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Sain B, Gupta A, Ghose A, Halder S, Mukherjee V, Bhattacharya S, Mondal RR, Sen AN, Saha B, Roy S, Boussios S. Clinico-Pathological Factors Determining Recurrence of Phyllodes Tumors of the Breast: The 25-Year Experience at a Tertiary Cancer Centre. J Pers Med 2023; 13:jpm13050866. [PMID: 37241036 DOI: 10.3390/jpm13050866] [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: 03/17/2023] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence. AIMS AND OBJECTIVES This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors associated with a recurrence of PTs of the breast. METHODOLOGY A retrospective cohort and observational study was conducted, which entailed analyzing the clinicopathological data of patients who were previously diagnosed or presented with PTs of the breast between 1996 and 2021. Data included the total number of patients diagnosed with PTs of the breast and their ages, tumor grade on initial biopsy, tumor location (left or right breast), tumor size, therapeutic interventions carried out (including surgery-either mastectomy or lumpectomy-and adjuvant radiotherapy), final tumor grade, recurrence status, type of recurrence, and time to recurrence. RESULTS We analyzed data on a total of 87 patients who were pathologically proven to have PTs, and 46 patients (52.87%) were found to have recurrences. All patients were female, with a mean age at diagnosis of 39 years (range 15-70). Patients aged <40 years had the highest incidence of recurrence, with a rate of 54.35% (n = 25/46), followed by patients aged >40 years, with a rate of recurrence of 45.65% (n = 21/46). A total of 55.4% of patients presented with primary PTs and 44.6% had recurrent PTs at presentation. The average time to local recurrence (LR) from the completion of treatment was 13.8 months, whereas for systemic recurrence (SR), it was 15.29 months. Surgery (mastectomy/lumpectomy) was the major determinant for local recurrence (p < 0.05). CONCLUSION Patients who received adjuvant radiotherapy (RT) had a minimal recurrence of PTs. Patients who were found to have a malignant biopsy on initial diagnosis (triple assessment) had a higher incidence of PTs and were more prone to SR than LR. Surgery was a determining factor in the increased rate of LR, with lumpectomy associated with a higher incidence of LR than mastectomy.
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Affiliation(s)
- Baijaeek Sain
- Department of Trauma & Orthopaedics, Imperial College London Healthcare NHS Trust, London W2 1NY, UK
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Arnab Gupta
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Aruni Ghose
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London SG1 4AB, UK
- Department of Medical Oncology, Barts Cancer Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London E1 1BB, UK
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
| | - Sudip Halder
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Vishal Mukherjee
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Samir Bhattacharya
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Radha Raman Mondal
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Aditya Narayan Sen
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Bijan Saha
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Shravasti Roy
- Department of Pathology, Saroj Gupta Cancer Centre and Research Institute, Kolkata 700001, India
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
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Ibrahimpur SS, Phulpagar M, Jatale A, Pandya JS. Phyllodes tumour initially diagnosed as keloid. BMJ Case Rep 2023; 16:e250546. [PMID: 37130642 PMCID: PMC10163419 DOI: 10.1136/bcr-2022-250546] [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: 05/04/2023] Open
Abstract
It is unusual to find a breast tumour in a keloid, as the management of both is distinct. In this case, a young woman was operated on 4 years ago, for a right chest wall swelling, situated near the inframammary fold. The histopathological report revealed a granuloma, for which anti-tuberculosis treatment was given. However, the swelling recurred and progressed in size over the next 3 years. Then, she consulted the dermatology department, where the swelling was managed as a keloid. There was no remission. Consequently, the possibility of a breast tumour was suspected, and the patient was referred to breast services (subdivision of the surgery department).Triple assessment of the breast lump was suggestive of a phyllodes tumour (PT). Surgical excision of the tumour was done, which showed a malignant PT. Radiotherapy was given and delayed breast reconstruction was planned.
