1
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Li WI, Ng KK, Au Yong TK, Kung BT. Unusual Metastatic Sites in Malignant Phyllodes Tumor Detected on FDG PET/CT. World J Nucl Med 2024; 23:147-150. [PMID: 38933073 PMCID: PMC11199038 DOI: 10.1055/s-0044-1786519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Phyllodes tumor is a rare fibroepithelial neoplasm of the breast. This tumor tends to spread by hematogenous route, with common metastatic sites in the lungs, bones, and liver. Metastases to the pleura, stomach, pancreas, kidneys, and adrenal gland are rare. We present a case of a 52-year-old lady with malignant phyllodes tumor of breast undergone local tumor resection, followed by solitary lung metastasis with lobectomy, and subsequently diagnosed of multiple new metastatic sites in pleura, stomach, pancreas, kidneys, adrenal gland, and bone detected on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography within 2 years.
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Affiliation(s)
- Wai Ip Li
- Nuclear Medicine Unit, Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital, Hong Kong
| | - Koon Kiu Ng
- Nuclear Medicine Unit, Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital, Hong Kong
| | - Ting Kun Au Yong
- Nuclear Medicine Unit, Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital, Hong Kong
| | - Boom Ting Kung
- Nuclear Medicine Unit, Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital, Hong Kong
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2
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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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3
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Chen JJ, Zhu I, Patel A, Krings G, Chen YY, Yuen F, Mukhtar RA, Melisko M, Singer L, Park CC, Prionas ND. Management of Concurrent Malignant Phyllodes Tumor and Invasive Breast Carcinoma. Adv Radiat Oncol 2024; 9:101448. [PMID: 38550370 PMCID: PMC10965428 DOI: 10.1016/j.adro.2024.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/09/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Jie Jane Chen
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Iowis Zhu
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Akshat Patel
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregor Krings
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Yunn-Yi Chen
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Florence Yuen
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Rita A. Mukhtar
- Division of Surgical Oncology, University of California, San Francisco, San Francisco, California
| | - Michelle Melisko
- Department of Medicine – Hematology/Oncology, University of California, San Francisco, San Francisco, California
| | - Lisa Singer
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Catherine C. Park
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Nicolas D. Prionas
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
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Klooz A, Kumar T, Maxwell J. Malignant phyllodes tumour of the breast with early recurrence in a young patient. BMJ Case Rep 2024; 17:e258352. [PMID: 38508594 PMCID: PMC10952906 DOI: 10.1136/bcr-2023-258352] [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] [Accepted: 03/02/2024] [Indexed: 03/22/2024] Open
Abstract
A young woman in her 20s was found to have a left breast malignant phyllodes tumour by ultrasound-guided core needle biopsy, after identifying a palpable lump. She then underwent lumpectomy excision with >1 cm gross margins; however, final pathology demonstrated <1 cm margins at the superior margin. She then underwent re-excision of superior and medial margins to ensure at least a 1 cm margin. Biopsy tract was not excised at initial or re-excision surgery. Approximately 6 weeks after completion lumpectomy, the patient noted a new palpable mass near the previous biopsy site and underwent punch biopsy. Final pathology of this new mass was concordant with early recurrence. The patient then underwent lumpectomy of the new mass along with excision of the overlying skin and biopsy tract with >1 cm margins.
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Affiliation(s)
- Andrea Klooz
- Surgery, The Nebraska Medical Center, OMAHA, Nebraska, USA
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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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6
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Pandit P, Murkey SP, Agarwal A, Jaiswal A, Agrawal S. Understanding Fibroadenoma of the Breast: A Comprehensive Review of Pre-operative and Post-operative Clinicopathological Correlations. Cureus 2023; 15:e51329. [PMID: 38288219 PMCID: PMC10823311 DOI: 10.7759/cureus.51329] [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: 11/23/2023] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Fibroadenomas of the breast are common benign lesions that predominantly affect young women. This review provides a comprehensive overview of fibroadenoma management, encompassing their definition, clinical presentation, diagnostic tools, surgical management, clinicopathological correlations, treatment outcomes, complications, and emerging research. Fibroadenomas typically present as palpable breast lumps, often with no associated nipple discharge, and their diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation. Surgical interventions, including excisional biopsy and lumpectomy, offer symptom relief and favorable long-term outcomes. Minimally invasive techniques and ongoing research into genomics and molecular aspects hold promise for the future of fibroadenoma management. Multidisciplinary collaboration among healthcare providers is paramount, ensuring accurate diagnosis, personalized treatment decisions, and holistic patient care. As research advances, the management of fibroadenomas is poised to evolve, providing improved diagnostic accuracy, minimally invasive treatments, and enhanced patient outcomes.
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Affiliation(s)
- Pranam Pandit
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Siddhant P Murkey
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash Agarwal
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suyash Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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7
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"Growing fibroadenoma": Are there clinical and pathological features predicting a phyllodes tumor on surgical excision? Ann Diagn Pathol 2023; 62:152069. [PMID: 36527840 DOI: 10.1016/j.anndiagpath.2022.152069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
In cases of growth of FA on imaging, core needle biopsies (CNB) are often performed to rule out phyllodes tumor (PT). We aim to focus on "growing FAs" and to identify clinical and histopathologic features that are likely to predict a PT on excision. Thirty-four FAs with radiologic documentation of growth were included. Various clinical and pathological features such as age, body mass index (BMI), lesion size, and growth rate were recorded. On excision, 17 cases (50 %) were FAs, whereas 16 (47 %) were re-classified as benign PT despite only 19 % being suspicious for PT on CNB. PT patients were older (mean age 42.6) than those with FAs (mean age 28.2), p = 0.0002. All false negative cases demonstrated intracanalicular growth. Mitotic rate was the most significant histologic feature in PT on excision compared to others, such as lesion circumscription and stromal cellularity. Recognition and careful counting of mitotic rate, especially with intracanalicular patterns in growing FAs, can potentially prevent missing a PT on CNB. In patients with "growing FAs" who are ≥40 years of age, excision may be recommended due to the high likelihood of PT diagnosis on excision and high false negative rate on CNB.
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Brouwer de Koning IM, van Heusden HC, Mol SJJ, Rots ML, Draaisma WA, Bosscha K. A rapidly growing fibroadenoma in a pregnant woman: A case report. Breast Dis 2023; 42:325-330. [PMID: 37899052 DOI: 10.3233/bd-230030] [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] [Indexed: 10/31/2023]
Abstract
BACKGROUND Fibroadenomas are the most common benign breast lesions in women. They present as a unilateral mass and can rapidly enlarge in size through hormonal changes. Fibroadenomas could be classified as small or giant, and as simple or complex. They are classified as 'giant' when the size exceeds 5 cm and/or weight 500 gram; and as 'complex' if one of the following characteristics is present: cysts with a size >3 mm, epithelial calcifications, sclerosing adenosis and papillary apocrine metaplasia. Giant fibroadenomas can cause compression of surrounding breast tissue or breast asymmetry, requiring surgical excision in order to preserve a normal breast shape. CASE A 26-year-old pregnant woman was referred with a palpable mass of her right breast. The mass rapidly increased in size to a diameter of 13 cm during the second trimester of her pregnancy. A tru-cut biopsy confirmed a fibroadenoma. The rapid growth and compression of normal breast tissues indicated a lumpectomy during her pregnancy. The mass was easily excised without any consequences for the pregnancy. Pathological examination showed a complex giant fibroadenoma. CONCLUSION A unique case of a pregnant woman with rapid progression of a fibroadenoma that met the criteria of a complex and giant fibroadenoma, was presented. This case emphasizes the importance of timely surgical intervention, even during pregnancy, to prevent permanent breast tissue damage.
