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Dong X, Song D, Ma J, Sun J, Wang X. Massive malignant phyllodes tumor accompanied by anemia and ulceration in the breast: A case report. Clin Case Rep 2024; 12:e9096. [PMID: 38887305 PMCID: PMC11180603 DOI: 10.1002/ccr3.9096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/24/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
Large malignant breast phyllodes tumors are uncommon in clinical settings. Here, we report such a case to provide a reference for clinical work. A 48-year-old woman identified a lump in her right breast, which eventually grew up to 25 cm × 10 cm and began to rapidly bleed and ulcerate within 3 months. The patient had visible signs of anemia and significant emaciation as a result of the tumor's wasting effect and the protracted course of the disease. The patient underwent a modified radical mastectomy on the right breast. The pathology results obtained after surgery revealed a malignant phyllodes tumor. No adjuvant therapy, such as chemotherapy or radiation, was administered. The patient had no symptoms of tumor recurrence and complications from the surgery after a follow-up of 9 months.
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Affiliation(s)
- Xiaoxiao Dong
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Dong Song
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Jinxiu Ma
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Jian Sun
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
| | - Xiaozhen Wang
- Department of Breast Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunJilinChina
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Management of Stromal Lesions. Surg Clin North Am 2022; 102:1017-1030. [DOI: 10.1016/j.suc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wei Y, Yu Y, Ji Y, Zhong Y, Min N, Hu H, Guan Q, Li X. Surgical management in phyllodes tumors of the breast: a systematic review and meta-analysis. Gland Surg 2022; 11:513-523. [PMID: 35402210 PMCID: PMC8984980 DOI: 10.21037/gs-21-789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 03/20/2024]
Abstract
BACKGROUND Information is still controversial in the studies regarding the current optimal surgical management of phyllodes tumors (PTs) of the breast. Local recurrence (LR) may occur with an upgraded in the pathological grade, influencing the prognosis of patients with PT. This systematic review and meta-analysis aimed to investigate the association of LR risk with margin status and margin width which could have significant implications on the surgical management of PT. METHODS Independent and comprehensive searches were performed by two authors through five databases including PubMed, Medline, Embase, ScienceDirect and Cochrane Library from January 1990 to October 2021. Studies investigating the association between margin width, margin status and LR rates were considered for inclusion. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan5.3 software, and statistical heterogeneity was assessed using the Chi-square test and quantified using the I2 statistic. Visual inspection of funnel plots was used to judge publication bias. RESULTS A total of 34 articles were included in this article, all of which with NOS scores above 5. Regardless of the PT grade, positive margin significantly increased the risk of LR [odds ratio (OR) 3.64, 95% confidence interval (CI): 2.60-5.12]. No significant difference was found in the risk of LR between the margins <1 and ≥1 cm (OR 1.39, 95% CI: 0.67-2.92). For benign and borderline PTs, there were no significant differences of the LR risk between breast-conserving surgery (BCS) and mastectomy (benign OR 0.68, 95% CI: 0.12-3.78; borderline OR 1.14, 95% CI: 0.29-4.51). While the LR risk was significantly increased by BCS for malignant PT (OR 2.77, 95% CI: 1.33-5.74). DISCUSSION Different surgical management strategies should be considered for different PT grades. BCS was a feasible option and margins <1 cm was not significantly associated with LR risk for all grade of PT. After BCS, benign PT with positive margin could adopt the "wait and watch" strategy with regular follow-up, while borderline and malignant PTs were expected to underwent re-excision to ensure negative margins. More studies are still needed to clarify and update the existing conclusions and improve the prognosis of PT patients.