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Affiliation(s)
| | - Mayura Phulpagar
- Department of Pathology, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Ashish Jatale
- General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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Muacevic A, Adler JR, Alrefaie M. Giant Malignant Phyllode Tumor: A Case Report. Cureus 2022; 14:e33016. [PMID: 36721620 PMCID: PMC9879734 DOI: 10.7759/cureus.33016] [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] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Phyllodes are an uncommon type of fibroepithelial neoplasm of the breast, which account for only 0.3 to 0.5% of all breast neoplasms. Management requires complete surgical excision with negative margins. Giant phyllode tumors portray a surgical challenge because complete surgical excision with negative margins is vital to reduce local recurrence and metastatic spread. Here, we report a case of giant malignant phyllode tumor, approached with wide local excision and negative margins were successfully achieved. The purpose behind this paper is to report the patient's clinical history, presentation, intra-operative and histopathological findings, accompanied by a literature review to determine the significance of this finding and the approach in management.
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Duckworth LA, Hoda R, Komforti MK, Rowe JJ, Downs-Kelly E, McIntire PJ. Re-Classification with Outcome Correlation of Previously Diagnosed Malignant Phyllodes Tumors Applying the 2016 Consensus Guidelines. Int J Surg Pathol 2022:10668969221106105. [PMID: 35786083 DOI: 10.1177/10668969221106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Classification of phyllodes tumors is challenging due unclear diagnostic criteria, recently addressed by consensus review criteria. Herein, we reviewed all malignant phyllodes tumor resections and reclassified them based on the consensus guidelines, correlating with outcome. We hypothesize that application of criteria would result in a significant proportion being "down-graded" to either borderline or benign phyllodes tumor. Methods. Primary resections of malignant phyllodes tumor were reviewed by four AP board-certified, breast fellowship-trained pathologists. Morphologic variables delineated in consensus guidelines (ie stromal cellularity, cellular atypia, tumor border, presence of heterologous elements, presence of stromal overgrowth) were evaluated. Following review, cases were reclassified as benign, borderline, or malignant. Results. Upon reclassification, 20% (5/20) cases were "down-graded" to borderline phyllodes tumor while 80% (15/20) remained malignant phyllodes tumor. Two morphologic features were statistically significant including broadly infiltrating tumor border in 80% (12/15) of malignant phyllodes tumors compared to none in borderline phyllodes tumor (0/5) (p = 0.004) and stromal overgrowth in 67% (10/15) of malignant phyllodes tumor compared to none in borderline phyllodes tumors (0/5) (p = 0.03). Upon review of the pathology reports, 30% (6/20) contained all 5 histomorphologic variables delineated in the consensus review criteria. Malignant phyllodes tumor resulted in five cases with recurrence (33.3%, 5/15) and three cases with metastases (20.0%, 3/15) and borderline phyllodes tumor resulted in one case with recurrence (20.0%, 1/5) and no metastases (0/5). Conclusion. The consensus guidelines for phyllodes tumor are useful for subclassification. We hypothesize that standardize reporting of the histomorphologic variables may lead to better consensus.
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Affiliation(s)
- Lauren A Duckworth
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, 9500 Euclid Ave L25, Cleveland, OH 44195, USA
| | - Raza Hoda
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, 9500 Euclid Ave L25, Cleveland, OH 44195, USA
| | - Miglena K Komforti
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, 9500 Euclid Ave L25, Cleveland, OH 44195, USA
| | - J Jordi Rowe
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, 9500 Euclid Ave L25, Cleveland, OH 44195, USA
| | - Erinn Downs-Kelly
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, 9500 Euclid Ave L25, Cleveland, OH 44195, USA
| | - Patrick J McIntire
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, 9500 Euclid Ave L25, Cleveland, OH 44195, USA
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Ofri A, Stuart KE, Chan B, Mak C, Warrier S, Bhadri V, Mander-Jones T, O'Toole S. Diagnosis and management of phyllodes tumours for the surgeon: An algorithm. Surgeon 2022; 20:e355-e365. [PMID: 35148937 DOI: 10.1016/j.surge.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
A Phyllodes Tumour (PT) is an uncommon fibroepithelial lesion, with three histological grades - benign, borderline and malignant. PTs cause significant challenges in diagnosis, management and prognostication. Recent publications have clarified the definitions and prognostication of PTs. Contemporary data currently challenge international guidelines on PT management. We performed an in-depth literature review to develop a best-practice management algorithm for PTs. Diagnostic recommendations are that neither current imaging techniques, nor fine-needle biopsies, can reliably diagnose a PT. Core needle biopsy is the optimal diagnostic technique. Indeterminate or suspicious lesions are recommended to undergo an excisional biopsy due to the inherently heterogeneous nature of PTs. Management guidelines are that benign PTs should be completely excised, although an involved margin is acceptable in select situations. Borderline PTs should have a clear margin on excision due to their higher risk of recurrence, as well as the potential for a recurrence to progress to a malignant PT. In malignant PTs, a margin of 3 mm is acceptable as there is no reduction in recurrence risk if margins are >3 mm. Routine axillary surgery is not indicated in PTs, with axillary surgery only indicated in a histologically-confirmed positive axilla. Adjuvant treatment recommendations are that borderline and malignant PTs should be discussed at MDT, with radiotherapy considered in both. Chemotherapy should be discussed in malignant PT patients. In summary, we have developed an up-to-date simple algorithm to guide the surgeon's management of patients diagnosed with PTs and reduce excessive surgery.