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Affiliation(s)
| | - H C van Heusden
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - S J J Mol
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M L Rots
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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9
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Choi JS, Ko EY, Kim MJ, Ko ES, Han BK. Combined use of shear-wave elastography and Doppler ultrasonography in equivocal fibroepithelial lesions of the breast diagnosed by core needle biopsy. Ultrasonography 2023; 42:31-40. [PMID: 36353790 PMCID: PMC9816696 DOI: 10.14366/usg.22008] [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: 01/17/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic value of shear-wave elastography (SWE) combined with Doppler ultrasonography (US) in selecting equivocal breast fibroepithelial lesions (FELs) for follow-up without further excision. METHODS A retrospective analysis was conducted of 88 patients with equivocal breast FELs (FELs with the possibility of both fibroadenoma [FA] and phyllodes tumor [PT]) diagnosed by core needle biopsy (CNB). For post-CNB treatment, surgical or vacuum-assisted excision was performed on 88 equivocal FELs, of which 56 were diagnosed as FAs and 32 as PTs on histopathology. Mean elasticity (Emean) and vascularity were determined using SWE and Doppler US. The diagnostic performances of B-mode US, SWE, and Doppler US were calculated to differentiate FAs and PTs in the excised equivocal FELs. RESULTS In the excised equivocal FELs diagnosed by CNB, FAs showed significantly lower median Emean values (36.4 vs. 66.7 kPa, P=0.005) and more frequent low vascularity (0-1 vessel flow signal) (P<0.001) than PTs. For the differentiation of FAs and PTs, the combination of Emean of >60.9 kPa and high vascularity (≥2 vessel flows) showed a sensitivity and negative predictive value of 100%, as well as better performance in other diagnostic values than B-mode US alone (Breast Imaging Reporting and Data System ≥4A) (all P<0.05). CONCLUSION Equivocal breast FELs showing both low elasticity and low vascularity were not upgraded to PTs upon further excision. Therefore, the combination of SWE and color Doppler US mode might help select patients with equivocal FELs for whom further excision is unnecessary.
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Affiliation(s)
- Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Correspondence to: Eun Young Ko, MD, PhD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel. +82-2-3410-2519 Fax. +82-2-3410-2509 E-mail:
| | - Min-Ji Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hassan MJ, Ahmed S, Siddiqui B, Akhtar K, Anees A, Arif SH, Hasan M. Borderline phyllodes tumor arising in ectopic breast tissue in the axilla: Report of a rare case with brief review of literature. Breast Dis 2023; 42:245-249. [PMID: 37545203 DOI: 10.3233/bd-230007] [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: 08/08/2023]
Abstract
Development of a neoplasm in an ectopic breast is uncommon, while the development of phyllodes tumor in an ectopic breast in the axilla is even rarer. We report a rare case of a 51-year-old female who presented with a complain of swelling and pain in the right axilla with no associated complaints in other organs. Magnetic resonance imaging suggested a possibility of metastatic lymphadenopathy. Complete excision of the right axillary mass was performed and sent for histopathological examination which was examined thoroughly and sections were given. On microscopic examination, stromal proliferation in a leaf-like pattern with mild stromal atypia and focal permeation of borders were seen, and a diagnosis of Ectopic borderline phyllodes tumor in axilla was made, which is extremely rare and needs to be differentiated from its close differentials like fibroadenoma and periductal stromal sarcoma.
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Affiliation(s)
- Mohammad Jaseem Hassan
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Saqib Ahmed
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttrakhand, India
| | - Bushra Siddiqui
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Kafil Akhtar
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Afzal Anees
- Department of General Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sayeedul Hasan Arif
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mahboob Hasan
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Rana C, Kamal N, Mishra P, Singh A, Ramakant P, Mishra A, Singh K. Cellular fibroadenoma versus phyllodes tumors: A pre‐operative diagnostic approach based on radiological and cytological features. Diagn Cytopathol 2022; 50:375-385. [DOI: 10.1002/dc.24965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/11/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Chanchal Rana
- Department of Pathology King George's Medical University Lucknow India
| | - Nidhi Kamal
- Department of Pathology King George's Medical University Lucknow India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow India
| | - Akanksha Singh
- Department of Pathology King George's Medical University Lucknow India
| | - Pooja Ramakant
- Department of Endocrine Surgery King George's Medical University Lucknow India
| | - Anand Mishra
- Department of Endocrine Surgery King George's Medical University Lucknow India
| | - Kulranjan Singh
- Department of Endocrine Surgery King George's Medical University Lucknow India
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Lapkittichot S, Chirappapha P, Rermluk N. Borderline phyllodes tumor arising in accessory breast tissue at the axilla. Radiol Case Rep 2022; 17:1110-1114. [PMID: 35169410 PMCID: PMC8829523 DOI: 10.1016/j.radcr.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Accessory breast tissue is an anatomical variation which occurs during embryogenic development. It appears most frequently at the axilla. Benign and malignant processes in general breast tissue can occur in accessory breast tissue. We report a case of 76-year-old female presented with palpable, huge mass at the right axilla which pathology of the mass was borderline phyllodes tumor. Phyllodes tumors arising in accessory breast tissue is an extremely rare condition. And this case study showed more detail on phyllodes tumor which would encourage the advance in management of the disease.
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Affiliation(s)
- Sarunthorn Lapkittichot
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand
- Corresponding author. S. Lapkittichot.
| | - Prakasit Chirappapha
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Naparat Rermluk
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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13
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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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14
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Li T, Li Y, Yang Y, Li J, Hu Z, Wang L, Pu W, Wei T, Lu M. Logistic regression analysis of ultrasound findings in predicting the malignant and benign phyllodes tumor of breast. PLoS One 2022; 17:e0265952. [PMID: 35325009 PMCID: PMC8947023 DOI: 10.1371/journal.pone.0265952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate ultrasound characteristics in the prediction of malignant and benign phyllodes tumor of the breast (PTB) by using Logistic regression analysis. METHODS 79 lesions diagnosed as PTB by pathology were analyzed retrospectively. The ultrasound features of PTB were recorded and compared between benign and malignant tumors by using single factor and multiple stepwise Logistic regression analysis. Moreover, the Logistic regression model for malignancy prediction was also established. RESULTS There were 79 patients with PTB, including 39 benign PTBs and 40 malignant PTBs (33 borderline PTBs and 7 malignant PTBs by pathologic classification). The area under the ROC curve (AUC) of lesion size and age were 0.737 and 0.850 respectively. There were significant differences in age, lesion size, shape, internal echo, liquefaction, and blood flow between malignant and benign PTBs by using single-factor analysis (P<0.05). Age, internal echo, and liquefaction were significant features by using Logistic regression analysis. The corresponding regression equation In (p/(1 - p) = -3.676+2.919 internal echo +3.029 liquefaction +4.346 age). CONCLUSION Internal echo, age, and liquefaction are independent ultrasound characteristics in predicting the malignancy of PTBs.
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Affiliation(s)
- Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanjie Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yingqi Yang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - ZiYue Hu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Wang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Pu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Wei
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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15
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Cheng CL, Md Nasir ND, Ng GJZ, Chua KWJ, Li Y, Rodrigues J, Thike AA, Heng SY, Koh VCY, Lim JX, Hiew VJN, Shi R, Tan BY, Tay TKY, Ravi S, Ng KH, Oh KSL, Tan PH. Artificial intelligence modelling in differentiating core biopsies of fibroadenoma from phyllodes tumor. J Transl Med 2022; 102:245-252. [PMID: 34819630 DOI: 10.1038/s41374-021-00689-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023] Open
Abstract
Breast fibroepithelial lesions (FEL) are biphasic tumors which consist of benign fibroadenomas (FAs) and the rarer phyllodes tumors (PTs). FAs and PTs have overlapping features, but have different clinical management, which makes correct core biopsy diagnosis important. This study used whole-slide images (WSIs) of 187 FA and 100 PT core biopsies, to investigate the potential role of artificial intelligence (AI) in FEL diagnosis. A total of 9228 FA patches and 6443 PT patches was generated from WSIs of the training subset, with each patch being 224 × 224 pixel in size. Our model employed a two-stage architecture comprising a convolutional neural network (CNN) component for feature extraction from the patches, and a recurrent neural network (RNN) component for whole-slide classification using activation values from the global average pooling layer in the CNN model. It achieved an overall slide-level accuracy of 87.5%, with accuracies of 80% and 95% for FA and PT slides respectively. This affirms the potential role of AI in diagnostic discrimination between FA and PT on core biopsies which may be further refined for use in routine practice.
