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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: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
A Phyllodes Tumour (PT) is an uncommon fibroepithelial lesion, with three histological grades - benign, borderline and malignant. PTs cause significant challenges in diagnosis, management and prognostication. Recent publications have clarified the definitions and prognostication of PTs. Contemporary data currently challenge international guidelines on PT management. We performed an in-depth literature review to develop a best-practice management algorithm for PTs. Diagnostic recommendations are that neither current imaging techniques, nor fine-needle biopsies, can reliably diagnose a PT. Core needle biopsy is the optimal diagnostic technique. Indeterminate or suspicious lesions are recommended to undergo an excisional biopsy due to the inherently heterogeneous nature of PTs. Management guidelines are that benign PTs should be completely excised, although an involved margin is acceptable in select situations. Borderline PTs should have a clear margin on excision due to their higher risk of recurrence, as well as the potential for a recurrence to progress to a malignant PT. In malignant PTs, a margin of 3 mm is acceptable as there is no reduction in recurrence risk if margins are >3 mm. Routine axillary surgery is not indicated in PTs, with axillary surgery only indicated in a histologically-confirmed positive axilla. Adjuvant treatment recommendations are that borderline and malignant PTs should be discussed at MDT, with radiotherapy considered in both. Chemotherapy should be discussed in malignant PT patients. In summary, we have developed an up-to-date simple algorithm to guide the surgeon's management of patients diagnosed with PTs and reduce excessive surgery.
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Affiliation(s)
- Adam Ofri
- Department of Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kirsty E Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, 166-174 Hawkesbury Rd, Westmead, NSW 2145, Australia; Westmead Breast Cancer Institute, Block F/189 Cnr Hawkesbury & Darcy Rd, Westmead, NSW 2145, Australia; Western Clinical School, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Belinda Chan
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Strathfield Private Hospital, 3 Everton Rd, Strathfield, NSW 2135, Australia
| | - Cindy Mak
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia; Mater Hospital, 25 Rocklands Rd, North Sydney, NSW 2060, Australia
| | - Sanjay Warrier
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia
| | - Vivek Bhadri
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Tim Mander-Jones
- Department of Radiology, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW 2139, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sandra O'Toole
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia; The Kinghorn Cancer Centre and Cancer Research Division, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, NSW 2010, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Johns Hopkins Dr, Camperdown, NSW 2050, Australia; Western Sydney University, Campbelltown, NSW 2560, Australia
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Under- and Normal-Weight Patients Are More Susceptible to Recurrence of Phyllodes Tumor. Breast J 2022; 2022:4474251. [PMID: 35711882 PMCID: PMC9187276 DOI: 10.1155/2022/4474251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
Purpose Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, and factors associated with the recurrence of PTs are poorly understood. This study sought to identify clinicopathological factors associated with the recurrence of PTs. Method From January 2009 to December 2019, we identified 100 patients who underwent definitive surgery for PT. Clinicopathological risk factors associated with the recurrence of PT were assessed. Results The median age of the patients was 44 y (range, 19–62 y), and the median tumor size was 4 cm (0.8–30 cm). At a median follow-up of 26.7 mo (0–103 mo), 22 of the 100 patients experienced local recurrence. In the univariate and multivariate analyses, body mass index ≥ 23 kg/m2 (P = 0.042 in the univariate analysis; P = 0.039 in the multivariate analysis), tumor size ≥ 5 cm (P = 0.006 in the univariate analysis; P = 0.036 in the multivariate analysis), and the presence of stromal overgrowth (P = 0.032 in the univariate analysis; P = 0.040 in the multivariate analysis) were associated with an increased risk of local recurrence. Resection margins and grade were not associated with local recurrence. Conclusion Normal- or underweight patients and those with larger tumor sizes were more prone to local recurrence. Further larger, multicenter studies with a long-term follow-up are required.
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Reddy R. Phyllodes tumor of the breast in a postmenopausal woman: Radio- pathological correlation of a rare entity. BLDE UNIVERSITY JOURNAL OF HEALTH SCIENCES 2022. [DOI: 10.4103/bjhs.bjhs_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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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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Mohan SC, Tseng J, Angarita S, Marumoto A, Dadmanesh F, Amersi F, Giuliano A, Chung A. Clinicopathologic Characteristics and Patient Outcomes of Phyllodes Tumors: A Single Institution Experience. Am Surg 2021; 87:1533-1538. [PMID: 34689588 DOI: 10.1177/00031348211051673] [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: 01/09/2023]
Abstract
Phyllodes tumors (PT) are rare fibroepithelial neoplasms that are classified as benign, borderline, or malignant. Patients with PT diagnosed between 2009 and 2019 were identified from a prospectively maintained single institutional database. 76 patients with PT were included; 47 (61.8%) were benign, 9 (11.8%) were borderline, and 20 (26.3%) were malignant. The mean age at diagnosis was 52. Surgical treatment of benign PT included excisional biopsy in 31 (66.0%) patients, segmental mastectomy in 15 (31.9%), and mastectomy in 1 (2.1%). Among patients with borderline PT, operative management was excisional biopsy in 4 (44.4%) and segmental mastectomy in 5 (55.6%). Of those with malignant PT, 7 (35.0%) were treated with excisional biopsy alone, 9 (45.0%) had lumpectomy (segmental mastectomy), and 4 (20.0%) underwent mastectomy. Malignant PT had a higher rate of necrosis compared to borderline or benign PT (25.0% vs 0% vs 4.3%, P = .016). Four patients had recurrent PT. Final positive margins were associated with recurrence (P = .044). The median overall follow-up time was 86.3 months (range 1.5-1414.1 months), and no deaths occurred among patients with malignant PT. Overall, recurrence rates of PT are low but may be increased by presence of positive margins.
