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Jamjoum G, Alrefaei M, Alhamed W, Alsefri J, Abuzinadah A. Co-existence of malignant phylloid tumor and metaplastic malignant spindle cell carcinoma: case report. J Surg Case Rep 2024; 2024:rjae465. [PMID: 39056023 PMCID: PMC11272168 DOI: 10.1093/jscr/rjae465] [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] [Received: 04/20/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Phyllodes tumors (PTs) and Metaplastic Malignant Spindle Cell Carcinoma (MMSCC) are rare and challenging breast malignancies. MMSCC is even rarer and highly aggressive. Surgical excision is the mainstay of treatment for both, but MMSCC generally carries a poorer prognosis. A 46-year-old woman with a history of breast augmentation 4 years ago presented with a rapidly progressing right breast mass. Imaging and core biopsy suggested a malignant PT. A right mastectomy with latissimus dorsi flap reconstruction was done. Initially diagnosed as a malignant PT, the post-operative pathology revealed a co-existence of malignant PT and MMSCC, an extremely rare finding. This case reports the unique challenge of a patient harboring both malignant PT and MMSCC within the same breast tissue. This exceedingly rare co-existence emphasizes the diagnostic complexities associated with uncommon breast malignancies. Our case highlights the challenges of diagnosing and managing uncommon and aggressive breast malignancies.
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Affiliation(s)
- Ghader Jamjoum
- Gastrointestinal Oncology Unit, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia
| | - Mariya Alrefaei
- King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia
| | - Wasan Alhamed
- King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia
| | - Joud Alsefri
- Fakeeh College for Medical Sciences, Jeddah 21461, Saudi Arabia
| | - Ahmed Abuzinadah
- Biomedical Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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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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Hasdemir S, Tolunay Ş, Özşen M, Gökgöz MŞ. Phyllodes Tumor of the Breast: A Clinicopathological Evaluation of 55 Cases. Eur J Breast Health 2020; 16:32-38. [PMID: 31912011 PMCID: PMC6939715 DOI: 10.5152/ejbh.2019.4709] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Phyllodes tumors are biphasic tumors consisting of epithelial and stromal components that account for less than 1% of all breast tumors. According to the World Health Organization (WHO) phyllodes tumors are classified into three categories as benign, borderline and malignant. It has been reported that these tumors are usually benign and both the stromal component and the epithelial component may progress to malignancy. In this descriptive study, it was aimed to present the cases of phyllodes tumor and to evaluate the clinicopathological features of these tumors in the light of the literature. MATERIALS AND METHODS In our study, 55 cases of phyllodes tumor diagnosed between 2005-2018 in the Department of Medical Pathology were retrospectively studied. A total of 55 cases were included in the study. RESULTS All cases were female with a mean age of 39.7+15.2 years. Fifty-seven tumors diagnosed in 55 cases were classed as benign in 20 cases (35.1%), borderline in 14 cases (24.6%) and malignant phyllodes tumors in 23 cases (40.3%). Ductal carcinoma in situ (solid and cribriform type) were detected in one case with malignant phyllodes tumor, whereas invasive ductal carcinoma was detected in one case. Bilateral ductal carcinoma in situ was present in the patient with invasive ductal carcinoma. CONCLUSION These tumors which rapidly grow into large masses can be clinically and pathologically confused with benign lesions, macroscopic and microscopic evaluation of concomitant in situ-invasive carcinomas should be considered. Phyllodes tumors have an important role in breast surgery and pathology.
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Affiliation(s)
- Seçil Hasdemir
- Department of Pathology, Uludağ University School of Medicine, Bursa, Turkey
| | - Şahsine Tolunay
- Department of Pathology, Uludağ University School of Medicine, Bursa, Turkey
| | - Mine Özşen
- Department of Pathology, Uludağ University School of Medicine, Bursa, Turkey
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Elghobashy M, Basu N, Warner R, Dickson J, Shaaban AM. Metaplastic Breast Cancer Masquerading as Liposarcoma of the Breast: A Case Report following Oncoplastic Treatment. Pathobiology 2018; 85:261-265. [PMID: 29788010 DOI: 10.1159/000488455] [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: 10/30/2017] [Accepted: 03/14/2018] [Indexed: 11/19/2022] Open
Abstract
Mammary liposarcoma is among the rarest of breast tumours. Here we report the presentation, macroscopic, microscopic, and immunohistochemical features of an extremely rare case of metaplastic carcinoma with extensive pleomorphic liposarcomatous differentiation. A 47-year-old woman presented with bilateral grade III breast ptosis and a 3 × 4 cm mass in the lower outer quadrant of the left breast. Mammography and ultrasound confirmed a well-defined mass. A core biopsy performed was diagnosed as pleomorphic liposarcoma. Microscopically, this was a well-defined, lobulated tumour comprising solid sheets of large pleomorphic and spindle cells with bizarre forms, vacuolated cytoplasm, and ample mitoses. Atypical lipoblasts were easily identifiable. Due to the strong, though patchy, cytokeratin expression, the diagnosis of metaplastic carcinoma with pleomorphic liposarcomatous differentiation was made. Extensive sampling, careful search for a biphasic pattern, ductal carcinoma in situ, and/or epithelial differentiation, and a panel of broad-spectrum cytokeratins are essential to establish the diagnosis.
