1
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Su J, Liu S, Tu G, Li F, Zhang J, Gan L. Surgical margins and prognosis of borderline and malignant phyllodes tumors. Clin Transl Oncol 2024; 26:1613-1622. [PMID: 38218916 DOI: 10.1007/s12094-023-03377-1] [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] [Received: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE To investigate the optimal surgical margin and prognostic risk factors for borderline and malignant phyllodes tumors (PTs). METHODS A retrospective analysis was conducted on patients with borderline and malignant PTs at our hospital from 2011 to 2022. Univariate and multivariate Cox proportional hazard models were employed to analyze the effects of various variables on local recurrence-free survival (LRFS) and disease-free survival (DFS). RESULTS This study comprised 150 patients, 85 classified as borderline and 65 as malignant. During a median follow-up of 66 months (range: 3-146 months), 34 cases (22.7%) experienced local recurrence, 9 cases (6.0%) exhibited distant metastasis, and 7 cases (4.7%) resulted in death. Irrespective of the histological subtypes, patients with surgical margins ≥ 1 cm exhibit significantly higher 5-year LRFS and 5-year DFS rates compared to those with margins < 1 cm. Among patients with initial margins < 1 cm, LRFS (P = 0.004) and DFS (P = 0.003) were improved in patients reoperated to achieve margins ≥ 1 cm. Surgical margin < 1 cm (HR = 2.567, 95%CI 1.137-5.793, P = 0.023) and age < 45 years (HR = 2.079, 95%CI 1.033-4.184, P = 0.040) were identified as independent risk factors for LRFS. Additionally, surgical margin < 1 cm (HR = 3.074, 95%CI 1.622-5.826, P = 0.001) and tumor size > 5 cm (HR = 2.719, 95%CI 1.307-5.656, P = 0.007) were determined to be independent risk factors for DFS. CONCLUSIONS A negative surgical margin of at least 1 cm (with secondary resection if necessary) should be achieved for borderline and malignant PTs. Tumor size > 5 cm and age < 45 years were predictive of recurrence, suggesting multiple therapy modalities may be considered for these high-risk patients.
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Affiliation(s)
- Jialin Su
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Shanling Liu
- Department of Clinical Nutrition, Yunan Cancer Hospital, Yunan, People's Republic of China
| | - Gang Tu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fangxuan Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jie Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Lu Gan
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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2
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Yasmin S, Rasul N, Hassan MA, Rabbani AE, Rizwan Khan AY. Multi-recurrent Asynchronous Bilateral Malignant Phyllodes. Cureus 2024; 16:e57936. [PMID: 38738143 PMCID: PMC11084918 DOI: 10.7759/cureus.57936] [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: 04/07/2024] [Indexed: 05/14/2024] Open
Abstract
In this comprehensive study, we present an exceptionally rare case characterized by the occurrence of multi-recurrent asynchronous bilateral malignant phyllodes tumors. Phyllodes tumors, known for their rapid growth, originate within the stromal tissue of the breast and predominantly manifest as benign entities. Our case stands out as an extraordinary anomaly, not only due to its bilateral malignant nature but also owing to the manifestation of a multi-recurrent pattern on both sides. This unprecedented presentation underscores the complexity and heterogeneity of malignant phyllodes tumors, necessitating further in-depth investigation to unravel the underlying mechanisms driving their aggressive behavior and to explore innovative therapeutic strategies aimed at optimizing patient outcomes and prognosis.
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Affiliation(s)
- Saeeda Yasmin
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Nida Rasul
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Muhammad Ali Hassan
- Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, PAK
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3
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Klooz A, Kumar T, Maxwell J. Malignant phyllodes tumour of the breast with early recurrence in a young patient. BMJ Case Rep 2024; 17:e258352. [PMID: 38508594 PMCID: PMC10952906 DOI: 10.1136/bcr-2023-258352] [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] [Accepted: 03/02/2024] [Indexed: 03/22/2024] Open
Abstract
A young woman in her 20s was found to have a left breast malignant phyllodes tumour by ultrasound-guided core needle biopsy, after identifying a palpable lump. She then underwent lumpectomy excision with >1 cm gross margins; however, final pathology demonstrated <1 cm margins at the superior margin. She then underwent re-excision of superior and medial margins to ensure at least a 1 cm margin. Biopsy tract was not excised at initial or re-excision surgery. Approximately 6 weeks after completion lumpectomy, the patient noted a new palpable mass near the previous biopsy site and underwent punch biopsy. Final pathology of this new mass was concordant with early recurrence. The patient then underwent lumpectomy of the new mass along with excision of the overlying skin and biopsy tract with >1 cm margins.
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Affiliation(s)
- Andrea Klooz
- Surgery, The Nebraska Medical Center, OMAHA, Nebraska, USA
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Faulds TT, Bruckner J, Mousa M, Bhanu S, Chin M, Cendrowski K. Giant phyllodes tumor of the breast: A case report. Radiol Case Rep 2024; 19:818-824. [PMID: 38111558 PMCID: PMC10726342 DOI: 10.1016/j.radcr.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Phyllodes tumors of the breast are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors. They tend to affect middle-aged women, who present with a rapidly growing, palpable mass. Here we present a case of a 34-year-old female surrogate mother without any reported personal or family history of breast cancer who presented with a rapidly growing left breast mass, pathologically proven to be a phyllodes tumor. The patient was a G7P7 surrogate mother who received estrogen and progesterone injections for her twin surrogate pregnancy starting 4 months before embryo implantation, after which, she discovered a large palpable mass in the left breast at approximately week 7 gestational age. At the initial presentation, the patient was at week 23 gestational age. She underwent C-section delivery of the twins at this time and obtained further work-up of the mass. She had a core needle biopsy which yielded a benign fibroepithelial tumor. Due to the size of her breast mass and atypical morphology, including extension to the nipple, and skin ulceration, the patient subsequently underwent left mastectomy. At the time of mastectomy, which was 8 months after the initial work-up, the mass had grown to measure approximately 12 × 10 cm on physical examination and took up most of her left breast. It was completely resected and was pathologically determined to be a borderline phyllodes tumor. Only a few cases have been reported about the development of phyllodes tumor during pregnancy in the literature, and we believe this is the first case report of phyllodes tumor related to a surrogate pregnancy. Although the relationship between exogenous hormones and fibroepithelial tumors is not well understood, the case poses the clinical question if screening mammograms should be offered to patients undergoing exogenous hormonal therapy, regardless of age to establish a baseline and monitor for the development (if any) or growth of these tumors.
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Affiliation(s)
- Tam Truong Faulds
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Jacob Bruckner
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Mousa
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Shiv Bhanu
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Chin
- Riverside Community Hospital, Riverside, CA, USA
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5
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Schaumann N, Bartels S, Kuehnle E, Kreipe H, Christgen M. Malignant phyllodes tumor and invasive lobular breast carcinoma: Morpho-molecular characterization of an uncommon collision tumor and review of the literature. Pathol Res Pract 2024; 254:155100. [PMID: 38277744 DOI: 10.1016/j.prp.2024.155100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
Phyllodes tumor (PT) of the breast is a biphasic neoplasia composed of mesenchymal and epithelial cells. PTs are graded as benign, borderline or malignant according to histological criteria. Invasive lobular carcinoma (ILC) is a special breast cancer subtype defined by non-cohesive growth and loss of E-cadherin. PT is treated by resection. ILC is treated by resection and adjuvant endocrine therapy with or without chemotherapy. Collision tumors composed of PT and concurrent ILC are rare. Due to their dissociated growth, ILC cells may escape histologic detection when admixed with PTs. Here we report the case of a 71-years-old female diagnosed with a PT/ILC collision tumor. The patient presented with a tumor in the right breast. A core needle biopsy showed mesenchymal spindle cell proliferates suspicious for a PT. The resection specimen confirmed a malignant PT with stromal overgrowth. Unexpectedly, the resection specimen also revealed sparse infiltrates of ILC admixed with the PT. Immunohistochemistry of mesenchymal PT cells and ILC cells was consistent with the histomorphological diagnosis. Molecular analyses demonstrated a IDH1 variant of unknown significance and GNAS gene mutation in microdissected PT tissue. ILC tissue showed wild-type IDH1 and GNAS, but harbored CDH1/E-cadherin and TP53 gene mutations, arguing against clonal relatedness of the two lesions. Review of the literature identified six reported PT/ILC collision tumors, involving three benign, two borderline and one malignant PT. In summary, this is the second report on a malignant PT/ILC collision tumor. Correct histologic diagnosis of PT/ILC collision tumors is clinically relevant, because adjuvant endocrine therapy is mandatory for ILC.
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Affiliation(s)
- Nora Schaumann
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany,.
| | - Stephan Bartels
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany,.
| | - Elna Kuehnle
- Department for Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany,.
| | - Matthias Christgen
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany,.