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Affiliation(s)
- Adam Ofri
- Department of Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kirsty E Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, 166-174 Hawkesbury Rd, Westmead, NSW 2145, Australia; Westmead Breast Cancer Institute, Block F/189 Cnr Hawkesbury & Darcy Rd, Westmead, NSW 2145, Australia; Western Clinical School, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Belinda Chan
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Strathfield Private Hospital, 3 Everton Rd, Strathfield, NSW 2135, Australia
| | - Cindy Mak
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia; Mater Hospital, 25 Rocklands Rd, North Sydney, NSW 2060, Australia
| | - Sanjay Warrier
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia
| | - Vivek Bhadri
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Tim Mander-Jones
- Department of Radiology, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW 2139, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sandra O'Toole
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia; The Kinghorn Cancer Centre and Cancer Research Division, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, NSW 2010, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Johns Hopkins Dr, Camperdown, NSW 2050, Australia; Western Sydney University, Campbelltown, NSW 2560, Australia
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Mustață L, Gică N, Botezatu R, Chirculescu R, Gică C, Peltecu G, Panaitescu AM. Malignant Phyllodes Tumor of the Breast and Pregnancy: A Rare Case Report and Literature Review. Medicina (B Aires) 2021; 58:medicina58010036. [PMID: 35056344 PMCID: PMC8780966 DOI: 10.3390/medicina58010036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Phyllodes Tumor (PT) is a rare fibroepithelial breast tumor that can behave differently depending on its biologic features. Traditionally, PTs are classified by their histologic features into benign, borderline, and malignant. In most cases that were reported, all PTs may recur, but only the borderline and malignant PT can metastasize. PT usually occurs as a breast lump or accidental finding on ultrasound (US) examination. The clinical features include a well-defined breast mass, regular or lobulated. The diagnosis is based on the integration of morphology features, but remains challenging, particularly in the distinction from fibroadenomas. We report a case of a 36-year-old patient who presented for a voluminous breast mass, rapidly growing in the past 3–4 months. At presentation, the patient was 19 weeks pregnant. The breast tumor had the clinical and US aspect of PT. A core needle biopsy was obtained, confirming a benign PT, and local excision was performed with no postoperative complications. The final pathology report showed a borderline PT with close resection margins of 1 mm. Immunohistochemistry (IHC) established the diagnosis of malignant PT with heterologous sarcomatous differentiation. The case was discussed in the multidisciplinary tumor board (MDT) and mastectomy was recommended. The patient fully consented but refused surgery at 25 weeks’ gestation, fearing premature delivery. The right breast was closely monitored by US, and at 9 weeks after the first surgery, signs of local recurrence were detected. At 35 weeks’ gestation, right mastectomy was performed, with no perioperative complications. The pregnancy was closely followed up and no complication were found. The final pathology report describes multiples PT recurrences with heterologous sarcomatous differentiation. The pregnancy outcome was uneventful, and the patient delivered a healthy child vaginally at term with no peripartum complication. Postpartum, a computer tomography (CT) examination of the head, thorax, abdomen and pelvis was performed, with no evidence of metastases. Adjuvant chemotherapy and radiotherapy completed the treatment. The follow-up and CT scan showed no metastases or further recurrence 4 years after diagnosis. In conclusion, diagnosis of PT can be difficult, especially because of the easy confusion with fibroadenoma of the breast. There are rare cases when a pathology exam needs further assessment and IHC is recommended for accurate diagnosis. Although malignant PT is rare and accounts for <1% of all breast cancers, the diagnosis and treatment that are recommended are based on the reported cases. Moreover, when complete surgical excision is achieved, the rates of recurrence and distant metastases are low, and adjuvant therapy might not be necessary.
