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Kaiser C, Abramian AV, Faridi A. Surgical Management and System Therapy of the Most Giant Known Malignant Metastatic Breast Phyllodes Tumor: A Case Report and Review of the Literature. Oncol Res Treat 2024; 47:145-148. [PMID: 38382477 DOI: 10.1159/000537956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Phyllodes tumors belong to uncommon fibroepithelial breast tumors with a range of biological behaviors. Phyllodes tumors are responsible for less than 1 percent of all neoplasms of the breast. CASE PRESENTATION A 66-year-old woman presented to our Breastcancer Unit in March 2021 because of a huge mass of her left breast with bleeding out of a tumor necrosis. Five years ago in 2016, a benign phyllodes tumor was diagnosed externally. When we started the treatment, the tumor had a weight of 18.6 kg. CONCLUSION We describe the surgical management and the systemic treatment of metastatic disease.
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Affiliation(s)
| | | | - Andree Faridi
- Department of Senology, University hospital Bonn, Bonn, Germany
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2
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Tan PH. Refining the classification of breast phyllodes tumours. Pathology 2023; 55:437-448. [PMID: 37085395 DOI: 10.1016/j.pathol.2023.02.001] [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: 11/20/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 04/23/2023]
Abstract
Phyllodes tumours of the breast are uncommon fibroepithelial neoplasms that pose recurrent classification challenges, in large part due to the multiple histological parameters of stromal hypercellularity and atypia, stromal mitotic count, stromal overgrowth and tumour borders, that are used for grading. While the World Health Organization (WHO) Classification of Breast Tumours provides recommendations on diagnostic features, defining criteria are not always applied in routine practice. Lack of concordance among pathologists in typing and grading further underscores the classification difficulties, especially in the borderline category. Although there has been significant molecular information on phyllodes tumours in recent years which has been diagnostically helpful, it has not been translated into daily clinical practice. In order to refine the classification of phyllodes tumours into one that is simple yet comprehensive, reproducible and prognostically precise, a multipronged approach is needed that leverages on global contributions of the International Fibroepithelial Consortium, support by the International Collaboration on Cancer Classification and Research (IC3 R) in amalgamating evidence translation, and guidance from the International Collaboration on Cancer Reporting (ICCR) for standardised reporting. It is hoped that the evidence generated can be used towards refining the classification of phyllodes tumours for the future.
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Affiliation(s)
- Puay Hoon Tan
- Luma Medical Centre, Singapore; KK Women's and Children's Hospital, Singapore; Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pathology, University of Western Sydney, Sydney, NSW, Australia.
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Malignant phyllodes tumor of the breast with metastases to the lungs: A case report and literature review. Radiol Case Rep 2022; 17:4006-4012. [PMID: 36039084 PMCID: PMC9418210 DOI: 10.1016/j.radcr.2022.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breasts. Approximately 10%-15% of PTs are malignant, and 9%-27% of patients with malignant PTs, develop metastatic disease. The lungs are the most common target organ for distant metastasis of PT. We report a case of 44-year-old female with a malignant PT. It had recurred locally 3 times, and 3 relapses occurred 13 months after the first diagnosis, presenting multiple metastases to the lungs by CT scan. The patient underwent radiation therapy, and palliative chemotherapy with doxorubicin was initiated. Two courses of doxorubicin therapy were administered, but the patient expired 16 months after PT diagnosis. We present a rare case of malignant PT with local recurrences, lung metastases, and poor patient outcome. Although malignant breast PTs have an unfavorable prognosis, adjuvant radiotherapy combined with margin-negative resection may be associated with decreased local recurrence and distant metastasis rates. Future research should include randomized clinical trials or well-designed prospective matched studies to clarify the effectiveness of treatments of PTs.
