Case Report: Mitral valve obstruction by metastatic malignant phyllodes tumor

Cardiac metastases are rare. Herein, we report a case of a 37-year-old female patient with a history of borderline breast phyllodes tumor (PT) treated by surgery, admitted to our department for concomitant cardiac and pulmonary metastases of malignant PT. Cardiac metastasis occurred through direct extension from pulmonary metastasis to the left atrium via the right inferior pulmonary vein, causing severe mitral valve obstruction. Although the total surgical removal of metastases, the patient had a huge relapse of the mediastinal metastasis resulting in her death.

Severe Hypoglycemia Caused by a Giant Borderline Phyllodes Tumor of the Breast: A Case Report and Literature Review

A case of hypoglycemic coma caused by a giant borderline phyllodes tumor of the breast has been described. The patient, a 63-year-old woman, was admitted with recurrent unconsciousness. She had a giant breast tumor with decreased blood glucose, insulin, and C-peptide. The patient's hypoglycemia resolved rapidly after resection of the breast tumor. Pathological examination indicated a borderline phyllodes tumor of the breast, and immunohistochemistry suggested high expression of insulin-like growth factor-2 (IGF-2) in the tumor tissue. A literature review is also included to summarize the clinical characteristics of such patients and to serve as a unique resource for clinical diagnosis and treatment of similar cases.

A malignant phyllodes tumor with liposarcomatous differentiation case with 3-year follow-up

Phyllodes tumors (PTs) are a group of rarely breast tumors of fibro-epithelial origin, counting for about 1% of the breast malignancies divided, based on histological features, in benign, borderline and malignant neoplasms, arising most of them in women in their 40's. Among this complex group of tumors, the liposarcomatous differentiation is an even more rare lesion, counting for about 0.3% of all primary sarcomas of the breast. This article presents a case of a 48-year-old woman with a breast malignant PT with liposarcomatous differentiation, diagnosed by guided core biopsy, treated by excision and subsequent simple mastectomy followed by radiotherapy, with a 3-year follow-up.

A Hypoglycemia-inducing Giant Borderline Phyllodes Tumor Secreting High-molecular-weight Insulin-Like Growth Factor II: Immunohistochemistry and a Western Blot Analysis

A 50-year-old woman with a large right breast mass was emergently hospitalized for generalized weakness and fatigue. A histological examination of tumor biopsy specimens revealed a phyllodes tumor (PT). She suddenly lost consciousness due to severe hypoglycemia. Non-islet cell tumor hypoglycemia (NICTH) due to the PT was suspected. The tumor was emergently resected. A histological examination revealed a borderline PT. The patient recovered from the hypoglycemic episode. High-molecular-weight insulin-like growth factor II was detected in serum that had been collected preoperatively and in the tumor tissue, but not in serum that had been collected postoperatively. We herein present a case of a borderline PT with NICTH.

[A Case of Giant Malignant Phyllodes Tumor Associated with Severe Anemia]

A 72-year-old woman noted a mass in the left breast about 5 years ago, but she did not consult a medical institution. She was taken in the ambulance and hospitalized to our department due to severe anemia and malnutrition. A computed tomography( CT)scan indicated an 18×12 cm tumor in her left breast. A fiborsarcoma protuberance was suspected based on needle core biopsy results. Simple mastectomy was performed to control hemorrhage and infection. The resected tumor weighed 2.6 kg. The pathological diagnosis was a malignant phyllodes tumor. We report a patient with giant malignant phyllodes tumor associated with severe anemia.

A Case of Giant Borderline Phyllodes Tumor of the Breast Associated with Hypoglycemia

We report a patient with a giant phyllodes tumor of the right breast associated with a hypoglycemic attack. A 48-year-old woman experienced a loss of consciousness and was transferred via ambulance to our hospital emergency department. Upon arrival, her blood glucose level was 26 mg/dl, and a giant tumor (>20 cm in diameter) with skin ulceration was observed on the right breast. Core needle biopsy led to a histological diagnosis of a phyllodes tumor of the breast. Ultrasonography and computed tomography detected neither distant metastasis nor a pancreatic endocrine tumor. Her preoperative serum insulin-like growth factor (IGF)-II and insulin levels were 1,330 ng/ml (normal range, 519-1067 ng/ml) and <1.0 µU/ml, respectively. Following a simple mastectomy, the 24-h postoperative serum IGF-II and insulin levels were 496 ng/ml and 10.0 µU/ml, respectively. The IGF-II levels detected in the phyllodes tumor and normal breast tissue were 10,600 ng/Wg (wet weight in grams) and 855 ng/Wg. We conclude from these findings that the hypoglycemic attack was related to the elevated IGF-II level in the giant phyllodes tumor of the breast.

