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Journal of Surgical Oncology May 2022Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated...
BACKGROUND
Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated the association of surgery and therapies with OS.
METHODS
We utilized the National Cancer Database (2004-2016). Patients without surgery, unknown surgery, or margins, or Stage IV disease were excluded. Kaplan-Meier curves and Cox proportional hazards models were used to estimate unadjusted and adjusted OS, respectively.
RESULTS
A total of 3209 (59.5%) MP, and 2185 (40.5%) PBS were identified. Despite a larger median tumor size in MP (46 vs. 40 mm PBS, p < 0.001), lumpectomy rate was higher for MP (52.9% vs. 27.0% PBS, p < 0.001). Compared to MP, PBS patients more frequently received radiation (28.9% vs. 24%), and chemotherapy (28.1% vs. 4%), both p < 0.001. Unadjusted OS was lower for PBS (57% vs. 85% MP, log-rank p < 0.001). PBS (vs. MP) had persistently worse survival (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.69-2.31) after adjustment. Receipt of adjuvant therapies was not associated with OS (either neoplasm); however, lumpectomy was associated with improved OS (vs. mastectomy) for both PBS (HR: 0.59, 95% CI: 0.50-0.75) and MP (HR: 0.65, 95% CI: 0.53-0.81). Positive margins had no association with OS for MP (HR: 1.09, 95% CI: 0.75-1.60), but was associated with worse survival for PBS (HR: 2.35, 95% CI: 1.82-3.02).
DISCUSSION
We found significant survival differences between MP and PBS, with PBS having a consistently worse OS. Our findings support surgery as the mainstay of treatment for both tumor types and suggest that lumpectomy may be a reasonable option for select patients without compromising outcomes.
Topics: Breast; Breast Neoplasms; Female; Humans; Margins of Excision; Mastectomy; Mastectomy, Segmental; Neoplasm Staging; Phyllodes Tumor
PubMed: 35179788
DOI: 10.1002/jso.26820 -
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 -
The Pan African Medical Journal 2022
Topics: Breast; Breast Neoplasms; Female; Humans; Phyllodes Tumor
PubMed: 36034036
DOI: 10.11604/pamj.2022.42.73.35409 -
Medicine Nov 2023The present study aimed to explore the association between immunohistochemical markers and phyllodes tumor (PT). The retrospective case control study included biopsies...
The present study aimed to explore the association between immunohistochemical markers and phyllodes tumor (PT). The retrospective case control study included biopsies from patients with PT who underwent surgical treatment, and patients with fibronenoma (FA), diagnosed in our hospital from October 2014 to May 2021. Differences in microscopic histopathological characteristics and expressions of common immunohistochemical markers (CD10, cluster of differentiation 117 marker, cluster of differentiation 34 marker, tumor protein P53, cell proliferation antigen) for different grades of PT and FA were analyzed. A total of 69 patients were enrolled, of them 34 with PT (12 with benign PT, 13 with borderline PT, and 9 with malignant PT) and 35 with FA. With the increase of tumor malignancy, significant enlargement trend was noted; for FA, most tumor boundaries were well-defined, the stromal distribution was homogeneous, the stromal cellularity was small. In contrast for PT, as the degree of malignancy increased, tumor boundary gradually became ill-defined and the stromal distribution was heterogeneous; stromal cellularity and stromal overgrowth had increased significantly (All P < .05). Multivariate analysis showed that among other markers only CD10 expression (OR = 0.67, 95%CI: -0.88, 2.22, P < .05) was independently associated with PT. The study showed that in addition to histological features, CD10 expression was independently associated with PT and has a potential to be used as a differentiation marker.
Topics: Humans; Female; Phyllodes Tumor; Retrospective Studies; Case-Control Studies; Stromal Cells; Breast Neoplasms
PubMed: 37933030
DOI: 10.1097/MD.0000000000035677 -
Revista Espanola de Enfermedades... Oct 2023We present the case of a 72-year-old woman with a history of right radical mastectomy due to the Phyllodes Tumor. Two months later, she went to the emergency room for...
We present the case of a 72-year-old woman with a history of right radical mastectomy due to the Phyllodes Tumor. Two months later, she went to the emergency room for intestinal occlusion. Analytically, she had anemia and thrombocytopenia. The abdominal tomography noticed signs of occlusion of the small bowell and injury of 5cm at the pericaecal level. Urgent exploratory laparotomy was performed and objectified distal ileum attached to the cecum with signs of irreversible ischemia, so an ileocaecal resection was performed with ileo-colonic anastomosis. In the postoperative period she presented paralytic ileus and paraneoplastic syndrome with bicytopenia refractory to corticosteroid treatment. To rule out abdominal complications, abdominal tomography was performed on the 5th day post-op that confirmed the integrity of the anastomosis and absence of signs of mechanical occlusion. The patient's evolution was unfavorable, went on to exitus on the 14th day. The anatomopathological study diagnosed metastasis of malignant Phyllodes Tumor at the ileal level.
