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Faulds TT, Bruckner J, Mousa M, Bhanu S, Chin M, Cendrowski K. Giant phyllodes tumor of the breast: A case report. Radiol Case Rep 2024; 19:818-824. [PMID: 38111558 PMCID: PMC10726342 DOI: 10.1016/j.radcr.2023.11.019] [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: 09/15/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Phyllodes tumors of the breast are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors. They tend to affect middle-aged women, who present with a rapidly growing, palpable mass. Here we present a case of a 34-year-old female surrogate mother without any reported personal or family history of breast cancer who presented with a rapidly growing left breast mass, pathologically proven to be a phyllodes tumor. The patient was a G7P7 surrogate mother who received estrogen and progesterone injections for her twin surrogate pregnancy starting 4 months before embryo implantation, after which, she discovered a large palpable mass in the left breast at approximately week 7 gestational age. At the initial presentation, the patient was at week 23 gestational age. She underwent C-section delivery of the twins at this time and obtained further work-up of the mass. She had a core needle biopsy which yielded a benign fibroepithelial tumor. Due to the size of her breast mass and atypical morphology, including extension to the nipple, and skin ulceration, the patient subsequently underwent left mastectomy. At the time of mastectomy, which was 8 months after the initial work-up, the mass had grown to measure approximately 12 × 10 cm on physical examination and took up most of her left breast. It was completely resected and was pathologically determined to be a borderline phyllodes tumor. Only a few cases have been reported about the development of phyllodes tumor during pregnancy in the literature, and we believe this is the first case report of phyllodes tumor related to a surrogate pregnancy. Although the relationship between exogenous hormones and fibroepithelial tumors is not well understood, the case poses the clinical question if screening mammograms should be offered to patients undergoing exogenous hormonal therapy, regardless of age to establish a baseline and monitor for the development (if any) or growth of these tumors.
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Affiliation(s)
- Tam Truong Faulds
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Jacob Bruckner
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Mousa
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Shiv Bhanu
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Chin
- Riverside Community Hospital, Riverside, CA, USA
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2
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Chen CY, Ya-Chen. Better survival was found in patients treated with breast-conserving surgery compared with mastectomy in malignant phyllodes tumor of the breast. Updates Surg 2024; 76:265-270. [PMID: 37289397 DOI: 10.1007/s13304-023-01547-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
Malignant phyllodes tumor of the breast (MPTB) is a rare type of breast cancer. The prognosis between breast-conserving surgery (BCS) and mastectomy remains unclear in MPTB. Therefore, long-term survival was investigated between BCS and mastectomy in MPTB via the Surveillance, Epidemiology, and End Results (SEER) database. MPTB patients with T1-2/N0 stage between 2000 and 2015 from SEER database were retrospectively reviewed. Prognosis between different surgical approaches was assessed by Kaplan-Meier curves and Cox proportional hazards analysis. A total of 795 patients were enrolled with a median follow-up of 126 months. BCS was associated with significantly increased 10-year overall survival (OS) (89.2% vs. 81.1%, p = 0.002) and breast cancer-specific survival (BCSS) (95.2% vs. 90%, p = 0.004) compared with mastectomy. Multivariate analysis showed better OS (HR = 0.587, 95% CI 0.406-0.850, p = 0.005) and BCSS (HR = 0.463, 95%CI 0.267-0.804, p = 0.006) in the BCS group than the mastectomy group. After 1:1 propensity score matching (PSM), improved 10-year OS (89.2% vs.81%, p = 0.023) and BCSS (95.8% vs. 90.1%, p = 0.033) were observed in BCS compared with mastectomy. This study found the survival benefit of BCS over mastectomy in patients with early-stage MPTB. BCS should be recommended as a priority in MPTB patients when both surgical approaches are feasible.
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Affiliation(s)
- Chu-Ying Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Ya-Chen
- Department of Respiratory and Critical Care Medicine, Division of Life Science and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
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3
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Dadmanesh F, Li X, Leong M, Maluf H, Balzer B. The Genetic Landscape of Fibroepithelial Lesions of the Breast. Adv Anat Pathol 2023; 30:415-420. [PMID: 37539688 DOI: 10.1097/pap.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Fibroepithelial lesions of the breast encompass a broad spectrum of lesions from fibroadenomas and their variants to phyllodes tumors, including their clinical range of benign, borderline, and malignant. Classification of this spectrum of neoplasms has historically and currently been based purely on morphology, although the nomenclature has shifted over the years largely due to the significant histologic overlap that exists primarily within the cellular fibroadenomas to borderline malignant phyllodes tumor categories. A review of the current diagnostic challenge, proposed ancillary studied and their value in prognostic significance, is provided. This article highlights the most recent molecular and genetic findings as well as the limitations of the studies, in the context of practical and available applications for the diagnostician and managerial implications for the clinician.
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Affiliation(s)
- Farnaz Dadmanesh
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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Zhang M, Arjmandi FK, Porembka JH, Seiler SJ, Goudreau SH, Merchant K, Hwang H, Hayes JC. Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230051. [PMID: 37856317 DOI: 10.1148/rg.230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Fibroepithelial lesions (FELs) are among the most common breast masses encountered by breast radiologists and pathologists. They encompass a spectrum of benign and malignant lesions, including fibroadenomas (FAs) and phyllodes tumors (PTs). FAs are typically seen in young premenopausal women, with a peak incidence at 20-30 years of age, and have imaging features of oval circumscribed hypoechoic masses. Although some FA variants are especially sensitive to hormonal influences and can exhibit rapid growth (eg, juvenile FA and lactational adenomas), most simple FAs are slow growing and involute after menopause. PTs can be benign, borderline, or malignant and are more common in older women aged 40-50 years. PTs usually manifest as enlarging palpable masses and are associated with a larger size and sometimes with an irregular shape at imaging compared with FAs. Although FA and FA variants are typically managed conservatively unless large and symptomatic, PTs are surgically excised because of the risk of undersampling at percutaneous biopsy and the malignant potential of borderline and malignant PTs. As a result of the overlap in imaging and histologic appearances, FELs can present a diagnostic challenge for the radiologist and pathologist. Radiologists can facilitate accurate diagnosis by supplying adequate tissue sampling and including critical information for the pathologist at the time of biopsy. Understanding the spectrum of FELs can facilitate and guide appropriate radiologic-pathologic correlation and timely diagnosis and management of PTs. Published under a CC BY 4.0 license. Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Meng Zhang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Firouzeh K Arjmandi
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jessica H Porembka
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Stephen J Seiler
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Sally H Goudreau
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Kanwal Merchant
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Helena Hwang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jody C Hayes
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
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Schiltz D, Sokolow AJ, Minck N, Schreml S, Moser L, von Fritschen U. The phyllodes menace-Variation in course, therapy, and appearance of phyllodes tumors in a case series of three patients. Clin Case Rep 2023; 11:e7836. [PMID: 37663819 PMCID: PMC10474313 DOI: 10.1002/ccr3.7836] [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: 12/21/2022] [Revised: 06/13/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Key Clinical Message Early and complete surgical resection is the most important therapeutic and diagnostic measure. Adjuvant radiation is suggested for malign phyllode tumors, phyllode tumors larger than 10 cm or those with a low distance to the resection margins. Abstract Phyllodes tumors are rare fibroepithelial tumors of the breast. Histologically, they are usually classified as benign, borderline or malignant, though these classifications do not necessarily reflect the clinical course of the disease. These tumors may stay undetected for years, or show sudden and rapid progression. There is currently no consistent therapy recommendation based upon histological findings, the localization of the tumor and/or whether it is recurrent. Using the examples of three patients, we show how courses and therapy may differ widely, and discuss this in the context of the current state of the literature.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic and Aesthetic Surgery, Hand SurgeryHelios Hospital Emil von BehringBerlinGermany
| | - Alexander Jan Sokolow
- Department of Plastic and Aesthetic Surgery, Hand SurgeryHelios Hospital Emil von BehringBerlinGermany
| | - Natalya Minck
- Department of PathologyHelios Hospital Emil von BehringBerlinGermany
| | - Stephan Schreml
- Department of DermatologyUniversity Hospital RegensburgGermany
| | - Lutz Moser
- Department of RadiotherapyHelios Hospital Emil von BehringBerlinGermany
| | - Uwe von Fritschen
- Department of Plastic and Aesthetic Surgery, Hand SurgeryHelios Hospital Emil von BehringBerlinGermany
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Li W, Fang K, Chen J, Deng J, Li D, Cao H. The application of clinical variable-based nomogram in predicting overall survival in malignant phyllodes tumors of the breast. Front Genet 2023; 14:1133495. [PMID: 37323673 PMCID: PMC10265739 DOI: 10.3389/fgene.2023.1133495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background: We aimed to explore prognostic risk factors in patients with malignant phyllodes tumors (PTs) of the breast and construct a survival prediction model. Methods: The Surveillance, Epidemiology, and End Results database was used to collect information on patients with malignant breast PTs from 2004 to 2015. The patients were randomly divided into training and validation groups using R software. Univariate and multivariate Cox regression analyses were used to screen out independent risk factors. Then, a nomogram model was developed in the training group and validated in the validation group, and the prediction performance and concordance were evaluated. Results: The study included 508 patients with malignant PTs of the breast, including 356 in the training group and 152 in the validation group. Univariate and multivariate Cox proportional hazard regression analyses showed that age, tumor size, tumor stage, regional lymph node metastasis (N), distant metastasis (M) and tumor grade were independent risk factors for the 5-year survival rate of patients with breast PTs in the training group (p < 0.05). These factors were used to construct the nomogram prediction model. The results showed that the C-indices of the training and validation groups were 0.845 (95% confidence interval [CI] 0.802-0.888) and 0.784 (95% CI 0.688-0.880), respectively. The calibration curves of the two groups were close to the ideal 45° reference line and showed good performance and concordance. Receiver operating characteristic and decision curve analysis curves showed that the nomogram has better predictive accuracy than other clinical factors. Conclusion: The nomogram prediction model constructed in this study has good predictive value. It can effectively assess the survival rates of patients with malignant breast PTs, which will aid in the personalized management and treatment of clinical patients.
