Usefulness of ultrasounds in the management of breast phyllodes tumors

INTRODUCTION

Breast phyllodes tumors (PT) are uncommon fibroepithelial lesions having potential malignant features. These tumors have characteristic features, like pleomorphism, mitoses and overgrowth of the stroma with possible infiltrative margins. The clinical behaviour could be unpredictable, since the relatively high recurrence rate despite correct surgical strategy. Conventional diagnostic examinations show high sensitivity and specificity, but cannot demonstrate the differences between benign and malignant PT. MRI is not more effective.

PATIENTS AND METHODS

Sixteen patients affected by PT have been surgically treated at our Institution. All patients received mammography and ultrasonography (US) as preoperative diagnostic work-up.

RESULTS

in 13 patients, US was effective in preoperative diagnosis of PT. Mammography was uneffective in detecting breast lesions in 5 cases, while in 11 cases mammographic findings presented benign features, with a round opacity with moderate tissue density and well-defined wall.

CONCLUSION

US remains the most useful diagnostic test in detecting PT. However, there is no test effective in identifying malignat PT. In case of suspicion, fine needle biopsy should be performed.

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.

[Clinical and therapeutic considerations on a case of benign phyllodes tumor]

Mamary phillodes tumours represent a fairly rare pathology. They can be benign, with a high risk of getting malignant (border line) or already malignant. More than 50% of phillodes tumours are benign and usually appear with women around 45 years old. We present this case for some particular features, with both elements, of either benign or malignant. The course is totally different in the two cases, which raised the issue of the treatment options. This is the case of a 57 years old female patient, who had been admitted with a right mammary tumour, of approximatly 40/50 mm that occupied the lower breast quadrants, with irregular outline, and with necrosis and hemorrhaging zones, mobile on the thorax wall, with right axillary adenopathy, in the latero-thorax group, of 1/2 cm wide, mobile and with a non-tumour aspect. The tumour appeared 1-2 years before and developped very much in the last 2 months when necrosis zones appeared; 3-4 days before presentation to the doctor and bleeding occurred. Intraoperatively, the tumour was fix compared with the back plan, with axillary ganglions being conglomerated, being almost invasive, thus suggesting neoplastic infiltration. The postoperatory histopathological exam with parafine preparation, highlighted the presence of an adenomixofibrom, with parcelled necrosis zones, with inflamatory infiltrate. The harvested biopsies from the axillary ganglions have highlighted a companion adenopathy with inflamatory character.

Preliminary data about female malignant breast tumours in Cambodia

BACKGROUND

Breast cancer is the most frequent cancer among women and the most frequent cause of cancer death in women in both developing and developed countries. However, little is known about the situation in Cambodian women living in Cambodia.

OBJECTIVES

To describe the different histological types of invasive breast cancer, their frequency, grade and stage and their surgical management in Cambodia.

MATERIALS AND METHODS

A retrospective study of female breast primary invasive malignant lesions processed during 2003 and 2004 in the pathology laboratory of the 'Institut Pasteur du Cambodge', in Phnom Penh, was carried out with conventional histology techniques.

RESULTS

A total of 102 patients were included, with an average age of 47. Most specimens were tumour excisions or mastectomies. Tumours were generally large (37.5 % at least T3), distributed into carcinomas (94.2 %), phyllodes tumours (3.9 %) and lymphomas (1.9 %). Most cases of carcinoma presented with histological grade III (76.6%) and were invasive ductal (82.3%) or medullary (11.4%) in type. Lymphadenectomy was not systematic but nodal metastases were observed in 26 of 31 (83.9%).

CONCLUSIONS

Late diagnosis of the disease is due to absence of systematic breast cancer screening and awareness. Apparent rarity of lobular carcinoma and over frequency of medullary carcinoma and phyllodes tumours should be confirmed on a larger series of patients using immunohistochemistry. Its use for other markers to help oncologists to decide whether anti-hormone treatment is indicated is also recommended, together with more standardized surgery.

Delayed cardiac metastasis from phyllodes breast tumor presenting as cardiogenic shock

Malignant metastases to the heart and pericardium, which occur far more often than do primary cardiac neoplasms, typically lead to fatal outcomes. The phyllodes tumor is a rare, predominantly benign fibroepithelial breast neoplasm with variable malignancy potential. Herein, we describe the case of a 35-year-old woman who, 3 years after undergoing a simple mastectomy for a rapidly enlarging breast neoplasm, presented with cardiogenic shock and was found to have a large right ventricular tumor that obstructed the right ventricular outflow tract. Despite successful resection of the ventricular mass and a right atrial mass of organized thrombus, the patient died 8 days postoperatively of multiorgan failure due to severe right ventricular dysfunction. Histopathologic analysis determined that the right ventricular mass was a malignant, metastatic phyllodes tumor. To our knowledge, this is only the 2nd reported case of a phyllodes tumor that metastasized to the heart and presented as an intracavitary mass with cardiogenic shock. In addition to discussing our patient's case, we review the pertinent medical literature.