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6
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Zhang G, Yang P, Zeng J, Wei C. Effect of radiation therapy on patients with stage T3 or T4 malignant phyllodes tumors: a retrospective observational study based on SEER. J Cancer Res Clin Oncol 2023; 150:2. [PMID: 38153521 PMCID: PMC10754728 DOI: 10.1007/s00432-023-05517-0] [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] [Received: 09/18/2023] [Accepted: 11/01/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Among all primary breast tumors, malignant phyllodes tumor of the breast (MPTB) make up less than 1%. In the treatment of phyllode tumors, surgical procedures such as mastectomy and breast-conserving surgery are the mainstay. MPTB has, however, been controversial when it comes to treating it with RT. We aimed to explore the prognostic impact of RT and other clinicopathologic factors on long-term survival for patients with stage T3 or T4 malignant phyllodes tumors. METHODS We select patients with stage T3 or T4 MPTB who qualified for the criteria between 2000 and 2018 via the Surveillance, Epidemiology, and End Results (SEER) database. We performed 1:1 propensity score matching (PSM) and Kaplan-Meier analysis to explore the role of RT in long-term survival of patients with stage T3 or T4 MPTB. A univariate and multivariate analysis of breast cancer-specific survival (BCSS) and overall survival (OS) risk factors was carried out using a Cox proportional hazards model. In addition, the nomogram graph of OS and BCSS was constructed. RESULTS A total of 583 patients with stage T3 or T4 malignant phyllodes tumors were included in this study, of whom 154 (26.4%) received RT, and 429 (73.6%) were treated without RT. Before adjustment, between groups with and without RT, BCSS (p = 0.1) and OS (p = 0.212) indicated no significant difference respectively. Using of PSM, the two groups still did not differ significantly in BCSS (p = 0.552) and OS (p = 0.172). In multivariate analysis, age (p < 0.001), surgery of primary site (p < 0.001) and distant metastatic status (p < 0.001) were related to prognosis, while RT still did not affect BCSS (p = 0.877) and OS (p = 0.554). CONCLUSION Based on the SEER database analysis, the study suggests that the patients with stage T3 or T4 MPTB treated with RT after surgery didn't have significant differences in BCSS or OS compared to those not treated with RT.
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Affiliation(s)
- Gongyin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ping Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jinsheng Zeng
- Department of Breast Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Changlong Wei
- Department of Breast Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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7
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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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8
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Mammography-based radiomics analysis and imaging features for predicting the malignant risk of phyllodes tumours of the breast. Clin Radiol 2023; 78:e386-e392. [PMID: 36868973 DOI: 10.1016/j.crad.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/21/2023]
Abstract
AIM To determine whether the mammography (MG)-based radiomics analysis and MG/ultrasound (US) imaging features could predict the malignant risk of phyllodes tumours (PTs) of the breast. MATERIALS AND METHODS Seventy-five patients with PTs were included retrospectively (39 with benign PTs, 36 with borderline/malignant PTs) and divided into thetraining (n=52) and validation groups (n=23). The clinical information, MG and US imaging characteristics, and histogram features were extracted from craniocaudal (CC) and mediolateral oblique (MLO) images. The lesion region of interest (ROI) and perilesional ROI were delineated. Multivariate logistic regression analysis was performed to determine the malignant factors of PTs. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS There was no significant difference found in the clinical or MG/US features between benign and borderline/malignant PTs. In the lesion ROI, variance in the CC view and mean and variance in the MLO view were independent predictors. The AUC was 0.942, sensitivity and specificity were 96.3% and 92%, respectively, in the training group. In the validation group, the AUC was 0.879, the sensitivity was 91.7%, and the specificity was 81.8%. In the perilesional ROI, the AUCs were 0.904 and 0.939, sensitivities were 88.9% and 91.7%, and the specificities were 92% and 90.9% in the training and validation groups, respectively. CONCLUSIONS MG-based radiomic features could predict the risk of malignancy of patients with PTs and may be used as a potential tool to differentiate benign and borderline/malignant PTs.
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9
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Dutt AS, Bakhshi G, Sabale C, Landge R, Baligar S, V. R, Jha M, Joshi S, Teja CR. Bilateral Breast Phyllodes Tumor in Androgen Insensitivity Syndrome. Surg J (N Y) 2023; 9:e23-e27. [PMID: 36742156 PMCID: PMC9897893 DOI: 10.1055/s-0042-1758668] [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: 05/12/2022] [Accepted: 10/14/2022] [Indexed: 02/05/2023] Open
Abstract
Phyllodes is a rare tumor found exclusively in females. It can be classified into benign, intermediate, or malignant variety based on the aggressive nature of the disease. With adequate preoperative clinical assessment combined with histopathology and radiological investigations the adequate treatment strategy can be formulated to avoid future recurrences. Complete androgen insensitivity syndrome (CAIS) is associated with a genotypic male, which can be confirmed by karyotyping, with phenotypic female characteristics. The present case is the first case of bilateral breast phyllodes tumor in a patient with CAIS. Preoperative assessment was suggestive of bilateral phyllodes tumor with bilateral gonads in the inguinal region which was confirmed to be testis postoperatively on histopathological analysis. A brief case report with review of literature is presented.
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Affiliation(s)
- Aishwarya Sunil Dutt
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India,Address for correspondence Aishwarya Sunil Dutt, MBBS Department of General Surgery, Grant Medical CollegeMumbai 400008, MaharashtraIndia
| | - Girish Bakhshi
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Chandrakant Sabale
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Ravi Landge
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Sushrut Baligar
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Rajalakshmi V.
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Madhu Jha
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Sampada Joshi
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Chettubattina Ravi Teja
- Department of General Surgery, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
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A Rare Case of the Malignant Phyllodes Breast Tumor - Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
The phyllodes tumor (cystosarcoma phyllodes) is a rare fibroepithelial neoplasm presenting less than 1% of all breast tumors. Based on histologic features World Health Organization (WHO) classifies into benign, border line and malignant tumors (the rarest). Only around 5-15% of all malignant form cases metastasize hematogeneosly in the lung, bone and brain. Clinically are mostly presented the phyllodes tumor mostly presents as a rapid growth, palpabile, painless, elastic, oval or lobulated masses over 5 cm among women between 40 to 50 years old. On ultrasound and mammography these tumors usually resembles other round or oval benign lesions, mostly like fibroadenomas. These tumors on ultrasound and mammography usually resembles other round or oval benign tumors, mostly like fibroadenomas. Ultrasound guided core needle biopsiy (CNB) performed under ultrasound is a gold standard for palpabile breast masses. Surgical resection remains the gold standard of treatment. To date, there is no consensus regarding the recommendations for radiotherapy, hormonal therapy and systemic chemotherapy. We present the case of 30 years old woman, who noted a painless mass in her left breast, which was gradually increasing in size. Clinical, ultrasound and magnetic resonance examination confirmed the existence of tumor formation without the possibility of making an accurate diagnosis. Malignant phyllodes tumor was initially diagnosed by core biopsy. The patient underwent a radical modified mastectomy and postoperative radiotherapy. During the follow-up for the first 11 months, our patient has been feeling well without signs of local recurrence and metastasis. The aim of our case is to emphasize the importance of early diagnosis and treatment of this rare breast tumor.
Treatment is based on the size and the extent of the mass with surgical resection and adequate margins extremely important in successful outcome. We present the case of 30 old woman, who noted a painless mass in her left breast, which was gradually increasing in size. She was diagnosed with ultrasound and magnetic resonance imaging and the diagnosis of the malignant phyllodes tumor was confirmed by patohistological verification.
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Phyllodes Tumors of the Breast: A Rare Lesion with Still-Evolving Prognostic Features and Clinical Management. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Li T, Li Y, Yang Y, Li J, Hu Z, Wang L, Pu W, Wei T, Lu M. Logistic regression analysis of ultrasound findings in predicting the malignant and benign phyllodes tumor of breast. PLoS One 2022; 17:e0265952. [PMID: 35325009 PMCID: PMC8947023 DOI: 10.1371/journal.pone.0265952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate ultrasound characteristics in the prediction of malignant and benign phyllodes tumor of the breast (PTB) by using Logistic regression analysis. METHODS 79 lesions diagnosed as PTB by pathology were analyzed retrospectively. The ultrasound features of PTB were recorded and compared between benign and malignant tumors by using single factor and multiple stepwise Logistic regression analysis. Moreover, the Logistic regression model for malignancy prediction was also established. RESULTS There were 79 patients with PTB, including 39 benign PTBs and 40 malignant PTBs (33 borderline PTBs and 7 malignant PTBs by pathologic classification). The area under the ROC curve (AUC) of lesion size and age were 0.737 and 0.850 respectively. There were significant differences in age, lesion size, shape, internal echo, liquefaction, and blood flow between malignant and benign PTBs by using single-factor analysis (P<0.05). Age, internal echo, and liquefaction were significant features by using Logistic regression analysis. The corresponding regression equation In (p/(1 - p) = -3.676+2.919 internal echo +3.029 liquefaction +4.346 age). CONCLUSION Internal echo, age, and liquefaction are independent ultrasound characteristics in predicting the malignancy of PTBs.
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Affiliation(s)
- Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanjie Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yingqi Yang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - ZiYue Hu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Wang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Pu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Wei
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Wei Y, Yu Y, Ji Y, Zhong Y, Min N, Hu H, Guan Q, Li X. Surgical management in phyllodes tumors of the breast: a systematic review and meta-analysis. Gland Surg 2022; 11:513-523. [PMID: 35402210 PMCID: PMC8984980 DOI: 10.21037/gs-21-789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 03/20/2024]
Abstract
BACKGROUND Information is still controversial in the studies regarding the current optimal surgical management of phyllodes tumors (PTs) of the breast. Local recurrence (LR) may occur with an upgraded in the pathological grade, influencing the prognosis of patients with PT. This systematic review and meta-analysis aimed to investigate the association of LR risk with margin status and margin width which could have significant implications on the surgical management of PT. METHODS Independent and comprehensive searches were performed by two authors through five databases including PubMed, Medline, Embase, ScienceDirect and Cochrane Library from January 1990 to October 2021. Studies investigating the association between margin width, margin status and LR rates were considered for inclusion. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan5.3 software, and statistical heterogeneity was assessed using the Chi-square test and quantified using the I2 statistic. Visual inspection of funnel plots was used to judge publication bias. RESULTS A total of 34 articles were included in this article, all of which with NOS scores above 5. Regardless of the PT grade, positive margin significantly increased the risk of LR [odds ratio (OR) 3.64, 95% confidence interval (CI): 2.60-5.12]. No significant difference was found in the risk of LR between the margins <1 and ≥1 cm (OR 1.39, 95% CI: 0.67-2.92). For benign and borderline PTs, there were no significant differences of the LR risk between breast-conserving surgery (BCS) and mastectomy (benign OR 0.68, 95% CI: 0.12-3.78; borderline OR 1.14, 95% CI: 0.29-4.51). While the LR risk was significantly increased by BCS for malignant PT (OR 2.77, 95% CI: 1.33-5.74). DISCUSSION Different surgical management strategies should be considered for different PT grades. BCS was a feasible option and margins <1 cm was not significantly associated with LR risk for all grade of PT. After BCS, benign PT with positive margin could adopt the "wait and watch" strategy with regular follow-up, while borderline and malignant PTs were expected to underwent re-excision to ensure negative margins. More studies are still needed to clarify and update the existing conclusions and improve the prognosis of PT patients.