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Affiliation(s)
| | - Naren Basu
- Department of Oncoplastic Surgery, The Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Robert Warner
- Department of Oncoplastic Surgery, The Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - John Dickson
- Department of Oncoplastic Surgery, The Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Abeer M Shaaban
- University of Birmingham, Birmingham, United Kingdom.,Department of Cellular Pathology, The Queen Elizabeth Hospital, Birmingham, United Kingdom
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Widya RL, Rodrigues MF, Truong PT, Watson PH, Weir LM, Knowling MA, Wai ES. Malignant Epithelial Transformation in Phyllodes Tumor: A Population-Based Case Series. Cureus 2017; 9:e1815. [PMID: 29312836 PMCID: PMC5752221 DOI: 10.7759/cureus.1815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background Phyllodes tumor (PT) of the breast is an uncommon fibroepithelial neoplasm. Malignant epithelial transformation in PT is rare. This study reports clinicopathologic characteristics and outcomes of patients with malignant epithelial transformation in PT. Methods From an institutional database of 183 patients with newly diagnosed PT referred to a Canadian provincial cancer institution between 1999 and 2014, 11 cases of PT with concomitant in situ or invasive carcinoma were identified. Descriptive analysis was performed to document the characteristics, treatment and outcomes of this cohort. Results Prevalence of malignant epithelial transformation in PT was 6.0%. Median (range) age was 54 (35-75) years. Types of carcinoma were ductal carcinoma in situ (DCIS) (n = 6), lobular carcinoma in situ (n = 4), and invasive ductal carcinoma (IDC) (n = 1). Median PT size was 5 (1-15) cm. Three PTs were classified as benign (27%), five as borderline (45%), and three as malignant (27%). Mastectomy was performed in six (55%) and breast conserving surgery in five (45%) patients. Hormonal therapy was used in two cases: one with a 1 cm, grade 2 DCIS, and one with an 11 cm, grade 1 IDC, the latter also receiving radiotherapy. Mean follow-up duration was 54 (6-175) months. None of the cases showed any evidence of disease after treatment at the time of their last follow-up. Conclusion This case series showed a higher prevalence of malignant epithelial transformation in PT than reported in previous literature. Outcomes were favourable despite the presence of either in situ or invasive carcinoma within PT.
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Affiliation(s)
| | | | - Pauline T Truong
- Radiation Oncology, University of British Columbia, BC Cancer Agency
| | - Peter H Watson
- Pathology, University of British Columbia, BC Cancer Agency
| | - Lorna M Weir
- Radiation Oncology, University of British Columbia, BC Cancer Agency
| | | | - Elaine S Wai
- Radiation Oncology, University of British Columbia, BC Cancer Agency
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Wu DI, Zhang H, Guo L, Yan XU, Fan Z. Invasive ductal carcinoma within borderline phyllodes tumor with lymph node metastases: A case report and review of the literature. Oncol Lett 2016; 11:2502-2506. [PMID: 27073506 DOI: 10.3892/ol.2016.4238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 07/30/2015] [Indexed: 11/06/2022] Open
Abstract
Phyllodes tumor (PT) is a rare type of biphasic fibroepithelial neoplasm that may coexist with a breast tumor in rare cases. In the current study, a 52-year-old female presented with a left breast lump. Mammography and sonographic examination results suggested a diagnosis of malignant tumor. Histological analysis revealed a borderline PT with invasive ductal carcinoma (IDC) within the tumor. Due to the presence of a single micrometastasis in three of the sentinel lymph nodes, the patient underwent modified radical mastectomy. The excised tumor contained triple negative breast cancer; therefore, postoperative treatment included six cycles of chemotherapy and 25 cycles of radiotherapy. The patient exhibited no recurrence and no metastatic disease at the 23-month follow-up examination. Thus, the present study discussed the case of a female patient that presented with IDC within borderline PT and reviewed the literature on this rare type of neoplasm. Various types of breast carcinoma have been identified to coexist with PT in different masses; however, no standard therapeutic regimen has been established for the coexistence of PT and breast cancer in the same mass. The present study indicates that determination of an appropriate treatment strategy predominantly depends on the characteristics of the individual breast tumor.
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Affiliation(s)
- D I Wu
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Haipeng Zhang
- Department of Obstetrics, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Liang Guo
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - X U Yan
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhimin Fan
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Sato T, Muto I, Sakai T. Coexistence of malignant phyllodes tumor and her2-positive locally advanced breast cancer in distinct breasts: A case report. Int J Surg Case Rep 2016; 19:163-7. [PMID: 26773878 PMCID: PMC4756194 DOI: 10.1016/j.ijscr.2015.12.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumor and breast cancer rarely occur simultaneously in distinct breasts. Phyllodes tumor rapidly enlarged during effective chemotherapy for breast cancer. Distinction of phyllodes tumor and fibroadenoma is frequently difficult. For correct diagnosis of phyllodes tumor, surgical resection is required.
