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APMIS : Acta Pathologica,... Jun 2019Phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast and constitute 0.3-1% of all primary breast tumors. They should be characterized in to a benign,...
Phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast and constitute 0.3-1% of all primary breast tumors. They should be characterized in to a benign, borderline or malignant category based on a combination of histological features. PTs can show heterologous components, typically sarcomatous, including osteosarcomatous and chondrosarcomatous. Benign heterologous components are exceedingly rare with only one prior reported case in the English literature. This case emphasizes how difficult establishing a correct diagnosis in PTs with heterologous components can be, especially when the tumor consists mainly of a benign heterologous component. We report the case of a 65 year old woman with a recurrent breast tumor initially misdiagnosed as benign osseous metaplasia. The tumor re-occurred as a malignant PT dominated by benign osseous and chondroid metaplasia. Multiple metastases consisting of primarily mature bone and cartilage were seen in the lungs. On microscopic revision and considering the clinical course the primary breast tumor was re-classified as a borderline PT.
Topics: Aged; Bone and Bones; Breast Neoplasms; Female; Humans; Metaplasia; Neoplasm Recurrence, Local; Phyllodes Tumor
PubMed: 30901115
DOI: 10.1111/apm.12949 -
Analytica Chimica Acta Dec 2023Breast fibroadenomas and phyllodes tumors are both fibroepithelial tumors with comparable histological characteristics. However, rapid and precise differential diagnosis... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Breast fibroadenomas and phyllodes tumors are both fibroepithelial tumors with comparable histological characteristics. However, rapid and precise differential diagnosis is a tough point in clinical pathology. Given the tendency of phyllodes tumors to recur, the difficulty in differential diagnosis with fibroadenomas leads to the difficulty in optimal management for these patients.
METHOD
In this study, we used Raman spectroscopy to differentiate phyllodes tumors from breast fibroadenomas based on the biochemical and metabolic composition and develop a classification model. The model was validated by 5-fold cross-validation in the training set and tested in an independent test set. The potential metabolic differences between the two types of tumors observed in Raman spectroscopy were confirmed by targeted metabolomic analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS).
RESULTS
A total of 204 patients with formalin-fixed paraffin-embedded (FFPE) tissue samples, including 100 fibroadenomas and 104 phyllodes tumors were recruited from April 2014 to August 2021. All patients were randomly divided into the training cohort (n = 153) and the test cohort (n = 51). The Raman classification model could differentiate phyllodes tumor versus fibroadenoma with cross-validation accuracy, sensitivity, precision, and area under curve (AUC) of 85.58 % ± 1.77 %, 83.82 % ± 1.01 %, 87.65 % ± 4.22 %, and 93.18 % ± 1.98 %, respectively. When tested in the independent test set, it performed well with the test accuracy, sensitivity, specificity, and AUC of 83.50 %, 86.54 %, 80.39 %, and 90.71 %. Furthermore, the AUC was significantly higher for the Raman model than that for ultrasound (P = 0.0017) and frozen section diagnosis (P < 0.0001). When it came to much more difficult diagnosis between fibroadenoma and benign or small-size phyllodes tumor for pathological examination, the Raman model was capable of differentiating with AUC up to 97.45 % and 95.61 %, respectively. On the other hand, targeted metabolomic analysis, based on fresh-frozen tissue samples, confirmed the differential metabolites (including thymine, dihydrothymine, trans-4-hydroxy-l-proline, etc.) identified from Raman spectra between phyllodes tumor and fibroadenoma.
SIGNIFICANCE AND NOVELTY
In this study, we obtained the molecular information map of breast phyllodes tumors provided by Raman spectroscopy for the first time. We identified a novel Raman fingerprint signature with the potential to precisely characterize and distinguish phyllodes tumors from fibroadenoma as a quick and accurate diagnostic tool. Raman spectroscopy is expected to further guide the precise diagnosis and optimal treatment of breast fibroepithelial tumors in the future.
Topics: Humans; Female; Phyllodes Tumor; Fibroadenoma; Spectrum Analysis, Raman; Chromatography, Liquid; Tandem Mass Spectrometry; Breast Neoplasms; Neoplasms, Fibroepithelial
PubMed: 37977771
DOI: 10.1016/j.aca.2023.341897 -
Tidsskrift For Den Norske Laegeforening... May 1989This very rare breast tumour has been diagnosed in five cases, four females and one male, at our hospital during the last two years. The females all presented tumours...
This very rare breast tumour has been diagnosed in five cases, four females and one male, at our hospital during the last two years. The females all presented tumours with a diameter ranging from 5 to 15 cm. Age at diagnosis ranged from 21 to 54 years. We focus on diagnostic challenges, since 3 of our patients were recently treated by removal of a breast tumour diagnosed morphologically as fibroadenomatosis. Our patients underwent different surgical therapy, and we focus on local treatment modalities advocated in recent literature. Systemic chemotherapy, endocrine treatment and/or radiation therapy, in the adjuvant setting or in advanced disease, do not increase survival in patients with malignant phyllodes tumour.
