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Modern Pathology : An Official Journal... Jan 2021Fibroepithelial lesions of the breast, comprising the fibroadenoma and phyllodes tumour, are a unique group of neoplasms that share histological characteristics but... (Review)
Review
Fibroepithelial lesions of the breast, comprising the fibroadenoma and phyllodes tumour, are a unique group of neoplasms that share histological characteristics but possess different clinical behaviour. The fibroadenoma is the commonest benign breast tumour in women, while the phyllodes tumour is rare and may be associated with recurrences, grade progression and even metastasis. The diagnosis of fibroadenoma is usually straightforward, with recognised histological variants such as the cellular, complex, juvenile and myxoid forms. The phyllodes tumour comprises benign, borderline and malignant varieties, graded using a constellation of histological parameters based on stromal characteristics of hypercellularity, atypia, mitoses, overgrowth and the nature of tumour borders. While phyllodes tumour grade correlates with clinical behaviour, interobserver variability in assessing multiple parameters that are potentially of different biological weightage leads to significant challenges in accurate grade determination and consequently therapy. Differential diagnostic considerations along the spectrum of fibroepithelial tumours can be problematic in routine practice. Recent discoveries of the molecular underpinnings of these tumours may have diagnostic, prognostic and therapeutic implications.
Topics: Breast; Breast Neoplasms; Diagnosis, Differential; Female; Fibroadenoma; Humans; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasms, Fibroepithelial; Phyllodes Tumor
PubMed: 32461622
DOI: 10.1038/s41379-020-0583-3 -
Canadian Association of Radiologists... May 2021Phyllodes tumors are rare breast neoplasms and the histopathological grade and surgical margins help guide treatment and follow-up. The traditional surgical teaching is...
BACKGROUND
Phyllodes tumors are rare breast neoplasms and the histopathological grade and surgical margins help guide treatment and follow-up. The traditional surgical teaching is resection with ≥10 mm margins, but are narrower surgical margins acceptable? The purpose of our study was to identify predictors of local recurrence.
METHODS
A retrospective analysis was performed to identify patients with phyllodes tumors who underwent surgery between 2002 and 2014 using a regional pathology database. Electronic medical records were used to identify surgical management, pathological characteristics, and follow-up encounters.
RESULTS
A total of 150 phyllodes tumors were included: 110 of 150 (73%) benign, 21 of 150 (14%) borderline, and 19 of 150 (13%) malignant. At initial surgery, 29 specimens had a positive margin and 15 (56%) underwent re-excision. Seventy tumors had a surgical margin of ≤1 mm, 40 had a margin of 2 to 9 mm, and 11 had a margin of ≥10 mm. There were 11 of 150 (7.3%) locally recurrent tumors: 5 of 11 (45%) benign, 3 of 11 (27%) borderline, and 3 of 11 (27%) malignant. In total, 10 of 11 locally recurrent tumors had a positive margin or ≤1 mm margin at initial surgery.
CONCLUSIONS
Phyllodes tumors can have a personalized treatment approach based on histopathological grade and surgical margins. Borderline and malignant phyllodes tumors with a positive or ≤1 mm surgical margin have an increased risk of recurrence. In benign phyllodes tumors, an optimal narrow negative margin may exist but the traditional ≥10 mm excisional margin is not necessary. Local recurrence rates may be sufficiently low in benign phyllodes tumors that imaging can be performed on the presence of clinical symptoms.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Cohort Studies; Female; Follow-Up Studies; Humans; Margins of Excision; Middle Aged; Neoplasm Recurrence, Local; Ontario; Phyllodes Tumor; Prospective Studies; Retrospective Studies; Risk Assessment; Young Adult
PubMed: 32090614
DOI: 10.1177/0846537119899553 -
Journal of Nuclear Medicine Technology Jun 2023Phyllodes tumor (PT) represents a rare type of breast tumor arising from the stromal component rather than the epithelium. Metastatic spread occurs hematogenously, with...
Phyllodes tumor (PT) represents a rare type of breast tumor arising from the stromal component rather than the epithelium. Metastatic spread occurs hematogenously, with lung, bone, brain, and liver being the most common sites. We present the F-FDG PET/CT scan of one such case of phyllodes tumor showing cardiac and pancreatic metastases, which are an extremely rare occurrence.