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Lissidini G, Mulè A, Santoro A, Papa G, Nicosia L, Cassano E, Ashoor AA, Veronesi P, Pantanowitz L, Hornick JL, Rossi ED. Malignant phyllodes tumor of the breast: a systematic review. Pathologica 2022; 114:111-120. [PMID: 35414723 PMCID: PMC9248247 DOI: 10.32074/1591-951x-754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumors (PT) are fibroepithelial neoplasms of the breast showing a peculiar leaf-like appearance. They account for 0.3 to 1% of all primary breast tumors and 2.5% of all fibroepithelial breast tumors. PT are classified into benign, borderline and malignant based upon their stromal morphology with a distribution of 60%, 20%, and 20%, respectively. Malignant PT of the breast constitute an uncommon challenging group of fibroepithelial neoplasms. They have a relatively high tendency to recur, although distant metastasis is uncommon, and nearly exclusive to malignant PT. Adequate surgical resection remains the standard approach to achieve maximal local control. Giant malignant PT are rare and a pose a diagnostic dilemma for pathologists, especially when comprised of sarcomatous elements. This review highlights the morphological features of PT detected in cytology and histology specimens and discusses diagnostic pitfalls and differential diagnosis.
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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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Liu HP, Chang WY, Hsu CW, Chien ST, Huang ZY, Kung WC, Liu PH. A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature. BMC Surg 2020; 20:187. [PMID: 32799838 PMCID: PMC7430829 DOI: 10.1186/s12893-020-00846-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Phyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported in up to 22% of malignant PTs, with most metastases being discovered in the lungs. PTs of the breast rarely metastasize to the gastrointestinal tract, and reported cases are scarce. To date, a review of the English literature revealed only 3 cases, including our case, of PTs metastasis to stomach. CASE PRESENTATION An 82-year-old female patient had 10-year-duration of palpable huge tumor on left breast which was in rapid growth in recent months. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Adjuvant radiotherapy was suggested while she declined out of personal reasons initially. For PTs recurred locally on left chest wall 2 months later, and excision of the recurrent PTs was performed. She, at length, completed adjuvant radiation therapy since then. Six months later, she was diagnosed of metastasis to stomach due to severe anemia with symptom of melena. Gastrostomy with tumor excision was performed for uncontrollable tumor bleeding. CONCLUSION For PTs presenting as anemia without known etiologies, further studies are suggested to rule out possible gastrointestinal tract metastasis though such cases are extremely rare. Management of metastatic gastric tumor from PTs should be done on a case-to-case basis, surgical intervention may be needed if there is persistent active bleeding despite medical treatment. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely.
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Affiliation(s)
- Hui-Pu Liu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 802, Taiwan
| | - Wen-Yen Chang
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 802, Taiwan.
| | - Chin-Wen Hsu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 802, Taiwan
| | - Shan-Tao Chien
- Department of Pathology, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 802, Taiwan
| | - Zheng-Yi Huang
- Department of Pathology, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 802, Taiwan
| | - Wen-Ching Kung
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 802, Taiwan
| | - Ping-Hung Liu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 802, Taiwan
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Abstract
Phyllodes tumor (PT) occurs predominantly in middle-aged women, and although its occurrence in young women, adolescents, and even children is documented, presentation in the pediatric population has been the least well studied because of its rarity. Incompletely defined in children with PT are recurrence rates and optimal surgical management. We retrospectively studied the pathology database of Hartford Hospital from 2010 to 2017 to find all cases of PT in patients 18 years of age or younger. A series of 8 children/adolescents with breast masses diagnosed as benign PT were identified. Patients were 14 to 16 years of age (mean 15.2 y) and tumor size ranged from 2.2 to 7.2 cm (mean 4.4 cm). Both breasts were equally affected. All patients were treated with excision, tantamount to simple enucleation in most cases, and positive or "tumor-abutting" margins were universal. Mean follow-up after surgery was 27.5 months, during which time a single recurrence (at 9 mo) became manifest, which was re-excised and again showed benign PT. There were no pathologic features (including marginal status) that could have predicted the sole recurrence. Despite positive margins, the local recurrence rate for pediatric benign PT appears acceptably low (1 in 8 cases) such that reflex re-excision is probably unnecessary.