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Affiliation(s)
- Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanying Yu
- Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yashuang Ji
- Department of Galactophore Surgery, Tongzhou District Hospital of Integrated TCM & Western Medicine, Beijing, China
| | - Yuting Zhong
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huayu Hu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Sun D, Tang L, Xing H, Zhang L, Zhang L. Recurrent borderline phyllodes tumor in nipple: a rare case report and review of the literature. Gland Surg 2020; 9:452-458. [PMID: 32420273 DOI: 10.21037/gs.2020.01.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Phyllodes tumor (PT) of the breast is a rare tumor. They are usually located in the four quadrants of the mammary gland and may also appear below the nipple. Although there have been a number of cases reported, here we report a very rare case of this tumor in an unusual location. The patient has been diagnosed with right breast borderline PT, who accepted breast-conserving surgery. Twelve months after surgery we found right nipple enlargement, without nipple discharge, ipsilateral and contralateral breast without palpable mass. Interestingly, ultrasound showed a lesion in the right nipple: a hypoechoic mass with a diameter of 2.0 cm was seen in the nipple, with no significant calcification. The patient underwent nipple-sparing mastectomy without postoperative adjuvant radiotherapy. Histopathological and immunohistochemical analysis demonstrated a borderline PT. There were no signs of recurrence after two years of follow-up. We consider that wide surgical resection and negative margin are still the main methods for the treatment of recurrent borderline PTs.
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Affiliation(s)
- Denghua Sun
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Lu Tang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Hua Xing
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Lijuan Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Le Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China
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Mitus JW, Blecharz P, Jakubowicz J, Reinfuss M, Walasek T, Wysocki W. Phyllodes tumors of the breast. The treatment results for 340 patients from a single cancer centre. Breast 2018; 43:85-90. [PMID: 30521986 DOI: 10.1016/j.breast.2018.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/13/2018] [Accepted: 11/25/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The primary treatment of choice for patients with phyllodes tumor of the breast (PTB) is surgery. Two major problems regarding the treatment of such patients remain unclear: what is the appropriate surgical margin and what role is played by adjuvant radiotherapy (ART). METHODS The study provides a retrospective review of all patients with PTB treated between 1952 and 2013 at a single institute. The histology slides were re-examined based on WHO criteria. The clinical characteristics and therapy outcomes were obtained. The five-year survival with no evidence of disease (NED) was used as the end point. RESULTS The study population comprised 340 women with PTB. Fifty-five percent of the patients were diagnosed with the benign, 11.8% with borderline and 33.2% with malignant PTB. All the patients received primary treatment with surgery (mastectomy-27.1%, and BCS- 72.9%). Local recurrence (LR) was found in 28 (9.1%) of these patients. Four patients with borderline and 8 with malignant PTB who were treated with BCS and had tumor-free margins < 1 cm received ART. None of these patients had LR and all survived 5 years NED. Of the 340 patients from our group, 294 (86.4%) survived five-years NED. CONCLUSION The prognosis for benign PTB is excellent and can be cured with surgery alone. A sufficient margin would be 0.1 cm (data from the literature) or 0.2-0.4 cm (our study). We recommend application of ART for such patients but the role of ART in patients with borderline and malignant PTB treated with BCS and with surgical margin < 1 cm remains uncertain.
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Affiliation(s)
- J W Mitus
- Department of Surgical Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland; Department of Anatomy, Collegium Medicum, Jagiellonian University, ul. Kopernika 12, 31-034 Cracow, Poland.
| | - P Blecharz
- Department of Gynecological Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - J Jakubowicz
- Department of Gynecological Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - M Reinfuss
- Department of Radiotherapy, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - T Walasek
- Department of Radiotherapy, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
| | - W Wysocki
- Department of Surgical Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland
