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Radiology Case Reports May 2023Phyllodes tumors of the breast are rare fibroepithelial neoplasms accounting for 0.3%-1.5% of all female breast tumors [1,2]. Malignant transformations occur in 10%-20%...
Phyllodes tumors of the breast are rare fibroepithelial neoplasms accounting for 0.3%-1.5% of all female breast tumors [1,2]. Malignant transformations occur in 10%-20% of phyllodes tumors, often in the form of stroma. Heterologous osteosarcoma and chondrosarcomatous differentiation of phyllodes tumor are extremely rare, and little is known about their imaging findings. Here, we report a rare case of a 52-year-old woman with no history of previous surgery or radiation therapy, who presented with a rapidly growing right breast mass that was diagnosed as a malignant phyllodes tumor with heterologous osteosarcoma and chondrosarcomatous differentiation. The patient underwent modified radical mastectomy.
PubMed: 36994218
DOI: 10.1016/j.radcr.2023.02.039 -
Medicine Mar 2023Malignant phyllodes tumor of the breast (MPTB) is a rare breast neoplasm that has a high recurrence rate and its optimal treatment strategies remain controversial. Our...
Malignant phyllodes tumor of the breast (MPTB) is a rare breast neoplasm that has a high recurrence rate and its optimal treatment strategies remain controversial. Our study used the most up-to-date database to determine prognostic factors that predict cancer-specific survival (CSS) and to evaluate the effects of different treatment strategies for MPTB. We performed a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Women who were diagnosed with MPTB from 2000 to 2019 were included. Kaplan-Meier method and Cox proportional hazards regressions were used to evaluate the prognostic power of variables on CSS. A total of 1902 women with MPTB were included in the study, with a median follow-up duration of 87.5 months. Age was found not to independently predict CSS in patients with tumors larger than 10 cm (P = .235). Mastectomy was performed on a total of 898 (47.2%) patients including 210 women (23.4%) undergoing radiotherapy after surgery. Mastectomy showed worse CSS when compared with breast-conserving surgery in patients with tumors smaller than 10 cm. Patients undergoing radiotherapy were not inferior to non-radiotherapy patients on CSS when patients were stratified by tumor size. Breast-conserving surgery showed survival benefits for patients with small tumors (T1 and T2). Patients with radiotherapy were not inferior to non-radiotherapy patients on CSS. Treatment of patients with MPTB should be carefully selected based on different tumor sizes.
Topics: Humans; Female; Mastectomy; Retrospective Studies; Breast Neoplasms; Breast; Prognosis; Mastectomy, Segmental; Phyllodes Tumor; SEER Program; Neoplasm Staging
PubMed: 36961178
DOI: 10.1097/MD.0000000000033326 -
International Journal of Surgery Case... Apr 2023Borderline phyllodes tumors are very infrequent breast tumors encountered by surgeons.
INTRODUCTION
Borderline phyllodes tumors are very infrequent breast tumors encountered by surgeons.
CASE PRESENTATION
We present a case of a young woman with a very large borderline phyllodes tumor measuring 20 cm × 20 cm, involving almost all of the breast, causing gross asymmetry of the breasts.
DISCUSSION
The patient wished to maintain symmetry following the surgery as a result of which a simple mastectomy followed by implant based Immediate breast reconstruction was planned. The patient had an uneventful recovery postoperatively with equal breast size bilaterally.
CONCLUSION
Implant based immediate breast reconstruction thus provides a comprehensive solution and excellent cosmesis for women with very large borderline phyllodes requiring mastectomy.
PubMed: 36948053
DOI: 10.1016/j.ijscr.2023.107996 -
Frontiers in Oncology 2023To evaluate the utility of apparent diffusion coefficient (ADC) values for differentiating breast tumors.
OBJECTIVE
To evaluate the utility of apparent diffusion coefficient (ADC) values for differentiating breast tumors.
METHODS
The medical records of 17 patients with phyllodes tumor [PT; circular regions of interest (ROI-cs) n = 171], 74 patients with fibroadenomas (FAs; ROI-cs, n = 94), and 57 patients with breast cancers (BCs; ROI-cs, n = 104) confirmed by surgical pathology were retrospectively reviewed.
RESULTS
There were significant differences between PTs, FAs, and BCs in ADCmean, ADCmax, and ADCmin values. The cutoff ADCmean for differentiating PTs from FAs was 1.435 × 10 mm/s, PTs from BCs was 1.100 × 10 mm/s, and FAs from BCs was 0.925 × 10 mm/s. There were significant differences between benign PTs, borderline PTs, and malignant PTs in ADCmean, ADCmax, and ADCmin values. The cutoff ADCmean for differentiating benign PTs from borderline PTs was 1.215 × 10 mm/s, and borderline PTs from malignant PTs was 1.665 × 10 mm/s.