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Affiliation(s)
- Wei Li
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Kun Fang
- Department of Surgery, Yinchuan Maternal and Child Health Hospital, Yinchuan, China
| | - Jiaren Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jian Deng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Dan Li
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Hong Cao
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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Sain B, Gupta A, Ghose A, Halder S, Mukherjee V, Bhattacharya S, Mondal RR, Sen AN, Saha B, Roy S, Boussios S. Clinico-Pathological Factors Determining Recurrence of Phyllodes Tumors of the Breast: The 25-Year Experience at a Tertiary Cancer Centre. J Pers Med 2023; 13:jpm13050866. [PMID: 37241036 DOI: 10.3390/jpm13050866] [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: 03/17/2023] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence. AIMS AND OBJECTIVES This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors associated with a recurrence of PTs of the breast. METHODOLOGY A retrospective cohort and observational study was conducted, which entailed analyzing the clinicopathological data of patients who were previously diagnosed or presented with PTs of the breast between 1996 and 2021. Data included the total number of patients diagnosed with PTs of the breast and their ages, tumor grade on initial biopsy, tumor location (left or right breast), tumor size, therapeutic interventions carried out (including surgery-either mastectomy or lumpectomy-and adjuvant radiotherapy), final tumor grade, recurrence status, type of recurrence, and time to recurrence. RESULTS We analyzed data on a total of 87 patients who were pathologically proven to have PTs, and 46 patients (52.87%) were found to have recurrences. All patients were female, with a mean age at diagnosis of 39 years (range 15-70). Patients aged <40 years had the highest incidence of recurrence, with a rate of 54.35% (n = 25/46), followed by patients aged >40 years, with a rate of recurrence of 45.65% (n = 21/46). A total of 55.4% of patients presented with primary PTs and 44.6% had recurrent PTs at presentation. The average time to local recurrence (LR) from the completion of treatment was 13.8 months, whereas for systemic recurrence (SR), it was 15.29 months. Surgery (mastectomy/lumpectomy) was the major determinant for local recurrence (p < 0.05). CONCLUSION Patients who received adjuvant radiotherapy (RT) had a minimal recurrence of PTs. Patients who were found to have a malignant biopsy on initial diagnosis (triple assessment) had a higher incidence of PTs and were more prone to SR than LR. Surgery was a determining factor in the increased rate of LR, with lumpectomy associated with a higher incidence of LR than mastectomy.
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Affiliation(s)
- Baijaeek Sain
- Department of Trauma & Orthopaedics, Imperial College London Healthcare NHS Trust, London W2 1NY, UK
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Arnab Gupta
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Aruni Ghose
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London SG1 4AB, UK
- Department of Medical Oncology, Barts Cancer Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London E1 1BB, UK
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
| | - Sudip Halder
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Vishal Mukherjee
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Samir Bhattacharya
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Radha Raman Mondal
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Aditya Narayan Sen
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Bijan Saha
- Department of Surgical Oncology, Saroj Gupta Cancer Center and Research Institute, Kolkata 700063, India
| | - Shravasti Roy
- Department of Pathology, Saroj Gupta Cancer Centre and Research Institute, Kolkata 700001, India
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King's College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
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Liu J, Li F, Liu X, Lang R, Liang R, Lu H. Malignant phyllodes tumors of the breast: the malignancy grading and associations with prognosis. Breast Cancer Res Treat 2023; 199:435-444. [PMID: 37071267 DOI: 10.1007/s10549-023-06933-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE This study aimed to correlate clinicopathological parameters with survival outcomes in a cohort of patients diagnosed with malignant phyllodes tumors (MPTs). We also analyzed the malignancy grade of MPTs and investigated the prognostic significance of the malignancy grading system. METHODS Clinicopathological parameters, malignancy grades, and clinical follow-up data of 188 women diagnosed with MPTs in a single-institution were analyzed. MPTs of the breast were grouped according to stromal atypia, stromal overgrowth, mitotic count, tumor differentiation, and necrosis. A Fleiss' kappa statistic was calculated to test the agreement between the pathologists for the grading of MPTs. Disease-free survival (DFS), distant metastasis-free survival (DMFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Cox regression was carried out to identify factors predictive of locoregional recurrence (LRR), distant metastasis (DM) and death. RESULTS A total of 188 MPTs were classified according to the malignancy grading system: 88 (46.8%) as low grade, 77 (41%) as an intermediate grade, and 23 (12.2%) as high grade. Excellent agreement between pathologists for the grading of MPTs (Fleiss' kappa 0.807). In our study population, the occurrence of DM and death were associated with the malignancy grade of MPTs (P < 0.001). Based on the DFS curves, the presence of heterologous elements (P = 0.025) and younger age (P = 0.014) were independent prognostic indicators. Additionally, the malignancy grade retained independent prognostic significance for predicting DMFS and OS (P < 0.001 and P = 0.009). CONCLUSIONS Higher malignancy grade, presence of heterologous elements, younger age, larger tumor size, and recent rapid tumor growth are poor prognostic factors for MPTs of the breast. The malignancy grading system may be generalized in the future.
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Affiliation(s)
- Junjun Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Fangfang Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Xuejing Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Ronggang Lang
- Department of Breast Pathology and Research Lab, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Rong Liang
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People's Republic of China.
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9
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Yoon KH, Kang E, Kim EK, Park SY, Shin HC. Recurrence is Not Associated with Margin Status in Phyllodes Tumor. Ann Surg Oncol 2023; 30:2154-2161. [PMID: 36596955 DOI: 10.1245/s10434-022-12997-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Phyllodes tumor (PT) is a rare fibroepithelial neoplasm of the breast. The proper extent of resection is still under debate. This study aimed to investigate the optimal surgical margin to prevent recurrence after surgery for PT and to evaluate risk factors for local recurrence (LR). METHODS Retrospective analysis of a prospective cohort database was performed. Patients who underwent curative surgery for PT at Seoul National University Bundang Hospital between July 2003 and February 2022 were reviewed. RESULTS Of the 439 patients included, 285 were benign, 129 were borderline, and 25 were malignant. There was no statistically significant difference in 5-year disease-free survival (DFS) between margin-negative and margin-involved patients (87.3% vs. 85.1%, p = 0.081). When patients were classified into groups, according to margin status, as conventional (≥ 1 cm from tumor), close (< 1 cm from tumor), or involved, 5-year DFS rates were also similar (100% vs. 86.9% vs. 85.1%, p = 0.170). In subgroup analysis for different histologic grades, 5-year DFS was not affected by margin involvement. In univariate analysis, large tumor size (> 5 cm; hazard ratio [HR] 2.857, p = 0.028) and infiltrative tumor border (HR 3.096, p = 0.012) were independent risk factors for LR. Further multivariate analysis found both factors to be prognostic. CONCLUSIONS Recurrence was not significantly influenced by margin status in all histological grades. In benign and borderline tumors, local excision without wide surgical margins could be sufficient, and watchful waiting could be an option for patients with positive margins after initial surgery.
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Affiliation(s)
- Kyung-Hwak Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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Ji Y, Zhong Y, Zheng Y, Hu H, Min N, Wei Y, Geng R, Hong C, Guan Q, Li J, Wang Z, Zhang Y, Li X. Surgical management and prognosis of phyllodes tumors of the breast. Gland Surg 2022; 11:981-991. [PMID: 35800748 PMCID: PMC9253188 DOI: 10.21037/gs-21-877] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/15/2022] [Indexed: 02/28/2024]
Abstract
BACKGROUND Regardless of histological grade, phyllodes tumors (PTs) exhibit the potential of local recurrence. The National Comprehensive Cancer Network (NCCN) recommends wide local excision (WLE) with a 1 cm margin or more for borderline/malignant PTs but excisional biopsy for benign PTs. However, the treatment of benign PTs remains controversial and the clinicopathologic risk factors for the local recurrence is still unclear. METHODS We retrospectively analyzed 238 patients with PTs who underwent surgery at the Chinese PLA General Hospital from January 1, 2006 and April 30, 2020. We stratified our analysis according to histologic grade and explored the clinicopathologic factors to influence local recurrence (LR), including age, histologic grade, history of fibroadenoma, type of surgery [vacuum-assisted biopsy system (VABS), local excision (LE), wide local excision (WLE) and mastectomy]. RESULTS All 238 cases were categorized as benign (171, 71.8%), borderline (38, 16.0%), or malignant (29, 12.2%). The median follow-up was 50.2 months. In multivariate analysis, histologic grade (P<0.01) and history of fibroadenoma (P<0.01) were independent prognostic factors for LR. No difference existed in the recurrence rate of BPT treated with different surgical procedures (P=0.397), whereas a higher recurrence rate was found in VABS and LE subgroups than in WLE and mastectomy subgroups for borderline/malignant tumors (P<0.01). CONCLUSIONS No association found between surgical modalities and LR rate for BPT. We suggested a "wait-and-watch" policy for patients with unexpected benign subtypes, instead of unnecessary re-excision. In addition, VABS or LE can be treated for BPT with small mass, whereas WLE or even mastectomy should be conducted for borderline/malignant PTs with large mass.
