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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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Fernández-Ferreira R, Arroyave-Ramírez A, Motola-Kuba D, Alvarado-Luna G, Mackinney-Novelo I, Segura-Rivera R. Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature. Case Rep Oncol 2021; 14:123-133. [PMID: 33776693 PMCID: PMC7983586 DOI: 10.1159/000510741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
Phyllodes tumor of the breast is an infrequently encountered fibroepithelial neoplasm, which accounts for 0.3–1% of all tumors. Few case reports have described the occurrence of giant phyllodes tumor. To our knowledge, about 20% of phyllodes tumors would be considered giant benign. Complete surgical excision is the standard of care for giant benign phyllodes tumors; axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes. We report the case of a 40-year-old Mexican woman with giant mammary tumor who underwent a right total mastectomy. The pathology results showed a benign phyllodes tumor 4,857 g in weight and 40.2 × 36.3 × 15 cm in size. We do not suggest adjuvant radiation therapy for patients with benign phyllodes tumors that are widely excised. A review of the pertinent literature was performed.
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Affiliation(s)
- Ricardo Fernández-Ferreira
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Andrés Arroyave-Ramírez
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Daniel Motola-Kuba
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Gabriela Alvarado-Luna
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Ileana Mackinney-Novelo
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Román Segura-Rivera
- Service of Anatomical Pathology, Medica Sur Clinic and Foundation, Mexico, Mexico
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Saxena P, Lalchandani A, Dausage C. Recurrent phyllodes tumour of breast infiltrating the latissimus dorsi reconstruction flap. BMJ Case Rep 2020; 13:13/12/e238306. [PMID: 33318256 PMCID: PMC7737035 DOI: 10.1136/bcr-2020-238306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Phyllodes tumour is a rare breast tumour with potential of malignancy. Recurrence in phyllodes tumour may also be suggestive of malignant transformation. We report a case of 29-year-old woman with recurrent phyllodes tumour infiltrating the latissimus dorsi reconstruction flap. Re-excision of the tumour along with excision of latissimus dorsi flap was done. Histopathology confirmed malignant phyllode tumour. A significantly higher incidence of recurrence is seen in phyllodes tumour of large size, tumours with infiltrative borders, increased mitotic activity, malignant histology and positive margins. Surgeons should always take into consideration the risk factors for recurrence before planning reconstructive breast surgery in recurrent phyllodes tumour. A preoperative MRI imaging and incisional biopsy are essential in planning surgery for these patients.
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Affiliation(s)
- Pradeep Saxena
- General Surgery, All India Institute of Medical Science—Bhopal, Bhopal, Madhya Pradesh, India
| | - Ankit Lalchandani
- General Surgery, All India Institute of Medical Science—Bhopal, Bhopal, Madhya Pradesh, India
| | - Chirag Dausage
- General Surgery, All India Institute of Medical Science—Bhopal, Bhopal, Madhya Pradesh, India
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Prihantono, Satria B, Faruk M. Juvenile phyllodes tumor of the breast. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Paryani J. A Huge Benign Phyllodes Tumour of the Breast: a Rare Entity. Indian J Surg Oncol 2019; 10:389-391. [PMID: 31168269 DOI: 10.1007/s13193-019-00911-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/07/2019] [Indexed: 12/23/2022] Open
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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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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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Pacioles T, Seth R, Orellana C, John I, Panuganty V, Dhaliwal R. Malignant phyllodes tumor of the breast presenting with hypoglycemia: a case report and literature review. Cancer Manag Res 2014; 6:467-73. [PMID: 25525388 PMCID: PMC4266253 DOI: 10.2147/cmar.s71933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Phyllodes tumors are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors and are typically found in middle-aged women. Phyllodes tumors that present with hypoglycemia are even rarer. No one morphologic finding is reliable in predicting the clinical behavior of this tumor. Surgery has been the primary mode of treatment to date. However, the extent of resection and the role of adjuvant radiotherapy or chemotherapy are still controversial. Here, we present a challenging case of malignant phyllodes tumor of the breast associated with hypoglycemia, and review the literature regarding clinical findings, pathologic risk factors for recurrence, and treatment recommendations.
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Affiliation(s)
- Toni Pacioles
- Department of Hematology and Oncology, Edwards Comprehensive Cancer Center, Marshall University, Huntington, WV, USA
| | - Rahul Seth
- Division of Hematology and Oncology, SUNY Upstate Medical University, Syracuse, NY, USA ; Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Cesar Orellana
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ivy John
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Veera Panuganty
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ruban Dhaliwal
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA ; Division of Endocrinology, SUNY Upstate Medical University, Syracuse, NY, USA
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Gibbings KW, Warrier S, Hwang S, Rice M, O'Toole S, Carmalt H. A giant phyllodes tumour with sepsis. ANZ J Surg 2013; 84:886-7. [PMID: 24172040 DOI: 10.1111/ans.12340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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