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Affiliation(s)
- Srivarshini Cherukupalli Mohan
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Tseng
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Stephanie Angarita
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ashley Marumoto
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Farnaz Dadmanesh
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Farin Amersi
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Armando Giuliano
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
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Okamoto A, Goto T, Omori M, Miyashita M. Nipple sparing mastectomy for a giant phyllodes tumor; a case report. Int J Surg Case Rep 2021; 88:106470. [PMID: 34655975 PMCID: PMC8521126 DOI: 10.1016/j.ijscr.2021.106470] [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: 08/20/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction Oncoplastic surgery has come into the limelight in the surgical treatment of breast cancer. In this report, we will introduce our challenge to apply oncoplastic surgery to a benign neoplasm like phyllodes tumor (PT). Presentation of case A 45-year-old female visited our hospital complaining of a rapidly growing lump on her left breast. She already had experienced lumpectomy twice on the same breast. Her left breast was occupied by a 14 × 10 cm mass with another small 1.7 × 1.6 cm nodule considered as a daughter lesion. Core needle biopsy suggested that it was a benign PT. We conducted nipple sparing mastectomy (NSM) and immediate reconstruction of the breast by latissimus dorsi muscle flap. During 7-years follow up, she has no recurrence and is satisfied with the reconstructed breast. Discussion There are some reports that performed conventional or radical mastectomy with immediate breast or chest wall reconstruction for giant PT. Reports about NSM with breast reconstruction for PT are rare, there are 5 including ours. All the cases accomplished long term recurrent free survival. All except ours were reconstructed by implants. Implant reconstruction is technically easier, but recently, malignant lymphoma after putting breast implant is concerned. Another merit of autologous tissue reconstruction is that they change naturally as age like contralateral breast so that it can achieve better long-term cosmetic result. Conclusion NSM with autologous tissue reconstruction is a good option for PT treatment even though it is not malignant. Oncoplastic surgery is a featured field in breast cancer surgery. We can apply oncoplastic surgery to phyllodes tumor. NSM with breast reconstruction can achieve both curability and cosmetic satisfaction. Oncoplastic surgery is important for benign tumor because patients have long life expectancy.
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Affiliation(s)
- Akiko Okamoto
- Department of Breast Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe City, Hyogo 658-0064, Japan.
| | - Tadahiro Goto
- Department of Surgery, Division of Hepato-Biliary-Pancreas Surgery, Kobe University Hospital, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo 650-0017, Japan
| | - Makoto Omori
- Department of Plastic Surgery, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-Ku, Osaka City, Osaka 533-0024, Japan
| | - Masaru Miyashita
- Department of Breast Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe City, Hyogo 658-0064, Japan
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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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Lerwill MF, Lee AHS, Tan PH. Fibroepithelial tumours of the breast-a review. Virchows Arch 2021; 480:45-63. [PMID: 34505197 DOI: 10.1007/s00428-021-03175-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/08/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
Fibroepithelial tumours of the breast are biphasic neoplasms composed of both epithelial and stromal elements, including the common fibroadenoma and the infrequent phyllodes tumour. The admixture of epithelium and stroma in the fibroadenoma shows intra- and pericanalicular patterns, and may display a variety of histological changes. Fibroadenoma variants include the cellular, juvenile, myxoid and complex forms. The cellular fibroadenoma may be difficult to distinguish from the benign phyllodes tumour. Stromal mitotic activity can be increased in fibroadenomas in the young and pregnant patients. Phyllodes tumours, neoplasms with the potential for recurrence, show an exaggerated intracanalicular growth pattern with broad stromal fronded architecture and stromal hypercellularity. They are graded into benign, borderline and malignant forms based on histological assessment of stromal features of hypercellularity, atypia, mitotic activity, overgrowth and the nature of the tumour borders. Classification of phyllodes tumours is imperfect, compounded by tumour heterogeneity with overlapping microscopic features among the different grades, especially in the borderline category. Malignant phyllodes tumours can metastasise and cause death. Determining which phyllodes tumours may behave aggressively has been difficult. The discovery of MED12 mutations in the pathogenesis of fibroepithelial tumours, together with other gene abnormalities in the progression pathway, has allowed refinements in diagnosis and prognosis.
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Affiliation(s)
- Melinda F Lerwill
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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Di Liso E, Bottosso M, Lo Mele M, Tsvetkova V, Dieci MV, Miglietta F, Falci C, Faggioni G, Tasca G, Giorgi CA, Giarratano T, Mioranza E, Michieletto S, Saibene T, Dei Tos AP, Conte P, Guarneri V. Prognostic factors in phyllodes tumours of the breast: retrospective study on 166 consecutive cases. ESMO Open 2021; 5:e000843. [PMID: 33020219 PMCID: PMC7537333 DOI: 10.1136/esmoopen-2020-000843] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Phyllodes tumours (PTs) are rare fibroepithelial tumours accounting for <1% of all breast tumours. We assessed clinicopathological features and their prognostic effect in a single-institution patients' cohort. METHODS Patients diagnosed with PT between 2001 and 2018 at our institution were identified. Clinical, surgical and pathological features were collected. Phyllodes-related relapse was defined as locoregional or distant recurrence (contralateral excluded), whichever first. RESULTS A total of 166 patients were included: 115 with benign, 30 with borderline and 21 with malignant PTs. Features associated with malignant PT were younger age, larger T size, higher mitotic count, marked cytological atypia, stromal overgrowth, stromal hypercellularity, necrosis and heterologous differentiation (all p<0.01). The majority of patients with malignant PT underwent mastectomy (63.2% vs 3% of benign/borderline, p<0.001) and had negative surgical margins (83.3%). 4-year cumulative phyllodes-related relapse incidence was 7% for benign/borderline PT and 21.3% for malignant PT (p=0.107). In the entire cohort, marked cellular atypia and heterologous differentiation were associated with worse phyllodes-related relapse-free survival (HR 14.10, p=0.036 for marked vs mild atypia; HR 4.21, p=0.031 for heterologous differentiation present vs absent). For patients with benign PT, larger tumour size was associated with worse phyllodes-related relapse-free survival (HR 9.67, p=0.013 for T>5 cm vs T≤2 cm). Higher tumour-infiltrating lymphocytes (TILs) were associated with borderline and malignant PT (p=0.023); TILs were not associated with phyllodes-related relapse-free survival (HR 0.58, p=0.361 for TILs>2% vs≤2%). Overall, four patients died because of PT: three patients with malignant and one with borderline PT. CONCLUSIONS Patients with malignant PT had increased rates of phyllodes-related relapse and phyllodes-related death. Cellular atypia and heterologous differentiation were poor prognostic factors in the entire cohort; large tumour size was associated with an increased risk of phyllodes-related relapse in benign PT.