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Affiliation(s)
- Chee Leong Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Nur Diyana Md Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Yier Li
- AI Singapore, Singapore, Singapore
| | | | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Seow Ye Heng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Valerie Cui Yun Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | - Venice Jing Ning Hiew
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Ruoyu Shi
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | | | | | | | | | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore. .,Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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Ofri A, Stuart KE, Chan B, Mak C, Warrier S, Bhadri V, Mander-Jones T, O'Toole S. Diagnosis and management of phyllodes tumours for the surgeon: An algorithm. Surgeon 2022; 20:e355-e365. [PMID: 35148937 DOI: 10.1016/j.surge.2022.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
A Phyllodes Tumour (PT) is an uncommon fibroepithelial lesion, with three histological grades - benign, borderline and malignant. PTs cause significant challenges in diagnosis, management and prognostication. Recent publications have clarified the definitions and prognostication of PTs. Contemporary data currently challenge international guidelines on PT management. We performed an in-depth literature review to develop a best-practice management algorithm for PTs. Diagnostic recommendations are that neither current imaging techniques, nor fine-needle biopsies, can reliably diagnose a PT. Core needle biopsy is the optimal diagnostic technique. Indeterminate or suspicious lesions are recommended to undergo an excisional biopsy due to the inherently heterogeneous nature of PTs. Management guidelines are that benign PTs should be completely excised, although an involved margin is acceptable in select situations. Borderline PTs should have a clear margin on excision due to their higher risk of recurrence, as well as the potential for a recurrence to progress to a malignant PT. In malignant PTs, a margin of 3 mm is acceptable as there is no reduction in recurrence risk if margins are >3 mm. Routine axillary surgery is not indicated in PTs, with axillary surgery only indicated in a histologically-confirmed positive axilla. Adjuvant treatment recommendations are that borderline and malignant PTs should be discussed at MDT, with radiotherapy considered in both. Chemotherapy should be discussed in malignant PT patients. In summary, we have developed an up-to-date simple algorithm to guide the surgeon's management of patients diagnosed with PTs and reduce excessive surgery.
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Affiliation(s)
- Adam Ofri
- Department of Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kirsty E Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, 166-174 Hawkesbury Rd, Westmead, NSW 2145, Australia; Westmead Breast Cancer Institute, Block F/189 Cnr Hawkesbury & Darcy Rd, Westmead, NSW 2145, Australia; Western Clinical School, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Belinda Chan
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Strathfield Private Hospital, 3 Everton Rd, Strathfield, NSW 2135, Australia
| | - Cindy Mak
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia; Mater Hospital, 25 Rocklands Rd, North Sydney, NSW 2060, Australia
| | - Sanjay Warrier
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia
| | - Vivek Bhadri
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Tim Mander-Jones
- Department of Radiology, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW 2139, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sandra O'Toole
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia; The Kinghorn Cancer Centre and Cancer Research Division, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, NSW 2010, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Johns Hopkins Dr, Camperdown, NSW 2050, Australia; Western Sydney University, Campbelltown, NSW 2560, Australia
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Lynda A, Amal K, Salah EB. Performance of Elastography, Color Doppler and B Mode Ultrasound to Differentiate Fibroadenomas from Phyllodes Tumor. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.220003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yalcin A, Goktepeli M, Taydas O, Sayar I. Native T1 mapping of the breast in MRI to differentiate fibroadenomas from benign phyllodes tumors: a preliminary study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2021; 35:441-447. [PMID: 34727247 DOI: 10.1007/s10334-021-00969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Both fibroadenomas (FAs) and phyllodes tumors (PTs) are classified as fibroepithelial lesions. PTs are rare fibroepithelial neoplasms that have a morphologic spectrum ranging from benign to malignant. The differentiation of these entities is important as PTs are to be enucleated surgically. The purpose of this study was to calculate the T1 relaxation times of fibroadenomas and phyllodes tumors and assess the potency of native T1 mapping for the differentiation of these tumors. MATERIALS AND METHODS This prospective study included 11 patients with a proven diagnosis of benign PT and 14 patients with a proven diagnosis of FA. All the patients underwent T1 mapping prior to conventional dynamic contrast-enhanced MRI (DCE-MRI). Two radiologists, in consensus, selected lesion locations using freehand regions of interest from the DCE images and copied them onto T1 maps to acquire T1 relaxation times. The T1 relaxation times of the FA and PT groups were compared statistically. RESULTS The mean T1 relaxation times were higher in the PT group compared to the FA group (p ≤ 0.001). The receiver operating characteristic analysis showed that the T1 relaxation time being longer than 1,478 ms differentiated PTs from FAs with a sensitivity of 0.89, specificity of 1, and area under the curve value of 0.93. CONCLUSION We found that benign PTs had longer relaxation times in T1 mapping compared to FAs. Native T1 mapping can be used to differentiate PTs from FAs and adding T1 mapping in breast MRI in cases with fast-growing fibroepithelial lesions or multiple fibroepithelial lesions can facilitate the decision-making process.
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Affiliation(s)
- Ahmet Yalcin
- Ataturk University Faculty of Medicine: Ataturk Universitesi Tip Fakultesi, Erzurum, Turkey.
| | - Mehmet Goktepeli
- Section of Radiology, Sanliurfa Research and Training Hospital, Sanliurfa, Turkey
| | - Onur Taydas
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ilyas Sayar
- Department of Pathology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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20
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Niu S, Huang J, Li J, Liu X, Wang D, Wang Y, Shen H, Qi M, Xiao Y, Guan M, Li D, Liu F, Wang X, Xiong Y, Gao S, Wang X, Yu P, Zhu J. Differential diagnosis between small breast phyllodes tumors and fibroadenomas using artificial intelligence and ultrasound data. Quant Imaging Med Surg 2021; 11:2052-2061. [PMID: 33936986 DOI: 10.21037/qims-20-919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background It is challenging to differentiate between phyllodes tumors (PTs) and fibroadenomas (FAs). Artificial intelligence (AI) can provide quantitative information regarding the morphology and textural features of lesions. This study attempted to use AI to evaluate the ultrasonic images of PTs and FAs and to explore the diagnostic performance of AI features in the differential diagnosis of PTs and FAs. Methods A total of 40 PTs and 290 FAs <5 cm in maximum diameter found in female patients were retrospectively analyzed. All tumors were segmented by doctors, and the features of the lesions were collated, including circularity, height-to-width ratio, margin spicules, margin coarseness (MC), margin indistinctness, margin lobulation (ML), internal calcification, angle between the long axis of the lesion and skin, energy, grey entropy, and grey mean. The differences between PTs and FAs were analyzed, and the diagnostic performance of AI features in the differential diagnosis of PTs and FAs was evaluated. Results Statistically significant differences (P<0.05) were found in the height-to-width ratio, ML, energy, and grey entropy between the PTs and FAs. Receiver operating characteristic (ROC) curve analysis of single features showed that the area under the curve [(AUC) 0.759] of grey entropy was the largest among the four features with statistically significant differences, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.925, 0.459, 0.978, and 0.190, respectively. When considering the combinations of the features, the combination of height-to-width ratio, margin indistinctness, ML, energy, grey entropy, and internal calcification was the most optimal of the combinations of features with an AUC of 0.868, and a sensitivity, specificity, PPV, and NPV of 0.734, 0.900, 0.982, and 0.316, respectively. Conclusions Quantitative analysis of AI can identify subtle differences in the morphology and textural features between small PTs and FAs. Comprehensive consideration of multiple features is important for the differential diagnosis of PTs and FAs.
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Affiliation(s)
- Sihua Niu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jianhua Huang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Jia Li
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Xueling Liu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Dan Wang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Yingyan Wang
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Huiming Shen
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Min Qi
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Yi Xiao
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Mengyao Guan
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Xiuming Wang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yu Xiong
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Siqi Gao
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Xue Wang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Ping Yu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jia'an Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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21
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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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İlhan B, Emiroğlu S, Türkay R. Report of Two Cases with Simultaneously Detected Tubular Carcinoma and Phyllodes Tumor of the Breast. Eur J Breast Health 2020; 17:80-83. [PMID: 33796835 DOI: 10.5152/ejbh.2020.5551] [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: 02/25/2020] [Accepted: 03/27/2020] [Indexed: 11/22/2022]
Abstract
Tubular carcinoma (TC) is a subtype of invasive breast carcinoma with better prognosis, and phyllodes tumors (PT) are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows for correct surgical planning and avoidance of reoperation for these breast neoplasms. A database was created by analyzing the archives of Department of General Surgery of the İstanbul Faculty of Medicine between September 2006 and November 2017, and a total of 105 PTs and 55 TCs were collected. Two cases with concurrence of TC and PT were identified and examined in detail. The first patient was a 33-year-old woman with a 20×12 mm2 TC and a 65×32 mm2 malignant PT in the left breast. The second patient was a 28-year-old woman with two masses in the right breast. The first mass was 38×16 mm2 on the upper outer quadrant, and the second mass was 10×8 mm2 in size in the lower inner quadrant, accompanied by a 16×10 mm2 TC and a 33×26 mm2 borderline PT. Both cases were treated by mastectomies due to patient's decisions or insufficient margin control. This study extrapolated that if two tumors are detected simultaneously, margin control can become more difficult, and breast-conserving surgery should be thoroughly reviewed.
