ji
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yuting Zhong
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yiqiong Zheng
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Huayu Hu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Rui Geng
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Chenyan Hong
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jie Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhili Wang
- Department of Ultrasound, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yanjun Zhang
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
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Cubas Farinha N, Teixeira W, Roque D, Livraghi S. Large mirror brain metastases from primary undifferentiated sarcoma of the breast: case report and review of the literature. CNS Oncol 2022; 11:CNS85. [PMID: 35535978 PMCID: PMC9134969 DOI: 10.2217/cns-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Primary breast sarcomas are rare high-grade tumors with a reported incidence of <1% of breast malignancies. Its dissemination to the CNS is exceptional and only one is found in the literature. The authors described the case of a 22-year-old female with history of a breast undifferentiated sarcoma that present with two large bilateral retrolenticular brain metastases. Both lesions were excised in the same procedure and she underwent adjuvant therapy. She died 24 months after surgery. Despite being aggressive lesions, aggressive treatment of primary breast sarcomas including brain metastases excision, should be considered in order to improve overall survival.
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Affiliation(s)
- Nuno Cubas Farinha
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Wilson Teixeira
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Diogo Roque
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Sergio Livraghi
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
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11
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Gutnik L, Ren Y, Thomas SM, Plichta JK, Greenup RA, Fayanju OM, Hwang ES, Rosenberger LH. Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast. J Surg Oncol 2022; 125:947-957. [PMID: 35179788 PMCID: PMC8995353 DOI: 10.1002/jso.26820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated the association of surgery and therapies with OS. METHODS We utilized the National Cancer Database (2004-2016). Patients without surgery, unknown surgery, or margins, or Stage IV disease were excluded. Kaplan-Meier curves and Cox proportional hazards models were used to estimate unadjusted and adjusted OS, respectively. RESULTS A total of 3209 (59.5%) MP, and 2185 (40.5%) PBS were identified. Despite a larger median tumor size in MP (46 vs. 40 mm PBS, p < 0.001), lumpectomy rate was higher for MP (52.9% vs. 27.0% PBS, p < 0.001). Compared to MP, PBS patients more frequently received radiation (28.9% vs. 24%), and chemotherapy (28.1% vs. 4%), both p < 0.001. Unadjusted OS was lower for PBS (57% vs. 85% MP, log-rank p < 0.001). PBS (vs. MP) had persistently worse survival (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.69-2.31) after adjustment. Receipt of adjuvant therapies was not associated with OS (either neoplasm); however, lumpectomy was associated with improved OS (vs. mastectomy) for both PBS (HR: 0.59, 95% CI: 0.50-0.75) and MP (HR: 0.65, 95% CI: 0.53-0.81). Positive margins had no association with OS for MP (HR: 1.09, 95% CI: 0.75-1.60), but was associated with worse survival for PBS (HR: 2.35, 95% CI: 1.82-3.02). DISCUSSION We found significant survival differences between MP and PBS, with PBS having a consistently worse OS. Our findings support surgery as the mainstay of treatment for both tumor types and suggest that lumpectomy may be a reasonable option for select patients without compromising outcomes.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yi Ren
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Jennifer K Plichta
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rachel A Greenup
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - E Shelley Hwang
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura H Rosenberger
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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12
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Lee JS, Chang J, Hagemann IS, Bennett DL. Malignant Phyllodes Tumor: Imaging Features With Histopathologic Correlation. JOURNAL OF BREAST IMAGING 2021; 3:703-711. [PMID: 38424928 DOI: 10.1093/jbi/wbab065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Indexed: 03/02/2024]
Abstract
Phyllodes tumors (PT) are rare fibroepithelial lesions of the breast that commonly present as rapidly enlarging, palpable masses. Phyllodes tumors may be classified as benign, borderline, or malignant on the basis of histopathologic analysis. Although malignant PT cannot be distinguished from benign PT on the basis of imaging findings alone, studies suggest that malignant PT tend to be larger and irregular in shape, and they are less likely to have circumscribed margins. If biopsy results are indeterminate, excisional biopsy should be performed. Malignant PT can be difficult to distinguish histologically from sarcomas and spindle cell metaplastic breast carcinoma; the distinction is important for prognosis and treatment. Malignant PT are treated surgically with wide local excision, without a clear role for adjuvant radiation or chemotherapy in most cases. Nearly one-third of malignant PT recur locally, usually within a few years after initial diagnosis. Distant metastatic disease is rare, and the five-year overall survival rate of malignant PT is close to 80%. The purpose of this article is to review the clinical presentation, imaging appearance, histopathology, and management of malignant PT.
