Phylloides tumor of the breast: a rare neoplasm, though not that innocent

Malignant phyllodes tumor of the breast: a systematic review

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.

Malignant Phyllodes Breast Tumor: A Rare Case of Metastasis in Skeletal Muscle Detected on 18-Fluorodeoxyglucose Positron Emission Tomography

Rapidly growing cystosarcoma phyllodes tumor (PT) of the breast are rarely encountered. Distant metastases are not uncommon in malignant PTs; however, rare sites of metastases are sometimes observed. Here, we present the case of a rapidly metastasizing malignant PT in which skeletal muscle metastasis was identified on 18F-fluorodeoxyglucose-based positron emission tomography-computed tomography reflecting its aggressive course and poor prognosis.

Imatinib Spares cKit-Expressing Prostate Neuroendocrine Tumors, whereas Kills Seminal Vesicle Epithelial-Stromal Tumors by Targeting PDGFR-β

Prostate cancer is a leading cause of cancer-related death in males worldwide. Indeed, advanced and metastatic disease characterized by androgen resistance and often associated with neuroendocrine (NE) differentiation remains incurable. Using the spontaneous prostate cancer TRAMP model, we have shown that mast cells (MCs) support in vivo the growth of prostate adenocarcinoma, whereas their genetic or pharmacologic targeting favors prostate NE cancer arousal. Aiming at simultaneously targeting prostate NE tumor cells and MCs, both expressing the cKit tyrosine kinase receptor, we have tested the therapeutic effect of imatinib in TRAMP mice. Imatinib-treated TRAMP mice experience a partial benefit against prostate adenocarcinoma, because of inhibition of supportive MCs. However, they show an unexpected outgrowth of prostate NE tumors, likely because of defective signaling pathway downstream of cKit receptor. Also unexpected but very effective was the inhibition of epithelial-stromal tumors of the seminal vesicles achieved by imatinib treatment. These tumors normally arise in the seminal vesicles of TRAMP mice, independently of the degree of prostatic glandular lesions, and resemble phyllodes tumors found in human prostate and seminal vesicles, and in breast. In both mice and in patients, these tumors are negative for cKit but express PDGFR-β, another tyrosine kinase receptor specifically inhibited by imatinib. Our results imply a possible detrimental effect of imatinib in prostate cancer patients but suggest a promising therapeutic application of imatinib in the treatment of recurrent or metastatic phyllodes tumors. Mol Cancer Ther; 16(2); 365-75. ©2016 AACR.

Phyllodes Tumors of the Breast

Objective:

To study all patients with phyllodes tumors of the breast which were diagnosed at King Hussien Medical Center and Prince Rashid Military Hospital between the 1st of may 2002 till January 2009.

Methods:

A total of 26 patients diagnosed to have phylloedes tumors were retrieved from the hospital records. All cases were analyzed and assessed in two main categories: demographical characteristics and histopathological parameters. The demographical characteristics included: sex and age of the patients, and tumor size while the histopathological aspects were divided into three subgroups: Benign, Borderline and Malignant tumors with its stromal components characteristics. All the histopathological reports for specimens sent by surgeons were reviewed by 2 senior pathologists. Statistical analysis was done by using Chi square and P-Value.

Results:

All our patients were females; their age range between 17-67 years, the mean patient age at presentation was 39 years. Out of the 26 patients diagnosed to have phyllodes tumor, 6 had breast-conserving therapy and 20 women had mastectomy. The types of Phyllodes tumors include: A-Benign phyllodes tumors (15 cases), B-Borderline phyllodes (7cases) and C-malignant phyllodes (4 cases). With significant values of benign tumors occurrence (p<0.01)), while borderline and malignant ones were not significant (NS) in comparison to the benign type. There were two cases below the age of 20 and one above the age of 65, with right breast involvement in eleven out of twenty six cases (42%), fifteen out of twenty six cases have involvement of the left breast (58%) and no cases found of bilateral phyllodes tumors of the breast. The greatest dimension of the tumors ranged from 1 to 15 cm, with a mean of 5 cm. Approximately 73.1% of tumors were less or equal to 5 cm in the greatest dimension and 26.9% >5 cm. The duration of symptoms varied from one month to ten year.s Six patients had painful swellings, whereas in twenty patients the pain was absent. Four patients had recurrent tumors; the distinctive features of those with recurrent tumors were the histological findings of stromal over growth and the presence of positive resection margin. In our series, we found that three patients of those with recurrence discovered to have stromal over growth. While one only had a previous positive resection margin without stromal overgrowth.

Conclusion:

Rapid growth of phyllodes tumor does not necessarily imply malignancy. In our series, clinical tumor’s size was not the significant factor for recurrence. Local recurrence occur in patients who were treated with breast-conserving surgery, and it is highly significant when there is stromal over growth (P value <0.01 and Chi square of 8.21) in comparison with the resection margin without stromal overgrowth (P value <0.1 and Chi square of 3.23) which gives a clue for further studies about the stromal factor role in recurrence of the tumor.

Distribution of ABO and Rh blood groups in Greece: an update

The aim of this study was to investigate and evaluate the frequency of the antigens classifying the ABO and Rh blood groups in the Greek population. In this study the 3.5% were first generation immigrants with both their parents immigrants from countries of the USSR, while 1.2% had only one immigrant parent, while the other one was Greek. We compared the frequency of distribution of blood groups ABO and Rh to previous studies conducted at a time before Greece became destination for refugees and immigrants from East and Northeast countries. Blood samples were collected from first year medical students. The frequency of distribution of the ABO and Rh blood groups was slightly differentiated in comparison to previous relevant studies. Significant increase was recorded with respect to the emergence of blood group B in the population investigated, and a considerable reduction was noted in blood group O. In reference to the remaining blood groups, no statistically significant difference was documented. The genetic pool and the genetic inventory of the population residing in Greece have been modified during the last years potentially due to the first generation immigrants. The results of this study could contribute significantly to the National Health System in aiding the prediction of percussions of certain diseases related to blood groups, as well as the requirement for certain blood groups within the blood donation program.