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Affiliation(s)
- Laura Mustață
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania; (L.M.); (R.B.); (C.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania;
| | - Nicolae Gică
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania; (L.M.); (R.B.); (C.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania;
- Correspondence:
| | - Radu Botezatu
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania; (L.M.); (R.B.); (C.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania;
| | | | - Corina Gică
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania; (L.M.); (R.B.); (C.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania;
| | - Gheorghe Peltecu
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania; (L.M.); (R.B.); (C.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania;
| | - Anca Maria Panaitescu
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania; (L.M.); (R.B.); (C.G.); (G.P.); (A.M.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania;
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Reinisch M, Kuemmel S, Breit E, Theuerkauf I, Harrach H, Schindowski D, Moka D, Bettstetter M, Bruzas S, Chiari O. Two progressed malignant phyllodes tumors of the breast harbor alterations in genes frequently involved in other advanced cancers. Orphanet J Rare Dis 2021; 16:363. [PMID: 34399808 PMCID: PMC8365991 DOI: 10.1186/s13023-021-01986-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
Background The genomic landscape of phyllodes tumors (PTs) of the breast is not well defined, especially in patients with advanced disease. To shed light on this topic, paired primary and progressed tumor samples from two patients with malignant PTs were subjected to next-generation sequencing (NGS) followed by functional analysis of genetic alterations using two prediction tools. Methods The DNA of both the primary tumor and distant metastases of Patient 1 and the primary and recurrent tumor of Patient 2 were subjected to molecular profiling. NGS with the FoundationOne® assay was performed in a commercial molecular pathology laboratory. Two in silico prediction tools were used to estimate the pathogenicity of indicated genetic alterations. Results In total, 38 genomic alterations were detected, of which 11 were predicted to be probably benign. In Patient 1, 14 aberrations were identified in the primary tumor and 17 in pulmonary metastases, 12 of which were identical. In the primary and recurrent tumor of Patient 2, 17 and 15 sequence variants, respectively, were found, with 13 overlapping findings. Affected genes included seven (TP53, TERT, APC, ARID1A, EGFR, KMT2D, and RB1) of the top 10 most frequently altered genes in other advanced cancer entities, as well as four actionable therapeutic targets (EGFR, KIT, PDGFRA, and BRIP1). Of note, seven genes coding for receptor tyrosine kinases were affected: three in Patient 1 and four in Patient 2. Several genes (e.g. EPHA3, EPHA7, and EPHB1) were shown to be altered for the first time in PTs. Conclusions The two progressed malignant PTs investigated here share some of the major genetic events occurring in other advanced cancers. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01986-z.
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Affiliation(s)
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, 45136, Essen, Germany.,Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, 10117, Berlin, Germany
| | | | | | - Hakima Harrach
- Breast Unit, Kliniken Essen-Mitte, 45136, Essen, Germany
| | | | - Detlef Moka
- Nuclear Medicine Centre, 45136, Essen, Germany
| | - Marcus Bettstetter
- Teilgemeinschaftspraxis Molekularpathologie Südbayern, 81539, München, Germany
| | - Simona Bruzas
- Breast Unit, Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Ouafaa Chiari
- Breast Unit, Kliniken Essen-Mitte, 45136, Essen, Germany
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Yuniandini A, Hamdani W, Prihantono P, Faruk M. A retrospective review of phyllodes tumors of the breast from a single institution. Breast Dis 2021; 40:S63-S70. [PMID: 34092583 DOI: 10.3233/bd-219009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Phyllodes tumors (PTs) are rare fibroepithelial breast tumors with diverse biological behavior. OBJECTIVE This study aimed to analyze the characteristics, management, and outcome of phyllodes tumors. METHODS Patients diagnosed with PTs in our institution from January 2013 to December 2017 were identified retrospectively by the ICD-10 code. Data were collected from medical records. The diagnosis of this tumor was based on histopathological results. Variables analyzed included age, tumor site, surgical option, axillary lymph nodes, chemotherapy and radiotherapy, metastases, disease-free survival (DFS), and overall survival (OS) rate. RESULTS Sixty-nine cases of PTs were diagnosed during the period, of which 31 were benign, 38 were malignant, and 1 was a case of bilateral metachronous tumors. We did not find any borderline pathologic cases. The patient's ages ranged from 20 to 71 years, with the highest number of cases (28) from the 40-49-year-old age group. The majority of patients (42) had PT on the right side. Simple mastectomy was the most performed treatment, with 53 such cases, including both benign and malignant. The axillary staging was carried out in 16 cases, of which none had nodal metastasis. Ten cases received chemotherapy, and 16 cases of malignant phyllodes received postoperative radiotherapy. We found 4 cases with distant metastases and 5 cases that developed local recurrence. The DFS rate reached 92.75%, and the overall 5-year survival rate was 84.21%. CONCLUSIONS The incidence of PTs is highest in women in the 3rd and fourth decades of age. Simple mastectomy and wide excision are the treatments of choice, with a low recurrence rate in both benign and malignant PTs cases.