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Affiliation(s)
- Jane S Lee
- Washington University School of Medicine, Department of Pathology and Immunology, St. Louis, MO, USA
| | - Jodie Chang
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
| | - Ian S Hagemann
- Washington University School of Medicine, Department of Pathology and Immunology, St. Louis, MO, USA
| | - Debbie L Bennett
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
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13
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Khalid IB, Parvaiz MA, Sarwar A, Shaikh OS, Javed N, Fatima A. A leafy surprise: Case report of male breast malignant phyllodes. Int J Surg Case Rep 2021; 88:106536. [PMID: 34715464 PMCID: PMC8577468 DOI: 10.1016/j.ijscr.2021.106536] [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: 09/22/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Phyllodes tumor is a biphasic fibroepithelial tumor which accounts for less than 1% of all breast neoplasms. We aim to raise awareness among clinicians that a male breast lump may be indicative of underlying sinister pathology and therefore, should be investigated thoroughly. CASE PRESENTATION A 62 year old male presented in clinic with right beast lump for the last 6 weeks. A preoperative diagnosis of spindle cell tumor was made on core needle biopsy. Neoadjuvant chemotherapy was administered in order to downsize the tumor as it was inseparable from underlying muscle. A post-operative diagnosis of malignant phyllodes was made following mastectomy. As the tumor was 1 mm from the deep margin, adjuvant radiotherapy was administered. CLINICAL DISCUSSION Differential diagnoses of malignant phyllodes include metaplastic carcinomas metastatic/primary sarcomas and fibroadenomas. Metaplastic carcinomas are morphologically heterogeneous and include adenosquamous carcinoma, squamous cell carcinoma and spindle cell carcinoma. In some malignant phyllodes, extensive stromal proliferation can make detection of epithelial component very difficult. This highlights the limitation of core biopsy in establishing an accurate preoperative diagnosis. The standard treatment for phyllodes treatment is surgical resection with margins of 1 cm or more. Adjuvant radiotherapy is used in cases with threatened margins. CONCLUSION Malignant phyllodes tumor of breast can exist in men, and its accurate pre-operative diagnosis is difficult given the limitations of core biopsy. This case report draws attention to the challenges associated with the diagnosis of this rare condition and highlights the role of different treatment modalities in its management.
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Affiliation(s)
- Ibtissam Bin Khalid
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
| | - Muhammad Asad Parvaiz
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan
| | - Albash Sarwar
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
| | - Omair Shahid Shaikh
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
| | - Nida Javed
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan
| | - Arooj Fatima
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan
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14
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Rakha E, Toss M, Quinn C. Specific cell differentiation in breast cancer: a basis for histological classification. J Clin Pathol 2021; 75:76-84. [PMID: 34321225 DOI: 10.1136/jclinpath-2021-207487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/03/2022]
Abstract
Breast parenchyma progenitor cells show a high degree of phenotypic plasticity reflected in the wide range of morphology observed in benign and malignant breast tumours. Although there is evidence suggesting that all breast cancer (BC) arises from a common epithelial progenitor or stem cell located at the terminal duct lobular units (TDLUs), BC shows a broad spectrum of morphology with extensive variation in histological type and grade. This is related to the complexity of BC carcinogenesis including initial genetic changes in the cell of origin, subsequent genetic and epigenetic alterations and reprogramming that occur at various stages of BC development and the interplay with the surrounding microenvironment, factors which influence the process of differentiation. Differentiation in BC determines the morphology, which can be measured using histological grade and tumour type. Histological grade, which measures the similarity to the TDLUs, reflects the degree of differentiation whereas tumour type reflects the type of differentiation. Understanding BC phenotypic differentiation facilitates the accurate diagnosis and histological classification of BC with corresponding clinical implications in terms of disease behaviour, prognosis and management plans. In this review, we highlight the potential pathways that BC stem cells follow resulting in the development of different histological types of BC and how knowledge of these pathways impacts our ability to classify BC in diagnostic practice. We also discuss the role of cellular differentiation in producing metaplastic and neuroendocrine carcinomas of the breast and how the latter differ from their counterparts in other organs, with emphasis on clinical relevance.
