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Huang Y, Yao G, Wan Y. Clinical and radiological evaluation of a phyllodes tumor of the breast: a case report. Anticancer Drugs 2024; 35:203-208. [PMID: 38085253 DOI: 10.1097/cad.0000000000001548] [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: 01/09/2024]
Abstract
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.
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Affiliation(s)
- Yan Huang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine & Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China
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Shaashua L, Eckerling A, Israeli B, Yanovich G, Rosenne E, Fichman-Horn S, Ben Zvi I, Sorski L, Haldar R, Satchi-Fainaro R, Geiger T, Sloan EK, Ben-Eliyahu S. Spontaneous regression of micro-metastases following primary tumor excision: a critical role for primary tumor secretome. BMC Biol 2020; 18:163. [PMID: 33158447 PMCID: PMC7646068 DOI: 10.1186/s12915-020-00893-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/09/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Numerous case studies have reported spontaneous regression of recognized metastases following primary tumor excision, but underlying mechanisms are elusive. Here, we present a model of regression and latency of metastases following primary tumor excision and identify potential underlying mechanisms. RESULTS Using MDA-MB-231HM human breast cancer cells that express highly sensitive luciferase, we monitored early development stages of spontaneous metastases in BALB/c nu/nu mice. Removal of the primary tumor caused marked regression of micro-metastases, but not of larger metastases, and in vivo supplementation of tumor secretome diminished this regression, suggesting that primary tumor-secreted factors promote early metastatic growth. Correspondingly, MDA-MB-231HM-conditioned medium increased in vitro tumor proliferation and adhesion and reduced apoptosis. To identify specific mediating factors, cytokine array and proteomic analysis of MDA-MB-231HM secretome were conducted. The results identified significant enrichment of angiogenesis, growth factor binding and activity, focal adhesion, and metalloprotease and apoptosis regulation processes. Neutralization of MDA-MB-231HM-secreted key mediators of these processes, IL-8, PDGF-AA, Serpin E1 (PAI-1), and MIF, each antagonized secretome-induced proliferation. Moreover, their in vivo simultaneous blockade in the presence of the primary tumor arrested the development of micro-metastases. Interestingly, in the METABRIC cohort of breast cancer patients, elevated expression of Serpin E1, IL-8, or the four factors combined predicted poor survival. CONCLUSIONS These results demonstrate regression and latency of micro-metastases following primary tumor excision and a crucial role for primary tumor secretome in promoting early metastatic growth in MDA-MB-231HM xenografts. If generalized, such findings can suggest novel approaches to control micro-metastases and minimal residual disease.
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Affiliation(s)
- Lee Shaashua
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Anabel Eckerling
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Boaz Israeli
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Gali Yanovich
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ella Rosenne
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Suzana Fichman-Horn
- Pathology Institute, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | - Ido Ben Zvi
- Neurosurgery Department, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | - Liat Sorski
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Rita Haldar
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Ronit Satchi-Fainaro
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Geiger
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erica K Sloan
- Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Shamgar Ben-Eliyahu
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel.
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Chen G, Sun S, Du Z, Sun Y, Pan Z, Che X, Xie R. Intra-Extracranial Primary Clear Cell Sarcoma: The First Report and Review of the Literature. World Neurosurg 2019; 126:e1140-e1146. [PMID: 30880192 DOI: 10.1016/j.wneu.2019.02.216] [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: 12/27/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clear cell sarcoma (CCS) is a rare malignant soft tissue tumor with poor prognosis owing to metastasis and insensitive response to chemotherapy and radiotherapy. METHODS We first searched PubMed and Embase using the terms "clear cell sarcoma," "malignant melanoma of soft tissue," "head," and "neck." In the 15 articles selected for literature review, only 27% (4/15) of patients were diagnosed with primary CCS of the head. Pathologically, those tumors arose from either the scalp or the superficial temporal fascia, but none invaded the skull and brain. Next, the search was performed in the same database using the terms "clear cell sarcoma," "malignant melanoma of soft tissue," and "bone," and only 24 articles were selected. RESULTS In the case reported here, a 36-year-old woman was found to have a palpable mass located at the left temporal-occipital region, and surgical finding confirmed the invasion into the skull and the brain. The diagnosis of primary CCS was made because of the detection of t(12;22)(q13;q12) in >50% of tumor cells by fluorescence in situ hybridization, and metastasis to the lymph nodes and lungs was discovered by postoperative positron emission tomography-computed tomography. CONCLUSIONS To the best of our knowledge, this is the first case of primary central nervous system CCS. Primary CCS may involve the skull and should be one of the differential diagnoses for intra-extracranial communicating tumors. Further research on biological characteristics and molecular targeted therapy of CCS are needed to improve its poor prognosis.
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Affiliation(s)
- Gong Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shifeng Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zunguo Du
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yirui Sun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiguang Pan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Che
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Xie
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
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Metastatic Malignant Phyllodes Tumor of the Breast: An Aggressive Disease-Analysis of 7 Cases. Indian J Surg Oncol 2015; 6:363-9. [PMID: 27065662 DOI: 10.1007/s13193-015-0397-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022] Open
Abstract
Malignant phyllodes tumor (PT) of the breast behaves aggressively and the presentation of distant metastases is varied, ranging from synchronous or short interval commonly to a decade rarely. To assess the clinical and temporal pattern of distant metastases in malignant PTs. A retrospective analysis of patients with Phyllodes tumor of the breast from January, 2001 to November, 2014. There were a total of 167 patients with PT; 49 (29 %) were malignant PT out of which 7 developed distant metastases. Detailed analysis of these 7 patients showed that mean age was 36.71 years (range 28-53 years). Three of the seven patients had additional local recurrences post lumpectomy. The procedure performed were wide local excision with muscle reconstruction (n = 1), lumpectomy (n = 1) and mastectomy (n = 5). The distant metastases were synchronous (n = 2) and other 5 had metastases developing within 2 months to 13 years. The sites for distant metastases included lung, brain, adrenal, para-aortic nodes and bone. Six patients received palliative chemotherapy (CT) and 2 also had radiation therapy for brain metastasis. Only 1 patient is alive and receiving CT and all others succumbed to the disease. Patients with malignant PT of the breast with distant metastases behave aggressively and have a dismal outcome with rare exceptions. They need multimodality therapy and close follow up. Newer targeted therapies may have a role to improve the outcome.
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