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Affiliation(s)
- Elisabetta Di Liso
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Michele Bottosso
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Marcello Lo Mele
- Department of Pathology, Padua University Hospital, Padova, Italy
| | - Vassilena Tsvetkova
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy.
| | - Federica Miglietta
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Cristina Falci
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Giovanni Faggioni
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Giulia Tasca
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Carlo Alberto Giorgi
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Tommaso Giarratano
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Eleonora Mioranza
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Silvia Michieletto
- Breast Surgery, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Tania Saibene
- Breast Surgery, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Padua University Hospital, Padova, Italy; Department of Medicine (DIMED), Anatomic Pathology, University of Padua, Padova, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
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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: 19] [Impact Index Per Article: 6.3] [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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61
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Boland PA, Ali Beegan A, Stokes M, Kell MR, Barry JM, O'Brien A, Walsh SM. Management and outcomes of phyllodes tumours - 10 year experience. Breast Dis 2021; 40:171-176. [PMID: 33749634 DOI: 10.3233/bd-201059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Phyllodes tumours represent 0.3-1% of breast tumours, typically presenting in women aged 35-55 years. They are classified into benign, borderline and malignant grades and exhibit a spectrum of features. There is significant debate surrounding the optimal management of phyllodes tumour, particularly regarding appropriate margins. METHODS This is a retrospective review of a prospectively maintained database of patients who underwent surgical management for phyllodes tumours in a single tertiary referral centre from 2007-2017. Patient demographics, tumour characteristics, surgical treatment and follow-up data were analysed. Tumour margins were classified as positive (0 mm), close (≤2 mm) and clear (>2 mm). RESULTS A total of 57 patients underwent surgical excision of a phyllodes tumour. The Mean age was 37.7 years (range: ages 14-91) with mean follow-up of 38.5 months (range: 0.5-133 months). There were 44 (77%) benign, 4 (7%) borderline and 9 (16%) malignant phyllodes cases. 54 patients had breast conserving surgery (BCS) and 3 underwent mastectomy. 30 (53%) patients underwent re-excision of margins. The final margin status was clear in 32 (56%), close in 13 (23%) and positive in 12 (21%). During follow-up, 4 patients were diagnosed with local recurrence (2 malignant, 1 borderline and 1 benign pathology on recurrence samples). CONCLUSION There are no clear guidelines for the surgical management and follow-up of phyllodes tumours. This study suggests that patients with malignant phyllodes and positive margins are more likely to develop local recurrence. There is a need for large prospective studies to guide the development of future guidelines.
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Affiliation(s)
- Patrick A Boland
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Azlena Ali Beegan
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm R Kell
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John M Barry
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Angela O'Brien
- Department of Breast Radiology, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Breast Health Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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Zhang B, Song L, Yin J. Texture Analysis of DCE-MRI Intratumoral Subregions to Identify Benign and Malignant Breast Tumors. Front Oncol 2021; 11:688182. [PMID: 34307153 PMCID: PMC8299951 DOI: 10.3389/fonc.2021.688182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate the potential of the texture features extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) intratumoral subregions to distinguish benign from malignant breast tumors. Materials and Methods A total of 299 patients with pathologically verified breast tumors who underwent breast DCE-MRI examination were enrolled in this study, including 124 benign cases and 175 malignant cases. The whole tumor area was semi-automatically segmented on the basis of subtraction images of DCE-MRI in Matlab 2018b. According to the time to peak of the contrast agent, the whole tumor area was partitioned into three subregions: early, moderate, and late. A total of 467 texture features were extracted from the whole tumor area and the three subregions, respectively. Patients were divided into training (n = 209) and validation (n = 90) cohorts by different MRI scanners. The least absolute shrinkage and selection operator (LASSO) method was used to select the optimal feature subset in the training cohort. The Kolmogorov-Smirnov test was first performed on texture features selected by LASSO to test whether the samples followed a normal distribution. Two machine learning methods, decision tree (DT) and support vector machine (SVM), were used to establish classification models with a 10-fold cross-validation method. The performance of the classification models was evaluated with receiver operating characteristic (ROC) curves. Results In the training cohort, the areas under the ROC curve (AUCs) for the DT_Whole model and SVM_Whole model were 0.744 and 0.806, respectively. In contrast, the AUCs of the DT_Early model (P = 0.004), DT_Late model (P = 0.015), SVM_Early model (P = 0.002), and SVM_Late model (P = 0.002) were significantly higher: 0.863 (95% CI, 0.808-0.906), 0.860 (95% CI, 0.806-0.904), 0.934 (95% CI, 0.891-0.963), and 0.921 (95% CI, 0.876-0.954), respectively. The SVM_Early model and SVM_Late model achieved better performance than the DT_Early model and DT_Late model (P = 0.003, 0.034, 0.008, and 0.026, respectively). In the validation cohort, the AUCs for the DT_Whole model and SVM_Whole model were 0.670 and 0.708, respectively. In comparison, the AUCs of the DT_Early model (P = 0.006), DT_Late model (P = 0.043), SVM_Early model (P = 0.001), and SVM_Late model (P = 0.007) were significantly higher: 0.839 (95% CI, 0.747-0.908), 0.784 (95% CI, 0.601-0.798), 0.890 (95% CI, 0.806-0.946), and 0.865 (95% CI, 0.777-0.928), respectively. Conclusion The texture features from intratumoral subregions of breast DCE-MRI showed potential in identifying benign and malignant breast tumors.
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Affiliation(s)
- Bin Zhang
- School of Medicine and Bioinformatics Engineering, Northeastern University, Shenyang, China
| | - Lirong Song
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiandong Yin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Rosenberger LH, Quintana LM, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Jakub JW, Bentley RC, Schnitt SJ. Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization. Ann Surg Oncol 2021; 28:7404-7409. [PMID: 33990927 DOI: 10.1245/s10434-021-10118-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Phyllodes tumors are rare fibroepithelial neoplasms that are classified by tiered histopathologic features. While there are protocols for the reporting of cancer specimens, no standardized reporting protocol exists for phyllodes. METHODS We performed an 11-institution contemporary review of phyllodes tumors. Granular histopathologic details were recorded, including the features specifically considered for phyllodes grade classification. RESULTS Of 550 patients, median tumor size was 3.0 cm, 68.9% (n = 379) of tumors were benign, 19.6% (n = 108) were borderline, and 10.5% (n = 58) were malignant. All cases reported the final tumor size and grade classification. Complete pathologic reporting of all histopathologic features was present in 15.3% (n = 84) of cases, while an additional 35.6% (n = 196) were missing only one or two features in the report. Individual details regarding the degree of stromal cellularity was not reported in 53.5% (n = 294) of cases, degree of stromal atypia in 58.0% (n = 319) of cases, presence of stromal overgrowth in 56.2% (n = 309) of cases, stromal cell mitoses in 37.5% (n = 206) of cases, and tumor border in 54.2% (n = 298) of cases. The final margin status (negative vs. positive) was omitted in only 0.9% of cases, and the final negative margin width was specifically reported in 73.8% of cases. Reporting of details was similar across all sites. CONCLUSION In this academic cohort of phyllodes tumors, one or more histopathologic features were frequently omitted from the pathology report. While all features were considered by the pathologist for grading, this limited reporting reflects a lack of reporting consensus. We recommend that standardized reporting in the form of a synoptic-style cancer protocol be implemented for phyllodes tumors, similar to other rare tumors.