Topics: Humans; Female; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Phyllodes Tumor; Tomography, X-Ray Computed; Pancreatic Neoplasms; Breast Neoplasms
PubMed: 36750379
DOI: 10.2967/jnmt.122.265212 -
The Pan African Medical Journal 2022
Topics: Breast; Breast Neoplasms; Female; Humans; Phyllodes Tumor
PubMed: 36034036
DOI: 10.11604/pamj.2022.42.73.35409 -
Annals of Surgical Oncology Jul 2019
Topics: Breast Neoplasms; Female; Humans; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Time Factors
PubMed: 30863938
DOI: 10.1245/s10434-019-07278-y -
Archives of Iranian Medicine Jul 2020Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy,...
BACKGROUND
Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy, gathering up to 14 patients. We performed a thorough systematic review of the literature in an attempt to find all reported cases, and identify their common characteristics.
METHODS
We searched Google scholar, PubMed, Ovid Medline, Scopus and ClinicalTrials.gov with several relevant combinations of keywords, looking for texts or abstracts without any date or language limitations, but using only English keywords. The existing literature only consisted of case reports and series; therefore any paper including one or several cases of PT presenting during pregnancy or breastfeeding was recognized as eligible. Articles with vague description of the tumor which made the diagnosis uncertain, and those lacking data about the tumor and management data were excluded. We contacted authors for more details in cases with incomplete information.
RESULTS
After excluding those with very deficient data, we included 37 studies, counting 43 cases. The mean age of the patients was 31 years (21-43 years). Some features were different from usual PT: bilaterality (16.2%), large size (14.2 ± 8.6 cm), rapid enlargement (79.5%), and rate of malignancy (60.5%).
CONCLUSION
Our findings show high rates of bilaterality, large size, rapid growth, and malignant pathology in the reported gestational PTs.
Topics: Breast Neoplasms; Female; Humans; Lactation; Mastectomy; Phyllodes Tumor; Pregnancy; Pregnancy Complications, Neoplastic
PubMed: 32657600
DOI: 10.34172/aim.2020.46 -
Oncology Letters Dec 2023There are markers of metabolic coupling in breast cancer. Loss of caveolin-1 (Cav-1) and upregulation of monocarboxylate transporters (MCTs), especially MCT1 and MCT4,...
There are markers of metabolic coupling in breast cancer. Loss of caveolin-1 (Cav-1) and upregulation of monocarboxylate transporters (MCTs), especially MCT1 and MCT4, serve an important role in metabolic coupling necessary for release and uptake of metabolites. However, the occurrence of these phenomena in phyllodes tumors (PTs) of the breast is unclear. A total of 101 PTs (60 benign, 26 borderline and 15 malignant) and nine breast tissue samples with no pathological lesions were analyzed. Immunohistochemical staining for Cav-1, MCT1 and MCT4 was performed using tissue microarray and their expression in both stromal and epithelial components was assessed. Cav-1 expression in PTs demonstrated a significant decrease in the stromal component compared with that in the normal breast tissues (P<0.001). MCT1 expression in both epithelial and stromal components was significantly increased in PTs, compared with that in normal breast tissues (both P<0.001). Stromal MCT1 and MCT4 expression were different depending on tumor grade of PTs, and stromal MCT1 expression significantly increased with increasing tumor grade (P<0.001). Although not statistically significant, stromal Cav-1 expression notably decreased with increases in PT grade. High stromal MCT1 expression was significantly associated with lower disease-free survival rate in comparison with low stromal MCT1 expression (P<0.05). These results suggested that changes in protein expression of Cav-1, MCT1 and MCT4 may be associated with tumorigenesis and progression of PTs of the breast.
PubMed: 38020291
DOI: 10.3892/ol.2023.14132 -
Indian Journal of Surgical Oncology Dec 2022Malignant phyllodes tumor (MPT) with heterologous sarcomatous differentiation is extremely rare. We reviewed eleven cases of MPT with heterologous sarcomatous...