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Affiliation(s)
- Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanying Yu
- Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yashuang Ji
- Department of Galactophore Surgery, Tongzhou District Hospital of Integrated TCM & Western Medicine, Beijing, China
| | - Yuting Zhong
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huayu Hu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Yoon E, Ding Q, Hunt K, Sahin A. High-Grade Spindle Cell Lesions of the Breast: Key Pathologic and Clinical Updates. Surg Pathol Clin 2022; 15:77-93. [PMID: 35236635 DOI: 10.1016/j.path.2021.11.005] [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: 06/14/2023]
Abstract
Most of the high-grade spindle cell lesions of the breast are malignant phyllodes tumors (MPTs), spindle cell carcinomas (SpCCs), and matrix-producing metaplastic breast carcinomas (MP-MBCs). MPTs have neoplastic spindle stromal cells and a classic leaf-like architecture with subepithelial stromal condensation. MPTs are often positive for CD34, CD117, and bcl-2 and are associated with MED12, TERT, and RARA mutations. SpCCs and MP-MBCs are high-grade metaplastic carcinomas, whereas neoplastic epithelial cells become spindled or show heterologous mesenchymal differentiation, respectively. The expression of epithelial markers must be evaluated to make a diagnosis. SAS, or rare metastatic spindle cell tumors, are seen in the breast, and clinical history is the best supporting evidence. Surgical resection is the standard of care.
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Affiliation(s)
- Esther Yoon
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA.
| | - Qingqing Ding
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 85, Room G1.3565C, Houston, TX 77030-4009, USA
| | - Aysegul Sahin
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
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15
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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: 4] [Impact Index Per Article: 2.0] [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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16
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Wu PS, Lin C, Yang PS, Chang YC, Ko WC, Lam HB. Clinical features, prognostic factors, and treatment outcomes in 611 patients with phyllodes tumors of the breast: The experience of a single institution in Taiwan. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Zhang H, Tang S, Biskup E, Zhang Y, Yong L, Chen L, Cai F. Long-term Survival After Diverse Therapeutic Modalities in Malignant Phyllodes Tumors of the Breast. Technol Cancer Res Treat 2022; 21:15330338221121086. [PMID: 36000314 PMCID: PMC9425899 DOI: 10.1177/15330338221121086] [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] [Indexed: 11/17/2022] Open
Abstract
Background and Objects: Malignant phyllodes tumor of the breast (MPTB) is a rare tumor for which surgery or surgery combined with radiotherapy (RT) is the primary treatment method. However, recently, the therapeutic effect of RT on MPTB has been controversial. We aimed to explore the role of RT, chemotherapy (CT), and surgical modalities in patients with MPTB. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to select patients with MPTB who met the criteria between 2010 and 2018. Kaplan–Meier curves and Cox proportional risk regression models were used to analyze the effects of RT on MPTB patients. Based on this, we compared the effects of breast-conserving surgery (BSC) and mastectomy on the postoperative survival of MPTB. Results: A total of 298 patients with MPTB were included in this study. RT was received by 22.1% (n = 66) of the patients while 77.9% (n = 232) did not receive RT. CT was received by 4.7% (n = 14) patients while 95.3% (n = 284) did not receive CT. According to Kaplan–Meier curves, RT and CT combined resulted in a decrease in breast cancer-specific survival (BCSS) and overall survival (OS) compared to patients who did not receive RT. Mastectomy improved the OS and BCSS of the patients more than BCS). The findings of univariate and multivariate Cox regression analyses suggested that “distant metastasis”, “tumor grade” and “number of positive lymph node biopsies” affected OS of breast cancer, while “distant metastasis”, “tumor grade”, “surgery combined with radiotherapy/surgery”, and “radiotherapy/chemotherapy or not”, had a significant effect on BCSS. Conclusion: RT and CT did not significantly improve the long-term survival of MPTB patients. Mastectomy improved OS and BCSS of the patient more than BCS. RT in an early stage improved early prognosis moderately in MPTB patients with tumor diameter less than 50 mm.
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Affiliation(s)
- Hongyi Zhang
- Department of Breast Surgery, School of Medicine, Yangpu Hospital, 481875Tongji University, Shanghai, China
| | - Shasha Tang
- Department of Breast Surgery, School of Medicine, Yangpu Hospital, 481875Tongji University, Shanghai, China
| | - Ewelina Biskup
- 191610Shanghai University of Medicine and Health Sciences, Shanghai, PR China
| | - Yi Zhang
- Department of Breast Surgery, School of Medicine, Yangpu Hospital, 481875Tongji University, Shanghai, China
| | - Liyun Yong
- Department of Breast Surgery, School of Medicine, Yangpu Hospital, 481875Tongji University, Shanghai, China
| | - Lijun Chen
- Department of Oncology, 58305Shanghai Medical College, Fudan University, Shanghai, China
| | - Fengfeng Cai
- Department of Breast Surgery, School of Medicine, Yangpu Hospital, 481875Tongji University, Shanghai, China
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Sanjay S, Ketul P, Mohit S, Jahnavi G, Ajay YK, Abhishek J, Shashank JP. Study of clinicopathological factors and their impact on survival in phyllodes tumour of breast at tertiary care cancer centre in India. Cancer Treat Res Commun 2021; 29:100482. [PMID: 34757273 DOI: 10.1016/j.ctarc.2021.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Phyllodes tumour is a rare breast neoplasm having three histological types i. e benign, borderline and malignant. Surgical excision is the mainstay of treatment, but quantification of adequate margin required during excision is still a matter of debate. Role of adjuvant radiotherapy also remains controversial. AIMS Study of prognostic factors in patients with phyllodes tumour of breast and their effect on survival. SETTING AND DESIGN A retrospective analysis. MATERIAL AND METHODS From the year 2016 to 2019 we included 54 patients in this study and assessment of clinical and histopathological features, requirement of adjuvant radiotherapy and their effect on DFS (disease free survival) and OS (overall survival) was done. Log-rank test was used for univariate analysis and multivariate analysis was done by using Cox propotion hazard ratio method. STATISTICAL ANALYSIS Descriptive statistics was used for calculating proportion and median value. Survival analysis was done by using Kaplan Meier method. P value of <0.05 was considered statistically significant. RESULTS Mitotic count and presence of heterologous component had significant effect on overall survival (OS) and disease free survival (DFS) on multivariate analysis. No effect of adjuvant radiotherapy and the type of surgery (breast conservation surgery v/s mastectomy) was found on survival (OS, DFS). CONCLUSION Surgery with adequate margins should be the treatment of choice for tumours with borderline and malignant histological type Histological features like high mitotic count and stromal overgrowth are known prognostic factors, however, heterologous component is also an important prognostic factor and should be studied in large randomized trials. Role of adjuvant radiotherapy remains controversial.
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Affiliation(s)
- Singh Sanjay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Puj Ketul
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Sharma Mohit
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Gandhi Jahnavi
- Department of Pathology, Gujarat Cancer & Research Institute Ahmedabad, Gujarat 380016, India.
| | - Yadav Kumar Ajay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Jain Abhishek
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - J Pandya Shashank
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
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19
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Peneş NO, Pop AL, Borş RG, Varlas VN. Large borderline phyllodes breast tumor related to histopathology, diagnosis, and treatment management - case report. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 62:283-288. [PMID: 34609433 PMCID: PMC8597354 DOI: 10.47162/rjme.62.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast phyllodes tumors (PTs) are uncommon tumors with a biphasic fibroepithelial component, characterized by rapid development in middle-aged women. A correct preoperative diagnosis after Tru-Cut biopsy allows for proper surgical planning. The treatment of choice remains surgery (wide local excision or mastectomy) with or without breast reconstruction, depending on the size and histopathological (HP) nature of the tumor. We reported a case of a 50-year-old woman with a large PT in her left breast, measuring 11/10 cm. Preoperative HP examination revealed biphasic proliferation, with the appearance of benign PT. The patient underwent a left mastectomy, with a favorable postoperative evolution. The final HP diagnosis was borderline PT, with areas of lipomatous metaplasia. After three months, breast reconstruction was performed. The therapeutic management of large PTs continues to be a challenge for pathologists and surgeons. Due to the increased frequency of local recurrence and HP progression to malignancies, the treatment of choice for these patients is mastectomy, without lymphadenectomy.