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Affiliation(s)
- Burak İlhan
- Department of Surgery, İstanbul Faculty of Medicine, General Surgery, İstanbul, Turkey
| | - Selman Emiroğlu
- Department of Surgery, İstanbul Faculty of Medicine, General Surgery, İstanbul, Turkey
| | - Rüştü Türkay
- Clinic of Radiology, University of Health Sciences Turkey, Haseki Training and Research Hospital, Istanbul, Turkey
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23
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Zmora O, Klin B, Iacob C, Meital A, Mendlovic S, Karni T. Characterizing excised breast masses in children and adolescents-Can a more aggressive pathology be predicted? J Pediatr Surg 2020; 55:2197-2200. [PMID: 32061367 DOI: 10.1016/j.jpedsurg.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/22/2019] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Our aim was to characterize excised breast masses in children and adolescent and to identify factors associated with a more aggressive pathology. METHODS Retrospective review of all female patients <19 who underwent excision of breast masses at our institution between 1999 and 2018. Demographic, clinical, imaging, pathological and management data were collected. We assessed possible association of any of the variables with a more aggressive pathology (phyllodes tumor and malignancy). Correlation between core needle biopsy results and final pathology results was also calculated. RESULTS 70 patients were included. Median age was 17 years (range: 11-19). Resected mass size was 4 cm (range: 2-16). Final pathology results were: fibroadenoma (49), juvenile fibroadenoma (7), hamartoma (5), benign phyllodes (7), malignant phyllodes (1) and sarcoma (1). Pathology was benign in 61 (87%) patients and more aggressive (phyllodes and sarcoma) in 9 (13%). None of the tested variables was associated with a more aggressive pathology. Presurgical core biopsy results matched final pathology in only 63.6%. CONCLUSIONS Excised breast masses in children and adolescents are sometimes of a more aggressive pathology, which cannot be predicted by presurgical factors, including a core needle biopsy. Prognosis study LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Baruch Klin
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catalin Iacob
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron Meital
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonia Mendlovic
- Department of Pathology, Shamir (Assafh Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Karni
- Department of General Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tummidi S, Kothari K, Agnihotri M, Naik L, Sood P. Fibroadenoma versus phyllodes tumor: a vexing problem revisited! BMC Cancer 2020; 20:648. [PMID: 32660435 PMCID: PMC7359567 DOI: 10.1186/s12885-020-07129-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibroepithelial lesions of the breast include fibroadenoma (FA) and phyllodes tumor (PT). Fibroadenomas are benign while phyllodes tumor range from benign, indolent neoplasms to malignant tumors capable of distant metastasis. Our study was to determine the select cytologic features that can accurately distinguish FA from PT. METHODS A retrospective review was performed of patients who had histopathology follow up of FA or PT and on whom a pre-operative fine needle aspiration was performed. Cytologic criteria i.e. epithelial component, stromal component and background cellularity were assessed. RESULTS 46 FA and 24 PT were specimens were reviewed. Median age and tumor size for FA and PT were 23.0 and 39.0 years, and 2.0 and 5.0 cm, respectively. Univariate analysis and regression models based on generalized estimating equations revealed that large opened out, folded epithelial sheets, frayed and irregular stromal fragment contours, spindle stromal cell nuclei, spindle cell nuclei in the background and background cell atypia are significant cytological predictors of PT. The GEE regression model achieved 78.9% diagnostic accuracy (p < 0.001) in identifying PT based on cytological features. Median epithelial: stromal ratio was 3.4 and 2.6 for FA and PT, respectively. CONCLUSION Presence of large, opened out, folded epithelial sheets, frayed and irregular stromal contours with spindle nuclei, background spindle cells and atypia can help distinguish PT from FA.
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Affiliation(s)
- Santosh Tummidi
- Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, 522503 Andhra Pradesh India
| | - Kanchan Kothari
- Department of Pathology, Seth GSMC & KEMH, Parel, Mumbai, Maharashtra 400012 India
| | - Mona Agnihotri
- Department of Pathology, Seth GSMC & KEMH, Parel, Mumbai, Maharashtra 400012 India
| | - Leena Naik
- Department of Pathology, LTMMC & LTMGH, Sion, Mumbai, 400012 India
| | - Prashant Sood
- Department of Microbiology, All India Institute of Medical Sciences, Mangalagiri, 522503 Andhra Pradesh India
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Al-Arnawoot B, Scaranelo A, Fleming R, Kulkarni S, Menezes RJ, McCready D, Done S, Freitas V. Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical-sonography features helping to differentiate fibroadenomas and phyllodes tumor? J Surg Oncol 2020; 122:382-387. [PMID: 32396665 DOI: 10.1002/jso.25977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the role of clinico-sonographic features of breast cellular fibroepithelial lesions (CFELs) diagnosed on core needle biopsy (CNB) in the differentiation between fibroadenoma (FA) and phyllodes. MATERIALS AND METHODS Results of consecutive women with a CNB showing CFEL from 2005 to 2010 were retrospectively reviewed. Clinical and sonographic findings were compared with surgical outcomes. Chi-square and Fisher's exact tests were used followed by a regression model for statistical analysis. RESULTS A total of 131 women with 134 CFEL were included in the study; 89 (66%) were FAs and 45 (34%) were phyllodes (32 benign; 13 malignant). Significant predictors of increased risk of phyllodes tumor were patient age equal to or greater than 50 years (P = .021) and lesion size less than 2 cm at sonography (P = .043). No other imaging or clinical features were able to differentiate FA from phyllodes tumors. CONCLUSION CFEL with a larger size in older women is associated with the surgical pathological result of phyllodes tumor and management should be tailored accordingly. Younger patients with small size nodules might be approached less aggressively, depending on a personalized discussion with the surgeons, taking into account the results obtained in this study.
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Affiliation(s)
- Basma Al-Arnawoot
- Department of Diagnostic Imaging, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Anabel Scaranelo
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Rachel Fleming
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Ravi J Menezes
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - David McCready
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Susan Done
- Laboratory Medicine Program, University Health Network-Toronto General Hospital Site, University of Toronto, Toronto, Ontario, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
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Mai H, Mao Y, Dong T, Tan Y, Huang X, Wu S, Huang S, Zhong X, Qiu Y, Luo L, Jiang K. The Utility of Texture Analysis Based on Breast Magnetic Resonance Imaging in Differentiating Phyllodes Tumors From Fibroadenomas. Front Oncol 2019; 9:1021. [PMID: 31681572 PMCID: PMC6803552 DOI: 10.3389/fonc.2019.01021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022] Open
Abstract
Background: The preoperative diagnosis of phyllodes tumors (PTs) of the breast is critical to appropriate surgical treatment. However, reliable differentiation between PT and fibroadenoma (FA) remains difficult in daily clinical practice. The purpose of this study was to investigate the utility of breast MRI texture analysis for differentiating PTs from FAs. Materials and Methods: Forty-two PTs and 42 FAs were enrolled in this retrospective study. Clinical and conventional MRI features (CCMF) and MRI texture analysis were used to distinguish between PT and FA. Texture features were extracted from the axial short TI inversion recovery T2-weighted (T2W-STIR), T1-weighted pre-contrast, and two contrast-enhanced series (first contrast and third contrast). The Mann–Whitney U test was used to select statistically significant features of texture analysis and CCMF. Using a linear discriminant analysis, the most discriminative features were determined from statistically significant features. The K-nearest neighbor classifier and ROC curve were applied to evaluate the diagnostic performance. Results: With a higher classification accuracy (89.3%) and an AUC of 0.89, the texture features on T2W-STIR outperformed the texture features on other MRI sequences and CCMF. The AUC of the combination of CCMF with texture features on T2W-STIR was significantly higher than that of CCMF or texture features on T2W-STIR alone (p < 0.05). Based on the result of the classification accuracy (95.2%) and AUC (0.95), the diagnostic performance of the combination strategy performed better than texture features on T2W-STIR or CCMF separately. Conclusions: Texture features on T2W-STIR showed better diagnostic performance compared to CCMF for the distinction between PTs and FAs. After further validation of multi-institutional large datasets, MRI-based texture features may become a potential biomarker and be a useful medical decision tool in clinical trials having patients with breast fibroepithelial neoplasms.