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Affiliation(s)
- Emad Rakha
- School of Medicine, The University of Nottingham, Nottingham, UK
| | - Michael Toss
- School of Medicine, The University of Nottingham, Nottingham, UK
| | - Cecily Quinn
- Histopathology, St. Vincent's Hospital, Dublin, Ireland.,Belfield, University College Dublin - National University of Ireland, Dublin, Ireland
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15
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Rakha EA, Quinn CM, Foschini MP, Muñoz Martin M, Dabbs DJ, Lakhani S, Varga Z, Pinder SE, Schmitt FC, Reis-Filho JS, Fox SB, Ellis IO, Tan PH, Mihai R. Metaplastic carcinomas of the breast without evidence of epithelial differentiation: a diagnostic approach for management. Histopathology 2020; 78:759-771. [PMID: 33113154 DOI: 10.1111/his.14290] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
AIMS Although rare, malignant sarcomatoid breast tumours without evidence of epithelial differentiation comprise a diagnostic challenge with management implications. Earlier studies have generally considered these to be primary breast sarcomas; however, supporting evidence is lacking and management remains variable. This study aimed to provide an evidence-based approach to improve the consistency of diagnosis and management for such cases. METHODS AND RESULTS A large series (n = 140) of metaplastic breast carcinoma (MBC) diagnosed in Nottingham over 18 years was analysed. Only cases with available data on immunohistochemical expression of cytokeratins (CKs) were included. The prevalence and pattern of expression for various CKs were assessed and details of tumours negative for CKs were collected. A diagnostic approach based on our experience is provided. Forty-seven cases (34%) showed foci of conventional type invasive breast carcinoma or ductal carcinoma in situ (DCIS), while 93 cases (66%) were diagnosed as MBC based on morphology and/or CK expression. Ninety-seven cases (69%) were negative for one or more CKs, with 18 cases (13%) negative for five or more CKs. Eight cases (6%) lacked expression of all CKs tested. Further examination showed evidence of carcinomatous nature in five cases, and three were diagnosed as MBC following extensive diagnostic work-up and based on our experience. CONCLUSION This study suggests that MBC represents a spectrum of neoplasms, with some lacking CK expression. Sarcomatoid neoplasms of the breast lacking evidence of carcinomatous morphology and CK expression may represent an extreme end of differentiation that can be considered as carcinomas rather than sarcomas for management purposes (following extensive work-up).
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Cecily M Quinn
- Department of Histopathology, St Vincent's University Hospital, University College, Dublin, Ireland
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology at Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Monica Muñoz Martin
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - David J Dabbs
- John A. Burns University of Hawaii Cancer Center, Honolulu, HI, USA.,Department of Pathology, Magee-Women's Hospital of UPMC, Pittsburgh, PA, USA
| | - Sunil Lakhani
- Faculty of Medicine and Pathology Queensland, University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Zsuzsanna Varga
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Sarah E Pinder
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology (IPATIMUP) and Medical Faculty, University of Porto, Porto, Portugal
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Stephen B Fox
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ian O Ellis
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Puay-Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Raluca Mihai
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
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16
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Koh VCY, Ng CCY, Bay BH, Teh BT, Tan PH. The utility of a targeted gene mutation panel in refining the diagnosis of breast phyllodes tumours. Pathology 2019; 51:531-534. [PMID: 31272781 DOI: 10.1016/j.pathol.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Valerie Cui Yun Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore; Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Boon Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Puay Hoon Tan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Medical School, Singapore; Division of Pathology, Singapore General Hospital, Singapore.