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Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Liza M Quintana
- Department of Pathology, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Suniti N Nimbkar
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kandice K Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan E Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Jasmine Wong
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Taryn E Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Tari A King
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rex C Bentley
- Department of Pathology, Duke University, Durham, NC, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
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Jahangir S, Loya A, Mushtaq S, Akhter N, Hashmi AA. CD117/c-KIT Expression in Phyllodes Tumor of the Breast and Its Correlation With Morphology and Clinical Outcome. Cureus 2021; 13:e14914. [PMID: 34123614 PMCID: PMC8189265 DOI: 10.7759/cureus.14914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction Breast phyllodes tumor’s (PT) clinical behavior is difficult to predict on histology. There is limited amount of data available on the role of biological markers. The objective of this study was to assess the expression of CD117 (c-KIT) in PT of the breast and its relationship with morphology and clinical outcome. Methods A total of 78 patients having available clinical records between 2004 and 2014 with breast PT were retrieved from the cancer registry at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and were followed up. Immunohistochemical studies were performed on all the cases using monoclonal antibody CD117 (DAKO A4502) using Leica Bond-Max automated biosystem (Leica Biosystems, Melbourne, Australia). Staining proportion and intensity of both epithelial and stromal elements were analyzed. Evaluation of the protein expression was determined and scored. Results Patients’ mean age was 45.13 ± 11.4 years. Thirty-nine (50.0%) patients had tumor on right side, 38 (48.7%) had on left and only one (1.3%) was bilateral. Thirty-two (41.0%) patients had benign PT, 21 (26.9%) had borderline and 25 (32.1%) had malignant PT. Negative CD117 expression was observed in 20 (62.5%), eight (38.0%) and 12 (48.0%) of benign, borderline and malignant PTs, respectively. Positive CD117 expression was observed in 12 (37.5%) benign, 13 (61.9%) borderline and 13 (52.0%) malignant PTs. There was insignificant association between CD117 expression with respect to tumor sub-type, patient’s age and clinical behavior (p-value > 0.05). Conclusion CD117 expression was not found to be associated with tumor type and was not associated with increased risk of recurrence in this sample of patients. Further work is needed to better understand the prognostic value of CD117 expression in breast PTs.
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Affiliation(s)
- Sidra Jahangir
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.,Pathology, Dallah Hospital, Riyadh, SAU
| | - Asif Loya
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Mushtaq
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Noreen Akhter
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Pankratjevaite L, Samulionis A, Miliou T. Diagnostic challenges of benign breast phyllodes tumour: A rapid-growing tumour during pregnancy caused breast loss. A case report. Int J Surg Case Rep 2021; 82:105866. [PMID: 33862409 PMCID: PMC8076702 DOI: 10.1016/j.ijscr.2021.105866] [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: 02/28/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/01/2022] Open
Abstract
Phyllodes tumours are rare breast neoplasms. Inadequate treatment of phyllodes tumour can result to tumour recurrence, growth or metastatic spread, when tumour has malignant potential. In suitable cases, skin-sparing mastectomy with immediate silicone implant reconstruction might be a treatment option. The patients with microscopically radical removed benign phyllodes tumours can be followed up with annual surveillance.
Introduction Phyllodes tumours are rare breast neoplasms. It is especially rare in pregnancy. Presentation of case We report a case of a 37-year-old woman with left breast benign phyllodes tumour, which started to grow very fast during pregnancy. The tumour was too big for breast-conserving surgery and it was necessary to remove the whole left breast. Patient underwent successful nipple-skin-sparing mastectomy with immediate silicone implant reconstruction. Conclusion Breast phyllodes are classified as benign, borderline, and malignant. Standard treatment of breast phyllodes is surgery. The choice of surgery type depends on the tumour factors and breast size. We highlight that, inadequate treatment of phyllodes tumour can result to recurrence, growth, or even metastatic spread, when tumour has malignant potential.
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Affiliation(s)
- Lina Pankratjevaite
- Department of Plastic and Breast Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Amuras Samulionis
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Theodora Miliou
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
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66
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Malignant Phyllodes Tumor of the Breast: A Practice Review. Clin Pract 2021; 11:205-215. [PMID: 33917271 PMCID: PMC8167791 DOI: 10.3390/clinpract11020030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Phyllodes tumor (PT) of the breast, particularly malignant phyllodes tumor (mPT), is a rare fibroepithelial neoplasm. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy. Objective: Our objective was to provide an overview of the clinical, pathologic, and therapeutic aspects of this rare tumor. Conclusions: mPT is a rare presentation of breast cancer and a challenge in clinical practice. A multidisciplinary approach should take into account some aspects like pathogenic mutations and hereditary syndromes. Oncologic surgery is the fundamental approach, and the use of adjuvant therapies is still controversial due to the lack of clinical trials. Treatment recommendations should be individualized according to patient risk and preferences. Prospective studies are fundamental to clarifying the best treatment for these tumors.
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67
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Liu T, Jiang L, Li J, Sun J, Li H, Gao J, Li S, Li J, Zhao H. A huge malignant phyllodes tumor of the breast with osteoclast-like giant cells: a case report. Gland Surg 2021; 10:1508-1514. [PMID: 33968702 DOI: 10.21037/gs-20-845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The malignant phyllodes tumor (PT) of the breasts is a rare type of fibroepithelial neoplasm. Osteoclast-like giant cells (OLGCs) exist in many types of tumors. But malignant PTs with OLGCs were rarely reported. Here, we presented a case of a 49-year-old woman who had a 23 cm ×21 cm ×6 cm mass which was growing for 2 years in her left breast. The patient had moderate anemia due to the hemorrhage and exudation on the surface of the tumor. The imaging examinations such as PET-CT found no lymphatic involvement and distant metastasis. We performed mastectomy with a 2 cm surgical margin and free skin flap transplantation to restore the big wound. The vacuum assisted closure (VAC) system was used to promote wound healing. Histological examination of the surgical specimen showed atypical spindle-like stroma cells, marked nuclear pleomorphism, focal necrosis, and mitotic activity. Typical leaf-like architectures of PTs were observed in some regions. OLGCs were found in many sections of the tumor with a number of vascular proliferations. The final diagnosis was malignant PT with OLGCs. After a three-month follow-up, no local recurrence or metastasis was found. Autogenous skin grafts with VAC are available for large area skin defect after excising a huge breast tumor. The presence of OLGCs in malignant tumors may be related to necrosis and hemorrhage of the tumor. These findings also provide opportunities for understanding the mechanisms of tumor formation and development.