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Affiliation(s)
- Yashuang Ji
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yuting Zhong
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yiqiong Zheng
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Huayu Hu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Rui Geng
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Chenyan Hong
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jie Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhili Wang
- Department of Ultrasound, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yanjun Zhang
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
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11
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Bandyopadhyay A, Sepai H, Mukherjee P, Ghosh B. A retrospective review of phyllodes tumor of breast treated with multimodality approach: Experience of a tertiary care institution in Eastern India. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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12
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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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13
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Sanjay S, Ketul P, Mohit S, Jahnavi G, Ajay YK, Abhishek J, Shashank JP. Study of clinicopathological factors and their impact on survival in phyllodes tumour of breast at tertiary care cancer centre in India. Cancer Treat Res Commun 2021; 29:100482. [PMID: 34757273 DOI: 10.1016/j.ctarc.2021.100482] [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: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Phyllodes tumour is a rare breast neoplasm having three histological types i. e benign, borderline and malignant. Surgical excision is the mainstay of treatment, but quantification of adequate margin required during excision is still a matter of debate. Role of adjuvant radiotherapy also remains controversial. AIMS Study of prognostic factors in patients with phyllodes tumour of breast and their effect on survival. SETTING AND DESIGN A retrospective analysis. MATERIAL AND METHODS From the year 2016 to 2019 we included 54 patients in this study and assessment of clinical and histopathological features, requirement of adjuvant radiotherapy and their effect on DFS (disease free survival) and OS (overall survival) was done. Log-rank test was used for univariate analysis and multivariate analysis was done by using Cox propotion hazard ratio method. STATISTICAL ANALYSIS Descriptive statistics was used for calculating proportion and median value. Survival analysis was done by using Kaplan Meier method. P value of <0.05 was considered statistically significant. RESULTS Mitotic count and presence of heterologous component had significant effect on overall survival (OS) and disease free survival (DFS) on multivariate analysis. No effect of adjuvant radiotherapy and the type of surgery (breast conservation surgery v/s mastectomy) was found on survival (OS, DFS). CONCLUSION Surgery with adequate margins should be the treatment of choice for tumours with borderline and malignant histological type Histological features like high mitotic count and stromal overgrowth are known prognostic factors, however, heterologous component is also an important prognostic factor and should be studied in large randomized trials. Role of adjuvant radiotherapy remains controversial.
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Affiliation(s)
- Singh Sanjay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Puj Ketul
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Sharma Mohit
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Gandhi Jahnavi
- Department of Pathology, Gujarat Cancer & Research Institute Ahmedabad, Gujarat 380016, India.
| | - Yadav Kumar Ajay
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - Jain Abhishek
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
| | - J Pandya Shashank
- Department of Surgical Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat 380016, India.
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14
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Alaofi RK, Nassif MO, Al-Hajeili MR. Prophylactic mastectomy for the prevention of breast cancer: Review of the literature. Avicenna J Med 2021; 8:67-77. [PMID: 30090744 PMCID: PMC6057165 DOI: 10.4103/ajm.ajm_21_18] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The high incidence and recurrence rate of breast cancer has influenced multiple strategies such as early detection with imaging, chemoprevention and surgical interventions that serve as preventive measures for women at high risk. Prophylactic mastectomy is one of the growing strategies of breast cancer risk reduction that is of a special importance for breast cancer gene mutation carriers. Women with personal history of cancerous breast lesions may consider ipsilateral or contralateral mastectomy as well. Existing data showed that mastectomy effectively reduces breast cancer risk. However, careful risk estimation is necessary to wisely select individuals who will benefit from preventing breast cancer.
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Affiliation(s)
- Rawan K Alaofi
- Taibah University College of Medicine, Medina, Saudi Arabia
| | - Mohammed O Nassif
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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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: 18] [Impact Index Per Article: 6.0] [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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16
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Clinical practice guideline for breast fibroadenoma: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021. Chin Med J (Engl) 2021; 134:1014-1016. [PMID: 33859107 PMCID: PMC8116029 DOI: 10.1097/cm9.0000000000001462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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17
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Alkushi A, Arabi H, Al-Riyees L, Aldakheel AM, Al Zarah R, Alhussein F, Altamimi AM, Alsulaiman YA, Omair A. Phyllodes tumor of the breast clinical experience and outcomes: A retrospective cohort tertiary hospital experience. Ann Diagn Pathol 2021; 51:151702. [PMID: 33472142 DOI: 10.1016/j.anndiagpath.2021.151702] [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] [Received: 11/04/2020] [Revised: 12/07/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Phyllodes tumor (PT) accounts for <1% of all breast tumors worldwide. Based on their microscopic features, these tumors are classified into benign, borderline, and malignant. This study aimed at evaluating the clinical experience and the clinicopathologic features of PT. METHODS A retrospective cohort study of 46 female patients with histologically diagnosed PT. Data collection and evaluation was done on patient demographics, preoperative radiological assessment and pathology, surgical procedure, post-surgery pathological evaluation, radiation therapy (RT), and follow-up. RESULTS The median age at diagnosis was 42 years and young premenopausal patients (median age 35 years) had malignant PT. Forty-five patients underwent core needle biopsy (CNB) with high sensitivity and the positive predictive value (82.2% and 97.4% respectively). Thirty-nine patients (86.7%) underwent conservative surgery and 6 (13.3%) had a mastectomy. Twenty-seven (58.6%) were classified as benign, 11 (23.9%) as borderline and only 8 (17.4%) as malignant PT. Malignant PT had the greatest median tumor size (13 cm). Mortality and recurrence rates were 4.3% and 2.2% respectively. RT was administered in 6 patients (13.0%), 5 having malignant and 1 borderline PT. The metastatic rate was found to be 6.5%. CONCLUSION PT are rare breast tumors with variable biologic behavior and heterogenous clinicopathological findings. Young, premenopausal women with large tumors may have malignant PT with a risk of recurrence and metastasis. Core needle biopsy is a reliable tool for diagnosis of PT with strict follow-up recommended for large tumors diagnosed as fibroadenoma on CNB. Surgical management must ensure a tumor-free margin on excision to reduce recurrence.
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Affiliation(s)
- Abdulmohsen Alkushi
- Dept. of Pathology, King Abdulaziz Medical City of National Guard, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Haitham Arabi
- Dept. of Pathology, King Abdulaziz Medical City of National Guard, Riyadh, Saudi Arabia
| | - Lolwah Al-Riyees
- Dept. of Surgery, King Abdulaziz Medical City of National Guard, Riyadh, Saudi Arabia
| | - Abdulelah M Aldakheel
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Raed Al Zarah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Alhussein
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Mohammed Altamimi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yazeed Abdulsalam Alsulaiman
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmad Omair
- College of Science & Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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18
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Morioka E, Noguchi M, Noguchi M, Inokuchi M, Shimada KI, Shioya A, Aikawa A, Minato H, Earashi M. A case of recurrent malignant phyllodes tumor undergoing nipple-sparing mastectomy with immediate breast reconstruction. Surg Case Rep 2020; 6:297. [PMID: 33237380 PMCID: PMC7688876 DOI: 10.1186/s40792-020-01022-5] [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] [Received: 06/11/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022] Open
Abstract
Background Although the primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR). Case presentation A 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size. She underwent tumor excision and a histological diagnosis of marked degenerative and necrotic induration suggested benign PT. One year later, however, she was found to have recurrent masses in the left breast on follow-up mammography and sonography. Needle biopsy was performed and the tumor was diagnosed as borderline or malignant PT. She underwent NSM and sentinel lymph-node biopsy with IBR using a tissue expander. Histological examination of the mastectomy specimen showed multiple fibroepithelial tumors with marked stromal overgrowth, focal necrosis, and hemorrhage. Stromal cells showed pleomorphism and a maximal mitotic rate of approximately 25 per 10 high-power fields. The tumor was diagnosed as malignant PT. She did not receive adjuvant chemotherapy or radiation treatment. At 3-year follow-up, the patient remains free of disease and highly satisfied with the cosmetic results. Conclusions NSM with IBR is not a contraindication for malignant PT. It is both curative and can offer an appealing cosmetic option for localized malignant PT.
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Affiliation(s)
- Emi Morioka
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Masakuni Noguchi
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Miki Noguchi
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Masafumi Inokuchi
- Department of Breast and Endocrine Surgery/Breast Center, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Ken-Ichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Akane Aikawa
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Hiroshi Minato
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University Hospital, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Mitsuharu Earashi
- Department of Breast Surgery, Toyama Nishi General Hospital, 1019, Shimokutsuwada, Fuchu-machi, Toyama-shi, Toyama, 939-2716, Japan
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19
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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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20
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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, Jakub JW. Germline Genetic Mutations in a Multi-center Contemporary Cohort of 550 Phyllodes Tumors: An Opportunity for Expanded Multi-gene Panel Testing. Ann Surg Oncol 2020; 27:3633-3640. [PMID: 32504368 PMCID: PMC9945652 DOI: 10.1245/s10434-020-08480-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND A paucity of data exists regarding inherited mutations associated with phyllodes tumors (PT); however, some are reported (TP53, BRCA1, and RB1). A PT diagnosis does not meet NCCN criteria for testing, including within Li-Fraumeni Syndrome (TP53). We sought to determine the prevalence of mutations associated with PT. METHODS We performed an 11-institution review of contemporary (2007-2017) PT practice. We recorded multigenerational family history and personal history of genetic testing. We identified patients meeting NCCN criteria for genetic evaluation. Logistic regression estimated the association of select covariates with likelihood of undergoing genetic testing. RESULTS Of 550 PT patients, 59.8% (n = 329) had a close family history of cancer, and 34.0% (n = 112) had ≥ 3 family members affected. Only 6.2% (n = 34) underwent genetic testing, 38.2% (n = 13) of whom had only BRCA1/BRCA2 tested. Of 34 patients tested, 8.8% had a deleterious mutation (1 BRCA1, 2 TP53), and 5.9% had a BRCA2 VUS. Of women who had TP53 testing (N = 21), 9.5% had a mutation. Selection for testing was not associated with age (odds ratio [OR] 1.01, p = 0.55) or PT size (p = 0.12) but was associated with grade (malignant vs. benign: OR 9.17, 95% CI 3.97-21.18) and meeting NCCN criteria (OR 3.43, 95% confidence interval 1.70-6.94). Notably, an additional 86 (15.6%) patients met NCCN criteria but had no genetic testing. CONCLUSIONS Very few women with PT undergo germline testing; however, in those selected for testing, a deleterious mutation was identified in ~ 10%. Multigene testing of a PT cohort would present an opportunity to discover the true incidence of germline mutations in PT patients.