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17
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Carl HM, Calotta NA, Siotos C, Bos TJ, Foster DG, Manahan MA, Cooney CM, Sacks JM, Rosson GD. Reconstruction options and outcomes for breast sarcoma patients. Breast J 2019; 25:702-705. [PMID: 31025484 DOI: 10.1111/tbj.13243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 05/24/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
Breast sarcomas constitute a rare and heterogeneous group of tumors. Given their aggressive nature and the potential for extensive resections, rates of reconstruction have been low. We retrospectively reviewed subjects derived from our institutional registry presented between 2003 and 2015. Thirty-four patients with primary breast sarcoma were identified. The average age was 51.9 years and the average follow-up was 58 months. The most common histological type was malignant phyllodes (61.8%). Two patients suffered cancer recurrence. Twelve patients (35.3%) underwent reconstruction. Four underwent implant-based reconstruction, seven had autologous-based reconstruction, and one had combined reconstruction. Major complications were one flap loss and one implant removal. Our relatively high rates of breast reconstruction suggest a newly increased willingness to offer reconstruction to this rarer patient population.
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Affiliation(s)
- Hannah M Carl
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas A Calotta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Charalampos Siotos
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Tobias J Bos
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Dennis G Foster
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Michele A Manahan
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
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18
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Chao X, Chen K, Zeng J, Bi Z, Guo M, Chen Y, Yao Y, Wu W, Liang S, Nie Y. Adjuvant radiotherapy and chemotherapy for patients with breast phyllodes tumors: a systematic review and meta-analysis. BMC Cancer 2019; 19:372. [PMID: 31014268 PMCID: PMC6480723 DOI: 10.1186/s12885-019-5585-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/05/2019] [Indexed: 12/03/2022] Open
Abstract
Background As the efficacy of radiotherapy and chemotherapy for treatment of phyllodes tumors (PTs) remains unclear, this study aimed to review all available data and evaluate the roles of radiotherapy and chemotherapy in PT treatment. Methods We performed a comprehensive search of databases, including PubMed, Web of Science and the Cochrane Library. The outcomes of interest included the local recurrence (LR) rate, metastasis rate, disease-free survival rate and overall survival rate. Results Seventeen studies enrolling 696 patients were included in this random effect meta-analysis. Subgroup analysis and meta-regression were also conducted to determine study heterogeneity. A pooled local recurrence rate of 8% (95% CI: 1–22%) was observed with a statistical heterogeneity of I2 = 86.6% (p < 0.01) for radiotherapy. This was lower than the recurrence rate of 12% for simple surgical treatment (95% CI: 7–18%). Meta-regression analysis found that surgical margin status was the main source of heterogeneity (p = 0.04). The metastasis rate of 4% (95% CI: 0–11%) for patients receiving radiotherapy without significant heterogeneity was also lower than the rate for the simple surgery group (8, 95% CI: 3–15%). The available data for chemotherapy were too limited to support meta-analysis. Accordingly, we offer a pure review of these data. Conclusion Our findings suggest that radiotherapy is effective in achieving local disease control and preventing metastasis. Electronic supplementary material The online version of this article (10.1186/s12885-019-5585-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xue Chao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jiayi Zeng
- Guangzhou Zhixin High School, 152 Zhixin South Road, Guangzhou, 510120, People's Republic of China
| | - Zhuofei Bi
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Mingyan Guo
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Yi Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Yandan Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Wei Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Shi Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Yan Nie
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China. .,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.