Topics: Adult; Breast Neoplasms; Female; Humans; Mammography; Middle Aged; Phyllodes Tumor; Ultrasonography
PubMed: 2546287
DOI: No ID Found -
Annals of Surgical Oncology Apr 2012Phyllodes tumors are classified as benign, borderline, and malignant according to a group of histological features. The expression of many biological markers has been...
BACKGROUND
Phyllodes tumors are classified as benign, borderline, and malignant according to a group of histological features. The expression of many biological markers has been explored to discriminate between different grades of phyllodes tumor and to predict their behavior. The immunohistochemical expression of CD10 has been shown to discriminate between benign and other grades of phyllodes tumor but has not been evaluated as a predictor of metastasis. The purpose of this study was to evaluate the usefulness of immunohistochemical staining of stromal CD10 in predicting the likelihood of metastasis in phyllodes tumors.
METHODS
The expression of CD10 was studied in 43 phyllodes tumors (16 benign, 10 borderline, and 17 malignant) using immunohistochemistry to evaluate whether differences in expression correlated with the presence of, and or, development of distant metastasis.
RESULTS
Metastasis occurred in six malignant phyllodes tumors. The expression of CD10 significantly (P<0.05) correlated with the occurrence of distant metastasis.
CONCLUSIONS
The expression of CD10 can be used to predict the occurrence of distant metastasis in phyllodes tumors of the breast.
Topics: Adolescent; Adult; Biomarkers, Tumor; Breast Neoplasms; Female; Humans; Immunohistochemistry; Middle Aged; Neoplasm Grading; Neprilysin; Phyllodes Tumor; Young Adult
PubMed: 22006372
DOI: 10.1245/s10434-011-2076-6 -
Breast (Edinburgh, Scotland) Jun 2004Reports of breast tumors together with Maffucci's syndrome are extremely rare in the literature. Maffucci's syndrome is an uncommon congenital disease characterized by... (Review)
Review
Reports of breast tumors together with Maffucci's syndrome are extremely rare in the literature. Maffucci's syndrome is an uncommon congenital disease characterized by the association of multiple enchondromas and different types of hemangiomas. To the best of our knowledge, this is the first well-documented case of a benign phyllodes tumor of the breast occurring in a patient with Maffucci's syndrome. The patient was an 18-year-old woman who had been diagnosed with Maffucci's syndrome at the age of 8 months when multiple enchondromas with subcutaneous hemangiomas of the toes were diagnosed. The tumor presented as a rapidly growing, painful mass of the right breast, which was removed by a wide resection with no apparent recurrence 10 months later. Our data, in addition to those on two other cases of fibroadenomas with this disease that have already been described in the literature, suggest that Maffucci's syndrome is probably a generalized mesodermal disorder that can also affect the connective tissue component of the breast.
Topics: Adolescent; Breast Neoplasms; Diagnosis, Differential; Enchondromatosis; Female; Humans; Mastectomy, Segmental; Phyllodes Tumor
PubMed: 15177431
DOI: 10.1016/j.breast.2003.06.001 -
Postgraduate Medical Journal Jul 2001Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast neoplasms. With the non-operative management of fibroadenomas widely... (Review)
Review
Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast neoplasms. With the non-operative management of fibroadenomas widely adopted, the importance of phyllodes tumours today lies in the need to differentiate them from other benign breast lesions. All breast lumps should be triple assessed and the diagnosis of a phyllodes tumour considered in women, particularly over the age of 35 years, who present with a rapidly growing "benign" breast lump. Treatment can be by either wide excision or mastectomy provided histologically clear specimen margins are ensured. Nodal metastases are rare and routine axillary dissection is not recommended. Few reliable clinical and histological prognostic factors have been identified. Local recurrence occurs in approximately 15% of patients and is more common after incomplete excision. It can usually be controlled by further surgery. Repeated local recurrence has been reported without the development of distant metastases or reduced survival. Approximately 20% of patients with malignant phyllodes tumours develop distant metastases. Long term survival with distant metastases is rare. The role of chemotherapy, radiotherapy, and hormonal manipulation in both the adjuvant and palliative settings remain to be defined.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis
PubMed: 11423590
DOI: 10.1136/pmj.77.909.428 -
The Surgical Clinics of North America Dec 2022Breast stromal lesions include fibroadenomas, phyllodes tumors, pseudoangiomatous stromal hyperplasia, periductal stromal tumors, and lipomas. Most of these lesions are... (Review)
Review
Breast stromal lesions include fibroadenomas, phyllodes tumors, pseudoangiomatous stromal hyperplasia, periductal stromal tumors, and lipomas. Most of these lesions are benign and can be managed with observation or surgical excision. Phyllodes tumors, however, are subcategorized into benign, borderline, and malignant. Benign phyllodes tumors may be removed without a margin of breast tissue while borderline and malignant phyllodes tumors need a wide excision with a greater than 1 cm margin. Because malignant phyllodes tumors have a poor prognosis, efforts should be made to discuss their treatment in a multidisciplinary setting and enrollment in a clinical trial should be considered.
