[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.

Astonishingly rapid growth of malignant cystosarcoma phyllodes tumor in a pregnant woman--a case report

There are very few reports concerning the presence of malignant cystosarcoma phyllodes (CSP) in breasts of pregnant women. In the hereby described case, a 28-year-old woman presented in our department with huge (18 x 11 x 8 cm) tumor of left breast, 2 weeks after labor. The patient discovered a tumor in 34th week of pregnancy, 6 weeks before labor. Histopatholgic examination of excised tumor revealed the presence of malignant CSP tumor. Simple mastectomy was proposed to patient as a best treatment modality. However, the patient refused. She underwent excision of tumor bed (2-cm tumor-free margin was achieved). Despite insufficient treatment, she remains free of disease 20 months after the wide excision of breast malignancy. It is not known how pregnancy influences prognosis of patients with malignant CSP. Lack of such information prompted us to describe the clinical course of our patient.

[Malignant phyllodes tumor of the breast with osteoclast-like giant cells: a case report]

Breast tumors, particularly of stromal origin, containing multinucleated osteoclast-like giant cells (OLGC) are rarely reported in the literature. We report here the first case of a malignant phyllodes tumor associated with OLGC occurring in a 43 year-old African woman who presented with a painful palpable mass of the outer upper quadrant of the right breast. After surgical excision, histological examination showed a malignant phyllodes tumor in which the stromal component displayed evident sarcomatous changes and was densely populated with benign multinucleated OLGC. These cells expressed the CD68 histiocytic marker. No evidence of osseous or cartilaginous differentiation was seen throughout the lesion. This lesion ressembles giant cell tumor of bone. However, the nature of the OLGC is not well precised yet.

[Giant phyllodes tumor of the prostate]

A 55 year-old man complained dysuria and visited to our hospital. Physical examination showed firm large mass occupying whole abdomen. Computed tomography (CT) demonstrated a huge retroperitoneal tumor which compressed intestine, liver, kidney, and urinary bladder. We performed extirpation of the tumor (8.6 kg, largest diameter 60 cm) which was composed of myxoid stromal region associated with cystic pattern. Histological examination revealed that the epithelium of the cystic region was positive for prostate specific antigen (PSA) immunostaining. The tumor was diagnosed phyllodes tumor of the prostate (prostatic stromal proliferation of uncertain malignancy, PSTUMP). Serum PSA was declined 3.9 ng/ml to 0.9 ng/ml; however, magnetic resonance imaging (MRI) demonstrated a residual (recurrent?) tumor in the pelvis one month after the operation. We carried out total prostatectomy and residual tumor resection. Phyllodes tumor of the prostate is histologically characterized with biphasic pattern of hyperplastic epithelial cysts and variably cellular spindle stroma. The tumor is considered to have malignant potential and several histological factors including cellularity, atypia, etc. are utilized to assess it. However diagnostic criteria and subsequent treatment modalities are not established thus far. Previous reports showed efficacy of total surgical removal rather than partial resection and that we performed radical extirpation of the entire tumor. Close follow up is needed against this frequently recurrent disease.

Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes

BACKGROUND

The diagnosis of phyllodes tumors of the breast is challenging due to many similarities with common fibroadenomas.

PURPOSE

To determine the diagnostic accuracy of core needle biopsy in diagnosing phyllodes tumors and to analyze the ultrasonographic (US) features of phyllodes tumors and fibroadenomas.

MATERIAL AND METHODS

From 1999 to 2003, 1010 breast lesions underwent imaging-guided core needle biopsy. Of these, 57 fibroadenomas and 12 phyllodes tumors were removed surgically. The US and needle biopsy results of a total of 64 lesions (52 fibroadenomas and 12 phyllodes tumors) were further analyzed, compared, and correlated with surgical histological results.

RESULTS

The median sonographic sizes of the phyllodes tumors and the fibroadenomas were 3.2 cm and 1.6 cm, respectively. At US, 58% of the phyllodes tumors (7/12) were classified as equivocal or suspicious of malignancy and 42% (5/12) as probably benign, while 54% of the fibroadenomas (28/52) were classified as probably benign and 46% (24/52) as equivocal. The sensitivity, specificity, and positive and negative predictive values of core needle biopsy histology regarding tumor phyllodes were 83%, 92%, 71%, and 96%, respectively.

CONCLUSION

Imaging-guided core needle biopsy was accurate in differentiating between fibroadenomas and phyllodes tumors. US classification was unreliable due to considerable overlap in the findings. Combined use of US feature analysis and needle biopsy may help to avoid the misinterpretation of phyllodes as fibroadenoma.