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19
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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: 85] [Impact Index Per Article: 17.0] [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.
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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.
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20
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Genomic profile of breast sarcomas: a comparison with malignant phyllodes tumours. Breast Cancer Res Treat 2018; 174:365-373. [DOI: 10.1007/s10549-018-5067-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 01/04/2023]
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Expression of EMT markers and mode of surgery are prognostic in phyllodes tumors of the breast. Oncotarget 2018; 8:33365-33374. [PMID: 28380418 PMCID: PMC5464874 DOI: 10.18632/oncotarget.16497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/27/2017] [Indexed: 02/06/2023] Open
Abstract
Phyllodes tumors of the breast are rare neoplasms that account for <1% of all mammary tumors and 2-3% of fibro-epithelial neoplasms of the breast. We evaluated the clinicopathological characteristics of a cohort of 246 Chinese patients in relation to the expression of epithelial-to-mesenchymal (EMT) markers in benign, borderline and malignant tumors and the prognostic value of different surgical regimens. We observed that survival outcomes correlated with the mode of surgical management in the three patient groups. Expression of E-cadherin, Snail, Slug and Twist were higher in epithelial cells from borderline and malignant tumors than those in benign tumors, whereas the expression of N-cadherin was opposite. Levels of the EMT markers Snail and Slug in the stromal compartment increased with the advancing tumor grade. Expression of mesenchymal stem cell markers contributed to the inherent heterogeneity in the malignant tumors. Based on Cox models, surgical management emerged as an independent predictor for disease-free survival, whereas a history of recent growth and tumor grade were independent predictors for overall survival. These findings show that expression of EMT markers, the mode of surgical management, and a history of recent tumor growth had prognostic potential for patients with phyllodes tumors of the breast.
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Abstract
RATIONALE Phyllodes tumors (PT) of the breast are rare neoplasm originating from fibroepithelial component. To our knowledge, our report is the first reported case of PT in 2 sisters. PATIENT CONCERNS We presented 2 cases of PT of the breast involving in 2 sisters. On physical examination of the younger sister, a firm mass measuring approximately 3 cm in diameter was identified in upper inner quadrant of the right breast. Physical examination of the elder sister revealed a 3 cm lump in upper outer quadrant of the left breast. DIAGNOSES Histopathology of the younger sister revealed a malignant PT. The elder sister was diagnosed with borderline PT. INTERVENTIONS The younger sister with malignant PT underwent right mastectomy. The elder sister with borderline PT was scheduled for wide resection of the mass in the left breast. OUTCOMES After a follow-up of 23 months, no local or distant recurrence was observed. LESSONS Our cases indicate that genetic factor may contribute to the risk of PT of the breast. Markers such as p53 and Ki-67 may have some correlation with PT malignancy.
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Affiliation(s)
| | | | | | | | - Xiaoqin Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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El Amine Elhadj O, Nasri M, Thabet S, Ben Hassouna J, Goucha A, Rahal K, Elmay A, Gamoudi A. [Primary breast sarcomas: About 30 cases treated at Salah-Azaiez institute in Tunisia]. Cancer Radiother 2017; 21:45-50. [PMID: 28223032 DOI: 10.1016/j.canrad.2016.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/01/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify retrospectively prognostic factors of primary breast sarcoma and review its treatment modalities. MATERIALS AND METHODS This is a descriptive study on 30 cases of primary breast sarcoma. We carried out a univariate and multivariate analysis correlating clinical, pathological and therapeutic parameters with disease-free survival and overall survival. RESULTS The mean age was 46.8 years. The mean tumour size was 10cm. The 30 cases were 18 phyllodes sarcomas, eight angiosarcomas, three liposarcomas and a case of granulocytic sarcoma. Sixteen patients had adjuvant radiotherapy and only seven patients received adjuvant chemotherapy. The median follow-up was 64 months. Overall survival rates at 3 and 5 years were 49.1% and 33.7%. Disease-free survival rates at 3 and 5 years were 22.8% and 15.2% respectively. The analytical study of the following parameters: tumour size and presence or absence of node or distant metastases, showed no correlation with overall survival nor with disease-free survival. Furthermore, adjuvant radiotherapy did not improve overall survival (P=0.298; hazard ratio [HR]=1 [0.982-1.04]) nor disease-free survival (P=0.61; HR=0.942 [0.862-1.029]). By univariate analyses, we identified a correlation between overall survival, surgical margins (>1cm) (P=0005; HR=3.4 [1.217-9.919]) and tumour necrosis (P=0.028; HR=0.099 [0.014-0.682]). We did not find any independent prognostic factor by multivariate analysis. CONCLUSION The prognosis of primary breast sarcoma seems to depend essentially on optimal surgical excision (margin over 1cm). The only potential histological parameter correlated with the prognosis is the presence of tumour necrosis. The histological subtype should not be considered as a prognostic marker for overall or disease-free survival in patients with primary breast sarcoma.