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Affiliation(s)
- Taiyuan Liu
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lili Jiang
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiasi Li
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Sun
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haomeng Li
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jiyue Gao
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Sushan Li
- Department of Dermatology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jun Li
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haidong Zhao
- Department of Breast Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Ercilla Orbañanos J, Martí Sopeña M, Martínez Gómez E, González de Diego Mª H, Arnanz Velasco F, Zapico Goñi A. Tumor phyllodes de la mama: nuestra experiencia durante 11 años y revisión de la literatura. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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69
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Li S, Tseng J. Phyllodes patients' perceptions of care: Do they trust their doctors? Breast J 2021; 27:621-623. [PMID: 33779019 DOI: 10.1111/tbj.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Suellen Li
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Tseng
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
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70
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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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Li GZ, Raut CP, Hunt KK, Feng M, Chugh R. Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Epidemiology, Diagnosis, Staging, and Histology-Specific Management Considerations. Am Soc Clin Oncol Educ Book 2021; 41:390-404. [PMID: 34010054 DOI: 10.1200/edbk_321341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast sarcomas arise from connective tissues of the breast and account for fewer than 1% of all breast malignancies. They can be subclassified as primary breast sarcomas, which arise de novo and are histologically diverse, and secondary breast sarcomas, which arise as a result of radiation or lymphedema and are most commonly angiosarcomas. Two other connective tissue neoplasms that occur within the breast include phyllodes tumors and desmoid tumors, which exhibit a spectrum of behaviors. Malignant phyllodes tumors are biologically similar to primary breast sarcomas, whereas desmoid tumors are technically benign but often locally aggressive. Patients with breast sarcomas often present with a rapidly growing mass or, in cases of radiation-associated angiosarcoma, violaceous cutaneous lesions. Core needle biopsy is generally required to confirm the diagnosis of sarcomas. Staging workup includes MRI and chest imaging, although these are not required in the case of benign phyllodes or desmoid tumors. In general, localized breast sarcomas should be resected, with the extent of resection tailored to histologic subtype. Radiation and chemotherapy can be used in the neoadjuvant or adjuvant setting, but data are limited, so treatment decisions should be made on an individualized basis. Systemic therapy options for metastatic disease and refractory breast desmoids mimic those used for the same histologies when present in other sites. Given the rarity and heterogeneity of breast sarcoma, as well as limited literature describing these entities, expert multidisciplinary evaluation is crucial for optimal decision making.
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Affiliation(s)
- George Z Li
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Rashmi Chugh
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Fernández-Ferreira R, Arroyave-Ramírez A, Motola-Kuba D, Alvarado-Luna G, Mackinney-Novelo I, Segura-Rivera R. Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature. Case Rep Oncol 2021; 14:123-133. [PMID: 33776693 PMCID: PMC7983586 DOI: 10.1159/000510741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
Phyllodes tumor of the breast is an infrequently encountered fibroepithelial neoplasm, which accounts for 0.3–1% of all tumors. Few case reports have described the occurrence of giant phyllodes tumor. To our knowledge, about 20% of phyllodes tumors would be considered giant benign. Complete surgical excision is the standard of care for giant benign phyllodes tumors; axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes. We report the case of a 40-year-old Mexican woman with giant mammary tumor who underwent a right total mastectomy. The pathology results showed a benign phyllodes tumor 4,857 g in weight and 40.2 × 36.3 × 15 cm in size. We do not suggest adjuvant radiation therapy for patients with benign phyllodes tumors that are widely excised. A review of the pertinent literature was performed.
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Affiliation(s)
- Ricardo Fernández-Ferreira
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Andrés Arroyave-Ramírez
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Daniel Motola-Kuba
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Gabriela Alvarado-Luna
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Ileana Mackinney-Novelo
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Román Segura-Rivera
- Service of Anatomical Pathology, Medica Sur Clinic and Foundation, Mexico, Mexico
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Genco IS, Purohit V, Hackman K, Ferreira L, Tugertimur B, Hajiyeva S. Benign and borderline phyllodes tumors of the breast: Clinicopathologic analysis of 205 cases with emphasis on the surgical margin status and local recurrence rate. Ann Diagn Pathol 2021; 51:151708. [PMID: 33513547 DOI: 10.1016/j.anndiagpath.2021.151708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The management of benign and borderline phyllodes tumors of the breast with a positive surgical margin is still controversial. Our aim in this study was to evaluate the impact of surgical margin status on the local recurrence rate of benign and borderline phyllodes tumors. METHODS We reviewed 205 phyllodes tumors (191 benign, 14 borderline) that were surgically excised at our hospital between 2005 and 2019. Follow-up information extending to at least 6 months after surgery was retrieved from the clinical, radiology, and pathology records. RESULTS The initial surgical margin was negative in 54 (26%) cases, close (≤ 1 mm) in 29 (14%) cases, and positive in 122 (60%) cases. Approximately half of the cases with a close margin and two-third of the cases with a positive margin underwent re-excision to obtain negative margins. Three (2.3%) local recurrences were observed among 131 cases with follow-up information, all three with benign phyllodes tumor. Of these three patients, one had a positive final margin, and two had negative final margins. There was no significant difference in the rate of local recurrence between PT with a positive surgical margin versus a close and negative margin. CONCLUSION The study results suggest that close clinical and radiologic follow-up may provide a better course of management rather than re-excision when managing positive margins in benign and borderline phyllodes tumors.
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Affiliation(s)
- Iskender Sinan Genco
- Northwell Health Lenox Hill Hospital, Department of Pathology and Laboratory Medicine, 100 E 77th Street, New York, NY 10075, USA.
| | - Vaishali Purohit
- Northwell Health Lenox Hill Hospital, Department of Surgery, 100 E 77th street, New York, NY 10075, USA
| | - Kayla Hackman
- Northwell Health Lenox Hill Hospital, Department of Pathology and Laboratory Medicine, 100 E 77th Street, New York, NY 10075, USA
| | - Lisa Ferreira
- Northwell Health Lenox Hill Hospital, Department of Pathology and Laboratory Medicine, 100 E 77th Street, New York, NY 10075, USA
| | - Bugra Tugertimur
- Northwell Health Lenox Hill Hospital, Department of Surgery, 100 E 77th street, New York, NY 10075, USA
| | - Sabina Hajiyeva
- Northwell Health Lenox Hill Hospital, Department of Pathology and Laboratory Medicine, 100 E 77th Street, New York, NY 10075, USA
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74
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Tan PH. Fibroepithelial lesions revisited: implications for diagnosis and management. Mod Pathol 2021; 34:15-37. [PMID: 32461622 DOI: 10.1038/s41379-020-0583-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
Fibroepithelial lesions of the breast, comprising the fibroadenoma and phyllodes tumour, are a unique group of neoplasms that share histological characteristics but possess different clinical behaviour. The fibroadenoma is the commonest benign breast tumour in women, while the phyllodes tumour is rare and may be associated with recurrences, grade progression and even metastasis. The diagnosis of fibroadenoma is usually straightforward, with recognised histological variants such as the cellular, complex, juvenile and myxoid forms. The phyllodes tumour comprises benign, borderline and malignant varieties, graded using a constellation of histological parameters based on stromal characteristics of hypercellularity, atypia, mitoses, overgrowth and the nature of tumour borders. While phyllodes tumour grade correlates with clinical behaviour, interobserver variability in assessing multiple parameters that are potentially of different biological weightage leads to significant challenges in accurate grade determination and consequently therapy. Differential diagnostic considerations along the spectrum of fibroepithelial tumours can be problematic in routine practice. Recent discoveries of the molecular underpinnings of these tumours may have diagnostic, prognostic and therapeutic implications.