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Affiliation(s)
- Ayu Yuniandini
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - William Hamdani
- Division of Oncology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Prihantono Prihantono
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Fernández-Ferreira R, Arroyave-Ramírez A, Motola-Kuba D, Alvarado-Luna G, Mackinney-Novelo I, Segura-Rivera R. Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature. Case Rep Oncol 2021; 14:123-133. [PMID: 33776693 PMCID: PMC7983586 DOI: 10.1159/000510741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
Phyllodes tumor of the breast is an infrequently encountered fibroepithelial neoplasm, which accounts for 0.3–1% of all tumors. Few case reports have described the occurrence of giant phyllodes tumor. To our knowledge, about 20% of phyllodes tumors would be considered giant benign. Complete surgical excision is the standard of care for giant benign phyllodes tumors; axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes. We report the case of a 40-year-old Mexican woman with giant mammary tumor who underwent a right total mastectomy. The pathology results showed a benign phyllodes tumor 4,857 g in weight and 40.2 × 36.3 × 15 cm in size. We do not suggest adjuvant radiation therapy for patients with benign phyllodes tumors that are widely excised. A review of the pertinent literature was performed.
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Affiliation(s)
- Ricardo Fernández-Ferreira
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Andrés Arroyave-Ramírez
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Daniel Motola-Kuba
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Gabriela Alvarado-Luna
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Ileana Mackinney-Novelo
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Román Segura-Rivera
- Service of Anatomical Pathology, Medica Sur Clinic and Foundation, Mexico, Mexico
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Abe H, Teramoto A, Takei Y, Tanaka Y, Yoneda G. Malignant phyllodes tumor of the breast with rapid progression: a case report. Surg Case Rep 2020; 6:308. [PMID: 33284362 PMCID: PMC7721958 DOI: 10.1186/s40792-020-00986-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Malignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period. CASE PRESENTATION A 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin-ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy. CONCLUSIONS A standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.
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Affiliation(s)
- Hajime Abe
- Breast Center, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247 Japan
| | - Atsuko Teramoto
- Breast Center, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247 Japan
| | - Yumiko Takei
- Breast Center, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247 Japan
| | - Yoshihito Tanaka
- Department of Breast Surgery, Kansai Medical University Kori Hospital, 8-45, Kori-Hondori Machi, Neyagawa, Osaka 572-8551 Japan
| | - Genichiro Yoneda
- Department of Pathology, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247 Japan
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DALCI K, GUL MO, SARITAŞ AG, GÜMÜŞ S, SAKMAN G, ERGİN M. Memenin filloides tümörlerinin klinik özellikleri ve süreci. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.738184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Alipour S, Eskandari A. Phyllodes Tumor of the Breast in Pregnancy and Lactation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:137-142. [PMID: 32816274 DOI: 10.1007/978-3-030-41596-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Phyllodes tumor constitutes around 1% of all and 2.5% of fibroepithelial breast lumps. Three types including benign, borderline, and malignant tumors have been described. The benign variant is the most common, is close to fibroadenoma, but is usually larger and recurs more frequently. The rare malignant type is aggressive. Standard treatment consists of lumpectomy with appropriate margins for benign phyllodes tumor, while the borderline and malignant variants must be treated by wide resection or mastectomy. Phyllodes tumor is a rare tumor in pregnancy and lactation, and the effect of gestational alterations in hormone levels on this tumor have not been discussed in the literature, except for several case reports. In summary and alluding to our recent literature review, large size, fast growth, bilaterality, and probably malignancy are more commonly expected in gestational phyllodes tumors.
