Gaint phyllodes tumour with axillary & interpectoral lymph node metastasis; A rare presentation

Clinical and radiological evaluation of a phyllodes tumor of the breast: a case report

Phyllodes tumors (PTs) are rare breast tumors characterized by varying biological behavior and heterogeneous clinical findings. As a result, accurately diagnosing PTs preoperatively is challenging, often leading to misdiagnosis. A 49-year-old patient presented with a steadily growing right breast mass that had persisted over a 10-year period. Breast mammography and ultrasonography results indicated the presence of a PT. Following a lumpectomy, the patient was diagnosed with a borderline PT. However, nearly 1 year later, she was readmitted due to the recurrence of a palpable mass at the site. Consequently, 1 year and 8 months after the initial operation, she underwent thoracoscopic lobectomy to address solitary lung metastases. Subsequently, the patient experienced brain metastasis and massive hemorrhage 14 months later. Long-term follow-up was recommended. This case study presents an instance of borderline PT with clinical and imaging features that are crucial for guiding clinical operations and evaluating patient prognosis.

A Large Phyllodes Tumor With Axillary Lymph Node Involvement: A Case Report

Malignant phyllodes tumors of the breast are uncommon and complex to treat. This case involves a 39-year-old woman with a rapidly growing mass in her right breast measuring 32cm. The patient underwent a bilateral mastectomy with a right sentinel node biopsy and right chest wall reconstruction. The final pathology of the tumor revealed a malignant phyllodes tumor, with one of two right axillary lymph nodes positive for metastatic phyllodes tumor. Malignant phyllodes tumors should be taken into consideration in any rapidly growing breast mass. Further studies analyzing the treatment of malignant phyllodes tumors are necessary to reduce the risk of tumor recurrence and metastasis.

Understanding the significance of biological clock and its impact on cancer incidence

The circadian clock is an essential timekeeper that controls, for humans, the daily rhythm of biochemical, physiological, and behavioral functions. Irregular performance or disruption in circadian rhythms results in various diseases, including cancer. As a factor in cancer development, perturbations in circadian rhythms can affect circadian homeostasis in energy balance, lead to alterations in the cell cycle, and cause dysregulation of chromatin remodeling. However, knowledge gaps remain in our understanding of the relationship between the circadian clock and cancer. Therefore, a mechanistic understanding by which circadian disruption enhances cancer risk is needed. This review article outlines the importance of the circadian clock in tumorigenesis and summarizes underlying mechanisms in the clock and its carcinogenic mechanisms, highlighting advances in chronotherapy for cancer treatment.

Successful Treatment of a Locally Recurrent and Metastatic Malignant Phyllodes Tumor with Accelerated Radiotherapy and Nab-Paclitaxel, Cisplatin, and Liposomal Doxorubicin Chemotherapy

Phyllodes tumors are rare breast lesions of fibroepithelial origin. Malignant transformation with metastases is linked with poor prognosis. We present a case of a 62-year-old woman with a recurrent malignant phyllodes tumor of the breast and lung metastases. The patient was originally presented with a borderline phyllodes tumor (7.4 cm) of the left breast, treated with wide local excision. A year later, the patient returned with palpable left breast masses. On PET-CT, increased uptake of 18F-FDG by large breast tumors was evident. A right lung lesion of metastatic origin was also present. A simple left breast mastectomy was performed. Histopathological report described 2 malignant phyllodes tumors (7 cm and 6.5 cm). One month later, during the CT simulation for radiotherapy planning, encysted fluid in the chest wall and 2 additional pulmonary lesions of the right lung were identified, confirming progressive lung metastatic disease. Both the chest wall and the regional lymph node area were irradiated with hypofractionated and accelerated radiotherapy. Biweekly chemotherapy with albumin-bound paclitaxel, cisplatin, and liposomal doxorubicin was also prescribed at the start of radiotherapy for 12 cycles. At the end of chemotherapy, complete regression of lung metastases was achieved, and there was no evidence of local recurrence. Within 2 years of follow-up, the patient is free of disease and treatment-related toxicities. Accelerated hypofractionated radiotherapy is effective in the locoregional control of malignant phyllodes tumors. The combination of cisplatin with nab-paclitaxel and liposomal doxorubicin chemotherapy has acceptable toxicity and is highly effective in eradicating metastatic lesions.

Rare case of gigantic ulcerating phyllodes tumour in developed country with a review of the literature

Phyllodes tumour (PT) is a rare type of fibroepithelial breast tumour that can present in a wide spectrum of biological behaviours, accounting for <1% of breast malignancies. Herein, we present a case of a rare gigantic ulcerating PT in a middle-aged woman from regional Western Australia, who presented with a rapidly growing right breast mass. Core biopsy showed spindle cell lesion with differentials being PT of at least borderline variety or metaplastic carcinoma. The ulcerations over the fungating tumour showed heavy growth of Staphylococcus aureus. The treating team subsequently proceeded to right total mastectomy with level 1 and 2 axillary clearance. This report emphasizes the rare presentation of PT, dilemma in investigations and the difficulties in managing non-compliant patient where treatment protocol needs to be modified.

Phyllodes Tumours Will Only Get Bigger During Pandemic Restrictions

Phyllodes tumours of the breast are rare fibroepithelial stromal tumours which are morphologically very different from epithelial breast cancer. Its diagnosis and management has always been challenging till the World Health Organization (WHO) divided it into two-three subtypes in 2003, only then it was found that incidence and management and follow-up of these three subtypes need to be completely different to reach the optimum outcome.

We are presenting a case of a 47-year-old female who presented relatively late (due to pandemic restrictions) with a large phyllodes tumour requiring mastectomy as well as adjuvant treatment.

Malignant phyllodes tumor of the breast with rapid progression: a case report

BACKGROUND

Malignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period.

CASE PRESENTATION

A 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin-ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy.

CONCLUSIONS

A standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

Introduction

Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on disease-specific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria.

Methods

We conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes - distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients' survival. The receiver operating characteristic curve was plotted to determine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan-Meier method.

Results

Sixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 ± 11.8 years. Tumour size (p = 0.018), histological type (p = 0.015), grade (p = 0.006), resection margin (p = 0.023), number of harvested nodes (p < 0.01), number of metastatic nodes (p < 0.001) and loco-regional recurrence (p < 0.01) are associated with survival. The overall 5-year survival was 65.3%.

Conclusion

Unfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.