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Neron M, Sajous C, Thezenas S, Piperno-Neumann S, Reyal F, Laé M, Chakiba C, Michot A, Penel N, Honoré C, Owen C, Bertucci F, Salas S, Saada-Bouzid E, Valentin T, Bompas E, Brahmi M, Ray-Coquard I, Blay JY, Firmin N. Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study. Ann Surg Oncol 2020; 27:1818-1827. [PMID: 31989361 DOI: 10.1245/s10434-020-08217-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated. PATIENTS AND METHODS We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates. RESULTS Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1-2 mm margins, 12.2% of patients with 3-7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (p < 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3, p = 0.005) and OS (HR 0.32, p = 0.005) compared with margins of 0-1-2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3-7 mm (3-7 mm vs. > 8 mm; HR 0.81, p = 0.69). Age (HR 2.14, p = 0.038) and tumor necrosis (HR 1.96, p = 0.047) were found to be poor prognostic factors and were associated with MFS. CONCLUSIONS This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0-1-2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.
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Affiliation(s)
- Mathias Neron
- Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France.
| | - Christophe Sajous
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Simon Thezenas
- Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
| | | | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, Paris, France
| | - Marick Laé
- Department of Pathology, Institut Curie, Paris, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Audrey Michot
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Penel
- Department of Medical Oncology, Institut Oscar Lambret, Lille, France
| | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Clémentine Owen
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Sébastien Salas
- Department of Medical Oncology, CHU La Timone, Marseille, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France
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9
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Ren J, Jin L, Leng B, Hu R, Jiang G. Surgical excision and oncoplastic breast surgery in 32 patients with benign phyllodes tumors. World J Surg Oncol 2018; 16:153. [PMID: 30041698 PMCID: PMC6058379 DOI: 10.1186/s12957-018-1453-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to assess the effectiveness and safety in patients with benign phyllodes after performing local excision and following with intra-operative breast flap reconstruction. Methods Patients (n = 32) with eligible breast cystosarcoma phyllodes underwent wide local excision followed by intra-operative breast flap reconstruction. Primary outcome measures included average operative time, length of in-hospital stay, postoperative recurrence, and intra-operative and postoperative complications. Results Thirty-two patients who underwent surgical excision and oncoplastic breast surgery were evaluated using the BCCT.core software. A satisfactory symmetrical breast shape was achieved. The average operative time was 56.3 ± 8.2 min. The average postoperative duration of hospitalization was 3.7 ± 1.2 days. While there was no breast disease recurred during the 1 to 8-year follow-up period. Conclusions Wide local excision accompanied by intra-operative breast flap reconstruction could be adopted for removing benign phyllodes tumors while retaining the basic shape of the breast.
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Affiliation(s)
- Jie Ren
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Liyan Jin
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Department of Thyroid and Breast Surgery, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215006, China
| | - Bingjing Leng
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Rongkuan Hu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Guoqin Jiang
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Yoshiba S, Saotome T, Mikogami T, Shirota T. Metastasis of Mammary Gland Malignant Phyllodes Tumor to the Mandibular Region: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2016; 75:440.e1-440.e9. [PMID: 27765548 DOI: 10.1016/j.joms.2016.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022]
Abstract
Phyllodes tumor is a rare breast tumor described by Müller (1938) as a lesion comprising leaflike stromal fibrous components and narrow cysts. The frequency of distant metastasis from this entity is reportedly approximately 20%, and no effective therapy has been established, so the prognosis is poor. This report describes the case of a 60-year-old woman with a history of left lung resection who showed metastasis of a mammary gland malignant phyllodes tumor to the oral cavity. Intraoral examination showed an elastic, hard mass measuring 28 × 27 mm in the gingiva around the left mandibular second molar. Biopsy examination showed growth of giant cells and roughly circular cells showing positivity for S-100, p63, and vimentin on immunohistochemical staining. The authors diagnosed metastasis of the mammary gland malignant phyllodes tumor to the left mandible and performed cyber knife irradiation (44 Gy in 5 fractions) of the left mandible. The mass in the oral cavity disappeared after cyber knife irradiation, but the patient died of direct invasion to the spine.
