151
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Çelik MF, Dural AC, Ünsal MG, Akarsu C, Alim ER, Kapan S, Kalaycı MU, Alış H. Giant juvenile fibroadenoma. ULUSAL CERRAHI DERGISI 2015; 31:96-8. [PMID: 26170749 DOI: 10.5152/ucd.2014.2574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/21/2014] [Indexed: 11/22/2022]
Abstract
Juvenile fibroadenoma is a common cause of breast masses seen in adolescents and young women. Giant juvenile fibroadenomas are usually single and unilateral. The etiology is thought to be due to increased levels of estrogen during adolescence, although it is not yet fully understood. Treatment options range from simple excision to sub-cutaneous mastectomy according to the size of the lesion. This article aimed to present a case that was diagnosed with "giant juvenile fibroadenoma".
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Affiliation(s)
- Muhammet Ferhat Çelik
- Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Cem Dural
- Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Gökhan Ünsal
- Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Cevher Akarsu
- Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Elmas Reyhan Alim
- Clinic of Pediatric Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Selin Kapan
- Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Uygar Kalaycı
- Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Halil Alış
- Clinic of General Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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152
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Phyllodes tumors in African American women. Am J Surg 2015; 210:74-9. [DOI: 10.1016/j.amjsurg.2014.09.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/30/2014] [Accepted: 09/08/2014] [Indexed: 11/22/2022]
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153
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Acar T, Tarcan E, Hacıyanlı M, Kamer E, Peşkersoy M, Yiğit S, Gür Ö, Cin N, Sarı AA, Tatar F. How to approach phyllodes tumors of the breast? ULUSAL CERRAHI DERGISI 2015; 31:197-201. [PMID: 26668526 DOI: 10.5152/ucd.2015.2941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/24/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Phyllodes tumor of the breast is a rare fibroepithelial breast tumor that comprise 0.3-0.9% of primary breast neoplasms. In this study, we aimed to present clinicopathologic symptoms of our patients along with their treatment modality. MATERIAL AND METHODS Clinicopathologic properties and treatment modality of 20 phyllodes tumor patients who underwent surgery between January 2008 and January 2013 were retrospectively evaluated. RESULTS Median patient age was 47 years (22-75). Fine-needle aspiration biopsy was applied to 19 patients. Biopsy results were reported as suspicious in four, malignant in three, benign in 11, and as non-diagnostic in one patient. Final histopathology reports revealed two benign, one malignant and one borderline tumor out of the four patients with suspicious findings on fine needle aspiration biopsy; all patients with malignant cytology had malignancy. There were two borderline and nine benign lesions within the benign biopsy group. Sixteen patients underwent segmental mastectomy, four patients underwent mastectomy with/without axillary dissection. The median tumor size was 6 (1-13) cm. Histopathologically, 11 (55%) tumors were benign, 5 (25%) were borderline, and 4 (20%) were malignant. Two of the four patients with malignancy underwent radiotherapy and chemotherapy, and one patient only received chemotherapy as adjuvant treatment. CONCLUSION Phyllodes tumors are rare, mix-type breast tumors. Due to high rates of local recurrence and potential for malignancy, preoperative diagnosis and accurate management are important.
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Affiliation(s)
- Turan Acar
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ercüment Tarcan
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Mehmet Hacıyanlı
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Erdinç Kamer
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Mustafa Peşkersoy
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Seyran Yiğit
- Clinic of Pathology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Özlem Gür
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Necat Cin
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ayşegül Akder Sarı
- Clinic of Pathology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Fatma Tatar
- Clinic of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
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154
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Augustyn A, Sahoo S, Wooldridge RD. Large Malignant Phyllodes Tumor of the Breast with Metastases to the Lungs. Rare Tumors 2015; 7:5684. [PMID: 26266007 PMCID: PMC4508638 DOI: 10.4081/rt.2015.5684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 11/24/2022] Open
Abstract
Phyllodes tumors of the breast account for less than 0.5% of breast cancers and present most commonly in women 45 to 49 years old. The importance in managing fibroepithelial lesions lies in distinguishing fibroadenomas, which are benign, from phyllodes tumors, which can be malignant and require complete surgical excision. We report the case of a 56-year-old female who presented with a rapidly enlarging mass in her right breast 18 cm in maximum dimension that completely effaced the breast and distorted the nipple. The patient underwent a successful total mastectomy after core biopsy revealed a diagnosis of phyllodes tumor. Surgical resection is the primary treatment modality; neoadjuvant and adjuvant therapies remain controversial. Here, we report the case of a large malignant phyllodes tumor metastatic to the lungs, review the literature, and discuss diagnostic modalities and adjunct nonsurgical therapies.
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Affiliation(s)
- Alexander Augustyn
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Sunati Sahoo
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Rachel D Wooldridge
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center , Dallas, TX, USA
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155
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Pfarr N, Kriegsmann M, Sinn P, Klauschen F, Endris V, Herpel E, Muckenhuber A, Jesinghaus M, Klosterhalfen B, Penzel R, Lennerz JK, Weichert W, Stenzinger A. Distribution ofMED12mutations in fibroadenomas and phyllodes tumors of the breast-implications for tumor biology and pathological diagnosis. Genes Chromosomes Cancer 2015; 54:444-52. [DOI: 10.1002/gcc.22256] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/12/2015] [Indexed: 12/28/2022] Open
Affiliation(s)
- Nicole Pfarr
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
| | - Peter Sinn
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
| | - Frederick Klauschen
- Institute of Pathology, Charité University Hospital; Charitéplatz 1 10117 Berlin Germany
| | - Volker Endris
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
| | - Esther Herpel
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
- Tissue Bank of the National Center for Tumor Diseases (NCT); Heidelberg Germay
| | - Alexander Muckenhuber
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
| | - Moritz Jesinghaus
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
| | - Bernd Klosterhalfen
- Institute of Pathology, Dueren Hospital; Roonstrasse 30 52351 Dueren Germany
| | - Roland Penzel
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
| | - Jochen K. Lennerz
- Department of Pathology; Massachusetts General Hospital/Harvard Medical School, Center for Integrated Diagnostics (CID); 55 Fruit Street 02114 Boston MA USA
| | - Wilko Weichert
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
- Member of the German Cancer Consortium (DKTK) and National Center for Tumor Diseases (NCT); 69120 Heidelberg Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg; Im Neuenheimer Feld 224 69120 Heidelberg Germany
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156
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Yoshida M, Sekine S, Ogawa R, Yoshida H, Maeshima A, Kanai Y, Kinoshita T, Ochiai A. Frequent MED12 mutations in phyllodes tumours of the breast. Br J Cancer 2015; 112:1703-8. [PMID: 25839987 PMCID: PMC4430713 DOI: 10.1038/bjc.2015.116] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/18/2015] [Accepted: 03/07/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Phyllodes tumours are rare fibroepithelial tumours of the breast, that include benign, borderline, and malignant lesions. Although the molecular basis of phyllodes tumours largely remains unknown, a recent exome study identified MED12 mutations as a sole recurrent genetic alteration in fibroadenoma, a common benign fibroepithelial tumour that shares some histological features with the phyllodes tumour. METHODS Forty-six phyllodes tumours and 58 fibroadenomas of the breast were analysed for MED12 mutations by using Sanger sequencing. RESULTS MED12 mutations were identified in 37 out of the 46 phyllodes tumours (80%). The prevalence of MED12 mutations was similar among benign (15/18, 83%), borderline (12/15, 80%), and malignant tumours (10/13, 77%). MED12 mutations were also identified in 36 of the 58 fibroadenomas (62%). The mutations were frequent among intracanalicular-type (24/32, 75%) and complex-type lesions (4/6, 67%), but were significantly less common among the pericanalicular-type lesions (8/20, 40%). A microdissection-based analysis showed that MED12 mutations were confined to the stromal components in both phyllodes tumours and fibroadenomas. CONCLUSIONS MED12 mutations were frequent among the phyllodes tumours of the breast, regardless of the tumour grade. Phyllodes tumours and fibroadenomas share, at least in part, a common genetic background.
