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Suo J, He P, He Q, Zhong X, Luo T. Neoadjuvant chemotherapy combined with transarterial embolization in an inflammatory breast cancer patient with a heavy tumor burden, ulceration, and exudation: A letter to the editor. J Vasc Interv Radiol 2021; 33:614-616.e1. [PMID: 34896574 DOI: 10.1016/j.jvir.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 11/25/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- Jiaojiao Suo
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping He
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing He
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaorong Zhong
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Luo
- Department of Head, Neck and Mammary Gland Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Yap RV, De La Serna FM, Cala-Or MA, Castillon AG. Preoperative embolization of a giant benign phyllodes tumor: A case report and review of literature. Int J Surg Case Rep 2021; 89:106602. [PMID: 34784531 PMCID: PMC8599164 DOI: 10.1016/j.ijscr.2021.106602] [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: 10/11/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Phyllodes tumors (PT) account for less than 1% of all breast tumors. Giant PTs can lead to breast disfigurement, tumoral ulceration, and bleeding. Outright surgical excision can be challenging or unsafe. Preoperative transarterial embolization (TAE) has a role but data on its use in the management of PT is limited. CASE PRESENTATION A 43-year-old female presented with a 28 cm fungating, necrotic, benign PT on her left breast that eventually developed tumoral bleeding leading to hemodynamic instability. Preoperative TAE controlled the bleeding and allowed the safe performance of mastectomy. A literature review of preoperative TAE of PTs is also presented including the addition of a chemotherapeutic agent in malignant types. CLINICAL DISCUSSION PTs are rare and comprise only 2.5% of all fibroepithelial breast lesions. Tumoral bleeding causing severe anemia is one of the most common presentations of massive (≥20 cm) PTs, especially when neglected. Indications for preoperative TAE include (1) to halt rapid tumor growth, (2) to control active/persistent tumoral bleeding, and (3) to shrink the tumor size and allow successful resection with negative margins, and avoidance of skin grafting. Post-TAE side effects include fever, chest pain, gradual/expanding tumor necrosis, decrease in tumor weight, and diminished tumoral abscess/discharge, and loss of tumoral vessel elasticity. CONCLUSION Neglected PTs can reach an alarming size. Preoperative TAE is a safe and effective method of controlling life-threatening tumoral hemorrhage and decreasing the size of PTs thereby allowing definitive resection while avoiding skin grafting and/or flap reconstruction.
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Affiliation(s)
- Ralph Victor Yap
- Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Philippines.
| | | | - Ma Arlene Cala-Or
- Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Philippines; Section of Plastic and Reconstructive Surgery, Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Philippines
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Fabrication of Fe 3O 4@PVA microspheres by one-step electrospray for magnetic resonance imaging during transcatheter arterial embolization. Acta Biomater 2021; 131:532-543. [PMID: 34245893 DOI: 10.1016/j.actbio.2021.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) has attracted increasing attention as a feasible alternative or adjunctive imaging modality for X-ray digital subtraction angiography because of the high tissue resolution and non-ionization radiation. In this study, a one-step electrospray method was developed to fabricate PVA microspheres encapsulated with in situ synthesized Fe3O4 nanoparticles. Fe3O4@PVA microspheres were mono-dispersed black spheres with a wide range of sizes (262-958 µm). The in situ-synthesized Fe3O4 nanoparticles were used as the contrast agent of MRI and the cross-linkers of PVA matrixes for the embolization purpose. In vivo evaluation of renal arteries of normal rabbits showed that Fe3O4@PVA microspheres had good embolic effect and enhanced capability of MRI. In vitro and in vivo biosafety assessment confirmed that Fe3O4@PVA microspheres had favorable biocompatibility. The DOX-loaded Fe3O4@PVA microspheres showed a typical drug-sustained release profile. These results suggest that the prepared DOX-loaded Fe3O4@PVA microspheres have the function of MRI, embolotherapy and chemotherapy. We expect our study could provide a simple and useful approach for the systematic design, fabrication, and application of a new type of magnetic microspheres as a triple-functional embolic agent for the development of MRI-guided TACE. STATEMENT OF SIGNIFICANCE: Due to the low tissue resolution and hazardous ionization radiation of X-ray digital subtraction angiography, it is beneficial to study MR imaging embolic microspheres for the development of MRI-guided TACE. In this study, a one-step electrospray method was firstly developed to fabricate PVA microspheres encapsulated with in situ synthesized Fe3O4 nanoparticles. Then, chemotherapeutic agent (DOX), contrast media of MRI (Fe3O4) and embolic agent (PVA matrix) were combined together in one body (DOX-loaded Fe3O4@PVA microspheres) to achieve the triple effects of chemotherapy, MR imaging and embolization. This triple-functional embolic agent offers potential for the future development of MRI-guided TACE.
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Tian Y, Liu L, Chen L, Zhao S, Su R, Zhang W, Jiang A, Chen W, Ge F. Preoperative interventional artery embolization for the treatment of a giant malignant phyllodes tumor: A case report. Mol Clin Oncol 2021; 15:133. [PMID: 34055348 PMCID: PMC8138852 DOI: 10.3892/mco.2021.2295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/01/2021] [Indexed: 12/14/2022] Open
Abstract
Phyllodes tumors (PTs) are rare but complex fibroepithelial lesions of the breast. The present report describes an unusual case of a giant malignant PT with a rich blood supply treated with dominant blood supply internal thoracic artery interventional embolization before surgery. A 41-year-old woman without underlying systemic disease presented with a tumor >20 cm in diameter growing rapidly in the left breast. Radiological results indicated a giant circular tumor with a clear boundary occupying the whole breast, possible invasion of the major pectoralis muscle and several enlarged lymph nodes in the left axillary region. Computed tomography angiography showed a large mass with a rich and powerful blood vessel supply and preoperative interventional embolization was performed to block the internal thoracic artery. Three days after artery embolization, mastectomy and grade I axillary lymph node dissection were performed. The giant tumor measured 17x16x11 cm. The surgery successfully treated the pain and tumor necrosis and the patient received chemotherapy and local radiotherapy. No recurrence was found at the 14-month follow-up.
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Affiliation(s)
- Yue Tian
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Linlin Liu
- School of Forensic Medicine, Kunming Medical University, Kunming, Yunnan 650118, P.R. China
| | - Liang Chen
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Shengdi Zhao
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Ruijun Su
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Wenzhu Zhang
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Aimei Jiang
- No. 1 School of Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650032, P.R. China.,First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Wenlin Chen
- The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650118, P.R. China
| | - Fei Ge
- First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
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Zhang T, Feng L, Lian J, Ren WL. Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report. World J Clin Cases 2020; 8:3591-3600. [PMID: 32913869 PMCID: PMC7457108 DOI: 10.12998/wjcc.v8.i16.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Phyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.
CASE SUMMARY A 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.
CONCLUSION This case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.
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Affiliation(s)
- Ting Zhang
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Liang Feng
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Jie Lian
- Department of Pathology, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
| | - Wei-Li Ren
- Department of Breast Disease Center, People's Hospital of Shangyu, Shaoxing 312300, Zhejiang Province, China
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