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Affiliation(s)
- Hui Mai
- Department of Medical Imaging, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yifei Mao
- Department of Radiology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Tianfa Dong
- Department of Medical Imaging, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu Tan
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaowei Huang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Songxin Wu
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shuting Huang
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xi Zhong
- Department of Medical Imaging, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yingwei Qiu
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liangping Luo
- Department of Medical Imaging, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Kuiming Jiang
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, China
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27
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Md Nasir ND, Ng CCY, Rajasegaran V, Wong SF, Liu W, Ng GXP, Lee JY, Guan P, Lim JQ, Thike AA, Koh VCY, Loke BN, Chang KTE, Gudi MA, Lian DWQ, Madhukumar P, Tan BKT, Tan VKM, Wong CY, Yong WS, Ho GH, Ong KW, Tan P, Teh BT, Tan PH, Rahman NA, Nahar Begum SMK, Cheah PL, Chen CJ, Dela Fuente E, Han A, Harada O, Kanomata N, Lee CS, Han Lee JY, Kamal M, Nishimura R, Ohi Y, Sawyer EJ, Teoh KH, Tsang AKH, Tsang JY, Tse GMK, Yamaguchi R. Genomic characterisation of breast fibroepithelial lesions in an international cohort. J Pathol 2019; 249:447-460. [DOI: 10.1002/path.5333] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/11/2019] [Accepted: 08/01/2019] [Indexed: 12/31/2022]
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Ambrosi F, Rossi ED, Calderoni S, Cucchi MC, Saguatti G, Foschini MP. Infiltrating Epitheliosis of the Breast: Fine Needle Aspiration Cytology. Int J Surg Pathol 2019; 28:38-43. [PMID: 31328594 DOI: 10.1177/1066896919863488] [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: 11/17/2022]
Abstract
Epitheliosis (or usual duct hyperplasia) is a proliferation of epithelial and myoepithelial cells located within enlarged acini and small ducts, which is characterized by irregular and peripheral fenestration. Infiltrating epitheliosis (IE) is a specific lesion, characterized by classical epitheliosis flowing out into the adjacent stroma. The stroma is desmoplastic and shows keloid appearance with irregular elastosis. IE can mimic malignancy both on radiological and histological grounds. The aim of the present study is to describe the fine needle aspiration cytological features of 6 consecutive cases of IE, with histological correlation. IE cases presenting as screen detected lesions and preoperatively diagnosed on fine needle aspiration cytology (FNAC) were reviewed. All patients had radiologically breast lesions suspicious for malignancy that underwent FNAC followed by surgical resection. The FNAC smears presented some features that could lead to a misdiagnosis of malignancy, such as bloody background, high cellularity, and stromal fragments containing epithelial cells. Nevertheless, malignancy was excluded, due to the absence of atypia and the presence of myoepithelial cells in the cell clusters. IE presents a special FNAC pattern that can be misinterpreted as malignancy. Therefore, knowledge is necessary to avoid patient overtreatment.
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Affiliation(s)
- Francesca Ambrosi
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
| | - Esther Diana Rossi
- Unit of Anatomic Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Serena Calderoni
- Unit of Breast Surgery, Department of Oncology, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Maria Cristina Cucchi
- Unit of Breast Surgery, Department of Oncology, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Gianni Saguatti
- Unit of Senoloy, Department of Oncology, Bellaria Hospital, AUSL Bologna, Bologna, Italy
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
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Paepke S, Metz S, Brea Salvago A, Ohlinger R. Benign Breast Tumours - Diagnosis and Management. Breast Care (Basel) 2018; 13:403-412. [PMID: 30800034 PMCID: PMC6381897 DOI: 10.1159/000495919] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With improvements in breast imaging, mammography, ultrasound and minimally invasive interventions, the detection of early breast cancer, non-invasive cancers, lesions of uncertain malignant potential, and benign lesions has increased. However, with the improved diagnostic capabilities comes a substantial risk of false-positive benign lesions and vice versa false-negative malignant lesions. A statement is provided on the manifestation, imaging, and diagnostic verification of isolated benign breast tumours that have a frequent manifestation, in addition to general therapy management recommendations. Histological evaluation of benign breast tumours is the most reliable diagnostic method. According to the S3 guideline and information gained from analysis of the literature, preference is to be given to core biopsy for each type of tumour as the preferred diagnostic method. An indication for open biopsy is also to be established should the tumour increase in size in the follow-up interval, after recurring discrepancies in the vacuum biopsy results, or at the request of the patient. As an alternative, minimally invasive procedures such as therapeutic vacuum biopsy, cryoablation or high-intensity focused ultrasound are also becoming possible alternatives in definitive surgical management. The newer minimally invasive methods show an adequate degree of accuracy and hardly any restrictions in terms of post-interventional cosmetics so that current requirements of extensive breast imaging can be thoroughly met.
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Affiliation(s)
- Stefan Paepke
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
- Roman Herzog Comprehensive Cancer Center, Munich, Germany
- Comprehensive Cancer Center München, Munich, Germany
| | - Stephan Metz
- Department of Radiology, Technical University of Munich, Munich, Germany
| | - Anika Brea Salvago
- Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Ralf Ohlinger
- Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
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Wang XY, Mahajan H, Dickinson N, Cox C, Byth K, Bayly A, Cahill MA, Pathmanathan N. Fine needle aspiration biopsy cytology of phyllodes tumour and fibroadenoma: A cytomorphological study of 104 cases. Diagn Cytopathol 2018; 46:927-935. [DOI: 10.1002/dc.24021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/01/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Xue Yu Wang
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Hema Mahajan
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Nicole Dickinson
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Carol Cox
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Karen Byth
- Research and Education Network; Westmead Hospital, Western Sydney Local Health District; Westmead New South Wales Australia
| | - Angela Bayly
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Michael A. Cahill
- School of Biomedical Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - Nirmala Pathmanathan
- Westmead breast cancer institute; Westmead Hospital, Western Sydney Local Health District; Westmead New South Wales Australia
- University of Sydney; Western Clinical School; Westmead New South Wales Australia
- Douglass Hanly Moir Pathology; Macquarie Park New South Wales Australia
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31
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A rare case of a giant ulcerated benign phyllode tumor. J Gynecol Obstet Hum Reprod 2018; 48:217-220. [PMID: 30142471 DOI: 10.1016/j.jogoh.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/13/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022]
Abstract
Phyllode tumors are rare fibroepithelial neoplasms divided into three histological grades according to their potential for malignancy. Low grade tumors are usually smaller with a slower evolution. We present here the case of a 40 year old women presenting an augmentation over one month of the volume of her right breast with an ulcerated mass measuring 25cm. The clinical characteristics were in favor as a malignant tumor. The radiological findings were not contributive and the pathologic examinations of the biopsies were benign. A therapeutic and diagnostic mastectomy was thus performed and the final pathologic examination confirmed a benign phyllode tumor. These rare tumors are very deceitful for the radiologic investigations are poorly contributive. Likewise, the pathologic examination can be incorrect. Biopsies must be repeated and a mastectomy performed if any doubts remain.