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Ross DS, Giri DD, Akram MM, Catalano JP, Olcese C, Van Zee KJ, Brogi E. Fibroepithelial Lesions in the Breast of Adolescent Females: A Clinicopathological Study of 54 Cases. Breast J 2017; 23:182-192. [PMID: 28299887 PMCID: PMC5356480 DOI: 10.1111/tbj.12706] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fibroepithelial lesions (FELs) are the most frequent breast tumors in adolescent females. The pubertal hormonal surge could impact the growth and microscopic appearance of FELs in this age group. In this study, we evaluate the morphology and clinical behavior of FELs in adolescents. We searched the 1992-2012 pathology data base for FELs in females 18 years old or younger (F ≤18 years). Seven FELs from 1975 to 1983 were also included. Three pathologists reviewed all available material. Patient (pt) characteristics and follow-up information were obtained from electronic medical records. Forty-eight F ≤18 years had 54 FELs with available slides. Thirty (67%) pts were Caucasian, 12 (27%) African-American, two (4%) Hispanic, one (2%) Asian; three were of unknown race/ethnicity. Median age at diagnosis was 16 years. Median age at menarche was 12 years; most (96%) FELs occurred after menarche (median interval 48 months). All patients underwent lumpectomy; one required subsequent mastectomy. The FELs were 34 fibroadenomas (FAs) (11 usual, 23 juvenile), and 20 phyllodes tumors (PTs) (16 benign, one borderline and three malignant). Eight (35%) juvenile FAs showed slight intratumoral heterogeneity. The mean mitotic rate was 1.3 mitoses/10 high-power fields (HPFs) (range, 0-6) in usual FAs, 1.8/10 HPFs in juvenile FAs, 3.1/10 HPFs in benign PTs, 10/10 HPFs in the borderline PT and 17/10 HPFs in malignant PTs. The mean follow-up for 29 pts with 33 FELs was 44 months. Two (10%) PTs recurred locally (a benign PT at 18 months, and a borderline PT at 11 months). Both recurrent PTs had microscopic margins <1 mm. Mitotic activity in FAs from adolescents can be substantial and this finding should be interpreted cautiously. Awareness of the morphologic features of FELs in adolescents is important to avoid overdiagnosis of PTs, which can lead to additional unnecessary and potentially disfiguring surgery.
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Affiliation(s)
- Dara S. Ross
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Dilip D. Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | | | - Cristina Olcese
- Department of Surgery, Memorial Sloan Kettering Cancer Center
| | | | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center
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Tremblay-LeMay R, Hogue JC, Provencher L, Poirier B, Poirier É, Laberge S, Diorio C, Desbiens C. How Wide Should Margins Be for Phyllodes Tumors of the Breast? Breast J 2016; 23:315-322. [DOI: 10.1111/tbj.12727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemarie Tremblay-LeMay
- Département de biologie moléculaire, biochimie médicale et pathologie; Université Laval; Quebec City Quebec Canada
| | - Jean-Charles Hogue
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Louise Provencher
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Brigitte Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Éric Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Sophie Laberge
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
- Service de Pathologie; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Caroline Diorio
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
| | - Christine Desbiens
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
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Zeng S, Zhang X, Yang D, Wang X, Ren G. Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: A systematic review and meta-analysis. Mol Clin Oncol 2015; 3:663-671. [PMID: 26137284 DOI: 10.3892/mco.2015.503] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/19/2014] [Indexed: 11/05/2022] Open
Abstract
The standard treatment for borderline and malignant phyllodes tumors is wide local excision (margins ≥1 cm), in the context of either breast-conserving surgery (BCS) or total mastectomy (TM). Due to the high risk of local recurrence (LR) following surgical intervention alone, the addition of adjuvant radiotherapy (RT) has been previously investigated; however, the conclusions have been inconsistent. This systematic review and meta-analysis was designed to assess the efficacy of adjuvant RT for borderline and malignant phyllodes tumors. Pubmed and Web of Science were systematically searched to identify relevant studies assessing the effect of adjuvant RT on borderline and malignant phyllodes tumors from the inception of this technique through May, 2014. A total of 8 studies were identified among 332 citations. In this meta-analysis, patients who received adjuvant RT had a lower relative risk of LR [hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.23-0.64]. The absolute risk difference was 10.1% (95% CI: 4.9-17.6), corresponding to a number needed to treat of 10. Our pooled meta-analysis clearly demonstrated a decreased risk of LR in patients with borderline and malignant phyllodes tumors who received RT following BCS (HR=0.31, 95% CI: -0.10-0.72). However, the combined HR for LR in the TM group did not demonstrate that adjuvant RT was superior to no RT (HR=0.68, 95% CI: -0.28-1.64). No significant differences were observed in overall survival (OS) or disease-free survival (DFS) between the two groups. Our analysis suggested that adjuvant RT for borderline and malignant phyllodes tumors decreased the LR rate in patients undergoing BCS. However, adjuvant RT was not found to exert an effect on OS or DFS.
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Affiliation(s)
- Shiyan Zeng
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xindan Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Dejuan Yang
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaoyi Wang
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Guosheng Ren
- Department of Breast and Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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