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Affiliation(s)
- O El Amine Elhadj
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie.
| | - M Nasri
- Service d'oncologie médicale, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - S Thabet
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - J Ben Hassouna
- Service de chirurgie carcinologique, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - A Goucha
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - K Rahal
- Service de chirurgie carcinologique, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - A Elmay
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
| | - A Gamoudi
- Service d'immuno-histocytologie, institut Salah-Azaiez, boulevard 9-avril, 1006 Bab-Saadoun, Tunis, Tunisie
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Zhang Y, Kleer CG. Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates. Arch Pathol Lab Med 2017; 140:665-71. [PMID: 27362571 DOI: 10.5858/arpa.2016-0042-ra] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm with risks of local recurrence and uncommon metastases. The classification proposed by the World Health Organization for PTs into benign, borderline, and malignant is based on a combination of several histologic features. The differential diagnosis between PT and fibroadenoma and the histologic grading of PT remain challenging. In addition, the molecular pathogenesis of PT is largely unknown. OBJECTIVE -To provide an updated overview of pathologic features, diagnostic terminology, and molecular alterations of PT. DATA SOURCES -Current English literature related to PT of the breast. CONCLUSIONS -Phyllodes tumor shows a wide spectrum of morphology. There are no clearly distinct boundaries between PT and fibroadenoma. Strict histologic assessment of a combination of histologic features with classification can help to achieve the correct diagnosis and provide useful clinical information. The genomic landscapes of PT generated from genomic sequencing provide insights into the molecular pathogenesis of PT and help to improve diagnostic accuracy and identify potential drug targets in malignant PT.
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Affiliation(s)
- Yanhong Zhang
- From the Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento (Dr Zhang); and the Department of Pathology, University of Michigan, Ann Arbor (Dr Kleer)
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Tremblay-LeMay R, Hogue JC, Provencher L, Poirier B, Poirier É, Laberge S, Diorio C, Desbiens C. How Wide Should Margins Be for Phyllodes Tumors of the Breast? Breast J 2016; 23:315-322. [DOI: 10.1111/tbj.12727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemarie Tremblay-LeMay
- Département de biologie moléculaire, biochimie médicale et pathologie; Université Laval; Quebec City Quebec Canada
| | - Jean-Charles Hogue
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Louise Provencher
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Brigitte Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Éric Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Sophie Laberge
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
- Service de Pathologie; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Caroline Diorio
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
| | - Christine Desbiens
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
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Ramalho I, Campos S, Rebelo T, Figueiredo Dias M. A Scary Onset of a Rare and Aggressive Type of Primary Breast Sarcoma: A Case Report. Case Rep Oncol 2016; 9:796-801. [PMID: 28101028 PMCID: PMC5216215 DOI: 10.1159/000452946] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022] Open
Abstract
Primary breast sarcoma, arising from connective tissue within the breast, is extremely rare, accounting for less than 1% of all primary breast malignancies and no more than 5% of all sarcomas. The rarity of this pathology limits most studies to case reports and small retrospective studies, which has led to a lack of consensus on the clinical management. We report a clinical case of a 52-year-old woman, perimenopausal, previously healthy, with regular breast surveillance, who presented with a large (>20 cm) and rapidly expanding hypervascularized tumor of the left breast developed over 10 days, with a very thin preulcerative skin over the last 4 days. There was no systemic dissemination. The patient was submitted to total mastectomy and excision of axillary adenopathy. The tumor was diagnosed histologically as malignant phyllodes tumor associated with areas of high-grade sarcoma. Due to rapid growth and aggressive histological characteristics, adjuvant chemotherapy and radiotherapy were performed. There is a lot of evidence that tumors larger than 5 cm are associated with a poor prognosis. Despite the poor prognosis associated with this aggressive entity, the patient had no recurrence during 5 years of follow-up. We review the relevant literature about primary breast sarcomas.