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Affiliation(s)
- Sayaka Yoshiba
- Assistant Professor, Showa University Northern Yokohama Hospital, Dentistry and Oral Surgery, Kanagawa; Department of Oral and Maxillofacial Surgery, Showa University School of Dentistry, Tokyo, Japan.
| | - Takashi Saotome
- Department Head, Department of Medical Oncology, Matsudo City Hospital, Chiba, Japan
| | - Tetsuya Mikogami
- Lecturer, Department of Clinico-Diagnostic Pathology, Showa University Northern Yokohama Hospital, Diagnostic Pathology, Kanagawa, Japan
| | - Tatsuo Shirota
- Professor, Department of Oral and Maxillofacial Surgery, Showa University School of Dentistry, Tokyo, Japan
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Sarcomas of the Breast with a Spotlight on Angiosarcoma and Cystosarcoma Phyllodes. Surg Oncol Clin N Am 2016; 25:713-20. [DOI: 10.1016/j.soc.2016.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Choi DI, Chi HS, Lee SH, Kwon Y, Park SY, Sim SH, Park IH, Lee KS. A Rare Case of Phyllodes Tumor Metastasis to the Stomach Presenting as Anemia. Cancer Res Treat 2016; 49:846-849. [PMID: 27586673 PMCID: PMC5512377 DOI: 10.4143/crt.2016.188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/11/2016] [Indexed: 11/21/2022] Open
Abstract
Metastasis of a phyllodes tumor to the stomach is an extremely rare condition with important clinical implications. A 44-year-old woman was initially diagnosed with a phyllodes tumor in her right breast in 2008, and subsequently presented to an outpatient clinic with dizziness on December 16, 2013. We found that she had severe anemia (hemoglobin levels, 6.7 g/dL), and we quickly performed esophagogastroduodenoscopy to identify the cause. This procedure revealed large ulcerofungating masses with active bleeding in the stomach. Histopathological examination revealed that the masses were consistent with phyllodes tumor metastases. In patients with a metastatic phyllodes tumor presenting as anemia, gastric metastasis should be considered as one of the differential diagnoses because overlooking the possibility might have dire consequences if cytotoxic chemotherapy were administered.
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Affiliation(s)
- Do Il Choi
- Department of Internal Medicine, National Cancer Center Hospital, Goyang, Korea
| | - Ho Seok Chi
- Department of Internal Medicine, National Cancer Center Hospital, Goyang, Korea
| | - Sang Ho Lee
- Department of Internal Medicine, National Cancer Center Hospital, Goyang, Korea
| | - Youngmee Kwon
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seog Yun Park
- Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Hoon Sim
- Department of Internal Medicine, National Cancer Center Hospital, Goyang, Korea.,Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - In Hae Park
- Department of Internal Medicine, National Cancer Center Hospital, Goyang, Korea.,Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Keun Seok Lee
- Department of Internal Medicine, National Cancer Center Hospital, Goyang, Korea.,Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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An 11 kg Phyllodes tumor of the breast in combination with other multiple chronic diseases: Case report and review of the literature. Oncol Lett 2013; 6:150-152. [PMID: 23946794 PMCID: PMC3742775 DOI: 10.3892/ol.2013.1361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 05/01/2013] [Indexed: 12/29/2022] Open
Abstract
Phyllodes tumors (PTs) of the breast are a rare type of tumor that account for <1% of breast tumors in females and usually present as a large lump of 3–5 cm in size. Surgery is the first line of treatment for PTs, and chemotherapy and irradiation may be useful in certain patients but not all. In the present study, the case of a 63-year-old female patient with a huge PT in the left breast is described. On physical examination, the patient presented with a huge mass of ∼45 cm in diameter, weighing ∼11 kg, and a composite of multiple chronic diseases. The breast and pectoris major and minor were excised. Post-operatively, the patient recovered well and to date there has been no evidence of local recurrence or distant metastasis.