Recurrent phyllodes tumor in the male breast in a background of gynaecomastia

Phyllodes tumor of the male breast is an extremely rare entity with only a few reports available in the literature. Though exact etiology for development of phyllodes tumor in the male breast is unknown, hormonal imbalance with excess of estrogen action relative to androgen appears to have significant association. This report describes recurrence of phyllodes tumor with malignant features developing in the background of gynaecomastia in a male breast.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE); a rare association with phyllodes tumour of breast

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare entity mainly found in elderly males. It is characterized by pitting edema mainly of dorsum of both hands giving a "boxing glove hand" appearance; rarely involving feet also, acute in onset, negative rheumatoid factor and a good response to low dose corticosteroid therapy. Clinically it almost resembles a case of polymyalgia rheumatica, late onset rheumatoid arthritis or other seronegative spondyloarthropathy.Though there are multiple underlying factors causing this rare entity but it has very close associations with many malignancies.So far its association with solid tumours and hematological malignancies has been reported. Phyllodes tumour of breast shows wide spectrum of activity from a benign condition to a locally aggressive and sometimes metastatic tumour.One fourth of the cases recur after definitive treatment.Our case represent an unusual association with recurrent phyllodes tumour of breast with RS3PE.

Poland syndrome and breast tumor: a case report and review of the literature

Poland syndrome is a rare congenital malformation. Hypoplasia of the sternocostal portion of the pectoralis major muscle is the most significant feature and is most frequently associated with homolateral breast hypoplasia. In this article, the authors present a case of bilateral phyllodes tumors in a 28-year-old woman with Poland syndrome and discuss (1) the relationship between the condition and breast cancer, (2) the modes of surveillance in patients with Poland syndrome, and (3) its impact on breast reconstruction.

Low-grade phyllodes tumor of the seminal vesicle treated with laparoscopic excision

BACKGROUND

A 43-year-old man presented with a 2-year history of hematospermia and dull ache in the left testis. On physical examination he had left epididymal tenderness and a normal digital rectal examination.

INVESTIGATIONS

Transrectal ultrasonography and MRI.

DIAGNOSIS

Low-grade phyllodes tumor of the left seminal vesicle.

MANAGEMENT

Laparoscopic excision of the left seminal vesicle.

Resolution of hypoalbuminemia after excision of malignant phyllodes tumor

A 42-year-old woman presented with a rapidly growing tumor of the breast accompanied by anemia (7.4 g/dL), hypoalbuminemia (1.6 g/dL), and increased alkaline phosphatase (256 U/L). Magnetic resonance imaging of the breast demonstrated a heterogeneous mass composed of verrucous solid components with hemorrhagic areas. There was no evidence of cachexia, and the metastatic workup was negative. Final pathology revealed a 22-cm malignant phyllodes tumor. Hypoalbuminemia and alkaline phosphatase quickly resolved after surgical excision without any further treatment.

A case of intracystic breast cancer

The case of a 70-year-old female patient with family history of breast cancer come to the breast Unit for the presence of a nodular swelling in the right breast is discussed. On mammography and US a gross cystic neoformation with vascularized mural nodes was identified. Another contralateral solid nodular neoformation suggestive of malignancy was also present. Diagnostic completion with MRI confirmed the mixed solid, partly cystic nature of the right lesion, leading to the differential diagnosis with cystosarcoma phylloides and intracystic tumor. On the left side, MRI confirmed the presence of the second lesion whose morphologic and dynamic characteristics suggested a neoplastic lesion. At the anatomopathological examination the left lesion was shown to be an infiltrating ductal carcinoma; the right lesion was shown to be an intracystic tumor.

Phyllodes tumor of the prostate: Recurrent obstructive symptom and stromal proliferative activity

We report the case of a 59-year-old man with a metachronous development of phyllodes tumor and adenocarcinoma of the prostate. He complained of urinary obstruction and transurethral resections of the prostate (TUR-P) had been performed six times in 10 years. Microscopic examination showed cystically dilated glands consisting of bizarre cells with pleomorphic, hyperchromatic nuclei in the stroma at the sixth TUR-P. Radical prostatectomy was performed against recurrences and adenocarcinoma was incidentally detected. Apparent up-regulation of proliferative nuclear antigens (PCNA), but not p53, was observed in the prostatectomy specimen by Western blotting. Active proliferation of stromal cells is considered to have caused the recurrent obstructive symptom.