PubMed: 37882213
DOI: 10.17235/reed.2023.9958/2023 -
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 -
Cancer Management and Research 2019Phyllodes tumor is a very rare tumor of the breast, incidence being 0.3-0.9% of all breast tumors. Phyllodes tumors are classified into three grades: benign, borderline...
BACKGROUND
Phyllodes tumor is a very rare tumor of the breast, incidence being 0.3-0.9% of all breast tumors. Phyllodes tumors are classified into three grades: benign, borderline or malignant. The aim of this study was to investigate patient characteristics, imaging characteristic findings, surgical treatment and outcome of phyllodes tumor.
MATERIALS AND METHODS
This is a retrospective review of phyllodes tumor patients who had undergone surgical management between 1 January 2006 and 31 December 2015 in Head, Neck and Breast Unit, Department of Surgery, Chiang Mai University Hospital.
RESULTS
A total of 188 phyllodes tumor patients were included in this study. The average age of the patients was 35.6 years. The majority of the tumors were of lobulated shape. Tumor morphology from imaging: lobulated shaped tumor 112 cases, oval-shape 37 cases, round shape 8 cases and irregular 5 cases. Surgical management is the standard procedure for treatment of phyllodes tumors. A wide local excision was performed in 147 cases, mastectomy in 20 cases (modified radical mastectomy in 2 cases) and wide excision followed by mastectomy 21 cases. The final pathological diagnoses of the phyllodes tumors were: benign 118 cases (62%), borderline 33 cases (18%) and malignant in 37 cases (20%). The margin did not affect recurrence in all types.
CONCLUSION
The most frequent is a benign phyllodes tumor. Surgical treatment to remove the tumor with a free margin is acceptable with no recurrence difference from a wider margin. However, younger age and malignant phyllodes tumor are the two highest risk factors for recurrence.
PubMed: 31695485
DOI: 10.2147/CMAR.S215039 -
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 -
Cureus Apr 2023Phyllodes tumors are uncommon biphasic breast tumors with a wide range of clinical behaviors. The distinction between a phyllodes tumor and a fibroadenoma can be...
Phyllodes tumors are uncommon biphasic breast tumors with a wide range of clinical behaviors. The distinction between a phyllodes tumor and a fibroadenoma can be difficult. The diagnosis of phyllodes tumor should be suspected in all women who present with a rapidly growing breast lump. Based on the histological characteristics, the World Health Organization (WHO) classifies phyllodes tumors as benign, borderline, or malignant. The risk of recurrence and metastatic potential varies based on histological features. Wide excision or mastectomy is the standard of care ensuring histologically clear margins. Despite the grading criteria defined by the WHO, the management of phyllodes tumors continues to be a challenge. We report the case of a 48-year-old woman who presented to the emergency department with a large and ulcerated phyllodes tumor of the left breast. The tumor size did not allow conservative surgery. The final diagnosis of a borderline phyllodes tumor was made, and, in this case, the patient did not undergo adjuvant treatment.
PubMed: 37193421
DOI: 10.7759/cureus.37537 -
Nigerian Journal of Clinical Practice Apr 2022Phyllodes tumors (PT) are rare biphasic breast tumors containing stromal mesenchyme and epithelial components. It was classified as benign, borderline, and malignant by...
BACKGROUND AND AIM
Phyllodes tumors (PT) are rare biphasic breast tumors containing stromal mesenchyme and epithelial components. It was classified as benign, borderline, and malignant by the World Health Organization (WHO). Although there is no certainty about the size of the desired margin in the surgery to be applied, a tumor-free area of 1 cm is often targeted. Our study aimed to determine the subtype rates in patients with PT and evaluate the surgical margin, recurrence, and survival times obtained after the surgery.
PATIENTS AND METHODS
This study was conducted at Seyhan Goverment Hospital and involved the PT patients treated between January 2010 and June 2020. We analyzed PT patients retrospectively. Sixty-one patients with PT were analyzed. In the patient, demographic characteristics, body mass index (BMI), surgical procedures, tumor type, size, mitosis rate, and distance of tumor to surgical margin were evaluated. During follow-up, reoperation, recurrence, metastasis, survival times, and mortality rates were evaluated.
RESULTS
Sixty-one phyllodes breast tumor patients whose histopathology was reported as malignant, borderline, and benign were evaluated and presented in our study. The mean age was 37.84 (15-100), and the BMI was 25.78 (±5.35) mm. Of the 61 patients, 41 (67.2%) were diagnosed with benign phyllodes tumor (BPT), 10 (16.4%) as borderline phyllodes tumor (BLPT), and 10 (16.4%) as malignant phyllodes tumor (MPT).
CONCLUSIONS
Preoperative diagnosis of PT can reduce the rate of secondary surgical procedures and the loss of extra breast tissue. A large diameter needle and sufficient number of tissue samples for preoperative core biopsy may increase the rate of accurate diagnosis.
Topics: Adult; Breast Neoplasms; Female; Humans; Margins of Excision; Neoplasm Recurrence, Local; Phyllodes Tumor; Retrospective Studies
PubMed: 35439900
DOI: 10.4103/njcp.njcp_1374_21