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Affiliation(s)
- Laura H. Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina,Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Samantha M. Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina,Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Suniti N. Nimbkar
- Brigham & Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tina J. Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kandice K. Ludwig
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lisa K. Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan E. Miller
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Jasmine Wong
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Taryn E. Hassinger
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James W. Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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21
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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: 17] [Impact Index Per Article: 4.3] [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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22
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Ibreaheem MH, Naguib S, Gamal M, Boutrus R, Gomaa MMM, Talaat O. Phyllodes Tumors of the Breast (the Egyptian Experience). Indian J Surg Oncol 2020; 11:423-432. [PMID: 33013122 PMCID: PMC7501369 DOI: 10.1007/s13193-020-01107-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/22/2020] [Indexed: 11/29/2022] Open
Abstract
Phyllodes tumors (PT) are rare fibroepithelial lesions, about 0.3-0.5% of all breast tumors. This study is an evaluation of patient characteristics, clinicopathologic features, diagnostic tools, therapeutic options, risk factors for recurrence, and distant metastasis and follow-up findings in patients with PTs. One hundred twenty-seven patients with pathologically proved PTs in the National Cancer Institute, Cairo University, Egypt, from January 2011 to January 2016 were reviewed and analyzed. Sixty patients presented with benign PTs (47.2%), 34 had borderline PTs (26.8%), and 33 had malignant PTs (26%). The mean follow-up period was approximately 36 months; local recurrence occurred in 34 patients, 9 benign cases (14.5%), 11 borderlines (32.4%), and 14 malignant PTs (42.4%). Mastectomy was the most commonly used surgery in recurrent cases (61.4%). Axillary staging was performed in 31 cases (24.4%); only 2 cases showed positive nodal metastasis (6.5%) and were of the malignant subtype. Distant metastasis occurred in 12 patients, 4 with borderline PTs, and 8 with malignant PTs. The most common site for metastasis was the lungs and bones. Adjuvant radiotherapy was applied in 9 patients, 2 in borderline phyllodes, and 7 in malignant phyllodes; post-radiotherapy recurrence occurred in 5 malignant phyllodes patients. Chemotherapy was employed in 10 metastatic patients (4 with borderline and 6 with malignant phyllodes); excision with clear margins is important to reduce the local recurrence. Routine axillary staging should not be done. The adjuvant radiation therapy is still controversial. Local recurrence can develop even after appropriate surgery. Therefore, close follow-up is mandatory.
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Affiliation(s)
- Maher H. Ibreaheem
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Sherif Naguib
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Mohammed Gamal
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Rimoun Boutrus
- Radiotherapy department, National Cancer Institute, Cairo University, Egypt, Giza, Egypt
| | | | - Omnia Talaat
- Nuclear medicine department, National Cancer Institute, Cairo University, Egypt, Giza, Egypt
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23
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The role of adjuvant radiotherapy in patients with malignant phyllodes tumor of the breast: a propensity-score matching analysis. Breast Cancer 2020; 28:110-118. [PMID: 32748225 PMCID: PMC7796876 DOI: 10.1007/s12282-020-01135-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 07/16/2020] [Indexed: 11/05/2022]
Abstract
Background and objectives Malignant phyllodes tumor of the breast (MPTB) is a kind of rare tumor. Our objective was to investigate the role of adjuvant radiotherapy (RT) in MPTB patients. Methods MPTB patients were identified in the Surveillance, Epidemiology and End Results (SEER) database. Kaplan–Meier curves and multivariable Cox proportional hazards analyses were conducted to determine the effect of adjuvant RT on MPTB patients. Propensity-score matching (PSM) method was used to balance the clinicopathological characteristics. Results A total of 1353 MPTB patients were included in our study and the median follow-up time was 99 months (range: 0–331 months). 16.7% (226) MPTB patients received adjuvant RT, of which 49.1% (111) received mastectomy and 50.9% (115) underwent breast conservation surgery (BCS). Patients receiving adjuvant RT were more likely to be white, with better differentiation and larger tumors (p < 0.05). Multivariate analysis showed that poorer tumor differentiation grade, larger tumor size, and lymph node metastasis were associated with reduced survival while BCS was a protective factor of disease-specific survival (DSS) (HR 0.297; 95% CI 0.184–0.480) and overall survival (OS) (HR 0.445; 95% CI 0.321–0.616). After PSM, survival curves showed patients did not achieve an improved OS or DSS from adjuvant RT (p > 0.05). In subgroup analysis, no subgroup benefited from adjuvant RT. Exploratory analysis showed a survival benefit trend from adjuvant RT in patients with tumor larger than 50 mm and undergoing BCS. Conclusions Among MPTB patients, adjuvant RT did not improve OS or DSS. In patients with tumor larger than 50 mm and receiving BCS, a survival benefit trend from adjuvant RT existed. Electronic supplementary material The online version of this article (10.1007/s12282-020-01135-7) contains supplementary material, which is available to authorized users.
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Singh N, Kushwaha P, Gupta A, Prakash O. Recent Advances of Novel Therapeutic Agents from Botanicals for Prevention and Therapy of Breast Cancer: An Updated Review. CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666181129101502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Breast cancer is among the foremost common malignancies and the second leading
cause for cancer-related deaths in females. Varied treatment approaches are projected to cause a
subject matter reduction in the fatality rate. Carcinoma treatment is highly challenging due to
therapeutic resistance and reoccurrence. Several studies have revealed that bioactive compounds
isolated from natural products such as plants, vegetables, and marine origins have a therapeutic
and preventive role in breast carcinoma. Utilization of these bioactive agents in amelioration of
cancer as complementary and alternative therapy increases day by day due to growing scientific
shreds of evidence of the biomedical innovation and clinical trials. Due to the safe nature of these
photochemical investigators are focusing on the investigation of lead compounds from traditional
herbal medicine to discover new lead anticancer agents in the single pure compound. This review
highlights the mechanism of action and future prospects of novel medicinal agents from botanical
sources that have chemoprevention activity against breast carcinoma together with other types of
body cancer. The major bioactive, which are used as a remedy for the prevention and treatment of
breast cancer, is summarized and explored here.
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Affiliation(s)
- Namrata Singh
- Faculty of Pharmacy, Integral University, Dasauli, Kursi Road, Lucknow, Uttar Pradesh 226026, India
| | - Poonam Kushwaha
- Faculty of Pharmacy, Integral University, Dasauli, Kursi Road, Lucknow, Uttar Pradesh 226026, India
| | - Amresh Gupta
- Goel Institute of Pharmacy and Sciences, Near Indira Canal, Faizabad Road, Lucknow, Uttar Pradesh, India
| | - Om Prakash
- Faculty of Pharmacy, Integral University, Dasauli, Kursi Road, Lucknow, Uttar Pradesh 226026, India
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25
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Cheema HS, Mehta R, Slanetz PJ. Imaging and management of fibroepithelial breast lesions on percutaneous core needle biopsy. Breast J 2020; 26:1216-1220. [PMID: 31925856 DOI: 10.1111/tbj.13749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to review the clinical presentation, multi-modality appearance, and management of the most common benign and malignant fibroepithelial lesions of the breast. Fibroepithelial lesions of the breast may exhibit characteristic features on mammography, ultrasound, and MRI, although definitive diagnosis most often requires biopsy and at times, surgical excision. Knowledge of the imaging features can assist in refining the differential diagnosis and guiding appropriate management.
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Affiliation(s)
- Hena S Cheema
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rashmi Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Priscilla J Slanetz
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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26
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Shafi AA, AlHarthi B, Riaz MM, AlBagir A. Gaint phyllodes tumour with axillary & interpectoral lymph node metastasis; A rare presentation. Int J Surg Case Rep 2019; 66:350-355. [PMID: 31927226 PMCID: PMC6953703 DOI: 10.1016/j.ijscr.2019.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Phyllodes tumors are rare fibroepithelial neoplasms of the breast, account for less than 1 % of all breast neoplasms, lymph node metastasis is even rare and routine axillary dissection is not recommended. Approximately 20 % of patients with malignant phyllodes tumors develop distant metastasis. CASE DESCRIPTION A 45 years old premenopausal female, presented with a huge right breast mass for 3 years. Physical examination revealed a 40 × 46 cm, lobulated mass, fixed to the chest wall and multiple enlarged and mobile ipsilateral axillary lymphadenopathy. Core tissue biopsy revealed fibroepithelial & stromal proliferation suggestive of phyllodes tumor. The CT scan of the chest and the abdomen revealed bilateral pulmonary metastasis. She underwent palliative Modified Radical Mastectomy. Pathology demonstrated malignant phyllodes with osseous and chondroid metaplasia, the resection margins were clear and 6 out of 25 nodes were positive. Her post-operative recovery was uneventful and she received adjuvant chemo-radiotherapy. During 12 months follow up, no local recurrence was noted, but despite chemotherapy her pulmonary disease was increasing. DISCUSSION Only a few cases of cystosarcoma phyllodes with lymph node involvement have been reported in the literature. Treves, Norris and Taylor's series have demonstrated the axillary node metastasis of less that 1 %. Since most sarcomas metastasize hematogenously, this finding explains why axillary metastasis is so rare. Hence most authors have concluded that removal of axillary lymph nodes is not warranted unless there are pathologically involved. CONCLUSION Management of Phyllodes tumor presents the surgeon with challenges. Core tissue biopsy is a reliable method for pre-operative diagnosis. Imaging like CT scan and MRI help to evaluate the primary lesion as well as distant metastasis. The majority of these cases can be managed by simple mastectomy. Axillary lymph node metastasis is rare and dissection should be limited to patients with pathological evidence of tumor in the lymph nodes.