Management of benign tumors of the adolescent breast

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Describe the differential diagnosis of breast tumors in adolescent girls. 2. Compare and contrast surgical options for the management of adolescent breast tumors. 3. Recognize the utility of a reduction mammaplasty technique when resecting these larger tumors in adolescents.

SUMMARY

Although 99 percent of breast lesions in female adolescents are benign tumors, surgical intervention is commonly required. This article reviews the differential diagnosis, evaluation, and management of these benign tumors. A modified surgical technique for resection of large fibroadenomas and reconstruction of the remaining breast is described. The authors review the approach to five specific breast lesions: fibroadenomas, phyllodes tumors, juvenile hypertrophy, inflammatory processes, and premature breast development.

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.

Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast

BACKGROUND

Phyllodes tumors (PT) are rare fibroepithelial neoplasms of the breast with unpredictable behavior. We reviewed our single institution experience with PT over 51 years to identify factors predictive of local recurrence (LR) and metastasis.

METHODS

From 1954 to 2005, a total of 352 cases of PT were identified; 293 had follow-up. All available pathology slides (90%) were rereviewed for margins, borders, fibroproliferation in the surrounding breast tissue, stromal pattern, stromal cellularity, frequency of mitoses, and necrosis.

RESULTS

All cases occurred in women, with a median age of 42, with 203 originally categorized as benign and 90 as malignant. Median follow-up was 7.9 years. A total of 35 patients developed LR at a median of 2 years. In univariate analyses, a higher actuarial LR rate was associated with positive margins (P = .04), fibroproliferation (P = .001), and necrosis (P = .006). PT classified as malignant did not have a higher risk of LR (P = .79). Five patients developed distant disease at a median of 1.2 years. These patients constituted 71% of the seven patients who had uniformly aggressive pathologic features, including large tumor size (>or=7.0 cm), infiltrative borders, marked stromal overgrowth, marked stromal cellularity, high mitotic count, and necrosis.

CONCLUSIONS

Positive margins, fibroproliferation in the surrounding breast tissue, and necrosis are associated with a marked increase in LR rates. Efforts should be made to achieve negative surgical margins to reduce risk of LR. Death from PT is rare (2%), and only PT that demonstrate uniformly aggressive pathologic features seem to be associated with mortality.

Full-thickness chest wall resection for recurrent breast phyllodes tumor

Phyllodes tumor is a rare breast neoplasm. We present the case of a woman who underwent multiple surgical procedures for phyllodes tumor treatment. Even after bilateral mastectomy and radiotherapy, local recurrences developed. We performed a full-thickness chest wall resection with wide margins, a procedure rarely reported in medical literature for this purpose. Only after this approach did we obtain disease control, with no signs of further recurrence at 4 years' follow-up.

Cystosarcoma phyllodes of the breast: a rare diagnosis: case studies and review of literature

Cystosarcoma phyllodes (CP), otherwise known as phyllodes tumour (PT) of the breast, is a very rare but locally aggressive fibroepithelial tumour in its malignant form, and accounts for 0.3-1% of all breast neoplasias. Using 4 cases reports with different histological classifications as examples (benign-borderline-malignant), we describe the (differential) diagnosis and treatment options of this tumour entity and give an additional review of the available literature.

Giant malignant phylloides tumor: case report

The incidence of phylloides breast tumors is less than 1% in the population affected by breast cancers. The age at higher risk is between 35 and 45 years. These neoplasms are characterized by a proliferation of mesenchimal and epithelial cells. We present a rare case of giant malignant phylloides tumor (28 x 21 x 15 cm) with a complet substitution of the gland. The clinical presentation of phylloides tumors is heterogenous; the surgical treatment is a conservative one of the gland if the neoplastic lesion size is less than 5 cm with a free margin of 1 cm and a mastectomy if the diameter of lesion is more than 5 cm. Complementary therapies still remain controversial.

Infiltrating ductal carcinoma and synchronous malignant phyllodes tumour. Diagnostic and therapeutic approaches

Simultaneous presentation of breast cancer and malignant phyllodes tumour is rare. A female patient presented with a nodule in her left breast (infiltrating ductal carcinoma). On magnetic nuclear resonance another suspicious lesion (malignant phyllodes) was found in the right breast. Bilateral mastectomy was performed. Thirty two months later the patient is still free of disease. The approach to dealing with synchronous breast tumours should be the same as that normally used.