Hypertrophic osteoarthropathy associated with metastatic phyllodes tumor

Hypertrophic osteoarthropathy (HOA) is a paraneoplastic syndrome consisting of digital clubbing, polyarthralgias, and periostosis that sometimes accompanies primary bronchogenic carcinoma and other pulmonary malignancies. We report a case of HOA as the initial manifestation of pulmonary metastases in a 42-year-old woman with malignant phyllodes tumor of the breast. Since the treatment for malignancy-associated HOA is targeted at the underlying neoplasm, it is important to make the diagnosis in a timely fashion so that appropriate therapy may be initiated without delay. HOA symptoms generally improve, as they did in our patient, if the cancer responds to treatment. The pathophysiology of HOA is poorly understood, but a role for tumor-associated humoral mediators has been postulated. The hypothesized mechanisms underlying HOA are reviewed, and evidence for a prominent role for platelet-derived growth factor in mediating this syndrome is examined. This unusual case illustrates the importance of suspecting HOA in a patient with a history of cancer who presents with otherwise unexplained polyarthralgias.

[Pseudomalignant changes in benign phyllodes breast tumor]

Phylloides tumor of the breast is well known entity in pathology for a long time. It includes fibroepithelial tumors of the different biological character. They are generally divided into three groups: benign, low-grade malignant (borderline) and high-grade malignant. Adenoses of the breast are a group of the benign lesions, the main feature of which is the proliferation of the glandular component of the breast. More frequent adenoses occurring in practice are: blunt duct adenosis, sclerosing adenosis, nodular adenosis, adenosis tumor and florid adenosis. The less frequent adenoses are: microglandular adenosis, tubular adenosis, apocrine adenosis, and myoepithelial (adenomyoepithelial) adenosis. In this article two histologically unusual lesions of the breast in middle-aged women are presented, consisting of the benign variants of the phylloides tumor, modified distinctly by various types of adenoses, which can cause, together with intensive myoepithelial proliferation, great diagnostic problems, especially on frozen sections. They may be mistaken with invasive ductal or lobular cancer. Reliable differentiation between these entities is possible only by using of the immunohistochemical methods.

Malignant phyllodes tumor of the breast with hypoglycemia: report of a case

A surgically resected case of giant malignant phyllodes tumor of the breast associated with a hypoglycemic attack is reported. A 54-year-old woman was referred to our hospital with loss of consciousness and a huge chest wall tumor. She was diagnosed as having a malignant phyllodes tumor by core needle biopsy and underwent palliative simple mastectomy because lung metastasis was detected on computed tomography and by other imaging modalities on admission. The preoperative laboratory data revealed a very low fasting blood sugar level of 37 mg/dl. After removal of the tumor, the blood sugar level gradually normalized (90-100 mg/dl) and the plasma insulin-like growth factor-II (IGF-II) level promptly decreased. The IGF-II level of tumor extracts was high (2500 ng/g wet weight) and the majority of atypical cells stained positively for IGF-II immunohistochemically. These findings suggested that the patient's hypoglycemia was associated with IGF-II produced by a giant malignant phyllodes tumor that consumed glucose.

Fibroadenoma phyllodes arising in vulvar supernumerary breast tissue: report of two cases

Ectopic breast tissue, found along the mammary line or sometimes outside it, can exhibit pathologic changes similar to those of the eutopic mammary gland. Fibroadenoma phyllodes, an unusual variant of mammary phyllodes tumor with stromal cellularity similar to a conventional fibroadenoma, rarely arises outside of breast. Its histogenesis is unclear; although some cases suggest an origin in cutaneous adnexa, the presence of normal breast tissue surrounding other tumors favors an ectopic mammary origin. Two cases of fibroadenoma phyllodes arising in ectopic vulvar breast tissue are described.

Immediate TRAM flap breast reconstruction in an obese patient with relapsing benign phyllodes tumor: report of a case

The authors present a case of relapsing benign phyllodes cystosarcoma of the breast in an obese female treated with a simple mastectomy and an immediate reconstruction using a bipedicled transverse rectus abdominis musculocutaneous (TRAM) flap. After a brief review of treatment options for phyllodes tumors, they discuss the advantages of TRAM flap breast reconstruction, suggesting that it may also be applied in obese patients.

Clinicopathologic study of phyllodes tumor of the breast

The clinical and pathologic features of 34 phyllodes tumors in 33 women were analyzed. These included 20 benign tumors, 7 borderline malignant tumors and 7 malignant tumors. The median age of the patients at the time of diagnosis was 38 years. Patients with malignant tumors were older and had larger tumors. The tumor size varied from 1.6 cm to 40 cm. Local recurrence was evident in 4 of 21 patients who were followed-up, irrespective of their tumor type (one benign, two borderline malignant and one malignant). The recurrence rate was higher in younger patients. No single pathologic feature was found to have prognostic significance. Distant or regional lymph node metastasis and mortality due to the disease were not identified. Based on these results, wide excision with an adequate margin continues to be the appropriate initial surgical treatment.