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Affiliation(s)
- Alam Ara Shafi
- Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Bandar AlHarthi
- Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Asim AlBagir
- Department of Surgical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
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Sim Y, Ng GXP, Ng CCY, Rajasegaran V, Wong SF, Liu W, Guan P, Nagarajan S, Ng WY, Thike AA, Lim JCT, Nasir NDBM, Tan VKM, Madhukumar P, Yong WS, Wong CY, Tan BKT, Ong KW, Teh BT, Tan PH. A novel genomic panel as an adjunctive diagnostic tool for the characterization and profiling of breast Fibroepithelial lesions. BMC Med Genomics 2019; 12:142. [PMID: 31647027 PMCID: PMC6813086 DOI: 10.1186/s12920-019-0588-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background Known collectively as breast fibroepithelial lesions (FELs), the common fibroadenomas (FAs) and the rarer phyllodes tumors (PTs) are a heterogenous group of biphasic neoplasms. Owing to limited tissue availability, inter-observer variability, overlapping histological features and heterogeneity of these lesions, diagnosing them accurately on core biopsies is challenging. As the choice management option depends on the histological diagnosis; a novel 16-gene panel assay was developed to improve the accuracy of preoperative diagnosis on core biopsy specimens. Methods Using this 16-gene panel, targeted amplicon-based sequencing was performed on 275 formalin-fixed, paraffin-embedded (FFPE) breast FEL specimens, archived at the Singapore General Hospital, from 2008 to 2012. Results In total, 167 FAs, 24 benign, 14 borderline and 6 malignant PTs, were profiled. Compared to FAs, PTs had significantly higher mutation rates in the TERT promoter (p < 0.001), RARA (p < 0.001), FLNA, RB1 and TP53 (p = 0.002, 0.020 and 0.018, respectively). In addition to a higher mutational count (p < 0.001), TERT promoter (p < 0.001), frameshift, nonsense and splice site (p = 0.001, < 0.001 and 0.043, respectively) mutations were also frequently observed in PTs. A multivariate logistic regression model was built using these as variables and a predictive scoring system was developed. It classifies a FEL at low or high risk (score < 1 and ≥ 1, respectively) of being a PT. This scoring system has good discrimination (ROC area = 0.773, 95% CI: 0.70 to 0.85), calibration (p = 0.945) and is significant in predicting PTs (p < 0.001). Conclusion This novel study demonstrates the ability to extract DNA of sufficient quality and quantity for targeted sequencing from FFPE breast core biopsy specimens, along with their successful characterization and profiling using our customized 16-gene panel. Prospective work includes validating the utility of this promising 16-gene panel assay as an adjunctive diagnostic tool in clinical practice.
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Affiliation(s)
- Yirong Sim
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore.
| | - Gwendolene Xin Pei Ng
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Cedric Chuan Young Ng
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Vikneswari Rajasegaran
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Suet Far Wong
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Liu
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Peiyong Guan
- Integrated Biostatistics and Bioinformatics Program, Duke-NUS Medical School, Singapore, Singapore
| | - Sanjanaa Nagarajan
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Wai Yee Ng
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Jeffrey Chun Tatt Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | - Veronique Kiak Mien Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Preetha Madhukumar
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Wei Sean Yong
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Chow Yin Wong
- SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Kong Wee Ong
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Division of Pathology, Singapore General Hospital, Singapore, Singapore
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Chaudhary D, Singh V, Mallya V, Mandal S, Khurana N, Singh R. Utility of Trucut Biopsy in Diagnosing Phyllodes Tumor. J Midlife Health 2019; 10:135-140. [PMID: 31579166 PMCID: PMC6767962 DOI: 10.4103/jmh.jmh_146_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Breast phyllodes are rare fibroepithelial neoplasms. Various classifications adopted to grade them into benign, borderline and malignant but the presently used one is the WHO classification of 2012. Trucut biopsy is a sensitive prediagnostic tool to grade phyllodes. But features can sometimes be overlapping making it difficult to grade it. In this study, an effort has been made to compare the morphology of trucut and histolopathology specimens. Sensitivity of the trucut bopsy in diagnosing benign and malignant phyllodes is calculated and is being compared with other studies. Hence due to varied morphological features sole diagnosis should not be based on trucut biopsy.
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Affiliation(s)
- Dimple Chaudhary
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Vishal Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Varuna Mallya
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shramana Mandal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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29
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Benign breast conditions: An eight-year single-centre histopathological review of women presenting with mass lesions at the Korle-Bu Teaching Hospital, Ghana. Ann Diagn Pathol 2019; 42:33-38. [DOI: 10.1016/j.anndiagpath.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/26/2019] [Accepted: 07/07/2019] [Indexed: 11/22/2022]
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30
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Papas Y, Asmar AE, Ghandour F, Hajj I. Malignant phyllodes tumors of the breast: A comprehensive literature review. Breast J 2019; 26:240-244. [DOI: 10.1111/tbj.13523] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Yasmine Papas
- Saint George Hospital University Medical Center University Of Balamand Beirut Lebanon
| | - Antoine El Asmar
- Saint George Hospital University Medical Center University Of Balamand Beirut Lebanon
| | - Fatmeh Ghandour
- Saint George Hospital University Medical Center University Of Balamand Beirut Lebanon
| | - Imad Hajj
- Saint George Hospital University Medical Center University Of Balamand Beirut Lebanon
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31
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Park HJ, Ryu HS, Kim K, Shin KH, Han W, Noh DY. Risk Factors for Recurrence of Malignant Phyllodes Tumors of the Breast. In Vivo 2019; 33:263-269. [PMID: 30587634 DOI: 10.21873/invivo.11470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In this study, the treatment outcome and risk factors for recurrence in patients undergoing surgery with or without adjuvant radiotherapy (RT) for malignant phyllodes tumors of the breast (MPTB) were analyzed. PATIENTS AND METHODS Forty-three patients (61.4%) underwent breast-conserving surgery (BCS) and 27 (38.6%) underwent mastectomy. Fifteen patients (21.4%) received adjuvant RT. RESULTS With a median follow-up of 76 months, the 7-year local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and cause-specific survival (CSS) rates were 90.7%, 85.2%, 80.3%, and 87.1%, respectively. Either the extent of surgery or treatment with adjuvant RT did not affect the outcomes. On multivariate analysis, the presence of tumor necrosis was associated with inferior DFS (p=0.017), while infiltrative tumor border showed a marginal significance (p=0.078). When stratified using these two adverse pathological features, the 7-year DFS rates were 100%, 54.9%, and 55.6% in patients with 0, 1, and 2 risk factors, respectively (p=0.002). CONCLUSION MPTB patients undergoing surgery with or without adjuvant RT had a favorable outcome. Although there was no local recurrence in patients treated with adjuvant RT, the effect of adjuvant RT failed to reach a statistical significance. Risk-grouping based on pathological features might help design a clinical trial for MPTB.
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Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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32
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Lu Y, Chen Y, Zhu L, Cartwright P, Song E, Jacobs L, Chen K. Local Recurrence of Benign, Borderline, and Malignant Phyllodes Tumors of the Breast: A Systematic Review and Meta-analysis. Ann Surg Oncol 2019; 26:1263-1275. [PMID: 30617873 DOI: 10.1245/s10434-018-07134-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to investigate local recurrence (LR) rates among the three grades (benign, borderline, and malignant) of phyllodes tumors (PTs). The study also assessed various risk factors for LR. METHODS Electronic articles published between 1 January 1995 and 31 May 2018, were searched and critically appraised. The authors independently reviewed the abstracts and extracted data for LR rates and LR risk factors. RESULTS The review incorporated 54 studies with 9234 individual cases. The pooled LR rates were 8% for benign, 13% for borderline, and 18% for malignant PTs. The risk of LR was significantly increased by borderline versus benign PTs (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.68-2.38) and malignant versus borderline PTs (OR 1.28; 95% CI 1.05-1.55). The significant risk factors for LR were mitoses, tumor border (infiltrating vs. pushing), stromal cellularity (moderate/severe vs. mild), stromal atypia (severe vs. mild/absent), stromal overgrowth (severe vs. mild/absent), and tumor necrosis (positive vs. negative). Age and tumor size were not associated with LR risk. The subgroup analysis showed that breast-conserving surgery versus mastectomy and positive versus negative surgical margins were significantly associated with an increased LR risk only in malignant PTs. CONCLUSIONS The risk of LR was significantly increased from benign to borderline to malignant PTs. Mitoses, tumor border, stromal cellularity, stromal atypia, stromal overgrowth, tumor necrosis, type of surgery, and surgical margin status may be risk factors for LR. Different management strategies could be considered for different PT grades.