CONCLUSION
DWI provides quantitative information that can help distinguish breast tumors.
PubMed: 36937381
DOI: 10.3389/fonc.2023.938189 -
Gland Surgery Feb 2023Grading based on histopathologic indicators cannot accurately assess the prognosis of phyllodes tumor (PT) of the breast. This article aimed to investigate the...
BACKGROUND
Grading based on histopathologic indicators cannot accurately assess the prognosis of phyllodes tumor (PT) of the breast. This article aimed to investigate the correlation between PT prognosis and clinicopathological features, treatment, and surgical margin.
METHODS
The clinicopathological data of patients with pathologically confirmed PT at our institution were retrospectively collected. Univariate and multivariate Cox proportional risk models were employed to test the effects of different variables on the prognosis of PT. A nomogram to predict the 1-, 3-, 5-, and 10-year recurrence-free survival (RFS) of PT was proposed, and its discriminative ability and calibration were tested using the concordance index (C-index), area under the curve (AUC), and calibration plots. All statistical analyses were performed using R.
RESULTS
A total of 342 PT patients were included, including 242 benign (70.8%), 75 borderline (21.9%) and 25 malignant (7.3%) cases. The median follow-up period was 64.5 months (range, 3-179 months), 66 PT patients had local recurrence (LR), and four patients had distant metastasis. The 1-, 3-, 5-, and 10-year RFS of the PT patients were 90.8%, 81.8%, 78%, and 76.7%, respectively. Age, fibroadenoma (FA) surgery history, treatment, mitotic activity, and surgical margin were selected as the independent factors for PT prognosis. The nomogram showed good discriminative ability and calibration, as indicated by the C-index [0.78, 95% confidence interval (CI): 0.75-0.11].
CONCLUSIONS
Independent predictors related to PT prognosis were selected to establish a nomogram for predicting the RFS of PT. This nomogram was able to objectively stratify PT patients into prognostic groups and performed well in the internal validation.
PubMed: 36915816
DOI: 10.21037/gs-22-542 -
Journal of Clinical Medicine Feb 2023To build a new staging system and new prognostic models for MPTB.
PURPOSE
To build a new staging system and new prognostic models for MPTB.
METHODS
We performed a comprehensive analysis of the data from the SEER database.
RESULTS
We discussed the characteristics of MPTB by comparing 1085 MPTB cases with 382,718 invasive ductal carcinoma cases. We established a new stage- and age-stratification system for MPTB patients. Furthermore, we built two prognostic models for MPTB patients. The validity of these models was confirmed through multifaceted and multidata verification.
CONCLUSIONS
Our study provided a staging system and prognostic models for MPTB patients, which can not only help to predict patient outcomes, but also enhance the understanding of the prognostic factors associated with MPTB.
PubMed: 36902676
DOI: 10.3390/jcm12051889 -
Indian Journal of Surgical Oncology Mar 2023Mucinous or colloid cancers are a rare subtype of invasive ductal carcinoma, making up only 2-3% of infiltrating carcinomas. Prevalence of pure mucinous breast...
Mucinous or colloid cancers are a rare subtype of invasive ductal carcinoma, making up only 2-3% of infiltrating carcinomas. Prevalence of pure mucinous breast cancer(PMBC) among infiltrating duct carcinomas in less than 60 year olds is 2-7%, and in less than 35 year olds, it is 1%. Mucinous carcinoma of the breast is divided into 2 subtypes, the pure type and mixed type. PMBC is characterized by a lower incidence of nodal involvement, favourable histological grade, and higher ER/PR expression. Axillary metastases are rare, though found in 12-14%. It has a better prognosis than infiltrative ductal cancer with 10-year survival being more than 90%. Here is the case of a 70-year-old female who presented with lump in the left breast since 3 years. On examination, we detected a left breast lump occupying the whole breast except lower outer quadrant, measuring 10 × 8 cm with overlying skin stretched with puckering and engorged veins seen, nipple displaced laterally and higher by 1 cm, firm to hard in consistency, and mobile with breast tissue. Sonomammography, mammography, FNAC and biopsy were suggestive of benign phyllodes tumour. Patient was hence posted for simple mastectomy on the left side with removal of attached lymph nodes (near axillary tail). Histopathological examination revealed pure mucinous breast carcinoma with nine lymph nodes, free from tumour and showing reactive hyperplasia. Immunohistochemistry studies demonstrated ER + , PR + , HER-2-NEU-. The patient was started on hormonal therapy. Therefore, mucinous carcinoma of the breast is a rare entity with imaging features sometimes mimicking a benign tumour such as Phyllodes tumour, hence making it important to include it as a differential diagnosis in our daily practice. It is especially important in the subtyping of carcinoma of the breast since it carries a favourable risk profile with less chances of lymph node involvement, higher hormone receptor positivity and good response to endocrine treatment.