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Affiliation(s)
- M Yoshida
- Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - S Sekine
- 1] Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 104-0045, Japan [2] Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - R Ogawa
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - H Yoshida
- Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - A Maeshima
- Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Y Kanai
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - T Kinoshita
- Breast Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - A Ochiai
- Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 104-0045, Japan
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157
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Hung CC, Yeh DC, Lee CH, Wu CC, Liu TJ. Invasive ductal carcinoma arising in borderline phyllodes tumor. FORMOSAN JOURNAL OF SURGERY 2015. [DOI: 10.1016/j.fjs.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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158
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Lightner AL, Shurell E, Dawson N, Omidvar Y, Foster N. A Single-center Experience and Review of the Literature: 64 Cases of Phyllodes Tumors to Better Understand Risk Factors and Disease Management. Am Surg 2015. [DOI: 10.1177/000313481508100336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phyllodes tumors of the breast are rare fibroepithelial tumors that are characterized as benign, borderline, or malignant based on cellular characteristics such as stromal overgrowth and number of mitoses. Currently, there is a lack of consensus on risk factors and management of patients with phyllodes tumors, which has led to variation in treatment patterns as well as patient outcomes across many institutions. This study seeks to understand the clinicopathologic features, risk factors for local and metastatic recurrence, and clinical outcomes of patients with phyllodes tumors to better define optimal treatment patterns.
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Affiliation(s)
- Amy L. Lightner
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Elizabeth Shurell
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Nicole Dawson
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Yasaman Omidvar
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Nova Foster
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
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159
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Testori A, Meroni S, Errico V, Travaglini R, Voulaz E, Alloisio M. Huge malignant phyllodes breast tumor: a real entity in a new era of early breast cancer. World J Surg Oncol 2015; 13:81. [PMID: 25880837 PMCID: PMC4350953 DOI: 10.1186/s12957-015-0508-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/09/2015] [Indexed: 11/10/2022] Open
Abstract
Phyllodes tumor is an extremely rare tumor of the breast. It occurs in females in the third and fourth decades. The difficulty in distinguishing between phyllodes tumors and benign fibroadenoma may lead to misdiagnosis. Lymph node involvement is rarely described in phyllodes tumors; for this reason, sentinel node biopsy may be warranted. We present a case of a 33-year-old woman affected by huge tumor of the right breast with ulceration in the skin with a rapid tumor growth and with omolateral axillary metastasis.
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Affiliation(s)
- Alberto Testori
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Stefano Meroni
- Division of Breast Radiology, European Institute of Oncology, Via Ripamonti, 435, Milan, Italy.
| | - Valentina Errico
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Roberto Travaglini
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Emanuele Voulaz
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Marco Alloisio
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
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160
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Warrier S, Hwang SY, Gibbings K, Carmalt H, O'Toole S. Phyllodes tumour with heterologous sarcomatous differentiation: Case series with literature review. Int J Surg Case Rep 2015; 11:91-94. [PMID: 25956039 PMCID: PMC4446672 DOI: 10.1016/j.ijscr.2015.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/01/2015] [Accepted: 02/04/2015] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Phyllodes tumours are rare fibroepithelial malignancies of the breast, accounting for less than 1% of malignant breast tumours. Further malignant differentiation of phyllodes tumours can occur, resulting in cases of extremely rare heterologous sarcomatous differentiation. PRESENTATION OF CASE Two females in their fifties were diagnosed with malignant phyllodes tumour associated with heterologous sarcomatous differentiation. The first patient, aged 50 had phyllodes tumour with chondrosarcoma, osteosarcoma and ductal carcinoma-in-situ. The second patient, aged 53 had phyllodes tumour with osteosarcoma and liposarcoma. DISCUSSION The association of phyllodes tumour and heterologous sarcomatous differentiation is rare, with only 4 previously reported cases in English literature. The paucity of evidence presents challenges in its management with uncertain prognosis and monitoring requirements for two aforementioned patients. CONCLUSION Further case series and long-term follow up is required for accurate characterisation of phyllodes tumours with heterologous sarcomatous differentiation.
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Affiliation(s)
- Sanjay Warrier
- Department of Breast Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Department of Surgery, Prince of Wales Hospital, Randwick, NSW, Australia; Faculty of Medicine, University of Sydney, Australia; RPA Institute of Academic Surgery, Sydney Local Health District, Australia.
| | - Sang Y Hwang
- Department of Surgery, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Hospital Clinical School, University of New South Wales, Australia
| | - Keagan Gibbings
- Department of Breast Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Hugh Carmalt
- Department of Breast Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine, University of Sydney, Australia
| | - Sandra O'Toole
- Faculty of Medicine, University of Sydney, Australia; RPA Institute of Academic Surgery, Sydney Local Health District, Australia
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161
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Zeng S, Zhang X, Yang D, Wang X, Ren G. Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: A systematic review and meta-analysis. Mol Clin Oncol 2015; 3:663-671. [PMID: 26137284 DOI: 10.3892/mco.2015.503] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/19/2014] [Indexed: 11/05/2022] Open
Abstract
The standard treatment for borderline and malignant phyllodes tumors is wide local excision (margins ≥1 cm), in the context of either breast-conserving surgery (BCS) or total mastectomy (TM). Due to the high risk of local recurrence (LR) following surgical intervention alone, the addition of adjuvant radiotherapy (RT) has been previously investigated; however, the conclusions have been inconsistent. This systematic review and meta-analysis was designed to assess the efficacy of adjuvant RT for borderline and malignant phyllodes tumors. Pubmed and Web of Science were systematically searched to identify relevant studies assessing the effect of adjuvant RT on borderline and malignant phyllodes tumors from the inception of this technique through May, 2014. A total of 8 studies were identified among 332 citations. In this meta-analysis, patients who received adjuvant RT had a lower relative risk of LR [hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.23-0.64]. The absolute risk difference was 10.1% (95% CI: 4.9-17.6), corresponding to a number needed to treat of 10. Our pooled meta-analysis clearly demonstrated a decreased risk of LR in patients with borderline and malignant phyllodes tumors who received RT following BCS (HR=0.31, 95% CI: -0.10-0.72). However, the combined HR for LR in the TM group did not demonstrate that adjuvant RT was superior to no RT (HR=0.68, 95% CI: -0.28-1.64). No significant differences were observed in overall survival (OS) or disease-free survival (DFS) between the two groups. Our analysis suggested that adjuvant RT for borderline and malignant phyllodes tumors decreased the LR rate in patients undergoing BCS. However, adjuvant RT was not found to exert an effect on OS or DFS.