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Abdelkrim SB, Trabelsi A, Bouzrara M, Boudagga MZ, Memmi A, Bakir DA, Mokni M. Phyllodes Tumors of the Breast: A Review of 26 Cases. World J Oncol 2010; 1:129-134. [PMID: 29147192 PMCID: PMC5649936 DOI: 10.4021/wjon2010.06.220w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2010] [Indexed: 11/03/2022] Open
Abstract
Background Phyllodes tumors of the breast are rare and locally aggressive neoplasms. Our study aimed to report the experience of the Farhat Hached Hospital (Sousse, Tunisia) acquired during a 7-year period and to give an additional review of the available literature. Methods The authors analyzed retrospectively clinical, radiological, histopathological and therapeutic features as well as outcome in a series of 26 cases diagnosed as phyllodes tumors of the breast at the Pathology Department of Farhat Hached Hospital, Sousse, Tunisia, from 2003 to 2009. The slides were reviewed in order to classify the tumors into benign, borderline and malignant on the basis of the criteria proposed by the World Health Organization. Results All the cases occurred in women. The analysis of this series showed the following characteristics: mean age at diagnosis was 40 years (19 - 66), tumor size was 1.5 - 40 cm (mean: 7.8 cm); the chief complaint was a mammary mass; the right breast was affected in 14 cases, the upper outer quadrant was the most commonly involved site (42.3%); surgical treatment was used in all cases, 21 patients (80.8%) were treated conservatively (13 benign, 6 borderline, and 2 malignant) and 5 (19.2%) by radical surgery (1 borderline and 4 malignant); seven patients underwent post-operative radiotherapy; in 14/19 cases (73.7%), a good correlation was observed between intraoperative frozen section analysis and definitive histology; the tumor was classed as benign in 13 cases (50%), borderline in 7 cases (27%) and malignant in 6 cases (23%); follow-up data was available in 22 cases; the rate of recurrence was 23% (1 benign, 3 borderline, and 2 malignant) after a mean follow-up of 13.6 months; all the recurrent tumors were initially treated by lumpectomy and were close to margin at the initial pathologic examination; the treatment of recurrences consisted of simple mastectomy in 5 cases, and local excision in one case; three patients developed metastases, one of whom after recurrence; three patients have died. Conclusions This is a substantial single institution experience of a rare tumor. Phyllodes tumors of the breast have an unpredictable outcome, thus a wide local excision, with an adequate margin of normal breast tissue, is the preferred initial therapy.
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Affiliation(s)
| | - Amel Trabelsi
- Department of Pathology, Farhat Hached Hospital, 4000, Sousse, Tunisia
| | - Mouna Bouzrara
- Department of Pathology, Farhat Hached Hospital, 4000, Sousse, Tunisia
| | | | - Anis Memmi
- Department of Gynecology, Farhat Hached Hospital, 4000, Sousse, Tunisia
| | | | - Moncef Mokni
- Department of Pathology, Farhat Hached Hospital, 4000, Sousse, Tunisia
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16
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Affiliation(s)
- Kristin L Cox
- Virginia Clinton Kelley/FFANY Breast Fellowship, Komen Interdisciplinary Breast Fellowship, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Lee HS, Kim HA, Shin DS, Kim YH, Chung SY, Jin MS, Kim MS, Lee JI, Paik NS, Moon NM, Noh WC. Risk Factors for Recurrence After Surgical Treatment of a Malignant Phyllodes Tumor of the Breast. J Breast Cancer 2007. [DOI: 10.4048/jbc.2007.10.4.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hee-Sang Lee
- Department of Surgery, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Dong-Sun Shin
- Department of Surgery, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Yang-Hee Kim
- Department of Surgery, Kangwon National University, College of Medicine, Chuncheon, Korea
| | - Soo-Young Chung
- Department of Anatomical Pathology, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Min-Sun Jin
- Department of Anatomical Pathology, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Min-Suk Kim
- Department of Anatomical Pathology, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Jong-Inn Lee
- Department of Surgery, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Nam-Sun Paik
- Department of Surgery, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Nan-Mo Moon
- Department of Surgery, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
| | - Woo-Chul Noh
- Department of Surgery, Korea Institution of Radiological and Medical Science, Korea Cancer Center Hospital, Seoul, Korea
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Deeming G, Divakaran R, Butterworth D, Foster M. Temporomandibular region metastasis from cystosarcoma phyllodes: a case report and review of the literature. J Craniomaxillofac Surg 2004; 31:325-8. [PMID: 14563335 DOI: 10.1016/s1010-5182(03)00019-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A rare breast tumour (Cystosarcoma phyllodes) in a 58-year-old female metastasizing to the temporomandibular region and infra-temporal fossa, presenting as temporomandibular pain dysfunction syndrome is reported, along with a literature review.