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Affiliation(s)
- Nicolae Ovidiu Peneş
- Department of Clinical Laboratory, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; ,
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20
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Basto R, Cunha Pereira T, Rei L, Rêgo Salgueiro F, Magalhães J, Sousa MJ, Monteiro AR, Macedo F, Soares RF, Carvalho T, Jacinto P, Sousa G. Giant Metastatic Breast Phyllodes Tumour with an Elusive Diagnosis: A Case Report and Literature Review. Eur J Case Rep Intern Med 2021; 8:002763. [PMID: 34527624 DOI: 10.12890/2021_002763] [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: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background The term phyllodes tumours, which account for less than 1% of breast neoplasms, describes a spectrum of heterogenous tumours with different clinical behaviours. Less than 30% present as metastatic disease. Complete surgical resection is the standard of care so that recurrence rates are reduced. The role of adjuvant chemotherapy or radiation therapy is controversial. Patients with metastatic disease have a median overall survival of around 30 months. Case description The authors present the case of a 57-year-old woman with an exuberant left malignant phyllodes tumour with bilateral involvement, as well as lung and axillar metastasis. The patient underwent haemostatic radiation therapy and started palliative chemotherapy with doxorubicin, achieving partial response with significant improvement in quality of life. A posterior simple mastectomy revealed a small residual tumour. Discussion Metastatic malignant phyllodes tumours are rare, so therapeutic strategies rely on small retrospective studies and guidelines for soft tissue sarcoma. Palliative chemotherapy protocols include anthracycline-based regimens, either as monotherapy with doxorubicin or doxorubicin together with ifosfamide. With few treatment options, management of these patients must rely on a continuum of care. LEARNING POINTS Phyllodes tumours are a rare type of breast neoplasm.The differential diagnosis of breast cancer should include phyllodes tumours.Accurate and rapid diagnosis is required.
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Affiliation(s)
- Raquel Basto
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Tatiana Cunha Pereira
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Luís Rei
- Anatomic Pathology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Fábio Rêgo Salgueiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Joana Magalhães
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Maria João Sousa
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Ana Raquel Monteiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Filipa Macedo
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Rita Félix Soares
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Teresa Carvalho
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Paula Jacinto
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
| | - Gabriela Sousa
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal
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21
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Bogach J, Shakeel S, Wright FC, Hong NJL. Phyllodes Tumors: A Scoping Review of the Literature. Ann Surg Oncol 2021; 29:446-459. [PMID: 34296360 DOI: 10.1245/s10434-021-10468-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Phyllodes tumors are rare tumors of the breast, with most literature being retrospective with limited guidelines on the management of these patients. Scoping review was performed to highlight themes and gaps in the available literature. METHODS A scoping review of the literature was performed as per PRISMA-ScR guidelines with titles, abstracts, and full texts reviewed in duplicate. Data were abstracted and summarized in categories of diagnostics, surgical management, adjuvant therapies, treatment of recurrence, and surveillance. Quality assessment was performed for each paper. RESULTS The search identified 4498 references, 434 full-text papers were reviewed, and 183 papers were included. Ultrasound, magnetic resonance imaging, and core needle biopsy are valuable preoperative diagnostics tools. Pathology reporting should include stromal overgrowth, stromal cellularity, nuclear atypia, mitotic rate, borders, and presence of heterologous elements. Ki67 may have a role in grading and prognosticating. Breast conservation is safe in all grades of phyllodes but may be associated with increased local recurrence in malignant phyllodes. Surgical margins should depend on grade. Axillary node positivity rate is very low, even with clinically enlarged lymph nodes. Adjuvant radiation is a useful tool to decrease local recurrence in malignant phyllodes tumors, tumors > 5 cm, age < 45 years, close margins, and breast conservation. There is no evidence supporting adjuvant chemotherapy. Recurrence can be managed with repeat wide excision; however, mastectomy is associated with lower re-recurrence. Surveillance protocols are variable in the literature. CONCLUSIONS There is heterogeneity in the literature on phyllodes tumors. Consensus guidelines based on the literature will help provide evidence-based care.
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Affiliation(s)
- Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Saad Shakeel
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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22
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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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23
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Tu He Ta Mi Shi ME, Wang N, Yao Q, Dong SS, Feng X, Zhao J, Zou H, Pang LJ, Qi Y. A Case of Phyllodes Tumor of the Breast with Mixed Liposarcoma: Case Report and Literature Review. Onco Targets Ther 2021; 14:3003-3011. [PMID: 33986601 PMCID: PMC8110257 DOI: 10.2147/ott.s298379] [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: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022] Open
Abstract
Phyllodes tumors (PTs) account for less than 1% of breast tumors, and malignant PTs account for even less. Here, we described an unusual case of malignant PT with mixed liposarcoma (myxoid liposarcoma [MLP] and pleomorphic liposarcoma [PLP]). A 52-year-old woman discovered a small lump in her left breast. Twenty years later, the lump suddenly grew within 1 month. Mammography showed space-occupying lesions of the left breast. Histologically, the tumor was characterized by hypercellular stroma covering the epithelium and protrusion of the myoepithelium into the cyst to form a lobulated structure; regions of loose mucus and hypercellular structures alternated. A region of peripheral benign fibroadenoma was also observed, and many stellate and spindle cells or signet ring-like cells were identified in loose areas. Some areas showed a characteristic thin branching vascular pattern. In the cell-rich area, adipocytes and odd megakaryocytes were observed. Atypical mitotic figures were observed in the cell-rich and mucus areas (16 mitoses/10 high-power fields [HPF] and 2 mitoses/10 HPF, respectively). In the immunohistochemical analysis, a small number of tumor cells were positive for AE1/3 and vimentin, whereas all cells were negative for cytokeratin 34βE12, E-cadherin, p63, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and S-100, ruling out the possibility of metaplastic carcinoma. Interestingly, cyclin-dependent kinase 4, mouse double minute 2 (MDM2), and p16 were strongly positive in both loose mucus and cell-rich areas. However, the fluorescence in situ hybridization test results showed that MDM2 was not amplified. Combined with morphological characteristics, these findings supported that the tumor was a mixed malignant PT with MLP and PLP. Our patient did not receive radiation therapy, and after 47 months of follow-up, no recurrence or metastasis occurred. This case report serves to expand the morphologic spectrum of mixed malignant PT with liposarcoma.
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Affiliation(s)
- Mei Er Tu He Ta Mi Shi
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Ning Wang
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Qing Yao
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Shuang-Shuang Dong
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Xiao Feng
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Jin Zhao
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Hong Zou
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Li-Juan Pang
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Yan Qi
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China.,Department of Pathology, Central People's Hospital of Zhanjiang and Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, People's Republic of China
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24
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Mihai R, Callagy G, Qassid OL, Loughlin MO, Al-Hilfi L, Abbas A, Campora M, Hodi Z, Ellis I, Lee AHS, Rakha EA. Correlations of morphological features and surgical management with clinical outcome in a multicentre study of 241 phyllodes tumours of the breast. Histopathology 2021; 78:871-881. [PMID: 33325544 DOI: 10.1111/his.14316] [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] [Received: 09/13/2020] [Accepted: 12/12/2020] [Indexed: 12/27/2022]
Abstract
AIMS Phyllodes tumours (PTs) represent an unusual but complex group of breast lesions with a tendency to recur locally and, less commonly, metastasise. On core biopsies, their appearances can be difficult to discriminate from those of other fibroepithelial lesions, which may compromise their surgical management. The aims of this study were to assess the preoperative diagnosis of PTs and to evaluate the impacts of surgical management and morphological features on their behaviour. METHODS AND RESULTS We combined datasets from three centres over two decades, including core biopsies, excision specimens, and follow-up. Core biopsy results were compared with final excision specimens. The relationships of surgical procedure and morphological features with local recurrence (LR) and metastasis were assessed. Two hundred and forty-one PTs were studied. Core biopsy resulted in a diagnosis of possible or definite PT in 76% of cases. Malignant tumours were more likely to be larger, occurred at an older age, and were surgically more challenging, with difficulties being encountered in achieving negative margins. There were 12 cases (5%) that showed LR alone, and another six cases (2.5%) that had distant metastases. Morphological features associated with adverse outcome were grade of PT, increased mitotic counts, necrosis, infiltrative margins, stromal atypia, and heterologous components. Both LR and metastatic behaviour correlated with larger size and distance to margins. CONCLUSIONS Our results suggest that excision margins have a significant impact on LR of PT, whereas metastatic behaviour is influenced by tumour biology. We add to the evidence base on histological features of tumours that contribute to long-term outcomes of PT patients.
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Affiliation(s)
- Raluca Mihai
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Grace Callagy
- Discipline of Pathology, NUI Galway, Lambe Institute for Translational Research, Galway, Ireland
| | | | - Mark O Loughlin
- Discipline of Pathology, NUI Galway, Lambe Institute for Translational Research, Galway, Ireland
| | | | - Areeg Abbas
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Michela Campora
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Zsolt Hodi
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Ian Ellis
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Andrew H S Lee
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Emad A Rakha
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
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Li Y, Song Y, Lang R, Shi L, Gao S, Liu H, Wang P. Retrospective study of malignant phyllodes tumors of the breast: Younger age, prior fibroadenoma surgery, malignant heterologous elements and surgical margins may predict recurrence. Breast 2021; 57:62-70. [PMID: 33774460 PMCID: PMC8027899 DOI: 10.1016/j.breast.2021.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The potential recurrence rate of malignant phyllodes tumors (MPTs) of the breast is high, and the prognostic factors are still unclear. We therefore aim to study the factors affecting the outcome of MPTs. Methods A retrospective review of MPT patients treated from 2006 to 2020 at our institution was conducted. Univariate and multivariate Cox proportional hazard models were used to examine the influence of different variables on RFS. Moreover, significant prognostic factors were combined to construct the nomogram to predict the probability of relapse occurring in MPT patients. The 5-year and 10-year RFS rates were estimated using the Kaplan–Meier method. Results During the study period, 188 MPT patients were identified. The presence of malignant heterologous elements was observed in 23 (12.2%) patients with MPT, and the patients with malignant heterologous elements who received chemotherapy had longer RFS, which could reduce the risk of recurrence (p = 0.022). Recurrence occurred in 56/188 (29.8%) patients, of whom 47 experienced local recurrence and 11 experienced distant metastases. The 5-year and 10-year cumulative RFS rates were 77.5% and 70.1%, respectively. Age (p = 0.041), fibroadenoma surgery history (p = 0.004), surgical margins (p = 0.001) and malignant heterologous elements (p < 0.001) were independent risk factors for postoperative RFS. Subsequently, a nomogram was built, with a C-index of 0.64 (95% CI: 0.629–0.661), to predict the risk of recurrence. Conclusion The results of this study showed that younger age, fibroadenoma surgery history, malignant heterologous elements and surgical margins <1 cm predict a higher incidence of recurrence in MPT patients. Patients with malignant heterologous elements treated with chemotherapy could have a reduced risk of recurrence. This is the largest cohort of malignant phyllodes tumors in China. Age, fibroadenoma surgery history, surgical margins and malignant heterologous elements predict the risk of recurrence. Patients with malignant heterologous elements treated with chemotherapy could reduce the risk of recurrence.