Topics: Humans; Female; Phyllodes Tumor; Fibroadenoma; Margins of Excision; Breast Neoplasms
PubMed: 36335922
DOI: 10.1016/j.suc.2022.07.002 -
International Journal of Radiation... Feb 2008To better identify prognostic factors for local control and survival, as well as the role of different therapeutic options, for phyllodes tumors, a rare fibroepithelial...
PURPOSE
To better identify prognostic factors for local control and survival, as well as the role of different therapeutic options, for phyllodes tumors, a rare fibroepithelial neoplasm of the breast.
METHODS AND MATERIALS
Data from 443 women treated between 1971 and 2003 were collected from the Rare Cancer Network. The median age was 40 years (range, 12-87 years). Tumors were benign in 284 cases (64%), borderline in 80 cases (18%), and malignant in 79 cases (18%). Surgery consisted of breast-conserving surgery (BCS) in 377 cases (85%) and total mastectomy (TM) in 66 cases (15%). Thirty-nine patients (9%) received adjuvant radiotherapy (RT).
RESULTS
After a median follow-up of 106 months, local recurrence (LR) and distant metastases rates were 19% and 3.4%, respectively. In the malignant and borderline group (n = 159), RT significantly decreased LR (p = 0.02), and TM had better results than BCS (p = 0.0019). Multivariate analysis revealed benign histology, negative margins, and no residual disease (no RD) after initial treatment and RT delivery as independent favorable prognostic factors for local control; benign histology and low number of mitosis for disease-free survival; and pathologic tumor size < or = 3 cm and no tumor necrosis for overall survival. In the malignant and borderline subgroup multivariate analysis TM was the only favorable independent prognostic factor for disease-free survival.
CONCLUSIONS
This study showed that phyllodes tumor patients with no RD after treatment have better local control. Benign tumors have a good prognosis after surgery alone. In borderline and malignant tumors, TM had better results than BCS. Thus, in these forms adjuvant RT should be considered according to histologic criteria.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Breast Neoplasms; Child; Female; Follow-Up Studies; Humans; Mastectomy; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Radiotherapy, Adjuvant; Survival Rate
PubMed: 17931796
DOI: 10.1016/j.ijrobp.2007.06.059 -
Breast Cancer (Tokyo, Japan) Jul 2013Phyllodes tumor of the breast is a rare fibroepithelial lesion and particularly uncommon in adolescent girls. It is thought to arise from the periductal rather than...
Phyllodes tumor of the breast is a rare fibroepithelial lesion and particularly uncommon in adolescent girls. It is thought to arise from the periductal rather than intralobular stroma. Usually, it is seen as a well-defined mass. Phyllodes tumor showing intraductal growth is extremely rare. Here we report a girl who has a phyllodes tumor with intraductal growth.
Topics: Breast Neoplasms; Child; Female; Humans; Neoplasm Staging; Phyllodes Tumor; Prognosis; Ultrasonography, Mammary
PubMed: 20490731
DOI: 10.1007/s12282-010-0208-7 -
The Breast Journal 2014Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery...
Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial. We report a single institution's experience with MPTB. We discuss controversial therapeutic aspects of this rare tumor. Seventy patients with MPTB treated primarily with surgery were evaluated. The mean age was 50 years (21-76), and the mean size of the tumor was 6 cm. Thirty-four (48.6%) patients were treated with total mastectomy, and 36 (51.4%) were treated with BCS (lumpectomy or wide local excision). Microscopic surgical margins were free of tumor in all cases. In 64 (91.4%) patients, margins were ≥1 cm. Remaining 6 (8.6%) patients treated with BCS margins were <1 cm and subsequently radiotherapy was performed. Among 70 patients, 58 (82.9%) had no evidence of disease (NED) after 5 years. The extent of surgery was not significantly related to the 5-year NED survival rates (82.4% in patients who underwent mastectomy and 83.3% in patients who underwent BCS only or BCS with adjuvant irradiation). The 5-year NED survival rates in BCS (tumor-free margin ≥1 cm) and BCS with irradiation (tumor-free margin <1 cm) groups were identical (83.3%). Our data support the potential use of BCS in patients with MPTB. Mastectomy is indicated only if tumor-free margins cannot be obtained by BCS. Adjuvant radiotherapy may be considered if tumor-free margins are <1 cm.
Topics: Adult; Aged; Breast Neoplasms; Female; Follow-Up Studies; Humans; Mastectomy; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Radiotherapy, Adjuvant; Survival Rate
PubMed: 25227987
DOI: 10.1111/tbj.12333