Mammary cystosarcoma with mature adipose stromal differentiation (lipophyllodes tumor) arising in a lipomatous hamartoma

This report documents an uncommon variant of benign cystosarcoma phyllodes with mature adipose stromal differentiation, for which the term lipophyllodes tumor is proposed. Origin of this unusual tumor within a lipomatous hamartoma was confirmed by histologic and mammographic observations. The lesion developed in a 40-year-old woman 2 months post partum, and she remained well after treatment by biopsy. Lipophyllodes tumor, which features mature adipose tissue in much of the stromal component of a cystosarcoma, should not be mistaken for a malignant neoplasm. Complete excision is adequate therapy.

Metastatic cystosarcoma phyllodes associated with paraplegia: an uncommon complication of an uncommon tumor

Cystosarcoma phyllodes is a rare form of breast cancer that rarely metastasizes. This case represents the first reported case of a pathological spine fracture and neurologic injury as a result of metastatic cystosarcoma phyllodes. Physicians should be aware of a recently identified histological subtype of cystosarcoma that exhibits an increased incidence of hematogenous metastasis.

Phyllodes tumor in a male patient with bilateral gynaecomastia induced by oestrogen therapy for prostatic carcinoma

We report a case of phyllodes tumor in a male patient following prolonged oestrogen therapy. The male mammary gland can be modified by oestrogen with a histological picture analogous to that of the female breast.

Surgical cure of hypoglycemia associated with cystosarcoma phyllodes and elevated nonsuppressible insulin-like protein

A woman with a large, benign cystosarcoma phyllodes of the breast was found to have recurrent, profound hypoglycemia. Plasma levels of nonsuppressible insulin-like protein were increased (15.18 micrograms/ml; normal = 1 to 4 micrograms/ml), whereas levels of insulin and nonsuppressible insulin activity soluble in acid ethanol were normal. Surgical excision of the tumor resulted in immediate and lasting correction of the metabolic abnormalities, although nonsuppressible insulin-like protein levels did not completely return to normal. Surprisingly, preoperative nonsuppressible insulin-like protein levels were highest in blood distant from the tumor site.

Tubular carcinoma developing within a recurring cystosarcoma phyllodes of the breast

Malignant alteration in cystosarcoma phyllodes is uncommon and almost always confined to the stromal component. A rare case of recurring cystosarcoma is reported. In the first recurrence, lobular carcinoma in situ was present within the tumor and the second recurrence revealed tubular carcinoma within the cystosarcoma. Epithelial proliferation of various sorts is not uncommon in cystosarcomas but only two previous instances of infiltrating carcinoma have been observed within these tumors. The problem of mammary carcinoma coexisting with cystosarcoma is reviewed and comparisons are made with a closely related neoplasm, the fibroadenoma.

Gigantic cystosarcoma phyllodes in a man with gynecomastia

A 70-year-old man had a breast tumor for 50 years. The tumor, which weighed 8.6 kg, proved to be a malignant cystosarcoma phyllodes. It was successfully removed by a simple mastectomy with low axillary dissection, and a skin graft was performed. The lesion was associated with gynecomastia, and it is believed to have represented a cystosarcomatous transformation of a giant fibroadenoma.

Cystosarcoma phyllodes metastatic to a brenner tumor of the ovary

A patient had cytosarcoma phyllodes that developed metastases to bone and to a Brenner tumor of the ovary. The original breast tumor was reported as benign, but the patient died of metastases four months following mastectomy. The rapid growth in the ovary may have been due to estrogenic stroma in the Brenner tumor. This is the first report, to our knowledge, of cystosarcoma phyllodes metastasizing to another tumor.

Desmoid tumor associated with cystosarcoma phyllodes of the breast

A case of desmoid tumor of 17 years' duration associated with cystosarcoma phyllodes of 17 months' duration is presented. Good initial response to radiation therapy of the desmoid tumor was shown. Poor response of cytosarcoma phyllodes to radiation therapy was noted. A comparison between the similarities and differences of the two tumors is presented.

Giant fibro-adenoma (cystosarcoma phyllodes) in adolescent females--a clinicopathological study

1. An analysis of the findings in a series of 25 cases of giant fibro-adenoma of the breast in adolescent females is presented together with a review of the relevant literature. The clinical features, histology, prognosis and treatment of these tumours are discussed.

2. Follow-up of from 2 to 8 years after total excision of the tumours has shown that normal breast development occurred in all the cases. There was no recurrence or distant metastasis.

3. Despite clinical features and histological characteristics suggestive of malignancy the tumour has been found in our experience to be strictly benign in patients under the age of 20 years.

Cystosarcoma phyllodes

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