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Affiliation(s)
- Yang Li
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yixuan Song
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ronggang Lang
- Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, State Key Laboratory of Breast Cancer Research, Tianjin, China
| | - Lu Shi
- College of Computer Science and Technology, Harbin Institute of Technology (Shenzhen), China
| | - Shuang Gao
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Hong Liu
- The Second Surgical Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
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Kuppusamy DA, Jinkala S, Thambiraj P, Stephen N, Gochhait D, Siddaraju N, Dharanipragada K. Malignant phyllodes tumor with liposarcomatous differentiation: Diagnosed on cytology. Diagn Cytopathol 2020; 49:E226-E230. [PMID: 33378115 DOI: 10.1002/dc.24681] [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: 09/12/2020] [Revised: 11/07/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022]
Abstract
Phyllodes tumor (PT) accounts for less than 1% of all primary tumors of the breast and 2% to 3% of all fibroepithelial lesions. We report a case of heterologous liposarcomatous elements in a malignant PT of the breast on Fine needle aspiration cytology (FNAC) and later confirmed by histopathological examination. A 58-years-old woman presented with a huge breast mass for which FNAC was done. Cytology showed features of malignant PT with a good representation of heterologous liposarcomatous areas. The cytological findings were in concordance with the histologic features. Malignant PT and its various heterologous elements of stroma can be diagnosed on FNA cytology when performed optimally. They can be vital for the preoperative assessment of patients suspected with malignancy to formulate the surgical plan accordingly.
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Affiliation(s)
- Devi Anu Kuppusamy
- Department of Pathology and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sreerekha Jinkala
- Department of Pathology and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Paruvathavarthini Thambiraj
- Department of Pathology and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Norton Stephen
- Department of Pathology and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- Department of Pathology and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kadambari Dharanipragada
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Width of margins in phyllodes tumors of the breast: the controversy drags on?-a systematic review and meta-analysis. Breast Cancer Res Treat 2020; 185:21-37. [PMID: 32935237 DOI: 10.1007/s10549-020-05924-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 09/02/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most studies suggested margins of at least 10 mm while some recent studies suggested narrower margins without an increased risk of local recurrences (LR) and distant metastases (DM). The objective of this systematic review was to identify and compare studies that assessed these different practices. METHODS A systematic review was performed through five databases up to April 2019. Studies exploring the association between the width of margins, subtypes of PT, and the LR and DM rates were considered for inclusion. A statistical model for analyzing sparse data and rare events was used. RESULTS Thirteen studies met eligibility criteria and were selected. Considering a threshold of 10 mm (margins < 10 vs margins ≥ 10 mm), the 5-year incidence rate of LR was estimated to be 5.22 vs. 3.63 (diff. -1.59) per 100 person-years for benign PT, 9.60 vs. 7.33 (diff. -2.27) for borderline PT, and 28.58 vs. 21.84 (diff. -6.74) for malignant PT. For DM, it was estimated to be 0.88 vs. 0.86 (diff. -0.02) for benign PT, 1.61 vs. 1.74 (diff. 0.13) for borderline PT, and 4.80 vs 5.18 (diff. 0.38) for malignant PT. The data for a threshold of 1 mm were not sufficient to draw any conclusions. CONCLUSION Irrespective of tumor grade, we found that DM was a rarer event than LR. Malignant PT had the highest incidence rate of LR and DM. This meta-analysis found a clear association between width of margins and LR rates. Whatever the tumor grade, surgical margins ≥ 10 mm guaranteed a lower risk of LR than margins < 10 mm. On the other hand, the width of margin did not influence the apparition of DM.
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Abstract
Phyllodes tumors (PTs) of the breast are considered a rare fibroepithelial neoplasms of the breast and are considered a challenging for both pathologists and surgeons. The World Health Organization (WHO) has classified PTs histologically as benign, borderline, and malignant. PTs can be detected in all ages; however, the median age of presentation is 45 years. PTs can mimic fibroadenoma in clinical presentations. Breast imaging is also similar to fibroadenomas. Cytological diagnosis of PTs by biopsy is usually unreliable. However, a core needle biopsy is superior to fine-needle aspiration. Surgery is considered the mainstay treatment for PTs of the breast with a goal of achieving negative margins. Adjuvant chemotherapy and radiation therapy use for malignant PTs are controversial.
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Affiliation(s)
- Musaed Rayzah
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
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Obeng-Gyasi S, Bhattacharyya O, Li Y, Eskander M, Tsung A, Oppong B. The implications of neighborhood socioeconomic status on surgical management and mortality in malignant phyllodes patients in the Surveillance, Epidemiology, and End Results program. Surgery 2020; 168:1122-1127. [PMID: 32847674 DOI: 10.1016/j.surg.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neighborhood socioeconomic status has been implicated in breast cancer incidence and mortality. However, there are no studies on the impact of neighborhood socioeconomic status on clinical outcomes or surgical management among patients with phyllodes tumors. The objective of this study is to understand the relationship between neighborhood socioeconomic status, surgical management and disease specific mortality in malignant phyllodes tumor patients in the Surveillance, Epidemiology, and End Results program. METHODS Surveillance, Epidemiology, and End Results program was queried for malignant phyllodes tumor patients diagnosed between 2000 and 2016. Using the National Cancer Institute census tract-level index for neighborhood socioeconomic status the data were stratified into low neighborhood socioeconomic status, middle neighborhood socioeconomic status, and high neighborhood socioeconomic status. Bivariate intergroup analysis was conducted. Disease specific mortality was evaluated using a Cox proportional hazards model. RESULTS Of the 651 patients with malignant phyllodes tumor in the sample, the disease specific mortality was 7.6% and 7.9% at 5 and 10 years, respectively. On bivariate analysis, there were no differences between the neighborhood socioeconomic status groups and surgery type (P = .794). On multivariable analysis, older age (≥71 years; hazard ratio 9.9; 95% confidence interval, 2.84-34.57; P < .001) and larger tumor size (≥40 mm; hazard ratio 2.20; 95% confidence interval, 1.09-4.44; P = .027) were associated with a higher disease specific mortality compared with younger age (≤ 40 years) and smaller tumor size (<40 mm). There was no association between neighborhood socioeconomic status and disease specific mortality (low neighborhood socioeconomic status-ref, middle neighborhood socioeconomic status hazard ratio 0.87 (95% confidence interval, 0.71-1.78; P = .71), high hazard ratio 0.91 (95% confidence interval, 0.44-1.90, P = .81). CONCLUSION Among malignant phyllodes tumor patients in the Surveillance, Epidemiology, and End Results program, disease specific mortality and surgical management are mostly driven by tumor characteristics and not social determinants of health.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH.
| | | | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Mariam Eskander
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Bridget Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
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Nistor-Ciurba CC, Şomcutian O, Lisencu IC, Ignat FL, Lazăr GL, Eniu DT. Malignant phyllodes tumors of the breast associating malignancy of both mesenchymal and epithelial components (invasive or in situ ductal carcinoma). ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2020; 61:129-135. [PMID: 32747903 PMCID: PMC7728119 DOI: 10.47162/rjme.61.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Phyllodes tumors of the breast are biphasic tumors consisting from an epithelial component and a mesenchymal component. Usually, the mesenchymal component of the tumor is the one who dictates the malignancy of the biphasic proliferation. Presence of the malignancy of the both, epithelial [under the form of invasive carcinoma or ductal carcinoma in situ (DCIS)] and mesenchymal components is very rare. Most of the data available from the literature refers to single case presentations. This paper presents the experience of Prof. Dr. Ion Chiricuţă Oncological Institute (IOCN), Cluj-Napoca, Romania, with the malignant phyllodes tumors with both epithelial and mesenchymal components showing malignancy. Over two decades (1999–2018), four cases of malignant phyllodes tumors with concomitant epithelial and mesenchymal malignancy were found and presented as a case series. Two out of four cases were malignant phyllodes tumors harboring invasive breast carcinomas (one case with associated DCIS and one case of pure invasive carcinoma) and two cases were malignant phyllodes tumors with the epithelial component showing DCIS. Average follow-up period was 67 months (from 39 to 132 months) with a disease-free survival of 58 months.