[Long-term results of surgical therapy for phyllodes tumor of the breast]

We report that the long-term results of surgical therapy for phyllodes tumor of the breast. During ten years, we experienced twenty-eight patients of phyllodes tumors of the breast. They were treated by surgical operation. Twenty-one cases were performed local excision with at least 1 cm surgical margin, and seven cases were performed muscle preserving mastectomy without axillary lymph nodes dissection. Pathological surgical margins of all patients were negative. Five patients were recognized the local recurrence, and only one patient was recognized a distant metastasis. The total recurrence rate was 21.4%. The patients with local recurrence were diagnosed the benign phyllodes tumor of the breast at the first operation. The mean time to recurrence was 5.4 years. If the pathological diagnosis was benign phyllodes tumor and surgical margin was negative at the first operation, it is necessary to follow up the patients, because there is a risk of local and distant metastasis.

Malignant phylloides tumor in pregnancy

Malignant phylloides tumors are exceedingly rare with few cases being reported in pregnancy. We describe the first case ever reported of a malignant phylloides tumor presenting in the first trimester of pregnancy and provide insight into the complexities of management as well as a review of the known literature. An extensive PubMed literature search for "cystosarcoma," "phylloides," and "pregnancy" was performed. References of each citation were reviewed. Only six previous cases of phylloides tumor in pregnancy were found, none of which were in the first trimester. Medical records of a patient presenting to our institution at 9 weeks gestation with a malignant phylloides tumor were reviewed. We further provide a review of the current literature of the management of phylloides tumor in pregnancy. A 27-year-old white G2P0SA1 woman with no family history of breast cancer presented with a right breast mass at her first prenatal examination at 9 weeks of pregnancy. Ultrasound confirmed a solid mass measuring 24 mm. Core needle biopsy demonstrated a malignant phylloides tumor. She previously had a fibroadenoma removed from the same breast 7 years previously. The current tumor was excised to clear margins. Histopathological examination revealed a 4-cm fibroepithelial tumor with marked stromal cellularity and a high mitotic count (five to seven mitoses/high-power field), confirming the diagnosis of malignant phylloides tumor. The patient continued her pregnancy without complications. Six other cases of phylloides tumor presenting in pregnancy have been reported in the literature, one of which had bilateral disease. Of these, the average patient age was 32 years (range, 28 to 35 years). The majority of these patients presented in their third trimester (mean, 29 weeks; range, 20 to 36 weeks) and often had large tumors (mean, 15 cm; range, 5 to 21 cm). Four of the seven tumors (57%) required a mastectomy. Previous cases have shown phylloides tumors to present in the third trimester as large masses that require mastectomy. With early detection, malignant phylloides tumors can present in the first trimester of pregnancy at smaller sizes; in these patients, breast-conserving surgery is possible.

Phyllodes tumor of the breast; a case series

BACKGROUND

Phyllodes tumor (PT) is a rare neoplasm comprising less than 1% of all breast tumors. Its clinical spectrum ranges from a benign and locally recurrent form of behavior to malignant and metastatic forms. The aim of the study was to evaluate the clinical characteristics, treatment regimens, survival and late complications in patients with PT.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 10 women who were treated for PT in our center between 1998 and 2002. All cases were histologically examined by an experienced breast pathologist, and tumors were classified as benign, borderline malignant or malignant according to standard histological criteria.

RESULTS

The median age at diagnosis was 45.5 years (range: 21-69 years). Seven (70%) of 10 tumors were benign and 3 (30%) were malignant. The median tumor size was 29 mm (range: 12-80 mm). The least safe margin was 1 cm. Three of 10 patients had malignant PT and underwent simple mastectomy. Local recurrence was determined in no patients. Only one patient had lung metastasis. Median follow-up period was 62 months (range, 12-96 months). The patient with lung metastasis was treated with doxorubicine but died one year after the operation.

CONCLUSION

PT is a rare neoplasm of the breast. It resembles fibroadenoma. Local excision with appropriate surgical margins seems adequate in all patients (Tab. 1, Fig. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Case report of a 30.8 pound cystosarcoma phyllodes of breast

This is a case report and literature review of a 30.8 pound cystosarcoma phyllodes tumor resected in a 54-year-old female. Starting at age 19, the patient had noted a small breast tumor that continued to grow over the years. Pathology reported a low-grade malignant phyllodes tumor with no nodal involvement. Surgical resection with clear margins still remains the main treatment for this tumor. Radiation may be helpful in those with positive margins, a tumor greater than 4 cm, and those with reoccurrence.