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Affiliation(s)
- Yiwen Lu
- 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.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanbo 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.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liling Zhu
- 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.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Paul Cartwright
- Departments of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - 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. .,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Lisa Jacobs
- Departments 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. .,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Assi H, Salem R, Sukhon F, Abbas J, Boulos F, Saghir NE. Phyllodes tumors of the breast treated in a tertiary health care center: case series and literature review. J Int Med Res 2018; 48:300060518803530. [PMID: 30318976 PMCID: PMC7113489 DOI: 10.1177/0300060518803530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective This study was performed to determine the subtypes of phyllodes tumor (PT) in
patients at a single tertiary healthcare center in Lebanon and to describe
their characteristics along with a review of the literature. Methods This single-institution retrospective cohort study included all cases of PT
of the breast treated at the American University of Beirut Medical Center
from 1 January 2010 to 31 December 2014. The patients’ demographic data,
tumor characteristics, treatment data, and pathology reports were
analyzed. Results Thirty patients were enrolled. Their median age was 42 years. In total, 66.7%
had benign disease and 22.3% had malignant disease. Twenty-seven patients
underwent surgery, four received radiotherapy, and one received systemic
chemotherapy after PT progression. Twenty-seven patients had no recurrence
at the last follow-up, two had local recurrence, and one had metastatic
disease. All three patients with recurrence had an adequate negative
surgical margin at the first excision. Conclusion This is the first cohort of patients with PT described in Lebanon and one of
few in the Middle East. Our findings provide insight into the epidemiology,
treatment modalities, and prognosis of PT in this geographical region.
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Affiliation(s)
- Hazem Assi
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Salem
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fares Sukhon
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaber Abbas
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nagi El Saghir
- Hematology and Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Albalawi IA. A huge phyllodes tumor in the breast: a case report. Electron Physician 2018; 10:6951-6955. [PMID: 30034663 PMCID: PMC6049979 DOI: 10.19082/6951] [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: 04/15/2018] [Accepted: 05/23/2018] [Indexed: 12/03/2022] Open
Abstract
Phyllodes tumor is a benign breast cancer with a malignant potential. It is very rare in Saudi Arabia and also rare around the world. Malignant phyllodes tumors originate from the connective tissue of the breast, so they are histologically sarcomas. We report the largest phyllodes tumor ever seen in Saudi Arabia, a 41-year-old female who presented with a huge breast mass occupying the whole breast with areas of ulceration. Her history had started 14 months previously with a slowly growing left breast swelling, ultimately the lump ulcerated and became necrotic. Mastectomy with partial resection of the pectoral muscles was done. The tumor specimen measured exactly 30×20×13 cm in size, and weight of 5.4 kg, and with the closest margin of resection 0.5 cm away from the tumor the histopathology report came back as malignant phyllodes tumor. The patient was sent for radiotherapy and chemotherapy. We concluded that accurate preoperative pathological diagnosis is very important for management of phyllodes tumor, and allows correct surgical planning and avoidance of reoperation.
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Affiliation(s)
- Ibrahim Altedlawi Albalawi
- Associate Professor of Surgical Oncology, Department of Surgery, Faculty of Medicine, University of Tabuk, Saudi Arabia
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35
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Pediatric phyllodes tumors: A review of the National Cancer Data Base and adherence to NCCN guidelines for phyllodes tumor treatment. J Pediatr Surg 2018; 53:1123-1128. [PMID: 29605260 DOI: 10.1016/j.jpedsurg.2018.02.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, few large pediatric phyllodes tumor series exist. Current guidelines do not differentiate treatment recommendations between children and adults. We examined national guideline adherence for children and adults. METHODS We queried the NCDB (2004-2014) for female patients with phyllodes tumor histology, excluding patients with missing age or survival data. Patients were stratified by age (pediatric <21, adult ≥21), and compared based on patient characteristics, treatment patterns, and survival. RESULTS We identified 2787 cases of phyllodes tumor (2725 adult, 62 pediatric). Median age was 17years in children and 52years in adults. Margin positivity rates and median tumor size were similar between adults and children. Treatment was discordant with NCCN guidelines in 28.6% of adults and 14.5% of children through use of axillary staging, chemotherapy, adjuvant endocrine therapy, and radiotherapy. Five-year and ten-year survival were comparable between both groups. CONCLUSION Children and adults present with similarly sized phyllodes tumors. Trends reveal high margin positivity rates, and overtreatment with regional axillary staging and systemic adjuvant therapies. Particularly in children, treatment decisions must consider risks of adjuvant therapy including radiation-related second primary cancers, given uncertain benefit. TYPE OF STUDY Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
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Kawashima H, Miyati T, Ohno N, Ohno M, Inokuchi M, Ikeda H, Gabata T. Differentiation between phyllodes tumours and fibroadenomas using intravoxel incoherent motion magnetic resonance imaging: comparison with conventional diffusion-weighted imaging. Br J Radiol 2018; 91:20170687. [PMID: 29231040 DOI: 10.1259/bjr.20170687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate whether the parameters derived from intravoxel incoherent motion (IVIM) MRI could differentiate phyllodes tumours (PTs) from fibroadenomas (FAs) by comparing the apparent diffusion coefficient (ADC) values. METHODS This retrospective study included 7 FAs, 10 benign PTs (BPTs), 4 borderline PTs, and one malignant PT. Biexponential analyses of IVIM were performed using a 3 T MRI scanner. Quantitative IVIM parameters [pure diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and fraction (f)] were calculated. The ADC was also calculated using monoexponential fitting. RESULTS The D and ADC values showed an increasing tendency in the order of FA, BPT, and borderline or malignant PT (BMPT). No significant difference was found in the D value among the three groups. The ADC value of the BMPT group was significantly higher than that of the FA group (p = 0.048). The D* value showed an increasing tendency in the order of BMPT, BPT, and FA, and the D* value of the BMPT group was significantly lower than that of the FA group (p = 0.048). CONCLUSION The D* derived from IVIM and the ADC were helpful for differentiating between FA and BMPT. Advances in knowledge: IVIM MRI examination showed that the perfusion-related diffusion coefficient is lower in borderline and malignant PTs than in FAs and the opposite is true for the ADC.
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Affiliation(s)
- Hiroko Kawashima
- 1 Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan.,2 Department of Breast Oncology, Kanazawa University Hospital , Kanazawa , Japan
| | - Tosiaki Miyati
- 1 Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Naoki Ohno
- 1 Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Masako Ohno
- 3 Division of Radiology, Kanazawa University Hospital , Kanazawa , Japan
| | - Masafumi Inokuchi
- 2 Department of Breast Oncology, Kanazawa University Hospital , Kanazawa , Japan
| | - Hiroko Ikeda
- 4 Division of Pathology, Kanazawa University Hospital , Kanazawa , Japan
| | - Toshifumi Gabata
- 5 Department of Radiology, Kanazawa University Hospital , Kanazawa , Japan
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Wolbert T, Leigh ECN, Barry R, Traylor JR, Legenza M. Early stage malignant phyllodes tumor case report. Int J Surg Case Rep 2017; 42:148-153. [PMID: 29247967 PMCID: PMC5985261 DOI: 10.1016/j.ijscr.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Malignant phyllodes tumor of the breast is an extremely rare entity usually presenting with similar clinical features with those of benign fibroadenoma. Due to its scarcity and clinical presentation, it is quite difficult for clinicians to suspect and diagnose the disease at its early stage. There is currently no consensus regarding adjunctive radiotherapy, hormonal therapy and systemic chemotherapy recommended for malignant phyllodes tumors. PRESENTATION OF CASE This report presents a case of early-stage malignant phyllodes tumor treated by lumpectomy only without adjunctive chemoradiation therapy, but with an excellent outcome. DISCUSSION Early diagnosis and staging with high suspicion are crucial in malignant phyllodes tumor patients since they do not only improve the overall outcome of the disease after lumpectomy only but they also decrease morbidity and mortality with adjunctive chemoradiation therapy. This case report has been reported in line with the SCARE criteria (Agha et al., 2016 [1]).
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Affiliation(s)
- Thao Wolbert
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
| | - Emilia C N Leigh
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States.
| | - Rahman Barry
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
| | - Jack R Traylor
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
| | - Mary Legenza
- Marshall University School of Medicine, Department of Surgery, Huntington, WV, United States
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Abstract
Malignant phyllodes tumor is a rare tumor of the breast occurring in females usually between the ages of 35 and 55 years. It is often difficult to distinguish benign from malignant phyllodes tumors from other benign entities such as fibroadenomas. This case presentation demonstrates a woman with malignant phyllodes tumor treated with mastectomy with abdominal skin flap reconstruction.
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Co M, Chen C, Tsang JY, Tse G, Kwong A. Mammary phyllodes tumour: a 15-year multicentre clinical review. J Clin Pathol 2017; 71:493-497. [DOI: 10.1136/jclinpath-2017-204827] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/26/2017] [Accepted: 10/28/2017] [Indexed: 11/04/2022]
Abstract
AimsPhyllodes tumour (PT) is an uncommon fibroepithelial tumour of the breast. It has a spectrum of aggressiveness in biological behaviour with chance of local recurrence and, occasionally, metastasis.MethodsA 15-year retrospective review from a multicentre database in Hong Kong was performed.ResultsClinical and pathological records of 465 patients with 469 PTs between 1998 and 2014 were reviewed. Median age of occurrence was 44 years (range 12–86 years). 281 (59.9%) PTs were benign, 124 (26.4%) were borderline and 64 (13.6%) were malignant. About half of all PTs (239, 51.5%) were between 2 and 5 cm while another 186 (40.1%) were >5 cm in size. Most PT (84.6%) were radiologically benign. Breast-conserving surgery (BCS) was feasible in 384 (82%) patients, whereas 84 (18%) patients had mastectomy. Multivariate analysis found that positive surgical margin (P<0.001) and BCS (P<0.001) were the only significant risk factors for local recurrence, while large tumour size (P=0.008) and malignant PT histotype (P<0.001) were the only significant risk factors for metastasis. Long-term prognosis of benign and borderline PT was excellent. After median follow-up interval of 85 months (range 12–180 months), the disease-specific survival of benign, borderline and malignant PT were 99.6%, 100% and 90.6%, respectively.ConclusionsLocal recurrence of PTs occurs irrespective of the tumour grade. Surgical margin is the only amendable factor to reduce the chance of recurrence.