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Affiliation(s)
- Codruţ Cosmin Nistor-Ciurba
- Department of Surgical and Gynecological Oncology, Prof. Dr. Ion Chiricuţă Oncological Institute, Cluj-Napoca, Romania;
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Abstract
Phyllodes tumor (PT) occurs predominantly in middle-aged women, and although its occurrence in young women, adolescents, and even children is documented, presentation in the pediatric population has been the least well studied because of its rarity. Incompletely defined in children with PT are recurrence rates and optimal surgical management. We retrospectively studied the pathology database of Hartford Hospital from 2010 to 2017 to find all cases of PT in patients 18 years of age or younger. A series of 8 children/adolescents with breast masses diagnosed as benign PT were identified. Patients were 14 to 16 years of age (mean 15.2 y) and tumor size ranged from 2.2 to 7.2 cm (mean 4.4 cm). Both breasts were equally affected. All patients were treated with excision, tantamount to simple enucleation in most cases, and positive or "tumor-abutting" margins were universal. Mean follow-up after surgery was 27.5 months, during which time a single recurrence (at 9 mo) became manifest, which was re-excised and again showed benign PT. There were no pathologic features (including marginal status) that could have predicted the sole recurrence. Despite positive margins, the local recurrence rate for pediatric benign PT appears acceptably low (1 in 8 cases) such that reflex re-excision is probably unnecessary.
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Wong RX, Koh YS, Wong FY, Kusumawidjaja G, Ng WL, Yeo RMC, Farid M, Sheng Chan JY, Yan Z, Gudi MA, Tan PH. The Impact of Radiotherapy and Histological Risk Factors on Outcomes in Malignant Phyllodes Tumors. Clin Breast Cancer 2020; 20:e695-e700. [PMID: 32636151 DOI: 10.1016/j.clbc.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Breast phyllodes tumors (PT) are classified into benign, borderline, and malignant grades based on histopathologic characteristics. Specific to malignant PT (MPT), surgery is the mainstay yet relapse rates are high and knowledge gaps in the literature exist regarding adjuvant radiotherapy (RT). We aimed to investigate the outcomes of patients with MPT treated in a tertiary Asian institution. METHODS AND MATERIALS Patients with nonmetastatic MPT treated from February 1992 to June 2019 were analyzed retrospectively. RT details and relapse fields were studied. Outcomes of patients with and without RT were compared and hazard ratios were calculated using Cox proportional hazard test. Multivariable analysis was performed. RESULTS Twenty-two of 89 patients received adjuvant RT and the median dose was 60 Gy. In the no-RT group, 4 patients received RT on relapse and had no further recurrences; a further 2 received RT for fungating relapses with good symptomatic relief. RT was only increasingly prescribed after 2004. Median follow-up in the RT group was 3.31 years, compared with 6.17 years in the no-RT group. In the RT group, 15 patients (68.2%) underwent mastectomy, versus 39 (58.2%) in the no-RT group. One patient in the RT group developed an infield local relapse, compared with 21 of 67 patients in the no-RT group. Multivariate model showed that RT decreased risk of locoregional failure (hazard ratio 0.12, 95% confidence interval [CI] 0.02-0.92, P = .04). Three-year locoregional recurrence-free survival was higher in the RT group, 92.3% (95% CI, 78.9-100) versus 73.3% (95% CI, 63.1-85.1) in the no-RT group (P = .03). There were no differences in 3-year survival. CONCLUSIONS We recommend that adjuvant radiotherapy be discussed for malignant PT for local control, even after mastectomy.
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Affiliation(s)
- Ru Xin Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.
| | - Yen Sin Koh
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Wee Loon Ng
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Richard M C Yeo
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Zhiyan Yan
- Department of Surgery, Kandang Kerbau Women & Children Hospital, Singapore
| | - Mihir A Gudi
- Department of Pathology and Laboratory Medicine, Kandang Kerbau Women and Children Hospital, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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Kolia AK, Kalles V, Zografos CG, Chamzin A, Michalopoulos NV. Giant phyllodes tumor occupying the whole breast in a young female: feasibility of mastectomy and immediate reconstruction. J Surg Case Rep 2020; 2020:rjz410. [PMID: 32280449 PMCID: PMC7135843 DOI: 10.1093/jscr/rjz410] [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: 11/25/2019] [Revised: 01/10/2020] [Accepted: 03/06/2020] [Indexed: 11/24/2022] Open
Abstract
Giant phyllodes tumors are rare fibroepithelial breast neoplasms typically >10 cm by definition. The best investigation for preoperative diagnosis is core biopsy, although it is often difficult for the pathologist to distinguish fibroadenomas from phyllodes tumors and determine the level of malignant potential. The wide excision is the appropriate therapy for phyllodes tumors taking into consideration that mastectomy may be required for huge phyllodes tumors. In the modern era of breast tissue expanders and breast implants, immediate breast reconstruction is feasible. We present a case report of a patient with a giant phyllodes tumor of 24 cm diameter who underwent mastectomy and immediate breast reconstruction with breast tissue expander.
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Affiliation(s)
- Aikaterini K Kolia
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Vasileios Kalles
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Constantinos G Zografos
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Alexandros Chamzin
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Nikolaos V Michalopoulos
- 1st Department of Propaedeutic Surgery, 'Hippocratio' General Hospital, Medical School, National and Kapodistrian University of Athens, Greece
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Phyllodes tumors of the breast: a retrospective analysis of 57 cases. Breast Cancer Res Treat 2020; 181:361-367. [PMID: 32277376 DOI: 10.1007/s10549-020-05620-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Current guidelines for the treatment of phyllodes tumors recommend wide local excision for all histopathological subtypes. However, it is unknown which subtypes have tendency to recur after marginal or incomplete excision. This may lead to over-treatment by re-excision surgery for tumors with little or no potential to recur. MATERIALS AND METHODS All patients with benign, borderline or malignant phyllode tumors presenting at our institution between 2000 and 2016 were retrospectively analyzed. RESULTS A total of 57 patients could be included, of which 39 tumors were benign (60%), three were borderline (5%), and seven were malignant phyllodes tumors (12%). There were also eight phyllodes-like fibroadenomas (14%). Fifty-two patients (91%) underwent local excision as primary treatment, resulting in tumor-positive or close-resection margins in 32 patients (61.5%) of whom five patients (15.6%) had re-excision surgery. During a median follow-up of 5 years, local recurrence occurred in four patients (7.0%) with a median time-to-recurrence of 12 months. Borderline and malignant subtypes were associated with a significantly higher recurrence rate compared to other subtypes (p = 0.039). CONCLUSION Although an adequate tumor-negative resection margin should be obtained for borderline and malignant phyllodes tumors, this study confirms that wide local excision is the appropriate primary treatment for all histopathological subtypes. However, if tumor-negative margins were not obtained at first excision, a wait-and-see approach is justified for benign phyllodes tumors.
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Wen B, Mousadoust D, Warburton R, Pao JS, Dingee C, Chen L, McKevitt E. Phyllodes tumours of the breast: Outcomes and recurrence after excision. Am J Surg 2020; 219:790-794. [PMID: 32145921 DOI: 10.1016/j.amjsurg.2020.02.048] [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: 11/06/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Wide excision margins are traditionally recommended for phyllodes tumours of the breast to reduce recurrence. Recent studies suggest margin status and histopathological features, excluding margin width, influence recurrence. This study evaluated treatment outcomes for phyllodes tumours and examined predictors of recurrence. METHODS Clinical and follow-up information for phyllodes tumours patients treated between 2008 and 2017 were obtained from chart review. Tumour subtype and histopathological features were determined from pathology reports. Primary endpoints were recurrence rate and time to recurrence or mortality. RESULTS Among 96 patients, there were 6 local and 1 distant recurrences. Overall recurrence rate was 7.3% and average time-to-recurrence was 13.7 months. Tumour size, margin status, necrosis, and mitoses were associated with recurrence; margin width was not. Two deaths (2.1%) from malignant phyllodes occurred. CONCLUSIONS Multiple histopathological features influence phyllodes recurrence. Wide excision and re-excising positive margins for benign tumours was not beneficial.
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Affiliation(s)
- Betty Wen
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Dorsa Mousadoust
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Leo Chen
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
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Lim RS, Cordeiro E, Lau J, Lim A, Roberts A, Seely J. Phyllodes Tumors-The Predictors and Detection of Recurrence. Can Assoc Radiol J 2020; 72:251-257. [PMID: 32090614 DOI: 10.1177/0846537119899553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Phyllodes tumors are rare breast neoplasms and the histopathological grade and surgical margins help guide treatment and follow-up. The traditional surgical teaching is resection with ≥10 mm margins, but are narrower surgical margins acceptable? The purpose of our study was to identify predictors of local recurrence. METHODS A retrospective analysis was performed to identify patients with phyllodes tumors who underwent surgery between 2002 and 2014 using a regional pathology database. Electronic medical records were used to identify surgical management, pathological characteristics, and follow-up encounters. RESULTS A total of 150 phyllodes tumors were included: 110 of 150 (73%) benign, 21 of 150 (14%) borderline, and 19 of 150 (13%) malignant. At initial surgery, 29 specimens had a positive margin and 15 (56%) underwent re-excision. Seventy tumors had a surgical margin of ≤1 mm, 40 had a margin of 2 to 9 mm, and 11 had a margin of ≥10 mm. There were 11 of 150 (7.3%) locally recurrent tumors: 5 of 11 (45%) benign, 3 of 11 (27%) borderline, and 3 of 11 (27%) malignant. In total, 10 of 11 locally recurrent tumors had a positive margin or ≤1 mm margin at initial surgery. CONCLUSIONS Phyllodes tumors can have a personalized treatment approach based on histopathological grade and surgical margins. Borderline and malignant phyllodes tumors with a positive or ≤1 mm surgical margin have an increased risk of recurrence. In benign phyllodes tumors, an optimal narrow negative margin may exist but the traditional ≥10 mm excisional margin is not necessary. Local recurrence rates may be sufficiently low in benign phyllodes tumors that imaging can be performed on the presence of clinical symptoms.