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Affiliation(s)
- Inês Ramalho
- Gynecology A Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sara Campos
- Gynecology A Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Rebelo
- Gynecology A Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Breast sarcomas and malignant phyllodes tumours: comparison of clinicopathological features, treatment strategies, prognostic factors and outcomes. Breast Cancer Res Treat 2016; 159:229-44. [DOI: 10.1007/s10549-016-3946-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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28
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Pasta V, Monti M, Cialini M, Vergine M, Urciuoli P, Iacovelli A, Rea S, D'Orazi V. Primitive sarcoma of the breast: new insight on the proper surgical management. J Exp Clin Cancer Res 2015; 34:72. [PMID: 26219853 PMCID: PMC4518869 DOI: 10.1186/s13046-015-0190-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primitive sarcoma of the breast is a rare and challenging disease at high risk of recurrence and with poor prognosis. There are controversies in the diagnosis and management of such solid tumor due to its rarity and heterogeneity. This sarcoma is poorly responsive to both chemotherapy and radiotherapy, thus, surgery is the first and most important therapeutic approach. However, given the rarity of this type tumor it has not be possible to standardize unique guidelines for the proper surgical strategy to adopt. Here, we performed a retrospective study of new 10 cases of primitive sarcoma of the breast that underwent either mastectomy or a more conservative quadrantectomy, in the attempt to better standardize correct surgical indications. METHODS Ten new cases of primitive sarcoma of the breast were registered between 2002 and 2012 and constituted the study group. They underwent either mastectomy or quadrantectomy and the clinical, prognostic and survival characteristics after surgery were analysed. RESULTS Within the group of patients treated with mastectomy, two had metastasis and died because of that. Among the five patients treated with quadrantectomy four are alive and free of disease after 3 to 5 years follow-up, while the patient with sarcoma arising in pregnancy, although is still alive, developed lung metastases four years after surgery. CONCLUSIONS The first and most important therapeutic approach to primary sarcomas of the breast is surgical which has the purpose to achieve radical tumor excision to prevent local recurrence and skip metastases. However, given the rarity of the condition and the consequent small number of cases in this, like in similar studies, it is not possible to draw any definitive conclusions and further studies with larger numbers are necessary. However it would appear that performing a larger procedure such as mastectomy rather than performing a more limited one such as a quadrantectomy, has no advantage in terms of overall prognosis.
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Affiliation(s)
- Vittorio Pasta
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Massimo Monti
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Michela Cialini
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Via Olevano Romano 25, 00171, Rome, Italy.
| | - Massimo Vergine
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Paolo Urciuoli
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Annunziata Iacovelli
- Department of Gynecology, "Fabia Mater" Hospital, Via Olevano Romano 25, 00171, Rome, Italy.
| | - Silvio Rea
- Department of Surgical Oncology, University of L'Aquila, Via Vetoio località Coppito, 67100, L'Aquila, Italy.
| | - Valerio D'Orazi
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Via Olevano Romano 25, 00171, Rome, Italy.
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