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Kim JY, Yu JH, Nam SJ, Kim SW, Lee SK, Park WY, Noh DY, Nam DH, Park YH, Han W, Lee JE. Genetic and Clinical Characteristics of Phyllodes Tumors of the Breast. Transl Oncol 2017; 11:18-23. [PMID: 29145046 PMCID: PMC5684533 DOI: 10.1016/j.tranon.2017.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/12/2017] [Accepted: 10/23/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE: Phyllodes tumors (PTs) of the breast are rare, accounting for less than 1% of all breast tumors. Among PTs, malignant PTs (MPTs) have malignant characteristics and distant metastases occur in about 20% to 30% of MPTs. However, there is no effective treatment for MPTs with distant metastasis, resulting in an abject prognosis. We performed targeted deep sequencing on PTs to identify the associations between genetic alterations and clinical prognosis. METHODS: We performed targeted deep sequencing to evaluate the genetic characteristics of PTs and analyzed the relationships between clinical and genetic characteristics. RESULTS: A total of 17 PTs were collected between 2001 and 2012. Histologic review was performed by pathologists. The samples included three benign PTs, one borderline PT, and 13 MPTs. The most frequently detected genetic alteration occurred in the TERT promoter region (70.6%), followed by MED12 (64.7%). EGFR amplification and TP53 alteration were detected in four MPTs without genetic alterations in MED12 and TERT promoter regions. Genetic alterations of RARA and ZNF703 were repeatedly found in PTs with local recurrence, and genetic alterations of SETD2, BRCA2, and TSC1 were detected in PTs with distant metastasis. Especially, MPT harboring PTEN and RB1 copy number deletion showed rapid disease progression. CONCLUSIONS: In this study, we provide genetic characterization and potential therapeutic target for this rare, potentially lethal disease. Further large-scale comprehensive genetic study and functional validation are warranted.
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Affiliation(s)
- Ji-Yeon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,06351, Korea
| | - Jong Han Yu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Seok Won Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Se Kyung Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, 06351, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Do-Hyun Nam
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Korea; Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea; Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,06351, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Korea; Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Korea; Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Korea.
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Strode M, Khoury T, Mangieri C, Takabe K. Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast 2017; 33:91-96. [DOI: 10.1016/j.breast.2017.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 01/31/2023] Open
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Kallam AR, Kanumury V, Korumilli RM, Gudeli V, Polavarapu H. Massive Benign Phyllodes Tumour of Breast Complicating Pregnancy. J Clin Diagn Res 2017; 11:PD08-PD09. [PMID: 28658847 DOI: 10.7860/jcdr/2017/26277.9929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/28/2017] [Indexed: 11/24/2022]
Abstract
Phyllodes tumour of the breast, earlier called cystosarcomaphyllodes, is a rare fibroepithelial breast neoplasm that occurs in all age groups from adolescents to elderly. Phyllodes tumour occurring during pregnancy and associated with lactating breast is extremely rare. Giant phyllodes tumours or giant fibroadenomas are those measuring more than 10 cms in diameter and weighing more than 500 gm. Phyllodes tumour typically exhibits an exclusive intracanalicular growth pattern of fibroepithelial cells with classical, deep leaf-like stromal projections into dilated lumens from which its name "phyllodes" is derived. A 32-year-old primigravida at 38 weeks of gestation, presented with massive and heavy swelling of the left breast, growing over the last eight months. Physical examination revealed a massively enlarged left breast with palpable, firm, nodular mass measuring 10 x 20 cm and occupying whole of the left breast. A trucut biopsy demonstrated a fibroepithelial lesion suggestive of benign phyllodes tumour. Simple mastectomy was performed six days after the delivery of the baby by caesarean section. The histopathological report confirmed the diagnosis as benign phyllodes tumour with ductal hyperplasia and no atypia. We are reporting this case because of its massive size, associated with lactating breast and difficulty in histopathological differentiation from Giant fibroadenoma.
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Affiliation(s)
- Anji Reddy Kallam
- Director, Department of Plastic Surgery, ASRAM Medical College, Eluru, Andhra Pradesh, India
| | - Vandana Kanumury
- Head and Professor, Department of Obstetrics and Gynaecology, ASRAM Medical College, Eluru, Andhra Pradesh, India
| | - Rama Murthy Korumilli
- Head and Professor, Department of Pathology, ASRAM Medical College, Eluru, Andhra Pradesh, India
| | - Vahini Gudeli
- Associate Professor, Department of Pathology, ASRAM Medical College, Eluru, Andhra Pradesh, India
| | - Havya Polavarapu
- Postgraduate Student, Department of Obstetrics and Gynaecology, ASRAM Medical College, Eluru, Andhra Pradesh, India
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Kim YJ, Kim K. Radiation therapy for malignant phyllodes tumor of the breast: An analysis of SEER data. Breast 2017; 32:26-32. [DOI: 10.1016/j.breast.2016.12.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/13/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022] Open
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Rajesh A, Farooq M. Resection and reconstruction following recurrent malignant phyllodes-Case report and review of literature. Ann Med Surg (Lond) 2017; 16:14-18. [PMID: 28275427 PMCID: PMC5331157 DOI: 10.1016/j.amsu.2017.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Phyllodes tumors are uncommon biphasic fibroepithelial neoplasms of the breast of varying malignant potential occurring in middle aged women. They exhibit diverse biological behavior. Margin free excision is the mainstay of treatment. CASE PRESENTATION A 27 year-old lady was referred with a painless ulceroproliferative right breast lesion which had rapidly progressed over six months. Three years back, she had been diagnosed with a borderline phyllodes tumor and underwent a wide local excision followed by a right mastectomy for recurrence. The resection margins were positive hence she underwent postoperative radiation. We performed a radical resection of the chest wall and reconstruction using a composite mesh (inner PTFE and outer vypro), pedicled latissimus dorsi flap and a split skin graft for the recurrent malignant tumor. She recovered uneventfully thereafter. DISCUSSION Malignant phyllodes tumor is uncommon and treatment principles are from case reports and retrospective studies. Aggressive resection of the lesion and reconstruction of the chest wall with bone cement and two meshes-a composite mesh (inner layer -polytetrafluroethylene and outer layer of polypropylene) and a Vypro mesh is a possibility. This case highlights the challenges encountered in managing these patients and presents a radical solution. CONCLUSION Treatment of phyllodes tumor necessitates adequate excision of the tumor and adjacent tissues to ensure tumor free margins. Pathological evolution from intermediate to malignant histology may be exhibited. A full-thickness chest wall resection and reconstruction although radical is a feasible option as these tumors rarely respond to other modalities of cancer management.
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Affiliation(s)
- Aashish Rajesh
- Madras Medical College & Rajiv Gandhi Government General Hospital, No. 3 EVR Periyar Salai, Chennai, 600003, Tamil Nadu, India
| | - Mohammed Farooq
- Madras Medical College & Rajiv Gandhi Government General Hospital, No. 3 EVR Periyar Salai, Chennai, 600003, Tamil Nadu, India
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Sera T, Kashiwagi S, Takashima T, Asano Y, Goto W, Iimori N, Noda S, Onoda N, Ohsawa M, Hirakawa K, Ohira M. Multiple metastatic malignant phyllodes tumor of the breast with tonsillar metastasis: a case report. BMC Res Notes 2017; 10:55. [PMID: 28103951 PMCID: PMC5248444 DOI: 10.1186/s13104-017-2375-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tonsillar metastasis is very rare and accounts for only 0.8% of tonsillar tumors. And phyllodes tumor of the breast with tonsillar metastasis is very rare. CASE PRESENTATION A 57-year-old Japanese woman received surgery (partial mastectomy) of malignant phyllodes tumor. Seven months after initial surgery, pharyngeal pain, swelling, and a feeling of dyspnea developed, and tumor was found in the left palatine tonsil. Computed tomography for further evaluation showed a tonsillar lesion with contrast enhancement, and tonsillar metastasis was suspected. The metastatic lung tumors had not progressed. Laryngoscopic biopsy showed a tonsillar metastasis from the malignant phyllodes tumor. Despite the diagnosis of malignant phyllodes tumor with tonsillar and pulmonary metastases, the patient refused further treatment and died about 1 month later. CONCLUSIONS A patient with a malignant phyllodes tumor of the breast and tonsillar metastasis was reported, along with a discussion of the relevant literature of this very rare pattern of metastasis.
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Affiliation(s)
- Tomohiro Sera
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Yuka Asano
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Wataru Goto
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Nozomi Iimori
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Satoru Noda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
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Varghese SS, Sasidharan B, Manipadam MT, Paul MJ, Backianathan S. Radiotherapy in Phyllodes Tumour. J Clin Diagn Res 2017; 11:XC01-XC03. [PMID: 28274029 DOI: 10.7860/jcdr/2017/24591.9167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/04/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Phyllodes Tumour (PT) of the breast is a relatively rare breast neoplasm (<1%) with diverse range of pathology and biological behaviour. AIM To describe the clinical course of PT and to define the role of Radiotherapy (RT) in PT of the breast. MATERIALS AND METHODS Retrospective analysis of hospital data of patients with PT presented from 2005 to 2014 was done. Descriptive statistics was used to analyze the results. Simple description of data was done in this study. Age and duration of symptoms were expressed in median and range. Percentages, tables and general discussions were used to understand the meaning of the data analyzed. RESULTS Out of the 98 patients, 92 were eligible for analysis. The median age of presentation was 43 years. A total of 64/92 patients were premenopausal. There was no side predilection for this tumour but 57/92 patients presented as an upper outer quadrant lump. Fifty percent of the patients presented as giant (10 cm) PT. The median duration of symptoms was 12 months (range: 1-168 months). A 60% of patients had Benign (B), 23% had Borderline (BL) and 17% had malignant (M) tumours. The surgical treatment for benign histology included Lumpectomy (L) for 15%, Wide Local Excision (WLE) for 48%, and Simple Mastectomy (SM) for 37%. All BL and M tumours were treated with WLE or SM. There was no recurrence in B and BL group when the margin was ≥1 cm. All non-metastatic M tumours received adjuvant RT irrespective of their margin status. Total 3/16 patients with M developed local recurrence. Total 6/16 M patients had distant metastases (lung or bone). Our median duration of follow up was 20 months (range: 1-120 months). CONCLUSION Surgical resection with adequate margins (>1 cm) gave excellent local control in B and BL tumours. For patients with BL PT, local radiotherapy is useful, if margins are close or positive even after the best surgical resection. There is a trend towards improved local control with adjuvant radiotherapy for malignant PT. Metastatic malignant PT has a poor outcome.