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Affiliation(s)
- Robert S Lim
- Department of Medical Imaging, The 6363University of Ottawa, Ottawa, General Campus, Ontario, Canada
| | - Erin Cordeiro
- Department of Surgery, 6363iThe University of Ottawa, Ottawa, General Campus, Ontario, Canada
| | - Jaqueline Lau
- Department of Medical Imaging, The 6363University of Ottawa, Ottawa, General Campus, Ontario, Canada
| | - Andrew Lim
- Department of Radiation Oncology, 3158The University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Roberts
- Department of Surgery, 6363iThe University of Ottawa, Ottawa, General Campus, Ontario, Canada
| | - Jean Seely
- Department of Medical Imaging, The 6363University of Ottawa, Ottawa, General Campus, Ontario, Canada
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Neron M, Sajous C, Thezenas S, Piperno-Neumann S, Reyal F, Laé M, Chakiba C, Michot A, Penel N, Honoré C, Owen C, Bertucci F, Salas S, Saada-Bouzid E, Valentin T, Bompas E, Brahmi M, Ray-Coquard I, Blay JY, Firmin N. Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study. Ann Surg Oncol 2020; 27:1818-1827. [PMID: 31989361 DOI: 10.1245/s10434-020-08217-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated. PATIENTS AND METHODS We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates. RESULTS Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1-2 mm margins, 12.2% of patients with 3-7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (p < 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3, p = 0.005) and OS (HR 0.32, p = 0.005) compared with margins of 0-1-2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3-7 mm (3-7 mm vs. > 8 mm; HR 0.81, p = 0.69). Age (HR 2.14, p = 0.038) and tumor necrosis (HR 1.96, p = 0.047) were found to be poor prognostic factors and were associated with MFS. CONCLUSIONS This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0-1-2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.
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Affiliation(s)
- Mathias Neron
- Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France.
| | - Christophe Sajous
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Simon Thezenas
- Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
| | | | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, Paris, France
| | - Marick Laé
- Department of Pathology, Institut Curie, Paris, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Audrey Michot
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Penel
- Department of Medical Oncology, Institut Oscar Lambret, Lille, France
| | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Clémentine Owen
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Sébastien Salas
- Department of Medical Oncology, CHU La Timone, Marseille, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
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Thind A, Patel B, Thind K, Isherwood J, Phillips B, Dhaliwal K, Remoundos DD. Surgical margins for borderline and malignant phyllodes tumours. Ann R Coll Surg Engl 2020; 102:165-173. [PMID: 31918563 DOI: 10.1308/rcsann.2019.0140] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins. METHODS MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale. RESULTS Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; p=0.33, n=456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; p=0.45, n=72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; p=0.40, n=58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm. CONCLUSION Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.
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Affiliation(s)
- A Thind
- Croydon University Hospital, Croydon Health Services NHS Trust, Thornton Heath, UK
| | - B Patel
- Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - K Thind
- King's College Hospital NHS Foundation Trust, London, UK
| | - J Isherwood
- Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - B Phillips
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Dhaliwal
- University of Western Ontario, London, Ontario, Canada
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Neron M, Sajous C, Thezenas S, Piperno-Neumann S, Reyal F, Laé M, Chakiba C, Penel N, Ryckewaert T, Honoré C, Bertucci F, Monneur A, Salas S, Duffaud F, Saada-Bouzid E, Isambert N, Brahmi M, Ray-Coquard I, Blay JY, Firmin N. Impact of Metastasis Surgery and Alkylating-Agent-Based Chemotherapy on Outcomes of Metastatic Malignant Phyllodes Tumors: A Multicenter Retrospective Study. Ann Surg Oncol 2019; 27:1693-1699. [PMID: 31773519 DOI: 10.1245/s10434-019-08097-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Metastatic phyllodes tumors have poor prognosis with median overall survival of 11.5 months. The objective of this study is to identify prognostic factors and the best options for management of metastatic malignant phyllode tumors (MMPTs). PATIENTS AND METHODS A multicentric retrospective study, including cases of MMPT from 10 sarcoma centers, was conducted. The primary end-point was overall survival (OS), and the secondary end-point was the clinical benefit of chemotherapy (CBCT) rate. RESULTS 51 MMPT patients were included. Median time from diagnosis to metastatic recurrence was 13 months. Management of MMPT consisted in surgery of the metastatic disease for 16 patients (31.3%), radiation therapy of the metastatic disease for 15 patients (31.9%), and chemotherapy for 37 patients (72.5%). Median follow-up was 62.1 months [95% confidence interval (CI) 31-80 months]. Median OS was 11.5 months (95% CI 7.5-18.7 months). On multivariate analysis, two or more metastatic sites [hazard ratio (HR) 2.81, 95% CI 1.27-6.19; p = 0.01] and surgery of metastasis (HR 0.33, 95% CI 0.14-0.78; p = 0.01) were independently associated with OS. The CBCT rate was 31.4% and 16.7% for the first and second lines. Polychemotherapy was not superior to single-agent therapy. Alkylating-agent-based chemotherapy, possibly associated with anthracyclines, was associated with a better CBCT rate than anthracyclines alone (p = 0.049). CONCLUSIONS The results of this study emphasize the impact of the number of metastatic sites on survival of MMPT patients and the leading role of metastasis surgery in MMPT management. If systemic therapy is used, it should include alkylating agents, which are associated with a better clinical benefit.
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Affiliation(s)
- Mathias Neron
- Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France.
| | - Christophe Sajous
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Simon Thezenas
- Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
| | | | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, Paris, France
| | - Marick Laé
- Department of Pathology, Institut Curie, Paris, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Audrey Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Sébastien Salas
- Department of Medical Oncology, CHU La Timone, Marseille, France
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone, Marseille, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du cancer Montpellier, Univ Montpellier, Montpellier, France
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40
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Cui WJ, Wang C, Jia L, Ren S, Duan SF, Cui C, Chen X, Wang ZQ. Differentiation Between G1 and G2/G3 Phyllodes Tumors of Breast Using Mammography and Mammographic Texture Analysis. Front Oncol 2019; 9:433. [PMID: 31192133 PMCID: PMC6548862 DOI: 10.3389/fonc.2019.00433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/07/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: To determine the potential of mammography (MG) and mammographic texture analysis in differentiation between Grade 1 (G1) and Grade 2/ Grade 3 (G2/G3) phyllodes tumors (PTs) of breast. Materials and methods: A total of 80 female patients with histologically proven PTs were included in this study. 45 subjects who underwent pretreatment MG from 2010 to 2017 were retrospectively analyzed, including 14 PTs G1 and 31 PTs G2/G3. Tumor size, shape, margin, density, homogeneity, presence of fat, or calcifications, a halo-sign as well as some indirect manifestations were evaluated. Texture analysis features were performed using commercial software. Receiver operating characteristic curve (ROC) was used to determine the sensitivity and specificity of prediction. Results: G2/G3 PTs showed a larger size (>4.0 cm) compared to PTs G1 (64.52 vs. 28.57%, p = 0.025). A strong lobulation or multinodular confluent was more common in G2/G3 PTs compared to PTs G1 (64.52 vs. 14.29%, p = 0.004). Significant differences were also observed in tumors' growth speed and clinical manifestations (p = 0.007, 0.022, respectively). Ten texture features showed significant differences between the two groups (p < 0.05), Correlation_AllDirection_offset7_SD and ClusterProminence_AllDirection_offset7_SD were independent risk factors. The area under the curve (AUC) of imaging-based diagnosis, texture analysis-based diagnosis and the combination of the two approaches were 0.805, 0.730, and 0.843 (90.3% sensitivity and 85.7% specificity). Conclusions: Texture analysis has great potential to improve the diagnostic efficacy of MG in differentiating PTs G1 from PTs G2/G3.
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Affiliation(s)
- Wen Jing Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Graduate, Bengbu Medical College, Bengbu, China
| | - Ling Jia
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Shuai Ren
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | | | - Can Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhong Qiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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41
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Can whole-tumor apparent diffusion coefficient histogram analysis be helpful to evaluate breast phyllode tumor grades? Eur J Radiol 2019; 114:25-31. [DOI: 10.1016/j.ejrad.2019.02.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 12/20/2022]
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42
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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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43
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Christensen LG, Di Caterino T, Talman ML. Phyllodes tumor with a benign heterologous osseous component: a diagnostic challenge. APMIS 2019; 127:484-488. [PMID: 30901115 DOI: 10.1111/apm.12949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
Phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast and constitute 0.3-1% of all primary breast tumors. They should be characterized in to a benign, borderline or malignant category based on a combination of histological features. PTs can show heterologous components, typically sarcomatous, including osteosarcomatous and chondrosarcomatous. Benign heterologous components are exceedingly rare with only one prior reported case in the English literature. This case emphasizes how difficult establishing a correct diagnosis in PTs with heterologous components can be, especially when the tumor consists mainly of a benign heterologous component. We report the case of a 65 year old woman with a recurrent breast tumor initially misdiagnosed as benign osseous metaplasia. The tumor re-occurred as a malignant PT dominated by benign osseous and chondroid metaplasia. Multiple metastases consisting of primarily mature bone and cartilage were seen in the lungs. On microscopic revision and considering the clinical course the primary breast tumor was re-classified as a borderline PT.