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Affiliation(s)
- Shiyan Zeng
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xindan Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Dejuan Yang
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaoyi Wang
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Guosheng Ren
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Yom CK, Han W, Kim SW, Park SY, Park IA, Noh DY. Reappraisal of Conventional Risk Stratification for Local Recurrence Based on Clinical Outcomes in 285 Resected Phyllodes Tumors of the Breast. Ann Surg Oncol 2015; 22:2912-8. [DOI: 10.1245/s10434-015-4395-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Indexed: 11/18/2022]
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163
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Gene expression-based classifications of fibroadenomas and phyllodes tumours of the breast. Mol Oncol 2015; 9:1081-90. [PMID: 25687451 PMCID: PMC5528764 DOI: 10.1016/j.molonc.2015.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 11/21/2022] Open
Abstract
Fibroepithelial tumors (FTs) of the breast are a heterogeneous group of lesions ranging from fibroadenomas (FAD) to phyllodes tumors (PT) (benign, borderline, malignant). Further understanding of their molecular features and classification might be of clinical value. In this study, we analysed the expression of 105 breast cancer‐related genes, including the 50 genes of the PAM50 intrinsic subtype predictor and 12 genes of the Claudin‐low subtype predictor, in a panel of 75 FTs (34 FADs, 5 juvenile FADs, 20 benign PTs, 5 borderline PTs and 11 malignant PTs) with clinical follow‐up. In addition, we compared the expression profiles of FTs with those of 14 normal breast tissues and 49 primary invasive ductal carcinomas (IDCs). Our results revealed that the levels of expression of all breast cancer‐related genes can discriminate the various groups of FTs, together with normal breast tissues and IDCs (False Discovery Rate < 5%). Among FTs, the levels expression of proliferation‐related genes (e.g. CCNB1 and MKI67) and mesenchymal/epithelial‐related (e.g. CLDN3 and EPCAM) genes were found to be most discriminative. As expected, FADs showed the highest and lowest expression of epithelial‐ and proliferation‐related genes, respectively, whereas malignant PTs showed the opposite expression pattern. Interestingly, the overall profile of benign PTs was found more similar to FADs and normal breast tissues than the rest of tumours, including juvenile FADs. Within the dataset of IDCs and normal breast tissues, the vast majority of FADs, juvenile FADs, benign PTs and borderline PTs were identified as Normal‐like by intrinsic breast cancer subtyping, whereas 7 (63.6%) and 3 (27.3%) malignant PTs were identified as Claudin‐low and Basal‐like, respectively. Finally, we observed that the previously described PAM50 risk of relapse prognostic score better predicted outcome in FTs than the morphological classification, even within PTs‐only. Our results suggest that classification of FTs using gene expression‐based data is feasible and might provide clinically useful biological and prognostic information. The levels expression of proliferation‐ and mesenchymal/epithelial‐related genes were found to be the most discriminative. The overall profile of benign phyllodes was very similar to fibroadenomas. The vast majority of fibroepithelial tumors (FTs) were identified as Normal‐like by the PAM50 and Claudin‐low predictors. The PAM50 risk of relapse prognostic score better predicted outcome in FTs than the morphological classification. Classification of FTs using gene expression‐based data provides clinically useful information.
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164
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Wang H, Wang X, Wang CF. Comparison of Clinical Characteristics Between Benign Borderline and Malignant Phyllodes Tumors of the Breast. Asian Pac J Cancer Prev 2015; 15:10791-5. [DOI: 10.7314/apjcp.2014.15.24.10791] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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165
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Roberts N, Runk DM. Aggressive malignant phyllodes tumor. Int J Surg Case Rep 2015; 8C:161-5. [PMID: 25697402 PMCID: PMC4353966 DOI: 10.1016/j.ijscr.2014.12.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/31/2014] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumor of breast could be either benign or malignant variety and they can grow into very large sizes and distort the breast. WHO classifies tumors into benign, borderline and malignant and it is the best methods to predict the local recurrence, distant metastasis or bath after resection. Borderline and malignant disease should have close follow up; as some of these tumors can rapidly change and metastasize.
Introduction Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3–0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount. Presentation of case We present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31 cm in diameter and weighed over 10 kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office. Conclusion Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.
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Affiliation(s)
- Nathan Roberts
- Jewish Hospital Department of Surgery, 4777 E. Galbraith Road, Cincinnati, OH 45236, USA.
| | - Dianne M Runk
- Jewish Hospital Department of Surgery, 4777 E. Galbraith Road, Cincinnati, OH 45236, USA
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166
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Mylvaganam S, Toro C, Frank L, Vestey S, Thrush S. Phylloides tumours of the breast: best practice for follow-up. Updates Surg 2015; 67:91-5. [PMID: 25575495 DOI: 10.1007/s13304-015-0278-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 01/05/2015] [Indexed: 11/25/2022]
Abstract
Phylloides tumours are rare fibroepithelial breast tumours accounting for 1% of breast cancers. No UK guidance exists on the assessment, treatment and follow-up of these patients. To assess the diagnostic accuracy of the clinical core biopsy compared to the gold standard excision biopsy and determine the current follow-up practice and recurrence rate of phylloides tumours across two UK hospital trusts. Multicentre retrospective analysis of all cases of phylloides tumours over 6 years at Worcestershire Acute NHS Trust (WANHST) and Gloucestershire Hospitals NHS Trust (GHNHST). 94 Patients included. Mean age 48 years. Mean clinical and radiological size of lesions 31.7 and 35.4 mm, respectively, preoperative core biopsy sensitivity was 87% for WANHST and 74% for GHNHST with a positive predictive value of 90 and 100%, respectively. 29 Different follow-up regimes were observed from the practice of the 10 surgeons observed following diagnosis and resection of tumours. The follow-up length ranged from discharge following one post-operative clinic attendance to 5-year clinical and/or radiological follow-up. 4 Benign and 2 malignant recurrent phylloides tumours were seen. All benign recurrences were local and found independently of follow-up. The earliest benign phylloides recurrence was at 6 years and the latest at 10 years. There is no standard follow-up of benign or malignant phylloides tumours. This study suggests that in the benign group, the risk of recurrence is small. We advocate no routine follow-up of benign phylloides tumours.
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167
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Güler SA, Uğurlu MÜ, Güllüoğlu BM. Five-Year Disease-Free Follow-Up of a Borderline Breast Phyllodes Tumor in a 15-year-old Patient. THE JOURNAL OF BREAST HEALTH 2015; 11:138-140. [PMID: 28331709 DOI: 10.5152/tjbh.2015.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/13/2014] [Indexed: 11/22/2022]
Abstract
Phyllodes tumors are large breast tumors representing only 1% of breast neoplasms and are rarely seen in young women. Histologically, phyllodes tumors are classified as benign, borderline, or malignant based on the characteristics of the stroma. Although wide local excision is recommended for the treatment modality, the reoccurrence rate after surgical excision varies between 36% and 65%, with recurrence more likely in those with the tumor at the margins of excision. Our aim was to report -a case in a 15-year-old girl with a 115-mm borderline phyllodes tumor in her left breast mimicking a juvenile fibroadenoma. We presented a 5-year disease-free follow-up after wide local excision with negative margins.