Introduction Phyllodes tumor of the breast is a rare biphasic neoplasm, accounting for less than 1% of all breast tumors. Coexistence of phyllodes tumor and breast cancer in distinct breasts is extremely rare. Case presentation A 47-year-old Japanese woman presented with bilateral breast lumps. A HER2-positive, unresectable invasive carcinoma in the right breast and fibroadenoma in the left were diagnosed via core needle biopsy. During chemotherapy with anti-HER2 therapy, the breast cancer shrank quickly, while the left breast lump suddenly enlarged. Under a diagnosis of malignant neoplasm of the breast, left mastectomy was performed. Malignant phyllodes tumor was diagnosed by postoperative histological examination and recurred in multiple areas as early as 2 months after surgery. Discussion Only 10 cases of coexisting phyllodes tumor and breast cancer in distinct breasts have been reported in the English literature. Phyllodes tumor associated with breast cancer in distinct breasts tends to be malignant. This is the first case of phyllodes tumor rapidly enlarging during anti-HER2 chemotherapy for locally advanced HER2-positive breast cancer. Conclusion Even during effective treatment of advanced or recurrent breast cancer, attention should also be paid to the contralateral breast for the possible association of a second malignancy such as phyllodes tumor.
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Affiliation(s)
- Tomoi Sato
- Department of Surgery, Niigata Prefectural Central Hospital, 205 Shinnan-cho, Joetsu, Niigata 943-0192, Japan.
| | - Ichiro Muto
- Department of Surgery, Niigata Prefectural Central Hospital, 205 Shinnan-cho, Joetsu, Niigata 943-0192, Japan.
| | - Takeshi Sakai
- Department ofDiagnostic Pathology, Niigata Prefectural Central Hospital, 205 Shinnan-cho, Joetsu, Niigata 943-0192, Japan.
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Jain S, Kaur R, Agarwal R, Chopra P. Bilateral invasive duct carcinoma, phyllodes tumor and multiple fibroadenomas of breast associated with lymph node metastases - rare coexistence. Indian J Surg Oncol 2014; 5:186-8. [PMID: 25419062 DOI: 10.1007/s13193-014-0338-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/11/2014] [Indexed: 11/24/2022] Open
Abstract
Concomitant occurrence of phyllodes tumor with an in situ or invasive carcinoma in the breast is an uncommon phenomenon and has been reported sparingly. We describe a rare case of simultaneous bilateral intraductal and infiltrating duct carcinoma with coexisting fibroadenomas and phyllodes tumor. To the best of our knowledge, only 19 cases of invasive carcinoma with phyllodes tumor have been reported so far and lymph node metastases has been described only once. A 43 year-old woman presented with multiple bilateral breast lumps. Core biopsies revealed phyllodes tumor in the right breast and invasive duct carcinoma of the left breast. Simple mastectomy done for right breast showed foci of invasive carcinoma arising in phyllodes tumor. Metastasis was detected in the left axillary lymph nodes. This case is being reported to create awareness of this rare transformation, which has significant prognostic and therapeutic implications.
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Affiliation(s)
- Sunila Jain
- Department of Pathology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060 India
| | - Ramneet Kaur
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Rajeev Agarwal
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Prem Chopra
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
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Choi Y, Lee KY, Jang MH, Seol H, Kim SW, Park SY. Invasive cribriform carcinoma arising in malignant phyllodes tumor of breast: a case report. KOREAN JOURNAL OF PATHOLOGY 2012; 46:205-9. [PMID: 23110003 PMCID: PMC3479779 DOI: 10.4132/koreanjpathol.2012.46.2.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 10/09/2011] [Accepted: 10/12/2011] [Indexed: 11/28/2022]
Abstract
Phyllodes tumor is an uncommon fibroepithelial neoplasm of the breast. And it is characterized by expanded stroma with increased cellularity and elongated epithelium-lined clefts. Mammary carcinomas within phyllodes tumors have been rarely reported. To date, however, no reports have described the invasive cribriform carcinoma arising in malignant phyllodes tumor. Here, we report a 62-year-old woman who presented with a large breast mass. Microscopically, the mass was a typical malignant phyllodes tumor showing well developed leaf-like architecture and stromal overgrowth with high cellularity and nuclear pleomorphism. In a portion of the tumor, however, the epithelial component showed a cribriform pattern of proliferation in the absence of myoepithelial cells, suggestive of the invasive cribriform carcinoma. To our knowledge, this is rare and it is difficult to make a differential diagnosis of it. Here, we report our case with a review of literatures.
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Affiliation(s)
- Yoomi Choi
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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