PubMed: 36891453
DOI: 10.1007/s13193-022-01638-z -
Breast Cancer Research and Treatment Jun 2023Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for...
PURPOSE
Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking.
METHODS
We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents.
RESULTS
A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types.
CONCLUSIONS
This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.
Topics: Humans; Female; Phyllodes Tumor; Cross-Sectional Studies; Breast Neoplasms; Margins of Excision; Neoplasm Recurrence, Local; Oncologists; Surgeons; Retrospective Studies
PubMed: 36879102
DOI: 10.1007/s10549-023-06896-1 -
Asian Pacific Journal of Cancer... Feb 2023Early detection and precise diagnosis of breast cancer (BC) plays an essential part in enhancing the diagnosis and improving the breast cancer survival rate of patients...
OBJECTIVE
Early detection and precise diagnosis of breast cancer (BC) plays an essential part in enhancing the diagnosis and improving the breast cancer survival rate of patients from 30 to 50%. Through the advances of technology in healthcare, deep learning takes a significant role in handling and inspecting a great number of X-ray, MRI, CTR images. The aim of this study is to propose a deep learning model (BCCNN) to detect and classify breast cancers into eight classes: benign adenosis (BA), benign fibroadenoma (BF), benign phyllodes tumor (BPT), benign tubular adenoma (BTA), malignant ductal carcinoma (MDC), malignant lobular carcinoma (MLC), malignant mucinous carcinoma (MMC), and malignant papillary carcinoma (MPC).
METHODS
Breast cancer MRI images were classified into BA, BF, BPT, BTA, MDC, MLC, MMC, and MPC using a proposed Deep Learning model with additional 5 fine-tuned Deep learning models consisting of Xception, InceptionV3, VGG16, MobileNet and ResNet50 trained on ImageNet database. The dataset was collected from Kaggle depository for breast cancer detection and classification. That Dataset was boosted using GAN technique. The images in the dataset have 4 magnifications (40X, 100X, 200X, 400X, and Complete Dataset). Thus we evaluated the proposed Deep Learning model and 5 pre-trained models using each dataset individually. That means we carried out a total of 30 experiments. The measurement that was used in the evaluation of all models includes: F1-score, recall, precision, accuracy.
RESULTS
The classification F1-score accuracies of Xception, InceptionV3, ResNet50, VGG16, MobileNet, and Proposed Model (BCCNN) were 97.54%, 95.33%, 98.14%, 97.67%, 93.98%, and 98.28%, respectively.
CONCLUSION
Dataset Boosting, preprocessing and balancing played a good role in enhancing the detection and classification of breast cancer of the proposed model (BCCNN) and the fine-tuned pre-trained models' accuracies greatly. The best accuracies were attained when the 400X magnification of the MRI images due to their high images resolution.
Topics: Humans; Female; Breast Neoplasms; Deep Learning; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Carcinoma, Papillary; Fibroadenoma; Fibroma
PubMed: 36853302
DOI: 10.31557/APJCP.2023.24.2.531 -
International Journal of Surgical... Dec 2023The molecular pathogenesis of breast fibroepithelial tumors continues to be elucidated. Recently, highly recurrent mutations arising in exon 2 at codon 44 were...
The molecular pathogenesis of breast fibroepithelial tumors continues to be elucidated. Recently, highly recurrent mutations arising in exon 2 at codon 44 were discovered in fibroadenomas and phyllodes tumors. In addition, a high prevalence of promoter mutations in two hotspots (124 and 126 bp upstream from the translation start site) was discovered in up to 65% of phyllodes tumors. Breast periductal stromal tumors are a potentially distinct category of fibroepithelial lesions that are exceptionally rare with controversial classification and pathogenesis. Herein, we report the first comprehensive molecular genetic workup of a breast periductal stromal tumor that harbored a promoter -124C > T mutation, supporting a relation to phyllodes tumors.
Topics: Humans; Female; Phyllodes Tumor; Mediator Complex; Breast; Breast Neoplasms; Mutation; Fibroadenoma; Telomerase
PubMed: 36823780
DOI: 10.1177/10668969231157306