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Affiliation(s)
- Sadaf Alipour
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran. .,Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Ibreaheem MH, Naguib S, Gamal M, Boutrus R, Gomaa MMM, Talaat O. Phyllodes Tumors of the Breast (the Egyptian Experience). Indian J Surg Oncol 2020; 11:423-432. [PMID: 33013122 PMCID: PMC7501369 DOI: 10.1007/s13193-020-01107-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/22/2020] [Indexed: 11/29/2022] Open
Abstract
Phyllodes tumors (PT) are rare fibroepithelial lesions, about 0.3-0.5% of all breast tumors. This study is an evaluation of patient characteristics, clinicopathologic features, diagnostic tools, therapeutic options, risk factors for recurrence, and distant metastasis and follow-up findings in patients with PTs. One hundred twenty-seven patients with pathologically proved PTs in the National Cancer Institute, Cairo University, Egypt, from January 2011 to January 2016 were reviewed and analyzed. Sixty patients presented with benign PTs (47.2%), 34 had borderline PTs (26.8%), and 33 had malignant PTs (26%). The mean follow-up period was approximately 36 months; local recurrence occurred in 34 patients, 9 benign cases (14.5%), 11 borderlines (32.4%), and 14 malignant PTs (42.4%). Mastectomy was the most commonly used surgery in recurrent cases (61.4%). Axillary staging was performed in 31 cases (24.4%); only 2 cases showed positive nodal metastasis (6.5%) and were of the malignant subtype. Distant metastasis occurred in 12 patients, 4 with borderline PTs, and 8 with malignant PTs. The most common site for metastasis was the lungs and bones. Adjuvant radiotherapy was applied in 9 patients, 2 in borderline phyllodes, and 7 in malignant phyllodes; post-radiotherapy recurrence occurred in 5 malignant phyllodes patients. Chemotherapy was employed in 10 metastatic patients (4 with borderline and 6 with malignant phyllodes); excision with clear margins is important to reduce the local recurrence. Routine axillary staging should not be done. The adjuvant radiation therapy is still controversial. Local recurrence can develop even after appropriate surgery. Therefore, close follow-up is mandatory.
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Affiliation(s)
- Maher H. Ibreaheem
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Sherif Naguib
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Mohammed Gamal
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Rimoun Boutrus
- Radiotherapy department, National Cancer Institute, Cairo University, Egypt, Giza, Egypt
| | | | - Omnia Talaat
- Nuclear medicine department, National Cancer Institute, Cairo University, Egypt, Giza, Egypt
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Ali NAM, Nasaruddin AF, Mohamed SS, Rahman WFW. Ki67 and P53 Expression in Relation to Clinicopathological Features in Phyllodes Tumour of the Breast. Asian Pac J Cancer Prev 2020; 21:2653-2659. [PMID: 32986365 PMCID: PMC7779430 DOI: 10.31557/apjcp.2020.21.9.2653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Phyllodes tumour (PT) is a rare fibroepithelial neoplasm of the breast that carries a risk of malignancy. Histopathological examination remains a gold standard for diagnosis. The usage of the immunohistochemical markers of Ki67 and p53 acts as a supplement method, particularly for the malignant PT. We aim here to study the expression of these markers in PT and to see their relation to the tumour grading. METHODOLOGY We conducted a retrospective cross-sectional study on 57 archived formalin-fixed paraffin-embedded tissue blocks of PT from the years 2015 to 2018 from two hospitals in East Coast Malaysia. The histopathological examination and immunohistochemical stain for Ki67 and p53 were analysed. RESULTS There was an association between clinical descriptive data of skin changes, lump size of more than 3 cm, cytological atypia, stromal hypercellularity, mitosis and immunohistochemistry with the clinical diagnosis of PT. Both marked expression of Ki67 and p53 were seen in borderline and malignant PT. Our study showed that in the presence of high mitotic figures, marked expression of Ki67 was only seen in cases of malignant PT. CONCLUSION We found a significant association of Ki67 and p53 expressions, high mitosis and other descriptive histopathological features in malignant PT. Further study with larger sample size is recommended to predict tumour grade and prognosis as well as the disease-free survival of the tumour. .