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Affiliation(s)
- Sertaç Ata Güler
- Department of General Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - M Ümit Uğurlu
- Department of General Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Bahadır M Güllüoğlu
- Department of General Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
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168
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Pacioles T, Seth R, Orellana C, John I, Panuganty V, Dhaliwal R. Malignant phyllodes tumor of the breast presenting with hypoglycemia: a case report and literature review. Cancer Manag Res 2014; 6:467-73. [PMID: 25525388 PMCID: PMC4266253 DOI: 10.2147/cmar.s71933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Phyllodes tumors are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors and are typically found in middle-aged women. Phyllodes tumors that present with hypoglycemia are even rarer. No one morphologic finding is reliable in predicting the clinical behavior of this tumor. Surgery has been the primary mode of treatment to date. However, the extent of resection and the role of adjuvant radiotherapy or chemotherapy are still controversial. Here, we present a challenging case of malignant phyllodes tumor of the breast associated with hypoglycemia, and review the literature regarding clinical findings, pathologic risk factors for recurrence, and treatment recommendations.
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Affiliation(s)
- Toni Pacioles
- Department of Hematology and Oncology, Edwards Comprehensive Cancer Center, Marshall University, Huntington, WV, USA
| | - Rahul Seth
- Division of Hematology and Oncology, SUNY Upstate Medical University, Syracuse, NY, USA ; Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Cesar Orellana
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ivy John
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Veera Panuganty
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ruban Dhaliwal
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA ; Division of Endocrinology, SUNY Upstate Medical University, Syracuse, NY, USA
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169
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Giant malignant phyllodes tumour of breast. Case Rep Oncol Med 2014; 2014:956856. [PMID: 25548696 PMCID: PMC4273467 DOI: 10.1155/2014/956856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/05/2014] [Indexed: 11/17/2022] Open
Abstract
The term phyllodes tumour includes lesions ranging from completely benign tumours to malignant sarcomas. Clinically phyllodes tumours are smooth, rounded, and usually painless multinodular lesions indistinguishable from fibroadenomas. Percentage of phyllodes tumour classified as malignant ranges from 23% to 50%. We report a case of second largest phyllodes tumour in a 35-year-old lady who presented with swelling of right breast since 6 months, initially small in size, that progressed gradually to present size. Examination revealed mass in the right breast measuring 36×32 cms with lobulated firm surface and weighing 10 kgs. Fine needle aspiration cytology was reported as borderline phyllodes; however core biopsy examination showed biphasic neoplasm with malignant stromal component. Simple mastectomy was done and specimen was sent for histopathological examination which confirmed the core biopsy report. Postoperatively the patient received chemotherapy and radiotherapy. The patient is on follow-up for a year and has not shown any evidence of metastasis or recurrence.
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170
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Keim-Malpass J, Mills AM, Showalter SL. Malignant phyllodes tumor of the breast: a case study. Clin J Oncol Nurs 2014; 18:595-7. [PMID: 25253115 DOI: 10.1188/14.cjon.595-597] [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: 11/17/2022]
Abstract
Malignant phyllodes tumors of the breast are rare, fast-growing tumors that can be difficult to diagnose. A case study is featured about a young adult patient who lacked insurance and received a delayed diagnosis of malignant phyllodes tumor of the breast. This article includes pertinent clinical and age-specific considerations for comprehensive management.
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Affiliation(s)
- Jessica Keim-Malpass
- School of Nursing, Emily Couric Clinical Cancer Center, University of Virginia in Charlottesville
| | - Anne M Mills
- Department of Pathology, University of Virginia in Charlottesville
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171
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Mituś J, Reinfuss M, Mituś JW, Jakubowicz J, Blecharz P, Wysocki WM, Skotnicki P. Malignant phyllodes tumor of the breast: treatment and prognosis. Breast J 2014; 20:639-44. [PMID: 25227987 DOI: 10.1111/tbj.12333] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial. We report a single institution's experience with MPTB. We discuss controversial therapeutic aspects of this rare tumor. Seventy patients with MPTB treated primarily with surgery were evaluated. The mean age was 50 years (21-76), and the mean size of the tumor was 6 cm. Thirty-four (48.6%) patients were treated with total mastectomy, and 36 (51.4%) were treated with BCS (lumpectomy or wide local excision). Microscopic surgical margins were free of tumor in all cases. In 64 (91.4%) patients, margins were ≥1 cm. Remaining 6 (8.6%) patients treated with BCS margins were <1 cm and subsequently radiotherapy was performed. Among 70 patients, 58 (82.9%) had no evidence of disease (NED) after 5 years. The extent of surgery was not significantly related to the 5-year NED survival rates (82.4% in patients who underwent mastectomy and 83.3% in patients who underwent BCS only or BCS with adjuvant irradiation). The 5-year NED survival rates in BCS (tumor-free margin ≥1 cm) and BCS with irradiation (tumor-free margin <1 cm) groups were identical (83.3%). Our data support the potential use of BCS in patients with MPTB. Mastectomy is indicated only if tumor-free margins cannot be obtained by BCS. Adjuvant radiotherapy may be considered if tumor-free margins are <1 cm.
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Affiliation(s)
- Jerzy Mituś
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Kraków Branch, Kraków, Poland
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172
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Yasir S, Gamez R, Jenkins S, Visscher DW, Nassar A. Significant histologic features differentiating cellular fibroadenoma from phyllodes tumor on core needle biopsy specimens. Am J Clin Pathol 2014; 142:362-9. [PMID: 25125627 DOI: 10.1309/ajcpzuz96resgpup] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Cellular fibroepithelial lesions (CFELs) are a heterogeneous group of tumors encompassing cellular fibroadenoma (CFA) and phyllodes tumor (PT). Distinction between the two is challenging on core needle biopsy (CNB) specimens. The objective of this study was to evaluate histologic features that can help distinguish PT from CFA on CNB specimens. METHODS Records of all patients diagnosed with CFELs on CNB specimens with follow-up excision between January 2002 and December 2012 were retrieved. Histopathologic stromal features were evaluated on CNB specimens, including mitoses per 10 high-power fields (hpf), overgrowth, increased cellularity, fragmentation, adipose tissue infiltration, heterogeneity, subepithelial condensation, and nuclear pleomorphism. RESULTS Twenty-seven (42.2%) of 64 were diagnosed as PT (24 benign PTs and three borderline PTs) and 37 (57.8%) as CFA on excision. All features except for increased stromal cellularity were statistically significant. The average number of histologic features seen in PT and CFA was 3.9 and 1.4, respectively (odds ratio [OR], 7.27; 95% confidence interval [CI], 2.44-21.69; P = .0004). The average number of mitoses per 10 hpf was 3.0 for PT compared with 0.8 for CFA (OR, 2.14; 95% CI, 1.18-3.86; P = .01). CONCLUSIONS The presence of mitoses (three or more) and/or total histologic features of three or more on CNB specimens were the most helpful features in predicting PT on excision.