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Affiliation(s)
- Guy Deeming
- Department of Oral and Maxillofacial Surgery, North Manchester General Hospital, Manchester, UK
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20
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Staton JB, Costello TH, Donovan FD, Laster RE. Cystosarcoma Phyllodes Metastatic to the Mandible: Report of a Rare Case and Literature Review. EAR, NOSE & THROAT JOURNAL 2003. [DOI: 10.1177/014556130308200513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cystosarcoma phyllodes is a rare breast tumor with variable malignant potential. Metastasis has been reported in a small percentage of cases. We describe the case of a 52-year-old woman who developed a large facial tumor 1 year after she had undergone a mastectomy fora rapidly enlarging breast neoplasm. The facial lesion was found to be a malignant cystosarcoma phyllodes metastatic to the mandible, and the patient died shortly after diagnosis. To our knowledge, this patient represents only the third reported case of a phyllodes tumor metastatic to the mandible.
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Affiliation(s)
- Jonathan B. Staton
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis
| | - Thomas H. Costello
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis
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Hopkins ML, McGowan TS, Rawlings G, Liu FF, Fyles AW, Yeoh JL, Manchul L, Levin W. Phylloides tumor of the breast: a report of 14 cases. J Surg Oncol 1994; 56:108-12. [PMID: 8007675 DOI: 10.1002/jso.2930560213] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objective of this retrospective study is to determine the role of radiation therapy in the management of benign phylloides tumors. Fourteen patients with a diagnosis of benign phylloides tumor (PT) and registered at the Princess Margaret Hospital are included in the study. Definitive surgery consisted of either lumpectomy in seven patients or mastectomy in the other seven patients. One patient died of her disease, and the remaining patients had no evidence of disease at last follow-up (median 38.4 months). Among these 13 patients, 4 had at least one recurrence and the recurrence rate was higher for the group who underwent lumpectomy (43% compared with 28%). One patient was treated by lumpectomy and adjuvant radiation therapy, and had no subsequent recurrence (follow-up time 35.5 months). The role for radiation therapy in the management of this disease remains unclear.
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Affiliation(s)
- M L Hopkins
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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24
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Morimoto T, Tanaka T, Komaki K, Sasa M, Monden Y, Kumagai H, Otsuka H. The coexistence of lobular carcinoma in a fibroadenoma with a malignant phyllodes tumor in the opposite breast: report of a case. Surg Today 1993; 23:656-60. [PMID: 8396471 DOI: 10.1007/bf00311918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
It is very unusual for a carcinoma of the breast to coexist with a phyllodes tumor, or for a carcinoma to arise within a fibroadenoma. We present herein an extremely rare case of lobular carcinoma in situ arising in a fibroadenoma, associated with a malignant phyllodes tumor in the opposite breast. A 49-year-old woman was admitted to our hospital with a large mass in the right breast and a small mass in the left breast. Microscopic examination of biopsy materials revealed a malignant phyllodes tumor in the right breast and a fibroadenoma in the left breast, for which a right standard radical mastectomy and left lumpectomy were performed. Microscopic findings of the material excised from the left breast showed the presence of multiple lobular carcinoma in situ within the tumor mass of the fibroadenoma. However, histological examination did not detect any metastasis to the bilateral axillary lymph nodes. To our knowledge this is the only such case ever to be reported in Japan.
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Affiliation(s)
- T Morimoto
- School of Medical Sciences, University of Tokushima, Japan
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25
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Abstract
We report a rare example of bilateral primary malignant phyllodes tumours. The diagnosis was supported by the identification of a benign epithelial element in each lesion. The case illustrates the typical dimorphic features of malignant phyllodes tumours. A contralateral tumour should not be regarded as metastatic without histological confirmation.