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Affiliation(s)
- Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Academia, Diagnostics Tower Level 7, 20 College Road, Singapore, 169856, Singapore.
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75
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Rosenberger LH, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Jakub JW. Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines. J Clin Oncol 2020; 39:178-189. [PMID: 33301374 DOI: 10.1200/jco.20.02647] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary. METHODS We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR). RESULTS Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96). CONCLUSION In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.
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Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC.,Duke Cancer Institute, Duke University, Durham, NC
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC.,Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Suniti N Nimbkar
- Brigham & Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | | | - Kandice K Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Megan E Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Jasmine Wong
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | | | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Taryn E Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Tari A King
- Brigham & Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
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76
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Yahaya JJ. Recurrent giant phyllodes tumour in a 17-year-old female: a rare case report. Oxf Med Case Reports 2020; 2020:omaa089. [PMID: 33133622 PMCID: PMC7583418 DOI: 10.1093/omcr/omaa089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 11/13/2022] Open
Abstract
Phyllodes tumours (PTs) are rare fibroepithelial tumours of the breast with incidence accounting for <1% in the general population. Availability of reports on PTs with size of 31 cm or more in diameter in the literature are extremely rare. Herein, the case of a 17-year-old female patient with a giant recurrent right breast PT is reported. Histologically, the tumour showed proliferation of stromal tumour cells consisting of spindle cells with uniform nuclear chromatin, inconspicuous nucleoli, abundant eosinophilic cytoplasm and proliferation labelling index for Ki67 of <10%. PTs require meticulous surgical excision due to the fact that they have a high rate of recurrence and status of surgical margins must be included in the pathology report. This is because recurrent cases of PTs tend to grow faster than the primary ones with a high chance of transforming to malignancy.
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Affiliation(s)
- James J Yahaya
- Department of Pathology, Makerere College of Health Sciences (MakCHS), Makerere University, Kampala, Uganda.,Department of Biomedical Science, College of Health Sciences (CHS), University of Dodoma, Dodoma,Tanzania
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77
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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: 24] [Impact Index Per Article: 6.0] [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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78
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Alipour S, Eskandari A. Phyllodes Tumor of the Breast in Pregnancy and Lactation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:137-142. [PMID: 32816274 DOI: 10.1007/978-3-030-41596-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Phyllodes tumor constitutes around 1% of all and 2.5% of fibroepithelial breast lumps. Three types including benign, borderline, and malignant tumors have been described. The benign variant is the most common, is close to fibroadenoma, but is usually larger and recurs more frequently. The rare malignant type is aggressive. Standard treatment consists of lumpectomy with appropriate margins for benign phyllodes tumor, while the borderline and malignant variants must be treated by wide resection or mastectomy. Phyllodes tumor is a rare tumor in pregnancy and lactation, and the effect of gestational alterations in hormone levels on this tumor have not been discussed in the literature, except for several case reports. In summary and alluding to our recent literature review, large size, fast growth, bilaterality, and probably malignancy are more commonly expected in gestational phyllodes tumors.
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Affiliation(s)
- Sadaf Alipour
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran. .,Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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79
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Ali NAM, Nasaruddin AF, Mohamed SS, Rahman WFW. Ki67 and P53 Expression in Relation to Clinicopathological Features in Phyllodes Tumour of the Breast. Asian Pac J Cancer Prev 2020; 21:2653-2659. [PMID: 32986365 PMCID: PMC7779430 DOI: 10.31557/apjcp.2020.21.9.2653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Phyllodes tumour (PT) is a rare fibroepithelial neoplasm of the breast that carries a risk of malignancy. Histopathological examination remains a gold standard for diagnosis. The usage of the immunohistochemical markers of Ki67 and p53 acts as a supplement method, particularly for the malignant PT. We aim here to study the expression of these markers in PT and to see their relation to the tumour grading. METHODOLOGY We conducted a retrospective cross-sectional study on 57 archived formalin-fixed paraffin-embedded tissue blocks of PT from the years 2015 to 2018 from two hospitals in East Coast Malaysia. The histopathological examination and immunohistochemical stain for Ki67 and p53 were analysed. RESULTS There was an association between clinical descriptive data of skin changes, lump size of more than 3 cm, cytological atypia, stromal hypercellularity, mitosis and immunohistochemistry with the clinical diagnosis of PT. Both marked expression of Ki67 and p53 were seen in borderline and malignant PT. Our study showed that in the presence of high mitotic figures, marked expression of Ki67 was only seen in cases of malignant PT. CONCLUSION We found a significant association of Ki67 and p53 expressions, high mitosis and other descriptive histopathological features in malignant PT. Further study with larger sample size is recommended to predict tumour grade and prognosis as well as the disease-free survival of the tumour. .
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Affiliation(s)
- Nurul Atiah Mohd Ali
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
- Department of Pathology, Hospital Sultanah Nur Zahirah, 20400, Kuala Terengganu, Terengganu, Malaysia.
| | - Ahmad Fazlin Nasaruddin
- Department of Pathology, Hospital Sultanah Nur Zahirah, 20400, Kuala Terengganu, Terengganu, Malaysia.
| | - Syarah Syamimi Mohamed
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Wan Faiziah Wan Rahman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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80
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A Novel Breast-Conserving Surgical Technique in the Management of Phyllodes Tumours of the Breast. World J Surg 2020; 44:4149-4152. [PMID: 32862277 DOI: 10.1007/s00268-020-05748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite advances in oncoplastic breast-conserving techniques, very large phyllodes tumours (PT) may still be recommended for mastectomy. METHODS We report a novel 2-staged breast-conserving technique that enables smaller excisional volumes whilst maintaining safe oncological excision. Stage-1 is a capsular dissection via a posterior glandular approach without sacrifice of native breast volume. Stage-2 is a delayed localised resection of the seroma cavity providing a circumferential "margin". Two cases are presented. CONCLUSION This novel technique preserves the breast, optimises cosmesis and is a safe approach to the surgical management of large PT.