Malignant phyllodes tumor (MPT) with heterologous sarcomatous differentiation is extremely rare. We reviewed eleven cases of MPT with heterologous sarcomatous differentiation at our institute between 2009 and 2020. Demographic and clinical data were collected from patient records in hospital information system and population-based cancer registry. Each case reviewed retrospectively for the clinical features, prior treatment history, radiological imaging, histopathological and immunohistochemical details, disease stage, outcome and follow-up. On histopathology, four cases showed heterologous liposarcomatous differentiation, three cases showed fibrosarcomatous differentiation, two cases showed osteosarcomatous, and each case had angiosarcomatous and undifferentiated sarcomatous differentiation. Meticulous histopathological sampling along with a correct histopathological diagnosis and subtyping of the heterologous sarcomatous components is essential for planning treatment modality and prognostication of patients, although there are no clear-cut guidelines for surgical management and targeted therapy of these patients due its rarity and paucity of literature.
PubMed: 36687243
DOI: 10.1007/s13193-022-01525-7 -
Nigerian Medical Journal : Journal of... 2021Phyllodes tumuor (PT) is a rare biphasic breast neoplasm. It constitutes <1% of the entire tumours of the breast. Based on the World Health Organization's (WHO)...
Phyllodes tumuor (PT) is a rare biphasic breast neoplasm. It constitutes <1% of the entire tumours of the breast. Based on the World Health Organization's (WHO) proposal, premised on multiple histological features, phyllodes tumour is categorized into benign, borderline, and malignant breast neoplasms. Malignant phyllodes tumor (MPT) is even a rarer neoplasm. It occurs more commonly in older patients. However, it can uncommonly occur in younger individuals. The transformation of benign phyllodes into malignant forms is extremely rare. Here, we present two cases of young females (aged 20 and 27 years, respectively) who individually presented with rapidly progressive breast lumps. The two breast lumps were huge while one was recurrent and underwent a malignant transformation in approximately 7 weeks interval following an initial complete excision and histological diagnosis of benign PT. Indeed, even in young females below the modal/peak age of phyllodes, the suspicion should be high. Additionally, breast ultrasonography findings, although not common, can be highly suggestive of PT. Furthermore, every breast lump should be further evaluated, and even more so, histologically, irrespective of the patient's age as our first patient had an excision without histology.
PubMed: 38736519
DOI: 10.60787/NMJ-62-6-70 -
Breast Cancer Research and Treatment Jul 2023Phyllodes tumor of the breast is a kind of rare neoplasm, which accounts for less than 1% of all breast tumors. Malignant phyllodes tumor (MPT) is the highest risk...
PURPOSE
Phyllodes tumor of the breast is a kind of rare neoplasm, which accounts for less than 1% of all breast tumors. Malignant phyllodes tumor (MPT) is the highest risk subtype of phyllodes tumor, and is characterized by the tendency of local recurrence and distant metastasis. The prediction of prognosis and the individual therapy for MPT is still challenging. It's urgent to develop a new reliable in vitro preclinical model in order to understand this disease better and to explore appropriate anticancer drugs for individual patients.
METHODS
Two surgically resected MPT specimens were processed for organoid establishment. MPT organoids were subsequently subjected to H&E staining, immunohistochemical analysis and drug screening, respectively.
RESULTS
We successfully established two organoid lines from different patients with MPT. The MPT organoids can well retain the histological features and capture the marker expression in original tumor tissues, including p63, vimentin, Bcl-2, CD34, c-Kit, and Ki-67, even after a long-term culture. The dose titration tests of eight typical chemotherapeutic drugs (paclitaxel, docetaxel, vincristine, doxorubicin, cisplatin, gemcitabine, cyclophosphamide, ifosfamide) on the two MPT organoid lines showed patient-specific drug responses and varying IC values. Of all the drugs, doxorubicin and gemcitabine showed the best anti-tumor effect on the two organoid lines.
CONCLUSION
Organoids derived from MPT may be a novel preclinical model for testing personalized therapies for patients with MPT.
Topics: Humans; Female; Phyllodes Tumor; Breast Neoplasms; Antineoplastic Agents; Doxorubicin; Organoids
PubMed: 37204665
DOI: 10.1007/s10549-023-06973-5