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Affiliation(s)
- A B Ball
- Academic Surgical Unit, Royal Marsden Hospital, London, England
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26
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Lewko WM, Vaghmar R, Maleckar JR, Husseini S, Montgomery CA, Thurman GB, Oldham RK. Cultured breast cystosarcoma phylloides cells and applications to patient therapy. Breast Cancer Res Treat 1990; 17:131-8. [PMID: 1965788 DOI: 10.1007/bf01806293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Malignant cystosarcoma phylloides (CP) is a relatively rare cancer of the breast. A CP tumor was processed as part of a tumor acquisition, propagation, and preservation program in patient biotherapy. Two tissue culture cell lines were developed from this tumor, one directly from the biopsy, another from a xenograft tumor grown in athymic mice. The two cell lines were similar in character. There was strong immunochemical reactivity with antibodies to vimentin, type I collagen, and type III collagen. There was no reactivity with antibodies to cytokeratin and epithelial membrane antigen. Both cell lines were aneuploid, clonogenic in soft agar, and tumorigenic in nude mice. 5 alpha-dihydrotestosterone and thyroxine added to the culture medium stimulated growth, while testosterone, 17 beta-estradiol, and 4-hydroxytamoxifen were without effect. Dexamethasone and cortisol were inhibitory at high doses (10(-6) M). Dibutyryl cyclic AMP, theophylline, and vitamin C were all inhibitory. The biopsy contained tumor-infiltrating lymphocytes which proliferated in cultures containing interleukin 2. The expanded lymphocytes were activated T cells which had the capacity to lyse tumor cells. These results suggest possibilities in the therapy of cystosarcoma phylloides involving vitamin C, certain hormones, and tumor-infiltrating lymphocytes.
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Affiliation(s)
- W M Lewko
- Biotherapeutics Inc., Franklin, TN 37064
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27
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Umpleby HC, Moore I, Royle GT, Guyer PB, Taylor I. An evaluation of the preoperative diagnosis and management of cystosarcoma phyllodes. Ann R Coll Surg Engl 1989; 71:285-8. [PMID: 2552895 PMCID: PMC2499001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cystosarcoma phyllodes is a rare tumour of the breast which is notoriously difficult to diagnose accurately preoperatively. In this review we report the clinical, imaging and histopathological features of 20 patients who have presented in our Centre over a 10-year period.
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Affiliation(s)
- H C Umpleby
- University Surgical Unit, Royal South Hants Hospital
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28
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Abstract
Cystosarcoma phyllodes of the breast appears to encompass a diverse group of tumors with variable clinical behaviors. Although the tumor can behave in a malignant fashion, metastases to the head and neck region are distinctly uncommon. A case is presented of a solitary metastasis to the mandible appearing 1 year after mastectomy and in the absence of widespread disease. The metastatic potential of this neoplasm is discussed and involvement of the head and neck region is reviewed.
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Affiliation(s)
- E Abemayor
- Division of Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Harbor-UCLA Medical Center, Torrance, CA 90509
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29
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Cooney BM, Ruth GJ, Behrman DA, Bova GS, Behrman SJ. Malignant cystosarcoma phyllodes of the breast metastatic to the oral cavity: report of a case and review of the literature. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1988; 66:599-604. [PMID: 2849080 DOI: 10.1016/0030-4220(88)90382-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case report involving an oral lesion that was found to be histologically identical to the stromal component of malignant metastatic cystosarcoma phyllodes of the breast is described. This represents the first reported histologically confirmed oral manifestation of an extremely rare breast tumor. The literature regarding oral manifestations of metastatic disease in general and of cystosarcoma phyllodes in particular is reviewed.
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Affiliation(s)
- B M Cooney
- Division of Oral and Maxillofacial Surgery, New York Hospital-Cornell Medical Center, N.Y
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Abstract
A unusually large tumor of the left breast diagnosed as a cystosarcoma phyllodes with multiple malignant sarcomatous changes of the stroma, consisting of liposarcoma, myxoid fibrosarcoma, anaplastic, and giant cell sarcoma is described. The weight of 6200 g (13.5 lb) seems to be the largest so far presented in the literature reviewed by the authors.