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81
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Zhang T, Feng L, Lian J, Ren WL. Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report. World J Clin Cases 2020; 8:3591-3600. [PMID: 32913869 PMCID: PMC7457108 DOI: 10.12998/wjcc.v8.i16.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Phyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.
CASE SUMMARY A 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.
CONCLUSION This case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.
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Affiliation(s)
- Ting Zhang
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Liang Feng
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Jie Lian
- Department of Pathology, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Wei-Li Ren
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
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82
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Lohmeyer JA, Huster N, Lühr C, Lindner C, Wittig KS, Keck MK. [Treatment of phyllodes tumours of the breast: evaluation of 66 cases and literature review]. HANDCHIR MIKROCHIR P 2020; 53:159-167. [PMID: 32785910 DOI: 10.1055/a-1164-6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Phyllodes tumours (PTs) of the breast are classified as benign, borderline and malignant based on the constellation of defined histological parameters. Surgical excision is the primary therapy, but the need to maintain certain safety margins is still controversially discussed for all three categories.This paper aims to provide a critical opinion on the existing recommendation on safety margins for resection.In our breast centre, all patients with phyllodes tumours were identified retrospectively on the basis of the histopathological documentation from 1999 to 2018. The cases were evaluated, in particular, with a view to recurrences and the occurrence of multicentricity.A total of 66 patients were diagnosed with a PT. In 38 cases, the tumours were benign, in 15 borderline and in 13 malignant. Local recurrences were observed in one benign PT, 7 borderline and 5 malignant PTs. Two PTs that were initially classified as borderline tumours progressed to malignant PTs. Multicentricity occurred in about 20 % of borderline and malignant PTs but only in 5 % of benign PTs.The resection margins for phyllodes tumours should be chosen depending on dignity and recurrence. The key question to be challenged is whether or not there is a need to maintain a certain safety margin in benign PTs. In case of recurrence of borderline or malignant PTs, a mastectomy should be considered early.
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Affiliation(s)
- Jörn Andreas Lohmeyer
- Agaplesion Diakonieklinikum Hamburg gGmbH, Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie
| | - Nora Huster
- Agaplesion Diakonieklinikum Hamburg gGmbH, Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie
| | | | - Christoph Lindner
- Agaplesion Diakonieklinikum Hamburg gGmbH, Frauenklinik und Brustzentrum
| | - Klaus Stephan Wittig
- Agaplesion Diakonieklinikum Hamburg gGmbH, Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie
| | - Maike Katharina Keck
- Agaplesion Diakonieklinikum Hamburg gGmbH, Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie
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83
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Sun D, Tang L, Xing H, Zhang L, Zhang L. Recurrent borderline phyllodes tumor in nipple: a rare case report and review of the literature. Gland Surg 2020; 9:452-458. [PMID: 32420273 DOI: 10.21037/gs.2020.01.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Phyllodes tumor (PT) of the breast is a rare tumor. They are usually located in the four quadrants of the mammary gland and may also appear below the nipple. Although there have been a number of cases reported, here we report a very rare case of this tumor in an unusual location. The patient has been diagnosed with right breast borderline PT, who accepted breast-conserving surgery. Twelve months after surgery we found right nipple enlargement, without nipple discharge, ipsilateral and contralateral breast without palpable mass. Interestingly, ultrasound showed a lesion in the right nipple: a hypoechoic mass with a diameter of 2.0 cm was seen in the nipple, with no significant calcification. The patient underwent nipple-sparing mastectomy without postoperative adjuvant radiotherapy. Histopathological and immunohistochemical analysis demonstrated a borderline PT. There were no signs of recurrence after two years of follow-up. We consider that wide surgical resection and negative margin are still the main methods for the treatment of recurrent borderline PTs.
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Affiliation(s)
- Denghua Sun
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Lu Tang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Hua Xing
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Lijuan Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Le Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
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84
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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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85
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Olaya J, Sanjuan J, Luna RL, Casanova L. Risk Factors for Disease Recurrence in Women With Phyllodes Tumors of the Breast in Southern Colombia: A Nine-Year Cohort Study. Cureus 2020; 12:e7951. [PMID: 32509477 PMCID: PMC7271061 DOI: 10.7759/cureus.7951] [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] [Indexed: 12/31/2022] Open
Abstract
Introduction Phyllodes tumors (PTs) are uncommon fibroepithelial breast tumors that occur in middle-aged women, and they tend to vary in biologic behavior. Surgical management is the standard therapy for the condition, but factors associated with recurrence remain unclear. The aim of this study was to evaluate clinical and surgical characteristics related to PT recurrences. Methods This retrospective cohort study included patients in southern Colombia who were diagnosed with PT and managed at a level I teaching and referral hospital over a nine-year period. Factors associated with recurrence were determined by Cox regression analysis. Results This study included 61 patients; their median age was 46 years [interquartile range (IQR): 39-55 years]. Pathologically, 37 tumors (60.7%) were classified as low-grade. The median tumor size was 7 cm (IQR: 4-11.5 cm). Thirty-nine (63.9%) patients underwent quadrantectomy. Nine patients (14.8%) experienced tumor recurrence, with the median time to recurrence being one year (IQR: 0.5-2 years). Distant metastasis was observed in four patients (6.6%) at a median of nine months (IQR: 0.4-2.5 years). Univariate analyses showed that patients with high-grade tumors [hazard ratio (HR): 2.90, p = 0.148] and those who underwent mastectomy (HR: 2.90, p = 0.460) were at higher risk of recurrence. Conclusion PT recurrence may be associated with biological features, the extent of local excision, tumor size, and negative margins. However, multicenter data are needed to confirm these findings.