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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: 4] [Impact Index Per Article: 0.7] [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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Neville G, Neill CO, Murphy R, Corrigan M, Redmond PH, Feeley L, Bennett MW, O'Connell F, Browne TJ. Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J 2018; 24:981-985. [DOI: 10.1111/tbj.13069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Grace Neville
- Department of Pathology; Cork University Hospital Group; Cork Ireland
| | | | - Rosemary Murphy
- Department of Radiology; Cork University Hospital Group; Cork Ireland
| | - Mark Corrigan
- Department of Surgery; Cork University Hospital Group; Cork Ireland
| | - Paul H. Redmond
- Department of Surgery; Cork University Hospital Group; Cork Ireland
| | - Linda Feeley
- Department of Pathology; Cork University Hospital Group; Cork Ireland
| | | | | | - Tara Jane Browne
- Department of Pathology; Cork University Hospital Group; Cork Ireland
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Jung J, Kang E, Chae SM, Kim H, Park SY, Yun BL, Kim SM, Jang M, Kim SW, Kim EK. Development of a Management Algorithm for the Diagnosis of Cellular Fibroepithelial Lesions From Core Needle Biopsies. Int J Surg Pathol 2018; 26:684-692. [DOI: 10.1177/1066896918775525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Surgical excision is recommended for complete evaluation of cellular fibroepithelial lesions identified from core needle biopsy. The purpose of this study was to determine factors associated with phyllodes tumor among cellular fibroepithelial lesions from core biopsies and develop a scoring system to predict the risk of phyllodes tumor. Methods. We retrospectively reviewed clinical data of 169 breast lesions that were diagnosed as cellular fibroepithelial lesions from core needle biopsy at the Seoul National University Bundang Hospital between March 2005 and January 2013. The clinical, histopathologic, and radiologic characteristics were compared between phyllodes tumors and fibroadenomas during the final diagnosis after surgical excision. Results. Of the 169 lesions, 17 were observed and 152 were surgically removed. After excision, final pathology revealed 60 (39.5%) fibroadenomas and 92 (60.5%) phyllodes tumors. Multivariate analysis demonstrated that age (≥40 years), stromal overgrowth, and stromal cellularity were independent factors associated with phyllodes tumors. A scoring system was developed based on a multivariate logistic regression model, and the area under the receiver operating characteristic curve was 0.828 (95% confidence interval = 0.763-0.893). Conclusion. The scoring system will help clinicians make appropriate treatment for patients with cellular fibroepithelial lesions on core needle biopsy.
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Affiliation(s)
- Jaehag Jung
- Department of Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Su Min Chae
- Department of Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
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Abstract
OBJECTIVE The purpose of this study is to evaluate the sonographic and histopathologic features distinguishing benign from borderline and malignant phyllodes tumors. MATERIALS AND METHODS The ultrasound examinations of women with pathologically proven phyllodes tumors from 2004 to 2011 were retrospectively reviewed. The sonographic features of benign, borderline, and malignant phyllodes tumors were compared and analyzed using the American College of Radiology's BI-RADS ultrasound lexicon. Fisher exact test and Wilcoxon rank sum test were used for statistical analysis. RESULTS Fifty-nine women were included in the study; 28 benign (47%), 19 malignant (32%), and 12 borderline (20%) phyllodes tumors were identified. Significant univariate predictors of increased risk of borderline or malignant phyllodes tumors were patient age greater than 55 years (p = 0.014), irregular lesion shape (p = 0.011), and longest lesion dimension greater than 7 cm (p = 0.0022) at sonography. No significant differences were observed in lesion margins, boundaries, echo patterns, or posterior acoustic features. CONCLUSION There is substantial overlap in the sonographic features of benign and borderline or malignant phyllodes tumors. Understanding the clinical and sonographic features of phyllodes tumors may aid the radiologist in predicting biological behavior, including the likelihood of benign versus borderline or malignant phyllodes tumors at pathologic analysis.
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Sanders LM, Sharma P, El Madany M, King AB, Goodman KS, Sanders AE. Clinical breast concerns in low-risk pediatric patients: practice review with proposed recommendations. Pediatr Radiol 2018; 48:186-195. [PMID: 29080125 DOI: 10.1007/s00247-017-4007-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/01/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fibroadenoma is overwhelmingly the most common pediatric breast lesion. Breast malignancy is quite uncommon in children, most frequently metastatic or hematological malignancy. Core biopsy has largely replaced excision for diagnosis of breast masses in adults. OBJECTIVE The purpose of this study is two-fold: (1) compare utilization at our institution of interventional procedures vs. surgery for breast mass diagnosis in patients ≤18 years and (2) propose guidelines for breast imaging and biopsy in this population. MATERIALS AND METHODS We extracted data for all patients ≤18 who, between 2004 and 2016, underwent either (a) imaging and/or intervention procedure, or (b) breast surgery, from the Radiology Information System and Pathology Data System, respectively. We recorded age, gender, imaging, procedure, lesion size and histopathology. RESULTS We found 1,050 pediatric patients ≤18 years who underwent diagnostic breast ultrasound between 2004 and 2016. Of these, 168 patients underwent 199 interventional procedures. One hundred thirty patients underwent 160 core biopsies of solid lesions. Core biopsy pathology diagnosed benign lesions in 99%, of which 84.3% were fibroadenomas (n=135). One malignancy was diagnosed, B cell lymphoma. Two hundred three patients underwent surgical excision for 266 discrete lesions, and 89% were fibroadenomas. Seven benign phyllodes tumors were surgically diagnosed. No malignancies were diagnosed. CONCLUSION Core biopsy in patients 18 years and younger is well-tolerated, has few risks, and is preferable to surgery in developing breasts, but the goal is to avoid any breast procedure whenever possible. We propose guidelines for pediatric breast imaging, follow-up, core biopsy and excisions.
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Affiliation(s)
- Linda M Sanders
- Department of Radiology, RWJBarnabas Health, ACC Breast Center, 200 South Orange Ave., Livingston, NJ, 07039, USA.
| | - Pinky Sharma
- Department of Radiology, RWJBarnabas Health, ACC Breast Center, 200 South Orange Ave., Livingston, NJ, 07039, USA
| | - Miriam El Madany
- Department of Radiology, RWJBarnabas Health, ACC Breast Center, 200 South Orange Ave., Livingston, NJ, 07039, USA
| | | | - Koren S Goodman
- Department of Surgery, RWJBarnabas Health, Livingston, NJ, USA
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Chen WH. A rare presentation of malignant phyllodes tumor with bloody nipple discharge-report of a case. Gland Surg 2017; 6:412-416. [PMID: 28861384 DOI: 10.21037/gs.2017.03.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Phyllodes tumor of the breast is a rare neoplasm, particularly in young women. It is usually presented as a unilateral palpable mass and nipple discharge presented as a symptom is rare. We reported a 22-year-old Taiwanese woman in our hospital for right breast tumor with nipple discharge. Preoperative diagnosis was intraductal papilloma but the histological examination showed a malignant phyllodes tumor with intraductal growth. Symptom of nipple discharge and intraductal growth in phyllodes tumor are rare presentations. Therefore, the management and the biological behavior of this uncommon tumor are discussed in this patient.
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Affiliation(s)
- Wei-Hsin Chen
- Division of General Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung City, Taiwan
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38
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Moo TA, Alabdulkareem H, Tam A, Fontanet C, Lu Y, Landers A, D’Alfonso T, Simmons R. Association Between Recurrence and Re-Excision for Close and Positive Margins Versus Observation in Patients with Benign Phyllodes Tumors. Ann Surg Oncol 2017; 24:3088-3092. [DOI: 10.1245/s10434-017-5955-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Indexed: 01/21/2023]
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Kim GR, Choi JS, Han BK, Ko EY, Ko ES, Hahn SY. Combination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy. PLoS One 2017; 12:e0175380. [PMID: 28472030 PMCID: PMC5417487 DOI: 10.1371/journal.pone.0175380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated shear-wave elastography (SWE) and color Doppler ultrasonography (US) features for fibroepithelial lesions (FELs), and to evaluate their utility to differentiate fibroadenomas (FAs) and phyllodes tumors (PTs). Methods This retrospective study included 67 FELs pathologically confirmed (49 FAs, 18 PTs). B-mode US, SWE and color Doppler US were performed for each lesion. Mean elasticity (Emean), maximum elasticity (Emax), and vascularity were determined by SWE and Doppler US. Diagnostic performances were calculated to differentiate FAs and PTs. Equivocal FELs diagnosed by core needle biopsy (CNB) were further analyzed. Results Median Emean and Emax were significantly lower for FAs than PTs (Emean, 15.7 vs. 66.7 kPa; Emax, 21.0 vs. 76.7 kPa, P<0.01). Low vascularity (0–1 vessel flow) on color Doppler US were more frequent in FAs than in PTs (P<0.01). SWE showed significantly higher specificities (Emean >43.9 kPa, 89.8%; Emax >46.1 kPa, 79.6%) than B-mode US (42.9%) (P<0.01) for differentiating PTs from FAs. Other diagnostic values of SWE and overall diagnostic values of Doppler US were not significantly different from B-mode US (P>0.05). The combination of SWE and Doppler US with ‘Emean>43.9 kPa or high vascularity (≥2 vessel flows)’ showed a higher area under the curve (0.786 vs. 0.687) and higher diagnostic values than B-mode US (sensitivity, 100 vs. 94.4%; specificity, 57.1 vs. 42.9%; positive predictive value, 46.2 vs. 37.8%; negative predictive value, 100 vs. 95.5%), without statistical significance (P>0.05). Of the 30 equivocal FELs, all lesions with ‘Emean≤43.9 kPa and low vascularity (0–1 vessel flow)’ (23.3%, 7/30) were finally confirmed as FAs by excision. Conclusion FAs have a tendency to have less stiffness and lower vascularity than PTs. Combined SWE and color Doppler US may help patients with equivocal FELs diagnosed by CNB avoid unnecessary excision.