Breast malignant phyllodes tumour metastasising to soft tissues of oral cavity

Metastases from infraclavicular neoplasms to the oral cavity are rare, and the anatomical structures most frequently affected are the maxillae. The primary sites that develop metastases to head and neck include lung, breast, liver, thyroid gland, kidney and melanomas, among others. The breast is one of the usual primary regions that can present them. In the literature, most metastases to these regions correspond to squamous cell carcinomas and adenocarcinomas; few studies report other type of neoplasms such as phyllodes tumour (PT) that present this behaviour. The importance of identifying metastatic disease to the oral cavity, be it as the first manifestation of a neoplasm from unknown origin or as a development in the course of the disease, is that it allows determination of adequate treatment, which has an effect on the patient's prognosis. The usual behaviour of PT is frequent recurrence and, when metastases are present, these are to lungs and bone. Two cases of malignant PT metastasising to tongue and lip are presented, as well as a review of the literature.

[Case of malignant tumour phyllodes converting to fibrosarcoma]

Tumour phyllodes is rare breast neoplasm. The majority arises in women between ages 35 and 55. Tumours phyllodes are composed of hypercellular mesenchymal stroma and epithelial elements. They are commonly classified as benign, rarely as borderline or malignant. Recurrences are observed in 8-36% patients and metastases--in 13-26%. There is a case of large (28 x 24 cm) malignant tumour phyllodes presented in the article. Mastectomy was performed. After surgical treatment of recurrent tumours (fibrosarcoma form) occurred two times during 1 year time. They were operated immediately. In spite of unfavorable prognostic features of the tumour (large size, malignant histological character) and recurrences, final therapeutic effect was good.

Bilateral benign phyllodes tumour in a nulliparous woman: a case report and review of literature

Cystosarcoma Phyllodes is an uncommon disease of the breast with variable clinical behaviour. Its incidence is reported as 1% of all breast tumours. The occurrence of bilateral disease is very rare. In this communication, we present a case of metachronous bilateral benign cystosarcoma phyllodes presenting in a 24year old nulliparous lady. She had right breast mastectomy after two recurrences following local excision. The left breast lesion developed one year after the treatment of the right lesion, again she had to be treated with mastectomy after 2 recurrences. This case unlike most reported cases of bilateral Phyllodes tumour occurred in a nulliparous lady. The problems of diagnosis, clinical behaviour and management are discussed.

Phyllodes Tumors of the Breast – Diagnostic and Therapeutic Dilemmas

BACKGROUND

This article compares experiences in the diagnosis and treatment of phyllodes tumors from 2 regional institutions with the relevant literature.

PATIENTS AND METHODS

From 1991 to 2005, 2,848 breast cancer patients were treated in our institutions, 36 (1.44%) for phyllodes tumors. The average tumor size was 5.1 cm (range 1.4-19.6). Triple assessment was the standard diagnostic algorithm. Wide excision with tumor-free margins was carried out in 29 (80.5%) cases and mastectomy in 7 (19.4%) cases. Axillary lymphadenectomy was performed in patients with positive lymph nodes.

RESULTS

Histology showed the phyllodes tumors to be benign in 27 (75.0%), malignant in 6 (16.6%), and borderline in 3 (8.3%) cases. Follow-up was from 5 months to 16 years. In this period, recurrences of 3 (8.3%) malignant and 2 (5.6%) benign phyllodes tumors were diagnosed and treated. 10 (27.7%) patients treated with wide local excision showed deformities in the form of scarring. The steroid receptor status was of no prognostic value in our patients, and chemotherapy was used in only 1 (2.7%) patient. 5-year survival was 86.2%.

CONCLUSION

Our study shows that tumor size, margin infiltration, mitotic activity and degree of cellular atypia are important prognostic factors. Problems in diagnosing this condition arise from its similarity to fibroadenoma. Although wide local excision is usually the treatment of choice, tumor recurrence is common. Axillary lymphadenectomy in malignant phyllodes tumors is, in our opinion, still controversial.

Difficulties in the pre-operative diagnosis of phyllodes tumours of the breast: A study of 84 cases

Eighty-four phyllodes tumours (71 benign, eight borderline and five malignant) diagnosed over a 16-year period were studied retrospectively, to assess the diagnostic value of the pre-operative modalities used. Mammography and ultrasound appearances were non-specific. The possibility of phyllodes tumour was raised in only 23% on fine needle aspiration cytology, and in 65% on core biopsy. Accuracy was better in smaller tumours, suggesting that larger tumours need more samples. For phyllodes tumours whose growth was measured, almost all had growth rates greater than for growing fibroadenomas. The pre-operative diagnosis of phyllodes tumours is difficult, and rapid growth and/or large size of apparent fibroadenomas may be the only imaging findings to suggest phyllodes tumour. It is important to review most fibroadenomas with ultrasound, to assess the rate of growth if any. Whole breast ultrasound showed that nearly one third of women with phyllodes tumours had concurrent fibroadenomas.