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Affiliation(s)
- Sunitha Susan Varghese
- Associate Physician, Department of Radiation Oncology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Balukrishna Sasidharan
- Associate Professor, Department of Radiation Oncology, Christian Medical College , Vellore, Tamil Nadu, India
| | | | - M J Paul
- Professor, Department of Surgery, Christian Medical College , Vellore, Tamil Nadu, India
| | - Selvamani Backianathan
- Professor, Department of Radiation Oncology, Christian Medical College , Vellore, Tamil Nadu, India
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Rakha EA, Badve S, Eusebi V, Reis-Filho JS, Fox SB, Dabbs DJ, Decker T, Hodi Z, Ichihara S, Lee AHS, Palacios J, Richardson AL, Vincent-Salomon A, Schmitt FC, Tan PH, Tse GM, Ellis IO. Breast lesions of uncertain malignant nature and limited metastatic potential: proposals to improve their recognition and clinical management. Histopathology 2016; 68:45-56. [PMID: 26348644 DOI: 10.1111/his.12861] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast lesions comprise a family of heterogeneous entities with variable patterns of presentation, morphology and clinical behaviour. The majority of breast lesions are classified traditionally into benign and malignant conditions and their behaviour can, in the vast majority of cases, be predicted with a reasonable degree of accuracy. However, there remain lesions which show borderline features and lie in a grey zone between benign and malignant, as their behaviour cannot be predicted reliably. Defined pathological categorization of such lesions is challenging, and for some entities is recognized to be subjective and include a range of diagnoses, and forms of terminology, which may trigger over- or undertreatment. The rarity of these lesions makes the acquisition of clinical evidence problematic and limits the development of a sufficient evidence base to support informed decision-making by clinicians and patients. Emerging molecular evidence is providing a greater understanding of the biology of these lesions, but this may or may not be reflected in their clinical behaviour. Herein we discuss some breast lesions that are associated with uncertainty regarding classification and behaviour, and hence management. These include biologically invasive malignant lesions associated with uncertain metastatic potential, such as low-grade adenosquamous carcinoma, low-grade fibromatosis-like spindle cell carcinoma and encapsulated papillary carcinoma. Other lesions of uncertain malignant nature remain, such as mammary cylindroma, atypical microglandular adenosis, mammary pleomorphic adenoma and infiltrating epitheliosis. The concept of categories of (1) breast lesions of uncertain malignant nature and (2) breast lesions of limited metastatic potential are proposed with details of which histological entities could be included in each category, and their management implications are discussed.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Sunil Badve
- Departments of Pathology and Internal Medicine, Clarian Pathology Laboratory of Indiana University, Indianapolis, IN, USA
| | - Vincenzo Eusebi
- Sezione Anatomia Istologia e Citologia Patologica 'M. Malpighi', Università-ASL Ospedale Bellaria, Bologna, Italy
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Fox
- Pathology Department, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia
| | - David J Dabbs
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Thomas Decker
- German Breast-Screening Program, Reference Centres Berlin and Muenster, Department of Pathology, Dietrich Bonhoeffer Medical Centre, Neubrandenburg, Germany
| | - Zsolt Hodi
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - Shu Ichihara
- Department of Pathology, Nagoya Medical Center, Nagoya, Japan
| | - Andrew H S Lee
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
| | - José Palacios
- Department of Pathology, Hospital Universitario Ramón y Cajal, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | - Fernando C Schmitt
- Department of Medicine and Pathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Puay-Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ian O Ellis
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
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Panda KM, Naik R. A Clinicopathological Study of Benign Phyllodes Tumour of Breast with Emphasis on Unusual Features. J Clin Diagn Res 2016; 10:EC14-7. [PMID: 27630851 DOI: 10.7860/jcdr/2016/18025.8184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Benign Phyllodes Tumours (PTs) are rare fibroepithelial neoplasms that resemble fibroadenoma. But unlike fibroadenoma, benign PT can recur and both stromal & epithelial components can progress to malignancy. Contrary to earlier belief that benign PT is a stromal neoplasm and possibly arises from fibroadenoma, more recent molecular studies have suggested that both stroma and epithelium can become neoplastic. Sometimes, benign PT can occur synchronously with fibroadenoma. Here histomorphologic analysis of eleven cases of benign PT are presented including some unusual features. MATERIALS AND METHODS Eleven cases of benign PT diagnosed between Dec 2014 and Jan 2016 in the Department of Pathology were studied. The demographic and clinicopathological features were analysed. RESULTS The most common age group affected was 20-30 years (range: 13-45). Clinical features included pain, lump and bleeding from nipple. The tumour size varied from 2.5-18 cm in diameter. H&E stained sections showed secondary changes (haemorrhage, myxoid, change, cystic degeneration), epithelial hyperplasia (8), squamous & columnar metaplasia (1), benign tubular adenoma like areas (1), Ductal Carcinoma In Situ (DCIS) (1), Invasive Ductal Carcinoma (IDC) (1), Pseudoangiomatous Stromal Hyperplasia (PASH) (1), histologic infarction (2), tumour necrosis (1) and synchronous fibroadenoma (1). Unusual histologic features included atypical ductal hyperplasia, DCIS, IDC, synchronous fibroadenoma and tubular adenoma like areas arising within benign PT. CONCLUSION This study shows a spectrum of hyperplastic, metaplastic, dysplastic, benign, in-situ-malignancy and even invasive ductal malignancy occurring in benign PT. Therefore adequate and extensive sampling is recommended for accurate diagnosis.
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Affiliation(s)
- Kishori Moni Panda
- Professor and HOD, Department of Pathology, Govt Medical College (LSLAMMC) , Raigarh, Chhattishgarh, India
| | - Reena Naik
- Assistant Professor, Department of Pathology, Govt Medical College (LSLAMMC) , Raigarh, Chhattishgarh, India
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Shan J, Zhang S, Wang Z, Fu Y, Li L, Wang X. Breast malignant phyllodes tumor with rare pelvic metastases and long-term overall survival: A case report and literature review. Medicine (Baltimore) 2016; 95:e4942. [PMID: 27661051 PMCID: PMC5044921 DOI: 10.1097/md.0000000000004942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Malignant phyllodes tumor (PT) is a rare fibro epithelial neoplasm of the breast, which is poor prognosis due to high risk of recurrence and distant metastasis. METHODS We report a case of malignant PT. It had recurred locally five times, and the sixth relapse was occurred 54 months after first diagnosis, presenting a huge pelvic mass (14 cm × 11 cm) by CT scan. Histopathological examination has demonstrated a metastatic phyllodes tumor. After postoperative chemotherapy treatment, a longer survival has been achieved, which is more than 72 months. RESULTS Our case report describes a breast PT with several local recurrences and a rare metastasis (pelvic cavity), but long-term overall survival was achieved after surgery and chemotherapy. CONCLUSION We conclude that trustworthy prognosticators that identify patients with excessive potential of aggressive clinical course should be explored. Moreover, proper treatment could prolong overall survival of metastatic PT patients.
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Affiliation(s)
- Jinlan Shan
- Department of Surgical Oncology and Cancer Institute, Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Shizhen Zhang
- Department of Surgical Oncology and Cancer Institute, Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Zhen Wang
- Department of Surgical Oncology and Cancer Institute, Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Yanbiao Fu
- Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ling Li
- Division of Hematopoietic Stem Cell and Leukemia Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA
| | - Xiaochen Wang
- Department of Surgical Oncology and Cancer Institute, Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Correspondence: Xiaochen Wang, Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (e-mail: )
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Islam S, Shah J, Harnarayan P, Naraynsingh V. The largest and neglected giant phyllodes tumor of the breast-A case report and literature review. Int J Surg Case Rep 2016; 26:96-100. [PMID: 27475116 PMCID: PMC5010640 DOI: 10.1016/j.ijscr.2016.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/17/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Phyllodes tumours are rare fibro-epithelial lesions. The role of the pathologist in the preoperative diagnosis of phyllodes tumours of the breast is critical to appropriate surgical planning. Wide local excision or mastectomy with adequate margin remains the treatment of choice. Local recurrence occurs in approximately 10- 16.1% of patients (Wei et al., 2014) [1] and distant metastases occurs in 6.3-31% of patients with malignant phyllodes tumours (Wei et al. (2014), Chaney et al., 1998) [1,2] but only in 4% of all phyllodes tumours (Salvador et al., 1989) [3]. Emphasis should be given in early diagnosis and intervention to decrease morbidity and mortality.
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Affiliation(s)
- S Islam
- San Fernando Teaching Hospital, Trinidad and Tobago.
| | - J Shah
- San Fernando Teaching Hospital, Trinidad and Tobago.
| | - P Harnarayan
- Department of Clinical surgical Sciences, University of West Indies; St. Augustine, Trinidad and Tobago.
| | - V Naraynsingh
- Department of Clinical surgical Sciences, University of West Indies; St. Augustine, Trinidad and Tobago.
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