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Affiliation(s)
- Ga Ram Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Duman L, Gezer NS, Balcı P, Altay C, Başara I, Durak MG, Sevinç AI. Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features. Breast Care (Basel) 2016; 11:123-7. [PMID: 27239174 DOI: 10.1159/000444377] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study was performed to compare the mammographic, sonographic, and magnetic resonance imaging (MRI) characteristics of phyllodes tumors and fibroadenomas, which may resemble each other. METHODS Preoperative mammograms, B-mode and Doppler sonograms, and dynamic breast MRIs of 72 patients with pathologically proven fibroadenomas and 70 patients with pathologically proven phyllodes tumor were evaluated in this retrospective study. Statistical significance was evaluated using chi-square and Fisher's exact tests. Correlations in lesion size among radiological methods were examined by Pearson's correlation analysis. RESULTS The features that differed on mammogram were size, shape, and margin of the mass. Sonograms showed significant differences in size, shape, margin, echo pattern, and vascularization of the mass. Pearson's correlation analysis showed strong agreement among radiological methods in terms of assessment of size. Tumor size ≥ 3 cm, irregular shape, microlobulated margins, complex internal echo pattern, and hypervascularity were significant findings of phyllodes tumors. Internal cystic areas on MRI were frequently associated with phyllodes tumors. CONCLUSION Mammographic, sonographic, and MRI findings of fibroadenomas and phyllodes tumors could help radiologists to ascertain imaging-histological concordance and guide clinicians in their decision making regarding adequate follow-up or the necessity of biopsy.
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Affiliation(s)
- Lale Duman
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Naciye S Gezer
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pınar Balcı
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Işıl Başara
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Merih G Durak
- Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali I Sevinç
- Department of General Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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41
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Can problematic fibroepithelial lesions be accurately classified on core needle biopsies? Hum Pathol 2016; 47:38-44. [DOI: 10.1016/j.humpath.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
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42
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Jones CP, Apple TM, Burton BJ, Sanders ME, Boyd KL, Salleng KJ. A Phyllodes-like Mammary Tumor in a Breeding Galago (Otolemur garnettii). Comp Med 2016; 66:424-428. [PMID: 27780011 PMCID: PMC5073069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/28/2016] [Accepted: 05/05/2016] [Indexed: 06/06/2023]
Abstract
In humans, phyllodes tumors of the breast are rare fibroepithelial tumors that are further characterized as benign, borderline, or malignant according to their histomorphologic features. Phyllodes tumors are poorly responsive to treatment other than excision. NHP have a much lower frequency of mammary neoplasia than do humans, and none of the lesions reported previously in NHP are consistent with phyllodes tumors. Here we present the case of a mammary tumor in a northern greater galago (Otolemur garnettii) that was histologically characteristic of a malignant phyllodes tumor. An 11-y-old, multiparous, pregnant galago presented with a mass in the right middle mammary gland. A fine-needle aspirate yielded neoplastic epithelial cells. Because the animal was pregnant and showed no signs of skin ulceration, pain, or distress, she was allowed to deliver and nurse the infant. At 20 wk after initial presentation, the infant was weaned and the mother was euthanized. At necropsy, the mammary mass measured 3.5 × 2.5 × 1.5 cm, a 13-fold increase in volume since initial presentation. There was no evidence of metastasis in draining lymph nodes, lungs, or any other tissue examined. The tumor was composed of neoplastic stromal, glandular, and adipose tissues and was diagnosed as a malignant phyllodes tumor in light of its high stromal cellularity, high mitotic rate, and marked atypia. This tumor also exhibited liposarcomatous differentiation, which occurs frequently in malignant phyllodes tumors. To our knowledge, this report represents the first described case involving an NHP of a mammary tumor with characteristics consistent with human phyllodes tumors.
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Affiliation(s)
- Carissa P Jones
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Troy M Apple
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bryce J Burton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melinda E Sanders
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelli L Boyd
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenneth J Salleng
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
We present a case of an 18-year-old woman with recurrent bilateral giant fibroadenomas that were evaluated by mammography and sonography with color Doppler. Imaging revealed solid lobulated masses with significant internal vascularity occupying most of each breast; this evaluation suggested a differential diagnosis of giant fibroadenoma versus phyllodes tumor. The unusual clinical story of recurrent bilateral lesions as reported by the patient, coupled with the findings on visualization of these lesions by mammography and ultrasound with color Doppler, led to the clinical decision to forego biopsy in favor of immediate bilateral surgical enucleation.
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Bendifallah S, Canlorbe G. [Common benign breast tumors including fibroadenoma, phyllodes tumors, and papillary lesions: Guidelines]. ACTA ACUST UNITED AC 2015; 44:1017-29. [PMID: 26547891 DOI: 10.1016/j.jgyn.2015.09.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning common benign breast tumors: fibroadenoma (FA), phyllodes breast tumors (PBT), and papillary lesions (BPL). METHODS Bibliographical search in French and English languages by consultation of PubMed, Cochrane and international databases. RESULTS In case of percutaneous biopsy diagnosis of FA, clinico-radiologic and pathologic discordance or complex FA or proliferative lesions or atypia with FA, a family history of cancer, it seems legitimate to discuss management in a multidisciplinary meeting. When surgery is proposed for FA, periareolar compared to direct incision is associated with more insensitive nipple but better aesthetic results (LE4). When surgery is proposed for FA, indirect incision is preferable for better cosmetic results (Grade C). Techniques of percutaneous destruction or resection can be used (Grade C). The WHO classification distinguishes three categories of phyllodes tumors (PBT): benign (grade 1), borderline (grade 2) and malignant (grade 3). For grade 1 PBT, the risk of local recurrence after surgical excision increases when PBT lesion is in contact with surgical limits (not in sano). After in sano resection, there is no correlation between margin size and the risk of recurrence (LE4). For grade 2 PBT, local recurrence after surgical excision increases for margins under 10mm margins (LE4). For grade 1-2 PBT, in sano excision is recommended. For grade 2 PBT, 10-mm margins are recommended (Grade C). No lymph node evaluation or neither systematic mastectomy is recommended (Grade C). Breast papillary lesion (BPL) without atypia, complete resection of radiologic signal is recommended (Grade C). For BPL with atypia, complete excisional surgery is recommended (Grade C).
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Affiliation(s)
- S Bendifallah
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 1136, institut Pierre-Louis et de santé publique (IPLESP), 56, boulevard Vincent-Auriol, 75646 Paris cedex 13, France.
| | - G Canlorbe
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 938, université Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75012 Paris, France
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Extremely rare borderline phyllodes tumor in the male breast: a case report. Clin Imaging 2015; 39:1108-11. [DOI: 10.1016/j.clinimag.2015.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/07/2015] [Accepted: 07/21/2015] [Indexed: 11/18/2022]
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Risks of Being Malignant or High Risk and Their Characteristics in Breast Lesions 20 mm or Larger After Benign Results on Ultrasonography-Guided 14-Gauge Core Needle Biopsy. Ultrasound Q 2015; 32:157-63. [PMID: 26441382 DOI: 10.1097/ruq.0000000000000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The malignancy risk, risk of being high-risk lesions after benign results on ultrasonography-guided 14-gauge core needle biopsies (US-CNBs), and their characteristics in breast lesions of 20 mm or greater were investigated. METHODS Eight hundred forty-seven breast lesions with benign results on US-CNB were classified as benign, high risk, and malignant through excision and clinical follow-up. The risks of being malignant or high risk were analyzed in all lesions, lesions 20 to 29 mm, and lesions 30 mm or greater. Their clinicopathological characteristics were evaluated. RESULTS Of 847, 18 (2.1%) were malignant, 53 (6.3%) were high-risk lesions, and 776 (91.6%) were benign. Of 18 malignancies, 6 (33.3%) were malignant phyllodes tumors and 12 (66.7%) were carcinomas. In benign lesions 20 to 29 mm, risks of being malignant or high risk were 1.6% (9 of 566) and 4.4% (25 of 566). In 281 lesions 30 mm or greater, the risks of being malignant or high risk were 3.2% and 10%. The risk of being high risk in lesions 30 mm or greater was 10%, significantly higher than 4.4% of lesions 20 to 29 mm (P = 0.002). CONCLUSIONS Excision can be considered in lesions measuring 20 mm or larger because of the 2.1% malignancy risk and the 6.3% risk of being high-risk lesions despite benign results on US-CNB. Excision should be considered in lesions measuring 30 mm or larger because of the 3.2% malignancy risk and the 10% risk of being high-risk lesions.