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Affiliation(s)
- Nurul Atiah Mohd Ali
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
- Department of Pathology, Hospital Sultanah Nur Zahirah, 20400, Kuala Terengganu, Terengganu, Malaysia.
| | - Ahmad Fazlin Nasaruddin
- Department of Pathology, Hospital Sultanah Nur Zahirah, 20400, Kuala Terengganu, Terengganu, Malaysia.
| | - Syarah Syamimi Mohamed
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Wan Faiziah Wan Rahman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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Sun D, Tang L, Xing H, Zhang L, Zhang L. Recurrent borderline phyllodes tumor in nipple: a rare case report and review of the literature. Gland Surg 2020; 9:452-458. [PMID: 32420273 DOI: 10.21037/gs.2020.01.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Phyllodes tumor (PT) of the breast is a rare tumor. They are usually located in the four quadrants of the mammary gland and may also appear below the nipple. Although there have been a number of cases reported, here we report a very rare case of this tumor in an unusual location. The patient has been diagnosed with right breast borderline PT, who accepted breast-conserving surgery. Twelve months after surgery we found right nipple enlargement, without nipple discharge, ipsilateral and contralateral breast without palpable mass. Interestingly, ultrasound showed a lesion in the right nipple: a hypoechoic mass with a diameter of 2.0 cm was seen in the nipple, with no significant calcification. The patient underwent nipple-sparing mastectomy without postoperative adjuvant radiotherapy. Histopathological and immunohistochemical analysis demonstrated a borderline PT. There were no signs of recurrence after two years of follow-up. We consider that wide surgical resection and negative margin are still the main methods for the treatment of recurrent borderline PTs.
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Affiliation(s)
- Denghua Sun
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Lu Tang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Hua Xing
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Lijuan Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Le Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
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Paryani J. A Huge Benign Phyllodes Tumour of the Breast: a Rare Entity. Indian J Surg Oncol 2019; 10:389-391. [PMID: 31168269 DOI: 10.1007/s13193-019-00911-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/07/2019] [Indexed: 12/23/2022] Open
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Wang Y, Zhang Y, Chen G, Liu F, Liu C, Xu T, Ma Z. Huge borderline phyllodes breast tumor with repeated recurrences and progression toward more malignant phenotype: a case report and literature review. Onco Targets Ther 2018; 11:7787-7793. [PMID: 30464526 PMCID: PMC6223390 DOI: 10.2147/ott.s171714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Phyllodes tumor (PT) is a rare breast fibroepithelial biphasic tumor composed of stromal and epithelial components. The patients suffering from this disease present with a large, round, mobile, fast-growing lump, and the giant PT of more than 10 cm in diameter is so uncommon. Surgery is regarded as the primary treatment, but curative efficiency of adjuvant chemotherapy and radiotherapy is so indefinite. Case presentation We reported one case of a middle-aged woman with a huge borderline PT in the right breast, over 20 cm in size. The pathology of needle core biopsy of the lump was suggestive of PT of the borderline subgroup, and then she underwent mastectomy of the right breast. The patient had recovered well without any postoperative treatment until a local recurrence occurred 1 year after operation. The tumor was removed with lumpectomy, which was pathologically diagnosed as malignant PT. We followed up her by telephone and heard about her postoperative adjuvant radiotherapy and chemotherapy, as well as her well recovery. Conclusion The pathology of PT with low incidence is mostly benign, but local recurrence is common, and the histopathology progresses toward worsen trend. Besides, due to the difficulty in precise diagnosis of the borderline PTs, it is recommended that this subtype of patients should undergo total mastectomy. Although the curative effect of postoperative treatment has not been recognized internationally, patients, especially those with huge tumors, may benefit from these treatments.
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Affiliation(s)
- Yining Wang
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China,
| | - Yonglin Zhang
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China,
| | - Guanglei Chen
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China,
| | - Fangming Liu
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China,
| | - Chao Liu
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China,
| | - Tiantian Xu
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China,
| | - Zhenhai Ma
- Department of Breast Disease and Reconstruction Center, Breast Cancer Key Lab of Dalian, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China,
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Wolbert T, Leigh ECN, Barry R, Traylor JR, Legenza M. Early stage malignant phyllodes tumor case report. Int J Surg Case Rep 2017; 42:148-153. [PMID: 29247967 PMCID: PMC5985261 DOI: 10.1016/j.ijscr.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Malignant phyllodes tumor of the breast is an extremely rare entity usually presenting with similar clinical features with those of benign fibroadenoma. Due to its scarcity and clinical presentation, it is quite difficult for clinicians to suspect and diagnose the disease at its early stage. There is currently no consensus regarding adjunctive radiotherapy, hormonal therapy and systemic chemotherapy recommended for malignant phyllodes tumors. PRESENTATION OF CASE This report presents a case of early-stage malignant phyllodes tumor treated by lumpectomy only without adjunctive chemoradiation therapy, but with an excellent outcome. DISCUSSION Early diagnosis and staging with high suspicion are crucial in malignant phyllodes tumor patients since they do not only improve the overall outcome of the disease after lumpectomy only but they also decrease morbidity and mortality with adjunctive chemoradiation therapy. This case report has been reported in line with the SCARE criteria (Agha et al., 2016 [1]).