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Affiliation(s)
- Saba Yasir
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Roberto Gamez
- Department of Pathology and Laboratory Medicine, Loyola University, Chicago, IL
| | - Sarah Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Daniel W. Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
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173
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Lawton TJ, Acs G, Argani P, Farshid G, Gilcrease M, Goldstein N, Koerner F, Rowe JJ, Sanders M, Shah SS, Reynolds C. Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. Int J Surg Pathol 2014; 22:695-8. [PMID: 25161205 DOI: 10.1177/1066896914548763] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibroepithelial lesions with cellular stroma are frequently termed cellular fibroadenomas although criteria for distinguishing them from a phyllodes tumor are vague and subjective. However, the clinical implications and surgical management for these 2 lesions may be different. We randomly selected 21 cases of fibroepithelial lesions sent in consultation to the senior author that were challenging to classify as cellular fibroadenoma or phyllodes tumor. One to 2 representative slides of each case along with patient age were sent to 10 pathologists who specialize in breast pathology. The World Health Organization criteria for phyllodes tumors and a diagnosis form were included with the study set. For the purposes of data reporting, fibroadenoma and cellular fibroadenoma are considered together. In only 2 cases was there uniform agreement as to whether the tumor represented a fibroadenoma or phyllodes tumor. Of the remaining 19 cases, if the diagnoses of fibroadenoma and benign phyllodes tumor were combined and separated from borderline and malignant phyllodes tumors, there was 100% agreement in 53% of cases and 90% agreement in 79% of cases. This study highlights the difficulty that exists in distinguishing some cellular fibroadenomas from phyllodes tumors even for pathologists who specialize in breast pathology. However, there appears to be considerable agreement when cellular fibroadenomas and benign phyllodes tumors are distinguished from borderline and malignant phyllodes tumors. Further studies are needed to determine if there is a clinically significant difference between cellular fibroadenomas and benign phyllodes tumors and how to better distinguish them from borderline and malignant phyllodes tumors.
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Affiliation(s)
- Thomas J Lawton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Geza Acs
- Ruffolo Hooper & Associates, Tampa, FL, USA
| | - Pedram Argani
- Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Gelareh Farshid
- SA Pathology, Adelaide, South Australia, Australia Adelaide University, Adelaide, South Australia, Australia
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Wei J, Tan YT, Cai YC, Yuan ZY, Yang D, Wang SS, Peng RJ, Teng XY, Liu DG, Shi YX. Predictive factors for the local recurrence and distant metastasis of phyllodes tumors of the breast: a retrospective analysis of 192 cases at a single center. CHINESE JOURNAL OF CANCER 2014; 33:492-500. [PMID: 25104281 PMCID: PMC4198752 DOI: 10.5732/cjc.014.10048] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The local recurrence rate of phyllodes tumors of the breast varies widely among different subtypes, and distant metastasis is associated with poor survival. This study aimed to identify factors that are predictive of local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with phyllodes tumors of the breast. Clinical data of all patients with a phyllodes tumor of the breast (n = 192) treated at Sun Yat-sen University Cancer Center between March 1997 and December 2012 were reviewed. The Pearson χ2 test was used to investigate the relationship between clinical features of patients and histotypes of tumors. Univariate and multivariate Cox regression analyses were performed to identify factors that are predictive of LRFS, DMFS, and OS. In total, 31 (16.1%) patients developed local recurrence, and 12 (6.3%) developed distant metastasis. For the patients who developed local recurrence, the median age at the diagnosis of primary tumor was 33 years (range, 17-56 years), and the median size of primary tumor was 6.0 cm (range, 0.8-18 cm). For patients who developed distant metastasis, the median age at the diagnosis of primary tumor was 46 years (range, 24-68 years), and the median size of primary tumor was 5.0 cm (range, 0.8-18 cm). In univariate analysis, age, size, hemorrhage, and margin status were found to be predictive factors for LRFS (P = 0.009, 0.024, 0.004, and 0.001, respectively), whereas histotype, epithelial hyperplasia, margin status, and local recurrence were predictors of DMFS (P = 0.001, 0.007, 0.007, and < 0.001, respectively). In multivariate analysis, independent prognostic factors for LRFS included age [hazard ratio (HR) = 3.045, P = 0.005], tumor size (HR = 2.668, P = 0.013), histotype (HR = 1.715, P = 0.017), and margin status (HR = 4.530, P< 0.001). Histotype (DMFS: HR = 4.409, P = 0.002; OS: HR = 4.194, P = 0.003) and margin status (DMFS: HR = 2.581, P = 0.013; OS: HR = 2.507, P = 0.020) were independent predictors of both DMFS and OS. In this cohort, younger age, a larger tumor size, a higher tumor grade, and positive margins were associated with lower rates of LRFS. Histotype and margin status were found to be independent predictors of DMFS and OS.
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Affiliation(s)
- Jing Wei
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China.
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175
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Onkendi EO, Jimenez RE, Spears GM, Harmsen WS, Ballman KV, Hieken TJ. Surgical treatment of borderline and malignant phyllodes tumors: the effect of the extent of resection and tumor characteristics on patient outcome. Ann Surg Oncol 2014; 21:3304-9. [PMID: 25034817 DOI: 10.1245/s10434-014-3909-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Malignant phyllodes tumors are rare fibroepithelial breast neoplasms. Appropriate surgical management remains a subject of debate. The purpose of our study was to define optimal surgical treatment and to identify factors associated with outcome. METHODS After confirmatory pathology review, we identified 67 patients with borderline (n = 15) and malignant (n = 52) phyllodes tumors treated at our institution between 1971 and 2008. We used Cox proportional hazards models to evaluate associations between treatment, patient and tumor characteristics, and disease-free (DFS) and cancer-specific survival (CSS). RESULTS Median patient age was 47 years. For 32 patients, definitive surgical treatment was wide local excision (WLE): 27 with margins ≥1 cm and 5 with margins <1 cm. Thirty-five underwent mastectomy. Two patients received radiotherapy after WLE and two after mastectomy with microscopically positive margins. After 10 years median follow-up, 16 patients (24 %) recurred locally (8 postmastectomy and 8 after WLE). Treatment type and margin extent did not impact local recurrence. Fifteen patients (22 %) developed distant disease. Overall 5-year DFS was 67.9 % and CSS 80.1 %. Tumor size >5 cm, mitotic rate ≥10/10 HPF, stromal overgrowth and cellularity (all p < 0.05) predicted DFS, whereas CSS was associated with the latter three variables. CSS was diminished for mastectomy patients who were significantly more likely to harbor tumors with adverse features. CONCLUSIONS With long-term follow-up, extent of surgical resection did not affect DFS for patients with borderline and malignant phyllodes tumors. Tumor features, most notably stromal overgrowth, were predictive of recurrence and survival, suggesting these high-risk patients may benefit from additional therapeutic strategies.
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176
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Weledji EP, Enow-Orock G, Ngowe MN, Aminde L. Breast-conserving surgery is contraindicated for recurrent giant multifocal phyllodes tumours of breast. World J Surg Oncol 2014; 12:213. [PMID: 25023082 PMCID: PMC4107467 DOI: 10.1186/1477-7819-12-213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 07/04/2014] [Indexed: 11/28/2022] Open
Abstract
Background The controversy between breast conserving surgery and simple mastectomy for phyllodes tumours of the breast remains because of the unpredictable nature of the disease. Although some benign tumours may show an unusually aggressive behaviour, modified radical surgery for phyllodes tumours offers no survival advantage, and recently more conservative surgical approaches have been deployed. Case presentation A 30-year-old woman with a giant multifocal tumour of the breast underwent breast-conserving surgery that made use of the well- circumscribed feature of the tumour. The case demonstrates the safety, and cosmetic benefit of the breast-conserving approach for multifocal phyllodes tumours except for the high recurrence rate. Conclusions Large size, multifocality, and borderline or malignant histology are contraindications for breast-conserving surgery.
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Affiliation(s)
- Elroy P Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, P,O, Box 126, Limbe, S,W, Region, Cameroon.