[Phyllodes tumor: institutional experience]

BACKGROUND

Phyllodes tumor represents one of the fibroepithelial breast neoplasms that accounts for 0.3% to 1% of the breast tumors.

OBJECTIVE

To describe a case series of patients with phyllodes tumor diagnosis.

MATERIAL AND METHODS

We retrospectively reviewed the medical records of patients that had confirmed histological phyllodes tumor collected over a period of ten years.

RESULTS

The incidence was 0.8%, 12.5% of cases corresponded to malignant phyllodes. The average age was 35 years (range 14-50 years); the most frequent site of localization was the superior and external quadrant of the breast; the average tumoral size by image studies (ultrasound or mastography) and by direct measurement was 61 mm (13-150 mm) and 77 mm (30-300 mm), respectively. One case coexisted with pregnancy.

CONCLUSIONS

It is a rare neoplasm, andthe clinician must be aware of its timely diagnosis and treatment, if not some cases will develop breast deformity and some others will be borderline or malignant.

[Benign phylloides tumor of the breast. Considerations on a clinical case]

Phyllodes tumors are unusual biphasic fibroepithelial neoplasms of the breast, accounting for < 1% of all breast tumors and raising issues of diagnosis and therapeutic choice. They can grow quickly and when the maximum diameter is greater than 10 cm. We talk about giant phyllodes tumors. Ultrasound, Mammography and FNA are not effective. A potentially useful diagnostic modality is MRI. Core tissue biopsy or incisional biopsy represent the preferred means of pre-operative diagnosis. Conservative treatment can be effective also in giant tumors depending upon the size of the tumor and the breast if a complete excision with an adequate margin of normal breast tissue can be achieved, so avoiding local recurrence often accompanied by worse histopathology. The Authors report the case of a giant benign phyllode tumor of the breast treated with conservative surgery, quadrantectomy and oncoplasty. No local recurrence at 4 years follow-up.

[Extraordinary case of malignant phylloid tumor of the breast: surgical reconstruction treatment]

Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. They are rare with an incidence of less than 1% of all breast neoplasms. They can be divided in three categories: benign, borderline, malignant. The Authors report the case of a 53 years old woman who presented an exceptional 6.5 kg phylloid tumor of the left mamma. The diagnostic strategies, the surgical total mastectomy procedure with anterior thoracic parietectomy and the surgical reconstructive treatment are described.

A large cystic phyllodes tumor of the prostate

We report a 65 year-old man with a large cystic phyllodes tumor of the prostate. The patient complained of abdominal discomfort and had a soft palpable mass. Computer tomography showed a solid and cystic mass in the pelvic fossa; the mass was adjacent only to the prostate. We excised the mass. Microscopic findings of the mass showed hyperplastic epithelium lined cysts with leaf-like intraluminal epithelia lined stromal projections, less than 2 mitotic counts/10 HPF, low-to-moderated cellularity, and mild-to-moderate cytoplasm atypia. The pathological findings were consistent with a phyllodes tumor of the prostate, a low-grade tumor. Twenty-eight months after the operation, the patient was well with no recurrence or metastases.

[Phyllodes tumour: a rare, rapidly growing breast tumour]

A 40-year-old woman presented at the breast outpatient clinic with a giant tumour of her left breast. The size, rapid growth and radiological characteristics of the lesion led us to suspect a phyllodes tumour. A histological examination of a needle biopsy confirmed this diagnosis. An additional CT scan revealed no signs of metastases. We performed a mastectomy during which a tumour measuring 48 x 33 x 25 cm was resected. Histological examination revealed a borderline phyllodes tumour. Phyllodes tumours are rare fibroepithelial neoplasms of the breast and pre-operatively these are often difficult to differentiate from fibroadenomas. Phyllodes tumours have a variable clinical course with the ability to metastasize and a propensity to recur locally. Complete excision with wide margins is essential to prevent local recurrence. In our case, the surgical margins were limited and our patient was therefore treated with postoperative radiation therapy.

[Analysis of the treatment and prognosis of recurrent breast phyllodes tumor]

OBJECTIVE

To explore the methods of diagnosis, treatment and prognosis for patients with recurrent breast phyllodes tumor.

METHODS

Clinicopathological data of 26 patients with pathologically proven recurrent phyllodes tumors treated from March 1972 to June 2006 were retrospectively analyzed.

RESULTS

The mean age of the 26 cases was 45 years, and the median follow-up duration was 83 months. The mean overall survival time of this series was 96 months. The primary breast phyllodes tumor was > or = 5 cm in 10 cases with a recurrence rate of 60.0% (6/10 cases); < 5 cm in 16 cases with a recurrence rate of 31.3% 5/16 cases). After surgical removal of the breast primary tumor, the recurrent tumor was > or = 5 cm in 14 cases with a re-recurrence rate of 35.7% (5/14 cases); < 5 cm was in 12 cases with are-recurrence rate of 50.0% (6/12 cases). There was no statistically significant relationship between the (primary and reccurent) tumor size and recurrence rate (P = 0.094, P = 0.383) or prognosis (P = 0.142, P = 0.486). The benign or malignant nature of the breast phyllodes tumor was significantly correlated with the rate of local re-recurrence (P = 0.046) and prognosis (P = 0.028).