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Affiliation(s)
- Thao Wolbert
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
| | - Emilia C N Leigh
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States.
| | - Rahman Barry
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
| | - Jack R Traylor
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
| | - Mary Legenza
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
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Abstract
Malignant phyllodes tumor is a rare tumor of the breast occurring in females usually between the ages of 35 and 55 years. It is often difficult to distinguish benign from malignant phyllodes tumors from other benign entities such as fibroadenomas. This case presentation demonstrates a woman with malignant phyllodes tumor treated with mastectomy with abdominal skin flap reconstruction.
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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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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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Kılıç MÖ, Terzioğlu SG, Bozkurt B, Dağlar G. Phyllodes Tumor of the Breast: Analysis of 48 Patients. THE JOURNAL OF BREAST HEALTH 2016; 12:158-164. [PMID: 28331755 PMCID: PMC5351441 DOI: 10.5152/tjbh.2016.3100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/12/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Phyllodes tumor (PT) is a rare biphasic breast neoplasm that accounts for less than 1% of all breast tumors. The aim of this study was to evaluate the clinicopathologic features, diagnostic difficulties, and therapeutic outcomes of patients with PT. MATERIALS AND METHODS A total of 48 female patients who underwent surgery for PT were included in the study. Patient characteristics, clinicopathologic features of tumors, diagnostic findings, surgical outcomes, adjuvant therapies, and follow-up findings were retrospectively evaluated. RESULTS The mean age of patients was 35 years. Painless breast mass was the most common (85.4%) presenting symptom. Total excision with at least 1 cm macroscopic clear margins was the most frequently performed (87.5%) surgery. Most patients (n=34, 70.8%) had benign PT; however, borderline and malignant tumors were found in 9 (18.8%) and 5 (10.4%) patients, respectively. During the mean follow-up period of approximately 30 months, local and distant recurrence was detected in three (6.3%) patients and one (2.1%) patient, respectively. Patients with malignant PT had larger tumors than those with benign and borderline PTs (p=0.010). No significant difference in other clinical, diagnostic, and pathologic characteristics was found between the groups. CONCLUSION PT can be easily confused with other breast masses such as fibroadenoma due to the non-specific clinical and radiologic findings. Surgical excision with at least 1 cm clear margins is of great importance to reduce the risk of local recurrence. However, recurrence can develop even after appropriate surgery, thus patients should be closely followed up after surgery.
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Affiliation(s)
- Murat Özgür Kılıç
- Clinic of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | | | - Betül Bozkurt
- Clinic of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | - Gül Dağlar
- Clinic of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
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Vergine M, Guy C, Taylor MR. Phyllodes Tumor of the Breast With Malignant Melanoma Component. Int J Surg Pathol 2015; 23:483-8. [DOI: 10.1177/1066896915592018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phyllodes tumors of the breast display a wide variation in histological appearance and are classified into benign, borderline, and malignant categories based on a combination of histological parameters. These tumors may include a malignant heterologous component that is believed to originate through a process of multidirectional differentiation from a cancer stem cell. In these cases, the tumor is classified as a malignant phyllodes tumor. Among the heterologous elements that have been described in malignant phyllodes tumors are rhabdomyosarcoma, chondrosarcoma, osteosarcoma, liposarcoma and angiosarcoma. We present the first case of a phyllodes tumor with a malignant melanoma component in the breast of a 71-year-old lady, discussing the clinical implications of this diagnosis.
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Affiliation(s)
- Marco Vergine
- Department of Histopathology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Catherine Guy
- Department of Histopathology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Mark R. Taylor
- Department of Histopathology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
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