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Neal L, Sandhu NP, Hieken TJ, Glazebrook KN, Mac Bride MB, Dilaveri CA, Wahner-Roedler DL, Ghosh K, Visscher DW. Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc 2014; 89:536-47. [PMID: 24684875 DOI: 10.1016/j.mayocp.2014.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/05/2014] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Abstract
Imaging abnormalities detected by mammographic screening often lead to diagnostic evaluations, with suspicious abnormalities subjected to image-guided core needle biopsy (CNB) to exclude malignancy. Most CNBs reveal benign pathological alterations, termed benign breast disease (BBD). Adoption of CNB presents challenges with pathologic classification of breast abnormalities and management of patients with benign or atypical histological findings. Patient management and counseling after CNB diagnosis of BBD depends on postbiopsy determination of radiologic-pathologic concordancy. Communication between radiologists and pathologists is crucial in patient management. Management is dependent on the histological type of BBD. Patients with concordant pathologic imaging results can be reassured of benign biopsy findings and advised about the future risk of developing breast cancer. Surgical consultation is advised for patients with discordant findings, symptomatic patients, and high-risk lesions. This review highlights benign breast lesions that are encountered on CNB and summarizes management strategies. For this review, we conducted a search of PubMed, with no date limitations, and used the following search terms (or a combination of terms): atypical ductal hyperplasia, atypical hyperplasia, atypical lobular hyperplasia, benign breast disease, cellular fibroepithelial lesions, columnar cell lesions, complex sclerosing lesion, core needle biopsy, fibroadenomas, flat epithelial atypia, lobular carcinoma in situ, lobular neoplasia, mucocele-like lesions, phyllodes tumor, pseudoangiomatous stromal hyperplasia, radial scar, and vascular lesions. The selection of references included in this review was based on study relevance and quality. We used additional articles culled from the bibliographies of retrieved articles to examine the published evidence for risk factors of BBD.
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Affiliation(s)
- Lonzetta Neal
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Nicole P Sandhu
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Karthik Ghosh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Immediate implant breast reconstruction with acellular dermal matrix for treatment of a large recurrent malignant phyllodes tumor. Aesthetic Plast Surg 2014; 38:373-8. [PMID: 24570179 DOI: 10.1007/s00266-014-0283-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Phyllodes tumors (PT) are rare fibroepithelial breast tumors representing less than 1 % of all breast malignancies. These tumors are unpredictable and fast growing with a high local recurrence rate, making this disease challenging to treat. Previous literature focused on surgical resection, and breast reconstruction following a mastectomy in patients with PT is rarely addressed. We report a case of a recurrent malignant PT treated with a nipple-sparing mastectomy followed by immediate single-stage silicone implant breast reconstruction. While PT is a rare breast malignancy that presents challenges with both surgical resection and reconstruction, we demonstrate that nipple-sparing mastectomy with immediate implant breast reconstruction with AlloMax is curative and can offer an appealing cosmetic option. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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179
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Puttasubbappa PS, Pallavi P, Jeevan RM, Shah SB. Giant fibroadenoma masquerading as cystosarcoma phylloides in an elderly lady-a case report and review of literature. Indian J Surg 2014; 75:54-6. [PMID: 24426512 DOI: 10.1007/s12262-011-0335-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 03/23/2011] [Indexed: 11/29/2022] Open
Abstract
Giant Fibroadenoma is commonly seen in young women. Here, we are reporting the case of an elderly lady who was diagnosed with Cystosarcoma Phylloides clinically and by FNAC. Simple mastectomy was performed and histopathology revealed a Giant Fibroadenoma. This report focuses on the rarity of the age of presentation, confusing clinical features, role of FNAC and histopathology, the need to differentiate them and the modalities of treatment.
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Affiliation(s)
| | - P Pallavi
- Department of Pathology, J.S.S Medical College, J.S.S University, Mysore, Karnataka India
| | - Ravi M Jeevan
- Department of General Surgery, J.S.S Medical College, J.S.S University, Mysore, Karnataka India
| | - Sanket B Shah
- Department of General Surgery, J.S.S Medical College, J.S.S University, Mysore, Karnataka India
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180
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Mituś JW, Blecharz P, Reinfuss M, Kulpa JK, Skotnicki P, Wysocki WM. Changes in the clinical characteristics, treatment options, and therapy outcomes in patients with phyllodes tumor of the breast during 55 years of experience. Med Sci Monit 2013; 19:1183-7. [PMID: 24356679 PMCID: PMC3871490 DOI: 10.12659/msm.889687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Data from the literature suggests that the clinical picture of phyllodes tumor (PT) of the breast, as well as treatment options and perhaps therapy outcomes, have significantly changed. The aim of this work was to review these changes by analysis of consecutive patients with PT over a 55-year period at a single institution. Material/Methods From 1952 to 2007, 280 women with PT were treated surgically at the Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Center in Cracow. Age, size of breast tumor, microscopic type, extent of surgery, and therapy outcomes were compared between 2 groups: 190 patients treated from 1952 to 1991 vs 90 patients treated from 1992 to 2007. Results The results show that the 1992–2007 group compared to the 1952–1991 included more patients <50 years of age, with tumor <5 cm in diameter, undergoing breast-conserving therapy, as well as no evidence of disease at 5-year survival had increased and this change was statistically significant. In addition, malignant PT cases had decreased in frequency. Conclusions The results of this study show that patients with PT are increasingly younger, the breast tumors at diagnosis are smaller, malignant PT is becoming less frequent, and BCT is now the treatment of choice. Most importantly, the general treatment outcomes are significantly better.
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Affiliation(s)
- Jerzy Władysław Mituś
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Paweł Blecharz
- Department of Gynecological Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Marian Reinfuss
- Department of Radiotherapy, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Jan Kanty Kulpa
- Department of Clinical Biochemistry, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Piotr Skotnicki
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Wojciech Maria Wysocki
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
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Gnerlich JL, Williams RT, Yao K, Jaskowiak N, Kulkarni SA. Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998-2009. Ann Surg Oncol 2013; 21:1222-30. [PMID: 24306659 DOI: 10.1245/s10434-013-3395-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Malignant phyllodes tumors of the breast have traditionally been treated with surgical excision. Recently, the use of adjuvant radiotherapy has been advocated to reduce the risk of local recurrence; however, this recommendation is controversial in the absence of consistent outcome data. We hypothesize that there has been a trend toward increased utilization of adjuvant radiotherapy for malignant phyllodes tumors despite its uncertain effect on outcomes. METHODS Using the National Cancer Data Base, predictors of radiotherapy utilization were examined for women with malignant phyllodes from 1998 to 2009. Kaplan-Meier and Cox regression models were generated to determine the effect of radiotherapy on local recurrence (LR), disease-free survival (DFS), and overall survival (OS). RESULTS Of the 3,120 patients with malignant phyllodes, 57 % underwent breast conservation surgery and 42 % underwent mastectomy. Overall, 14.3 % of women received adjuvant radiotherapy. Utilization of radiotherapy doubled over the study period (9.5 % in 1998-1999 vs. 19.5 % in 2008-2009, p < 0.001). Women were significantly more likely to receive radiotherapy if they were diagnosed later in the study, were age 50-59 years old, had tumors >10 cm, or had lymph nodes removed. For the 1,774 patients with available recurrence data, overall recurrence was 14.1 %, and LR was 5.9 %. In adjusted models, adjuvant radiotherapy reduced LR (aHR 0.43, 95 % CI 0.19-0.95) but did not impact DFS or OS after 53 months' median follow-up. CONCLUSIONS Utilization of adjuvant radiotherapy for malignant phyllodes doubled from 1998 to 2009. Radiotherapy significantly reduced LR but had no effect on DFS or OS.