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Affiliation(s)
| | - Tina Di Caterino
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Maj-Lis Talman
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, København Ø, Denmark
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44
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Choi N, Kim K, Shin KH, Kim Y, Moon HG, Park W, Choi DH, Kim SS, Ahn SD, Kim TH, Chun M, Kim YB, Kim S, Choi BO, Kim JH. The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08). Clin Breast Cancer 2019; 19:345-353.e2. [PMID: 31103280 DOI: 10.1016/j.clbc.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/22/2019] [Accepted: 04/01/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite margin-negative breast-conserving surgery (BCS), phyllodes tumors (PT) of the breast show high local recurrence (LR) rates. In this study we aimed to assess the site and grade of LR to identify high-risk patients after initial treatment of malignant and borderline PT using BCS alone. PATIENTS AND METHODS From 1981 to 2014, 312 patients with malignant (n = 164) and borderline (n = 148) PT were treated using BCS alone at 10 centers. LR was defined as true recurrence (TR) if < 2 cm from the primary tumor bed and as elsewhere failure (EF) if otherwise. RESULTS At a median of 21 months, LR occurred in 17.6% (55 of 312), 18.9% (31 of 164) among malignant and 16.2% (24 of 148) among borderline PT (P = .636). Only 1.9% (6 of 312) had EF. Five-year cumulative LR rates were 14.7% and 35.9% after margin-negative and -positive BCS, respectively (P < .001). Positive margin was an independent risk factor for TR (P = .002) and EF (P = .002). In multivariable competing risk regression of patients with negative margins < 1 cm (n = 115), age < 35 years (P = .001), and tumor size ≥ 5 cm (P = .008) independently increased LR risk. Of patients who experienced a LR, 30.9% (17 of 55) had a second or third repeated event. Borderline-to-malignant transformation rates increased at each LR event: 4.1% (6 of 148), 12.5% (3 of 24), and 77.8% (7 of 9) at first, second, and third LR, respectively (P = .006). CONCLUSION LRs almost always develop near the primary tumor bed. Many patients experience multiple events, with heightened risk of borderline-to-malignant transformation at each subsequent event. For patients with negative margins < 1 cm, younger age and larger tumor size are independent risk factors for increased LR.
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Affiliation(s)
- Noorie Choi
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
| | - Yumi Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Tae Hyun Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Ock Choi
- Department of Radiation Oncology, Seoul St Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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45
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Park HJ, Ryu HS, Kim K, Shin KH, Han W, Noh DY. Risk Factors for Recurrence of Malignant Phyllodes Tumors of the Breast. In Vivo 2019; 33:263-269. [PMID: 30587634 DOI: 10.21873/invivo.11470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In this study, the treatment outcome and risk factors for recurrence in patients undergoing surgery with or without adjuvant radiotherapy (RT) for malignant phyllodes tumors of the breast (MPTB) were analyzed. PATIENTS AND METHODS Forty-three patients (61.4%) underwent breast-conserving surgery (BCS) and 27 (38.6%) underwent mastectomy. Fifteen patients (21.4%) received adjuvant RT. RESULTS With a median follow-up of 76 months, the 7-year local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and cause-specific survival (CSS) rates were 90.7%, 85.2%, 80.3%, and 87.1%, respectively. Either the extent of surgery or treatment with adjuvant RT did not affect the outcomes. On multivariate analysis, the presence of tumor necrosis was associated with inferior DFS (p=0.017), while infiltrative tumor border showed a marginal significance (p=0.078). When stratified using these two adverse pathological features, the 7-year DFS rates were 100%, 54.9%, and 55.6% in patients with 0, 1, and 2 risk factors, respectively (p=0.002). CONCLUSION MPTB patients undergoing surgery with or without adjuvant RT had a favorable outcome. Although there was no local recurrence in patients treated with adjuvant RT, the effect of adjuvant RT failed to reach a statistical significance. Risk-grouping based on pathological features might help design a clinical trial for MPTB.
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Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Barth RJ. Borderline and Malignant Phyllodes Tumors: How Often do They Locally Recur and is There Anything we can do About it? Ann Surg Oncol 2019; 26:1973-1975. [DOI: 10.1245/s10434-019-07278-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Indexed: 12/28/2022]
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Spanheimer PM, Murray MP, Zabor EC, Stempel M, Morrow M, Van Zee KJ, Barrio AV. Long-Term Outcomes After Surgical Treatment of Malignant/Borderline Phyllodes Tumors of the Breast. Ann Surg Oncol 2019; 26:2136-2143. [PMID: 30783853 DOI: 10.1245/s10434-019-07210-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Malignant/borderline phyllodes tumors (PTs) are rare, and little is known about their long-term prognosis. This study sought to evaluate recurrence rates and identify factors associated with local and distant failure. METHODS From 1957 to 2017, we identified 124 patients with 125 PTs (86 malignant and 39 borderline). Recurrence rates and survival were assessed using the Kaplan-Meier method, and correlated with clinicopathologic factors using the log-rank test. RESULTS The median age of the patients was 44 years, and the median tumor size was 5 cm. Breast-conserving surgery was performed for 57% of the patients. At a median follow-up of 7.1 years, 14 patients experienced a locoregional recurrence (LRR), with a 10-year cumulative LRR incidence of 12%. On univariable analysis, age younger than 40 years (p = 0.02) and close/positive margins (p = 0.001) were associated with increased risk of LRR. Seven patients developed distant disease, all occurring in malignant PTs. The 10-year distant recurrence-free survival was 94%. Uniformly poor pathologic features consisting of marked stromal cellularity, stromal overgrowth, infiltrative borders, and 10 or more mitoses per 10 high-power fields (hpf) were identified in 25 PTs (20%), and all distant recurrences occurred in this group. For the patients who did not have uniformly poor features, the 10-year disease-specific survival was 100%, and the overall survival was 94% compared with 66% and 57%, respectively, among those with poor features. CONCLUSION Malignant/borderline PTs without uniformly poor histologic features have an excellent prognosis after surgical resection, with a 10-year disease-specific survival of 100%. The presence of uniformly poor pathologic features predicts a poor prognosis. Efforts should be directed toward new treatment approaches for these tumors.
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Affiliation(s)
- Philip M Spanheimer
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa P Murray
- Breast Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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48
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Mitus JW, Blecharz P, Jakubowicz J, Reinfuss M, Walasek T, Wysocki W. Phyllodes tumors of the breast. The treatment results for 340 patients from a single cancer centre. Breast 2018; 43:85-90. [PMID: 30521986 DOI: 10.1016/j.breast.2018.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/13/2018] [Accepted: 11/25/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The primary treatment of choice for patients with phyllodes tumor of the breast (PTB) is surgery. Two major problems regarding the treatment of such patients remain unclear: what is the appropriate surgical margin and what role is played by adjuvant radiotherapy (ART). METHODS The study provides a retrospective review of all patients with PTB treated between 1952 and 2013 at a single institute. The histology slides were re-examined based on WHO criteria. The clinical characteristics and therapy outcomes were obtained. The five-year survival with no evidence of disease (NED) was used as the end point. RESULTS The study population comprised 340 women with PTB. Fifty-five percent of the patients were diagnosed with the benign, 11.8% with borderline and 33.2% with malignant PTB. All the patients received primary treatment with surgery (mastectomy-27.1%, and BCS- 72.9%). Local recurrence (LR) was found in 28 (9.1%) of these patients. Four patients with borderline and 8 with malignant PTB who were treated with BCS and had tumor-free margins < 1 cm received ART. None of these patients had LR and all survived 5 years NED. Of the 340 patients from our group, 294 (86.4%) survived five-years NED. CONCLUSION The prognosis for benign PTB is excellent and can be cured with surgery alone. A sufficient margin would be 0.1 cm (data from the literature) or 0.2-0.4 cm (our study). We recommend application of ART for such patients but the role of ART in patients with borderline and malignant PTB treated with BCS and with surgical margin < 1 cm remains uncertain.
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Affiliation(s)
- J W Mitus
- Department of Surgical Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland; Department of Anatomy, Collegium Medicum, Jagiellonian University, ul. Kopernika 12, 31-034 Cracow, Poland.
| | - P Blecharz
- Department of Gynecological Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - J Jakubowicz
- Department of Gynecological Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - M Reinfuss
- Department of Radiotherapy, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - T Walasek
- Department of Radiotherapy, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - W Wysocki
- Department of Surgical Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
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To H, Ong BS, Dodd T, Prasannan S. Synchronous malignant phyllodes tumour and invasive lobular carcinoma-case report and review. J Surg Case Rep 2018; 2018:rjy258. [PMID: 30310645 PMCID: PMC6174625 DOI: 10.1093/jscr/rjy258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/17/2018] [Indexed: 11/12/2022] Open
Abstract
Synchronous phyllodes tumour and invasive lobular carcinoma is an extremely rare event. We report these concurrent diagnoses in a patient observed in an ipsilateral breast, suspected due to breast risk factors (family history and lobular carcinoma in situ) and the presence of malignant phyllodes. Screening breast magnetic resonance imaging was able to identify the carcinoma which was occult in other imaging. An understanding of the possibility of dual diagnoses may lead to additional investigations for its identification. Treatment may then be tailored to the individual's pathology.
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Affiliation(s)
- Henry To
- Department of Surgery, Lyell McEwin Hospital, Adelaide, Australia
| | - Bee Shan Ong
- Department of Surgery, Lyell McEwin Hospital, Adelaide, Australia
| | - Tom Dodd
- SA Pathology, Lyell McEwin Hospital, Adelaide, Australia
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Yeh R, Chong LN, Hughes TM. Malignant phyllodes: excellent response to neoadjuvant radiotherapy. ANZ J Surg 2018; 89:1668-1670. [PMID: 30208507 DOI: 10.1111/ans.14807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/28/2018] [Accepted: 07/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Rudy Yeh
- Division of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Lee Na Chong
- Multidisciplinary Breast Team, Cancer Services, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - T Michael Hughes
- Division of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Multidisciplinary Breast Team, Cancer Services, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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