CONCLUSION

The benign or malignant nature of the breast phyllodes tumor is significantly correlated with the local re-recurrence and prognosis, while the size of the primary breast phyllodes tumor has no significant effect on either re-recrruence or prognosis. The first rescue operation is most important in the treatment of recurrent breast phyllodes tumor. The resection margin should be wide enough. Active surgical treatment can still effectively save the life of the patients with a local re-recurrent tumor.

Surgical breast lesions in adolescent females

PURPOSE

Breast diseases in teenage girls are fortunately uncommon, with most presenting masses being benign. The aim of this study was to evaluate the histopathological results of breast lesions excised from adolescent females less than 19 years of age.

METHODS

The authors reviewed the medical and pathology records at the University Hospital of Vienna, Department of Obstetrics and Gynaecology, between 1993 and 2006, retrospectively. All data included the patient age, age of menarche, pregnancy, hormonal contraception, family history of breast cancer, size of the breast lesion and its histopathology following surgery.

RESULTS

Thirty-seven female patients with an average age of 16 years (ranging 12-18 years) were operated on for breast tumor and/or discharge. All tumors were palpable. Six patients had bilateral breast masses; thus, 43 breast lesions were evaluated following surgical excision. Surprisingly, breast cancer was found in two cases. Both patients were diagnosed with a noninvasive ductal carcinoma in situ (DCIS) within a fibroadenoma at the age of 16. These are the first reported cases of DCIS found in this young age group. As breast neoplasm was found in two cases, a malignancy rate of 4.7% was observed. The most common histologies were fibroadenoma (n=27) and fibrocystic disease (n=4).

CONCLUSION

The incidence of primary breast cancer in adolescent women is low. However, our experience shows the need for compulsory excision of all breast masses and highlighting the importance of histopathological evaluation of all breast tumors including adolescents.

[Bilateral phylloid cystosarcoma of the breast: a case report and review of the literature]

Phylloides tumours are unusual neoplasms, accounting for less than 0.5% of breast tumours and approximately 2.5% of fibro-epithelial tumours. They usually present as fast-growing, painless masses, with a high local recurrence rate. Grading and an adequate surgical resection with tumour-free margins are the most important factors predictive of recurrence. The treatment is based on surgery, with poor results reported for chemo- and radiotherapy, but controversy still exists as to whether the best surgical approach consists in radical or conservative procedures, depending upon tumour size at diagnosis. The authors report the case of a patient affected by a metachronous bilateral malignant phylloid tumour of the breast, involving regional nodes and with a single pulmonary metastasis. The patient was treated with radical surgery including a bilateral mastectomy, an axillary dissection and a right inferior pulmonary lobectomy. Unfortunately, even this substantially aggressive management was unable to change the final outcome of the disease. The review of the literature on the subject is consistent with a preferably conservative surgical treatment also in advanced stages of the disease.

[Phyllodes tumor in a pediatric patient. Case report and literature review]

BACKGROUND

Phyllodes tumors occur with a frequency of 0.3- 0.9% and are rare in young women. Their clinical presentation is unilateral and behavior and management are unclear. We present a phyllodes tumor in an 11-year-old female and we reviewed the literature regarding this pathology.

CASE REPORT

We present the case of an 11-year-old female with a diagnosis of phyllodes tumor. Her disease began 4 months previously. We made an incision biopsy followed by simple mastectomy. Histological report demonstrated benign phyllodes tumor. The patient is currently disease free after 1 year.

CONCLUSIONS

Small phyllodes tumors can be excised with a 1-cm surgical border, whereas larger phyllodes tumors are treated with simple mastectomy. Precise pathological evaluation is necessary to plan a better surgical approach and to determine recurrence possibility.

Ductal carcinoma in situ arising in a benign phyllodes tumor: report of a case

Malignant epithelial change within a phyllodes tumor (PT) is a rare event. To our knowledge, only six cases of ductal carcinoma in situ arising in a PT have been reported in English. We report a case of PT with an intraductal carcinoma component, which grew rapidly to a huge size in 3 months. Histologically, the stromal element showed mild to moderate cellularity with few mitoses and mild nuclear atypia. The epithelial element consisted of irregularly dilated ducts with a phyllodes structure that had moderate to severe epithelial hyperplasia, and foci of cribriform ductal carcinoma in situ with comedo necrosis.