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Affiliation(s)
- Jennifer L Gnerlich
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
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182
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Gibbings KW, Warrier S, Hwang S, Rice M, O'Toole S, Carmalt H. A giant phyllodes tumour with sepsis. ANZ J Surg 2013; 84:886-7. [PMID: 24172040 DOI: 10.1111/ans.12340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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183
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Spitaleri G, Toesca A, Botteri E, Bottiglieri L, Rotmensz N, Boselli S, Sangalli C, Catania C, Toffalorio F, Noberasco C, Delmonte A, Luini A, Veronesi P, Colleoni M, Viale G, Zurrida S, Goldhirsch A, Veronesi U, De Pas T. Breast phyllodes tumor: A review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol 2013; 88:427-36. [DOI: 10.1016/j.critrevonc.2013.06.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/03/2013] [Accepted: 06/12/2013] [Indexed: 11/12/2022] Open
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184
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White DS, Irvine TE. Rapidly progressive multifocal phyllodes tumour of the breast: A case report and review of the literature. Int J Surg Case Rep 2013; 4:901-3. [PMID: 24013041 DOI: 10.1016/j.ijscr.2013.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 04/08/2013] [Accepted: 04/09/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Malignant transformation of a phyllodes tumour is a rare form of breast cancer, accounting for just 0.5% of all breast cancer cases.(1) PRESENTATION OF CASE: We report a case of a 49 year old female with rapidly progressive, multifocal disease. She initially presented with two giant fibroadenomas which were excised. She represented eight months post surgery with two new lesions in the same breast, one suspicious, one suggestive of fibroadenoma. Biopsy was borderline. Surgery was therefore scheduled for wide local excision. At localisation two weeks later, at least eight lesions were seen on ultrasound scan. Three were removed as histology was at this point unknown to conserve the breast. Histology revealed intermediate grade DCIS, benign Phyllodes and borderline/malignant phyllodes. She was scheduled for mastectomy and immediate Strattice reconstruction. An MRI was performed pre-operatively to ascertain extent of disease. Two weeks post localisation, 13 lesions were identified. The right breast was entirely unaffected. Surgery interval was three weeks and final histology revealed 18 lesions, ranging from fibroadenoma through to borderline/malignant phyllodes with an incidental papilloma. DISCUSSION This is the first report of such rapid progression of disease, with 16 new lesions, of varied histology, developing in just an eight week period. CONCLUSION This case highlights the difficulty of forming a clear diagnostic and therapeutic pathway in this highly variable disease. Arguments for over and under treating these patients remain but those with any borderline/malignant potential have to be removed as recurrence is both common and aggressive, with a clear surgical margin the only proven protective factor.
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Affiliation(s)
- D S White
- Department of Breast Surgery, Royal Surrey County Hospital, Guildford GU2 7XX, United Kingdom.
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185
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Mishra SP, Tiwary SK, Mishra M, Khanna AK. Phyllodes tumor of breast: a review article. ISRN SURGERY 2013; 2013:361469. [PMID: 23577269 PMCID: PMC3615633 DOI: 10.1155/2013/361469] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 02/11/2013] [Indexed: 02/07/2023]
Abstract
Introduction. Phyllodes tumours are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows correct surgical planning and avoidance of reoperation. Treatment can be either wide local excision or mastectomy to achieve histologically clear margins. Discussion. The exact aetiology of phyllodes tumour and its relationship with fibroadenoma are unclear. Women aged between 35 and 55 years are commonly involved. The median tumour size is 4 cm but can grow even larger having dilated veins and a blue discoloration over skin. Palpable axillary lymphadenopathy can be identified in up to 10-15% of patients but <1% had pathological positive nodes. Mammography and ultrasonography are main imaging modalities. Cytologically the presence of both epithelial and stromal elements supports the diagnosis. The value of FNAC in diagnosis of phyllodes tumour remains controversial, but core needle biopsy has high sensitivity and negative predictive value. Surgical management is the mainstay and local recurrence in phyllodes tumours has been associated with inadequate local excision. The role of adjuvant radiotherapy and chemotherapy remains uncertain and use of hormonal therapy has not been fully investigated. Conclusion. The preoperative diagnosis and proper management are crucial in phyllodes tumours because of their tendency to recur and malignant potential in some of these tumours.
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Affiliation(s)
- Shashi Prakash Mishra
- Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Ultar Pradesh 221005, India
| | - Satyendra Kumar Tiwary
- Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Ultar Pradesh 221005, India
| | - Manjaree Mishra
- Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Ultar Pradesh 221005, India
| | - Ajay Kumar Khanna
- Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Ultar Pradesh 221005, India
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186
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Sawalhi S, Al-Shatti M. Phyllodes tumor of the breast: a retrospective study of the impact of histopathological factors in local recurrence and distant metastasis. Ann Saudi Med 2013; 33:162-8. [PMID: 23563006 PMCID: PMC6078618 DOI: 10.5144/0256-4947.2013.162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The challenging issue for the breast surgeons is local recurrence of phyllodes tumor. The histological criteria to predict local recurrence has been a controversial issue. The objective of this study was to determine pathological parameters and surgical margins that influence outcome of local recurrence and distant metastasis in phyllodes tumor (PT). DESIGN AND SETTING Retrospective review between January 2003 to August 2008 at King Hussein Cancer Center-Jordan. PATIENTS AND METHODS Forty-two female patients diagnosed as having PT were classified to benign, borderline and malignant. The medical records were reviewed in relation to the surgical management, recurrence, follow-up, the histological features of the tumor and grading of tumors based on the following histological parameters: mitotic count, stromal cellularity, stromal overgrowth, cellular pleomorphism, nuclear grade, tumor necrosis, tumor margin, and surgical margin status. All patients underwent wide local excision of the tumor or mastectomy. RESULTS Forty-two patients with PT (16 benign, 9 borderline, 17 malignant PT) were followed up for 30 months. The mean age was 39.8 years, and the average tumor size was 6.6 cm. The recurrence rate of PT in our study was 21% at a mean time of 11 months. Nine patients had local recurrence; 2 benign, 6 malignant and 1 borderline. Cellular pleomorphism had correlation with recurrence rate (P=.045). We had six patients (14%) with distant metastasis. All had malignant PT. Metastasis in PT has a relationship with histological grade (P=.02). CONCLUSIONS We conclude that patients with moderate and severe cellular pleomorphism had higher local recurrence, while metastatic PT occur more in patients with high nuclear grade.
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Affiliation(s)
- Samer Sawalhi
- Department of Surgery- College of Medicine, Taibah University, Al-Madinah 30001, Saudi Arabia.
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187
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Chaudhry IU, Asban A, Mahboub T, Arini A. Recurrent phyllodes sarcoma of breast with complete chest wall invasion; a multidisciplinary approach for radical resection. BMJ Case Rep 2013; 2013:bcr2012008110. [PMID: 23425565 PMCID: PMC3603788 DOI: 10.1136/bcr-2012-008110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Phyllodes tumour of the breast is a relatively uncommon condition, and rarely invades the chest wall. We report a case of young women who had recurrent large phyllodes tumour invading the chest wall, following mastectomy, chemotherapy and radiotherapy. A multidisciplinary approach was used for radical resection of the tumour, chest wall and reconstruction.