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Ossa CA, Herazo F, Gil M, Echeverri C, Ángel G, Borrero M, Madrid J, Jaramillo R. Phyllodes tumor of the breast: a clinic-pathologic study of 77 cases in a Hispanic cohort. Colomb Med (Cali) 2015; 46:104-8. [PMID: 26600624 PMCID: PMC4640431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Breast Phyllodes tumors are rare breast tumors present in less than 1% of new cases of breast cancer, usually occurring among middle-aged women (40-50 yrs). OBJECTIVE This study shows diagnostic experience, surgical management and follows up of patients with this disease during a period of ten years in a oncology referral center. METHODS Retrospectively, breast cancer registries at the institution were reviewed, identifying 77 patients with Phyllodes tumors between 2002 and 2012, who had been operated on at the Instituto de Cancerología - Clínica Las Américas, in Medellín (Colombia). Clinical and histopathological data belonging to these cases was captured and analyzed and descriptive statistics were used. RESULTS The follow up median was 22.5 months (IQR: 10.5-60.0), average age was 47.2 yrs (SD: 12.4), mean tumor size was 3.6 cm (SD: 4.6), 88.3% of the patients (68 cases) presented negative margins and none of them received adjuvant chemotherapy. Of the patients with Phyllodes tumors; 33.8% had benign, 31.2% had borderline and 35.0% had malignant tumor. Disease-free survival was 85.8% and overall survival was 94.5%. DISCUSSION Reported data in this article is in accordance with what has been reported in worldwide literature. In our cohort even the high mean size of the tumors, the risk of local relapse and metastatic disease is low than previously reported in literature. Trials with longer follow up and molecular trials in Phyllodes tumors are necessary to understand the behavior of these tumors in Hispanics population.
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Bellezza G, Prosperi E, Del Sordo R, Colella R, Rulli A, Sidoni A. IMP3 Is Strongly Expressed in Malignant Phyllodes Tumors of the Breast. Int J Surg Pathol 2015; 24:37-42. [DOI: 10.1177/1066896915603119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background. Phyllodes tumors (PTs) of the breast are rare biphasic neoplasms and are classified as benign, borderline, or malignant. Many biological markers have been studied to discriminate between different grades of PTs. IMP3 is a member of the insulin-like growth factor II mRNA binding protein (IMP) family and is expressed in developing tissues during embryogenesis, whereas in adult tissues it is found only at low or undetectable levels. IMP3 is considered a marker of biological aggressiveness in many cancers, including breast and lung. The aim of this study was to evaluate the immunohistochemical expression of IMP3 in a series of PTs and to determine its association with histological grade and clinical outcome. Materials and Methods. We reviewed retrospectively 62 cases of PTs including their recurrences and 20 cases of fibroadenoma. PTs have been classified as benign in 40 cases, borderline in 13 cases, and malignant in 9 cases. Results. There were significant differences in IMP3 expression: in malignant PTs IMP3 expression was higher (56% of cases) than in borderline (15%) and benign cases (5%), ( P = .001). Fibroadenoma showed no expression for IMP3. IMP3 expression was different in cases with recurrence than cases without recurrence. Furthermore, 3 of the recurrences had a higher histological grade with a positive IMP3 expression compared with the primary tumor. Conclusions. This is the first study evaluating the IMP3 immunohistochemical expression in PTs. Its expression correlates with histological grade and could be used in the differential diagnosis of fibroepithelial tumors and in predicting a more aggressive behavior.
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Affiliation(s)
- Guido Bellezza
- Department of Experimental Medicine - Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Italy
| | - Enrico Prosperi
- Department of Experimental Medicine - Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Italy
| | - Rachele Del Sordo
- Department of Experimental Medicine - Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Italy
| | - Renato Colella
- Department of Experimental Medicine - Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Italy
| | - Antonio Rulli
- Department of Surgery - Breast Unit, Medical School, University of Perugia, Italy
| | - Angelo Sidoni
- Department of Experimental Medicine - Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Italy
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Augustyn A, Sahoo S, Wooldridge RD. Large Malignant Phyllodes Tumor of the Breast with Metastases to the Lungs. Rare Tumors 2015; 7:5684. [PMID: 26266007 PMCID: PMC4508638 DOI: 10.4081/rt.2015.5684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 11/24/2022] Open
Abstract
Phyllodes tumors of the breast account for less than 0.5% of breast cancers and present most commonly in women 45 to 49 years old. The importance in managing fibroepithelial lesions lies in distinguishing fibroadenomas, which are benign, from phyllodes tumors, which can be malignant and require complete surgical excision. We report the case of a 56-year-old female who presented with a rapidly enlarging mass in her right breast 18 cm in maximum dimension that completely effaced the breast and distorted the nipple. The patient underwent a successful total mastectomy after core biopsy revealed a diagnosis of phyllodes tumor. Surgical resection is the primary treatment modality; neoadjuvant and adjuvant therapies remain controversial. Here, we report the case of a large malignant phyllodes tumor metastatic to the lungs, review the literature, and discuss diagnostic modalities and adjunct nonsurgical therapies.
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Affiliation(s)
- Alexander Augustyn
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Sunati Sahoo
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Rachel D Wooldridge
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center , Dallas, TX, USA
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50
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Wiratkapun C, Piyapan P, Lertsithichai P, Larbcharoensub N. Fibroadenoma versus phyllodes tumor: distinguishing factors in patients diagnosed with fibroepithelial lesions after a core needle biopsy. Diagn Interv Radiol 2015; 20:27-33. [PMID: 24356293 DOI: 10.5152/dir.2013.13133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to identify factors that might help differentiate phyllodes tumors from fibroadenomas among cases in which a fibroepithelial breast lesion was diagnosed from core needle biopsy (CNB) under imaging guidance. MATERIALS AND METHODS A retrospective review was performed on 213 lesions in 200 patients who had undergone both CNB and excisional biopsy during a four-year period between 2008 and 2011. The final pathology revealed 173 fibroadenomas and 40 phyllodes tumors. The data, including patient characteristics, clinical presentation, and mammography, ultrasonography (US), and pathology findings were analyzed. RESULTS Upon univariable analysis, the factors that significantly helped to identify phyllodes tumors consisted of the presenting symptoms (palpable mass or breast pain), increased size on clinical examination, hyperdense mass on mammogram, and the following three US features: heterogeneous echo, presence of round cysts within the mass, and presence of clefts within the mass. The pathologist's suggestion of a phyllodes tumor was also helpful. The factors that remained statistically significant upon multivariable analysis consisted of symptoms of breast pain, the presence of clefts on US, the presence of round cysts on US and the pathologist's favoring of phyllodes tumors from a CNB specimen. CONCLUSION A multidisciplinary approach was needed to distinguish phyllodes tumors from fibroadenomas in patients who had undergone CNB. US findings (clefts and round cysts), suggestive pathological diagnoses, and clinical symptoms were all useful for the decision to surgically remove the fibroepithelial lesions diagnosed from CNB.
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Affiliation(s)
- Cholatip Wiratkapun
- From the Departments of Radiology (C.W. e-mail: , P.P.), Surgery (P.L.) and Pathology (N.L.), Mahidol University School of Medicine, Ramathibodi Hospital, Bangkok, Thailand
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