Unusual aggressive breast cancer: metastatic malignant phyllodes tumor

Palliative Surgery for Metastatic Fungating Phyllodes Tumors: A Series of Two Cases

INTRODUCTION

Local treatment of metastatic cystosarcoma phyllodes is classically viewed with skepticism because it does not provide survival benefit. When these advanced tumors ulcerate, they reduce quality of life dramatically because of associated pain, infection, malodor, massive discharge, and bleeding.

CASE PRESENTATIONS

Two patients with metastatic cystosarcoma phyllodes presented to our hospital with recurrent disease featuring foul-smelling, ulcerated chest wall masses that caused physical pain and social exclusion. The first patient underwent radical chest wall resection with pedicled lattisimus dorsi flap reconstruction. The second patient underwent wide local excision with split-thickness skin grafting. There was significant improvement in the quality of life for these patients after the operations.

DISCUSSION

Though both patients finally succumbed to progressive metastatic disease, palliative resection allowed them to have good social and family support to the end. Palliative surgery plays an important role in alleviating suffering of patients with metastatic fungating cystosarcoma phyllodes and has the potential to improve their quality of life significantly.

Bone metastasis from malignant phyllodes breast tumor: report of two cases

Background

Phyllodes tumors are rare fibroepithelial tumors accounting for less than 1 % of all breast neoplasms. They are malignant in 20 % of cases. Only a few cases of malignant phyllodes tumors metastatic to bone have been reported.

Case presentation

Case 1: A 40 year-old white woman presented with three-week history of pain and functional impairment of the left lower limb. Her clinical past was remarkable for previous left mastectomy and radiotherapy for malignant phyllodes tumor performed one year ago. Computed tomography revealed a moth-eaten appearance of the left femoral head. The patient underwent computed guided femoral head biopsy. Pathological findings were consistent with metastatic malignant phyllodes tumor. The patient received ifosfamide and adriamycin chemotherapy. She is doing well without any evidence of progression on her imaging follow- up after 8 months.

Case 2: A 48 year-old white woman, with history of bilateral mastectomy and radiotherapy for malignant phyllodes tumor performed one and two year ago, presented with four-week left lower quadrant abdominal pain. Computed tomography and magnetic resonance imaging revealed a solid aggressive osteolytic mass of the left iliac bone with extensive soft tissue invasion. Biopsy of the tumor was performed and showed a sarcomatous proliferation consistent with metastatic malignant phyllodes tumor. The patient received the same chemotherapy regimen as in the first case but without any response on her imaging follow up after 6 months.

Conclusion

Malignant phyllodes tumor is a rare and aggressive fibroepithelial neoplasm. An accurate diagnosis of metastases should be based on clinicopathological correlation allowing exclusion of differential diagnoses. The goal of successful managing this tumor is early detection and complete resection prior to dissemination.

A Phyllodes-like Mammary Tumor in a Breeding Galago (Otolemur garnettii)

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.

Phyllodes tumor of the verumontanum: a case report

The current report presents the case of a 42-year-old male with extraordinarily salient urination difficulty that had lasted 6 months. Transrectal ultrasonography and pelvic magnetic resonance imaging demonstrated prostatic hyperplasia and cyst. PSA level was 20.65 (>4) μg/L in the patient. Transrectal prostatic biopsy revealed benign prostatic hyperplasia. He agreed to receive plasmakinetic resection of the prostate. During operation a lobulated lump was unexpectedly found on the verumontanum, with the prostate macroscopically normal. Complete tumor excision was performed and pathological assessment indicated phyllodes tumor of the verumontanum. The patient had an uneventful post-operative course and recovered well. The diagnosis, histological classification, treatment, and prognosis of this case are presented. It is necessary to perform cystoscopy to exclude verumontanum tumor even when all imaging examinations indicate prostate hyperplasia, especially in young males. Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1868931661161758.

Phyllodes tumor of the breast metastasizing to the vulva

Phyllodes tumors of the breast are rare breast tumors that resemble fibroadenoma. They are composed of two types of tissues: stromal and glandular tissues. Unlike fibroadenoma, they are commonly found in the third decade of life and they tend to grow more rapidly. Depending on the relative components of the cells and mitotic activity, they are classified into benign, borderline, and malignant. They are usually present as a lump in the breast. Phyllodes tumors are usually managed by wide excision. The excision should be wide enough to ensure a tumor-free margin. Recurrence rate is very high and most recurrences are usually local. Metastasis to the vulva has not been reported.

Malignant phyllodes tumor with chondrosarcomatous differentiation: radiological-pathological correlation

We present a case of a 63-year-old woman with malignant phyllodes tumor in her left breast. On imaging, a large, dumbbell-shaped, predominantly cystic mass with thin peripheral enhancement was noted. The lesion was causing rib destruction, chest wall invasion, and intrathoracic extension. These aggressive imaging features were considered highly suspicious of a malignant chest wall tumor. Subsequent chest wall resection of the tumor showed breast tissue with a biphasic lesion composed of proliferated spindle cells in loose sheets with extensive islands of atypical cartilage and a scanty epithelial component, including compressed ducts in the periphery of the lesion. A diagnosis of a malignant phyllodes tumor with stromal overgrowth and chondrosarcomatous differentiation was made in view of the presence of a benign epithelial component and negative reaction of the stromal component with a pancytokeratin. To the best of our knowledge, a phyllodes tumor with the radiological features of chest wall invasion and intrathoracic extension has not been described in the literature until now. Malignant phyllodes should be included in the list of differentials along with sarcomas on encountering lesions with such aggressive imaging features.