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Affiliation(s)
- Ikram Ulhaq Chaudhry
- Department of Chest Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
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188
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Ramakant P, Chakravarthy S, Cherian JA, Abraham DT, Paul MJ. Challenges in management of phyllodes tumors of the breast: A retrospective analysis of 150 patients. Indian J Cancer 2013; 50:345-8. [DOI: 10.4103/0019-509x.123625] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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189
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Lin CC, Chang HW, Lin CY, Chiu CF, Yeh SP. The clinical features and prognosis of phyllodes tumors: a single institution experience in Taiwan. Int J Clin Oncol 2012; 18:614-20. [DOI: 10.1007/s10147-012-0442-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 06/17/2012] [Indexed: 10/28/2022]
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190
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Park HL, Kwon SH, Chang SY, Huh JY, Kim JY, Shim JY, Lee YH. Long-term follow-up result of benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum-assisted breast biopsy. J Breast Cancer 2012; 15:224-9. [PMID: 22807941 PMCID: PMC3395747 DOI: 10.4048/jbc.2012.15.2.224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/20/2012] [Indexed: 01/11/2023] Open
Abstract
Purpose Percutaneous removal of benign breast tumors using ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible and safe method without serious complications. The aim of this study was to evaluate the efficacy and safety of the VABB in the treatment of benign phyllodes tumors, and to identify whether or not surgical re-excision is necessary for benign phyllodes tumors diagnosed and excised by VABB. Methods From January 2003 to December 2011, a total of 6,923 VABB were performed in 5,434 patients. Out of 6,923 lesions, 53 were benign phyllodes tumors. Among these, 31 lesions, with a follow-up period of longer than 24 months, were enrolled in this study. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. The mean follow-up period was 75.9±13.5 months (range, 24-94 months). Results The mean patient age at presentation was 31.6±9.4 years. The mean size of the lesion was 1.60±0.88 cm. The majority of lesions, 74.2% (23 cases), were palpable, and 25.8% (8 cases) were non-palpable. Twenty-two lesions (71.0%) were classified as Breast Imaging Reporting and Data System category 3, and nine lesions (29.0%) were classified as category 4a, by ultrasonography. During the follow-up period, local recurrence developed in one lesion, making the local recurrence rate 3.2%. Conclusion If a benign phyllodes tumor is diagnosed, and sufficiently excised by VABB, observing the clinical course may be considered as an alternative to performing immediate wide local excision; this is the case despite the fact that it would need to be observed for a prolonged period of time.
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Affiliation(s)
- Hai-Lin Park
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
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191
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Jang JH, Choi MY, Lee SK, Kim S, Kim J, Lee J, Jung SP, Choe JH, Kim JH, Kim JS, Cho EY, Lee JE, Nam SJ, Yang JH. Clinicopathologic Risk Factors for the Local Recurrence of Phyllodes Tumors of the Breast. Ann Surg Oncol 2012; 19:2612-7. [DOI: 10.1245/s10434-012-2307-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Indexed: 12/11/2022]
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192
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Teo JY, Cheong CSJ, Wong CY. Low local recurrence rates in young Asian patients with phyllodes tumours: less is more. ANZ J Surg 2012; 82:325-8. [DOI: 10.1111/j.1445-2197.2012.06045.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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193
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Bilen MA, Laucirica R, Rimawi MF, Nangia JR, Cyprus GS. Jejunal intussusception due to malignant phyllodes tumor of the breast. Clin Breast Cancer 2012; 12:219-21. [PMID: 22381472 DOI: 10.1016/j.clbc.2012.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 01/02/2012] [Indexed: 02/06/2023]
Abstract
Phyllodes tumors are rare fibroepithelial neoplasms of the breast; classified as benign, borderline, or malignant based on the mitotic activity, cellular atypia, and stromal overgrowth. Wide surgical excision is the treatment of choice. The most common locations for metastasis are lung, bone, and liver; small intestinal metastasis is extremely rare. Here we present the first patient with jejunal metastases and intussusception due to malignant phyllodes tumor of the breast. Adjuvant treatment of malignant phyllodes tumor needs to be investigated.
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Affiliation(s)
- Mehmet Asim Bilen
- Department of Internal Medicine, Baylor College of Medicine, 1709 Dryden Road, Houston, TX 77030, USA.
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194
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Ward S, Jewkes A, Jones B, Chaudhri S, Hejmadi R, Ismail T, Hallissey M. The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast. Int J Surg 2012; 10:527-31. [DOI: 10.1016/j.ijsu.2012.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 10/28/2022]
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195
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Management of non metastatic phyllodes tumors of the breast: Review of the literature. Surg Oncol 2011; 20:e143-8. [DOI: 10.1016/j.suronc.2011.04.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 03/26/2011] [Accepted: 04/23/2011] [Indexed: 11/18/2022]
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196
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Quinlan-Davidson S, Hodgson N, Elavathil L, Shangguo T. Borderline phyllodes tumor with an incidental invasive tubular carcinoma and lobular carcinoma in situ component: a case report. J Breast Cancer 2011; 14:237-40. [PMID: 22031807 PMCID: PMC3200521 DOI: 10.4048/jbc.2011.14.3.237] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/06/2011] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumors are an infrequent breast tumor presentation. A phyllodes tumor with a synchronous invasive ductal carcinoma is rarely described and has never been reported with lobular carcinoma in situ component. A 53-year-old female presented with a nine-year history of twice core biopsy proven fibroadenoma. After an increase in the tumor's growth velocity it was decided upon to undergo an excisional biopsy. Microscopic examination of the well-circumscribed pale-tan mass found focal areas of leaf like architecture with variable number of mitoses present, representing a phyllodes tumor of borderline malignant potential. Incidentally, at one edge of the mass was found a tubular carcinoma and lobular carcinoma in situ components. Thorough, routine follow-up of patients with biopsy proven benign breast masses is important to finding a masked malignant component.
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Affiliation(s)
- Sean Quinlan-Davidson
- Department of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
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197
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de Souza JA, Ferreira Marques E, Guatelli C, Santiago Girão D, Queroz T, Graziano L, Macedo M, Iyeyasu H, Chojniak R. Malignant phyllodes tumor of the breast: case report. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000500003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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198
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Malignant phyllodes tumor of the breast: case report. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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199
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Harden SV, Ball RY, Harnett AN. Angiosarcoma of the scalp presenting in association with borderline malignant phyllodes tumour of the breast. Sarcoma 2011; 7:173-6. [PMID: 18521383 PMCID: PMC2395529 DOI: 10.1080/13577140310001644823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumours and angiosarcoma are both rare mesenchymal tumours. There are no reports of their coexistence in the
literature except in families with germline p53 mutations. Here we report a case of an elderly woman who developed an
extensive angiosarcoma of the scalp nearly 4 years after surgical removal of a borderline malignant phyllodes tumour of the
breast. The scalp lesion was initially thought more likely to be a metastasis of her first rare tumour than a second equally rare
primary tumour, but histologically this was not the case. The case and the literature are discussed.
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Affiliation(s)
- Susan V Harden
- Department of Oncology Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY UK
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200
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Guillot E, Couturaud B, Reyal F, Curnier A, Ravinet J, Laé M, Bollet M, Pierga JY, Salmon R, Fitoussi A. Management of Phyllodes Breast Tumors. Breast J 2011; 17:129-37. [DOI: 10.1111/j.1524-4741.2010.01045.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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