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Tokuda Y, Kubota M, Ueyama Y, Maruo K, Hata J, Tamaoki N, Tajima T, Mitomi T. A malignant cystosarcoma phyllodes with positive estrogen receptor and its heterotransplantation into nude mice. Cancer 1985; 55:370-4. [PMID: 2981144 DOI: 10.1002/1097-0142(19850115)55:2<370::aid-cncr2820550213>3.0.co;2-f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We detected cytosol estrogen receptors in a malignant cystosarcoma phyllodes and succeeded in serial transplantations into athymic nude mice. The tumors of this transplantable strain (MC-3-JCK) have the same histologic features as the original tumors, and retain significant amounts of cytosol estrogen receptors. This strain appears to provide a useful experimental model for the study of biologic and therapeutic aspects of human cystosarcoma phyllodes of the breast.
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33
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Fiks A. Cystosarcoma phyllodes of the mammary gland--Müller's tumor. For the 180th birthday of Johannes Müller. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1981; 392:1-6. [PMID: 6269275 DOI: 10.1007/bf00430543] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
For the last 150 years, cystosarcoma phyllodes of the mammary gland has had 62 different synonyms. At the present time, the most logical name for it seems to be tumor phyllodes. The result of the histological analysis of every single tumor should contain information about the degree of its maturity. The classical description of cystosarcoma phyllodes given by Johannes Müller (1838) is still considered the basis for understanding the clinical and histogenetical aspects of this neoplasm.
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Abstract
Two cases of cystosarcoma phylloides in the adolescent female are presented and the literature reviewed. This lesion is usually benign. Even when malignant, simple excision has been curative in 2 or 3 cases. Therapy recommended is local excision with a small margin of normal tissue.
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35
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Kessinger A, Foley JF, Lemon HM, Miller DM. Metastatic cystosarcoma phyllodes: a case report and review of the literature. J Surg Oncol 1972; 4:131-47. [PMID: 4338176 DOI: 10.1002/jso.2930040208] [Citation(s) in RCA: 118] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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36
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Hillenbrand HJ. [Fibroadenoma intracanaliculare phyllodes mammae. (Cystosarcoma phyllodes of the breast)]. LANGENBECKS ARCHIV FUR CHIRURGIE 1970; 327:523-7. [PMID: 4329468 DOI: 10.1007/bf01259080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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37
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Minkowitz S, Zeichner M, Di Maio V, Nicastri AD. Cystosarcoma phyllodes: a unique case with multiple unilateral lesions and ipsilateral axillary metastasis. THE JOURNAL OF PATHOLOGY AND BACTERIOLOGY 1968; 96:514-7. [PMID: 4301640 DOI: 10.1002/path.1700960236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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38
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Hansen JR. Recurrent cystosarcoma phylloides. Calif Med 1967; 106:462-5. [PMID: 4292573 PMCID: PMC1502678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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43
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STEPHENSON HE, GROSS S, GUMPORT SL, MEYER HW. Cystosarcoma phyllodes of the breast; a review of the literature with the addition of 15 new cases. Ann Surg 1952; 136:856-63. [PMID: 12986665 PMCID: PMC1802142 DOI: 10.1097/00000658-195211000-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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TREVES N, SUNDERLAND DA. Cystosarcoma phyllodes of the breast: A malignant and a benign tumor. A clinicopathological study of seventy-seven cases. Cancer 1951; 4:1286-1332. [PMID: 14886887 DOI: 10.1002/1097-0142(195111)4:6<1286::aid-cncr2820040614>3.0.co;2-t] [Citation(s) in RCA: 151] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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SMITH C, PARSONS RJ, BOGART WM. Giant intracanalicular fibroadenoma. With report of five cases. Calif Med 1951; 75:101-4. [PMID: 14848732 PMCID: PMC1520979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Five cases of giant intracanalicular fibroadenoma ("cystosarcoma phylloides") were observed at one hospital in a period of three years. In a search of the literature, additional reports of breast tumors of this kind, not included in previous reviews, were noted. As there is record of 229 cases, it would appear that this rapidly growing benign tumor should be kept in mind in the diagnosis of masses in the breast. If removal is incomplete, there may be recurrence. Simple mastectomy is the treatment of choice. Radical mastectomy should be avoided.
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46
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47
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Oberhelman HA. Benign Lesions of the Breast. Surg Clin North Am 1948; 28:95-112. [DOI: 10.1016/s0039-6109(16)32334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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