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Affiliation(s)
- Justo Olaya
- Surgery - Mastology, Unidad Oncologica Surcolombiana, Neiva, COL.,Surgery - Mastology, Universidad Surcolombiana, Neiva, COL.,Surgery - Mastology, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, COL
| | - Juan Sanjuan
- Clinical Research, Utopiapp SAS, Cali, COL.,Clinical Research, Cirugia y Trauma (CYTRA) - Universidad Surcolombiana, Neiva, COL.,Surgery, Universidad Surcolombiana, Neiva, COL.,Surgery, Hospital Hernando Moncaleano Perdomo, Neiva, COL
| | - Rina L Luna
- Pathology, Hospital Hernando Moncaleano Perdomo, Neiva, COL
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86
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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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87
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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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88
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Mberu V, Macaskill EJ, Purdie C, Evans A. Preoperative prediction of margin requirement following a core biopsy result suggestive of a phyllodes tumour. Clin Radiol 2019; 75:319.e21-319.e27. [PMID: 31862110 DOI: 10.1016/j.crad.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine if imaging features of lesions with a core biopsy suggestive of a phyllodes tumour can be used to identify which lesions require surgical excision with margins. MATERIALS AND METHODS Thirty-one lesions were identified from a prospective database of ultrasound visible masses. Demographic, mammographic, and ultrasound features were assessed while blinded to surgical outcome. Features of those lesions requiring a margin and those that did not were compared. Statistical significance was established using the chi-square test and receiver operating characteristic (ROC) curves. RESULTS Thirteen lesions (42%) required a margin and 18 lesions (58%) did not. Features found significantly more frequently in those requiring a margin were a poorly defined margin on mammography (7/9 [78%] versus 4/13 [31%]; p=0.04) and at ultrasound, an irregular margin (8/13 [62%] versus 3/18 [17%]; p=0.01), micro-lobulations (7/13 [54%] versus 3/18 [17%]; p=0.028), mixed echogenicity (9/13 [69%] versus 1/18 [6%]; p=0.0002), echogenic clefts (6/13 [46%] versus 1/18 [6%]; p=0.007), posterior enhancement (9/11 [82%] versus 6/18 [33%]; p=0.01), large size (p=0.003) and stiffness at shear-wave elastography (p=0.026). All six screen-detected lesions were benign. CONCLUSIONS There are multiple preoperative features that can be used to guide surgical management of lesions with a preoperative core biopsy result suggestive of a phyllodes tumour.
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Affiliation(s)
- V Mberu
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - E J Macaskill
- Department of Breast Surgery, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - C Purdie
- Department of Pathology, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - A Evans
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK.
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89
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Ditsatham C, Chongruksut W. Phyllodes tumor of the breast: diagnosis, management and outcome during a 10-year experience. Cancer Manag Res 2019; 11:7805-7811. [PMID: 31695485 PMCID: PMC6707441 DOI: 10.2147/cmar.s215039] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/12/2019] [Indexed: 12/18/2022] Open
Abstract
Background Phyllodes tumor is a very rare tumor of the breast, incidence being 0.3–0.9% of all breast tumors. Phyllodes tumors are classified into three grades: benign, borderline or malignant. The aim of this study was to investigate patient characteristics, imaging characteristic findings, surgical treatment and outcome of phyllodes tumor. Materials and methods This is a retrospective review of phyllodes tumor patients who had undergone surgical management between 1 January 2006 and 31 December 2015 in Head, Neck and Breast Unit, Department of Surgery, Chiang Mai University Hospital. Results A total of 188 phyllodes tumor patients were included in this study. The average age of the patients was 35.6 years. The majority of the tumors were of lobulated shape. Tumor morphology from imaging: lobulated shaped tumor 112 cases, oval-shape 37 cases, round shape 8 cases and irregular 5 cases. Surgical management is the standard procedure for treatment of phyllodes tumors. A wide local excision was performed in 147 cases, mastectomy in 20 cases (modified radical mastectomy in 2 cases) and wide excision followed by mastectomy 21 cases. The final pathological diagnoses of the phyllodes tumors were: benign 118 cases (62%), borderline 33 cases (18%) and malignant in 37 cases (20%). The margin did not affect recurrence in all types. Conclusion The most frequent is a benign phyllodes tumor. Surgical treatment to remove the tumor with a free margin is acceptable with no recurrence difference from a wider margin. However, younger age and malignant phyllodes tumor are the two highest risk factors for recurrence.
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Affiliation(s)
- Chagkrit Ditsatham
- Division of Head, Neck, and Breast Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wilaiwan Chongruksut
- Research Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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90
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Kuo CY, Lin SH, Lee KD, Cheng SJ, Chu JS, Tu SH. Transcatheter arterial chemoembolization improves the resectability of malignant breast phyllodes tumor with angiosarcoma component: a case report. BMC Surg 2019; 19:100. [PMID: 31351458 PMCID: PMC6660949 DOI: 10.1186/s12893-019-0562-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background A giant phyllodes tumor of the breast is a rare fibroepithelial lesion, and its treatment is controversial. Many case reports have reported performing skin graft reconstruction after tumor excision. Chest wall resection may be required if the tumor has invaded the chest muscle layer. We speculated that transcatheter arterial chemoembolization (TACE) can improve the resectability of malignant phyllodes tumor of the breast without requiring skin grafting. The English literature contains only one case report similar to our experience. Case presentation We report a rare case of a 51-year-old woman who had a giant malignant phyllodes tumor with heterologous sarcomatous differentiation in her right breast. The tumor was 19.43 × 12.98 × 21.47 cm. Whole-body computed tomography (CT) and bone scan did not reveal distant metastasis. Chest magnetic resonance imaging showed chest wall tumor invasion. Considering that skin defects after mastectomy can be extensive, we administered four courses of chemoembolization in the 5 weeks before surgery (30 mg of epirubicin and embozene microspheres [400, 500, and 700 μm]/week). Each process was well tolerated, with no serious complications. Only fever and local pain at the tumor site were noted, and these symptoms resolved with time. The follow-up CT scan showed a 45% reduction in tumor volume. Therefore, simple mastectomy was performed without skin grafting reconstruction. Wound healing was satisfactory, and the patient was discharged 1 week after surgery. Pathological and immunohistochemistry (IHC) findings showed a malignant phyllodes tumor with an angiosarcoma component. Because of tumor invasion of the chest wall, we recommended the patient receive radiotherapy, but she refused. Two months after surgery, recurrence of the malignant phyllodes tumor with right axillary lymph node involvement and lung metastasis was confirmed. Conclusion Initial surgical resection of giant phyllodes tumors is often challenging. For initial presentation with unresectable giant phyllodes tumor, we recommend to perform TACE prior to surgery. In our patient, preoperative TACE was effective and safe. If the tumor has invaded the chest wall, early radiotherapy after surgery may be recommended for preventing recurrence.
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Affiliation(s)
- Chih-Yu Kuo
- Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shing-Huey Lin
- Division of Family Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Kuan-Der Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jan-Show Chu
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Hsin Tu
- Division of Breast Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
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91
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Song E, Jacobs L, Chen K. ASO Author Reflections: Local Recurrence Risk and Risk Factors of Breast Phyllodes Tumors. Ann Surg Oncol 2019; 26:637-638. [PMID: 31209669 DOI: 10.1245/s10434-019-07434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Lisa Jacobs
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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92
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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: 45] [Impact Index Per Article: 9.0] [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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