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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 -
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 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 Diagnostic Pathology Oct 2023Phyllodes tumors (PTs) are biphasic fibroepithelial lesions that occur in the breast. Diagnosing and grading PTs remains a challenge in a small proportion of cases, due...
Phyllodes tumors (PTs) are biphasic fibroepithelial lesions that occur in the breast. Diagnosing and grading PTs remains a challenge in a small proportion of cases, due to the lack of reliable specific biomarkers. We screened a potential marker versican core protein (VCAN) through microproteomics analysis, validated its role for the grading of PTs by immunohistochemistry, and analyzed the correlation between VCAN expression and clinicopathological characteristics. Cytoplasmic immunoreactivity for VCAN was identified in all benign PT samples, among which 40 (93.0 %) showed VCAN-positive staining in ≥50 % of tumor cells. Eight (21.6 %) borderline PT samples showed VCAN-positive staining in ≥50 % of the cells with weak to moderate staining intensity, whereas 29 samples (78.4 %) showed VCAN-positive staining in <50 % of the cells. In malignant PTs, 16 (84.2 %) and three (15.8 %) samples showed VCAN-positive staining in <5 % and 5-25 % of stromal cells, respectively. Fibroadenomas showed a similar expression pattern to benign PTs. Fisher's exact test showed that the percentages of positive cells (P < .001) and staining intensities (P < .001) of tumor cells were significantly different between the five groups. VCAN positivity was associated with tumor categories (P < .0001) and CD34 expression (P < .0001). The expression of VCAN gradually decreases as the tumor categories increases, following recurrence. To the best of our knowledge, our results are the first in the literature to reveal that VCAN is useful for diagnosing and grading PTs. The expression level of VCAN appeared to be negatively associated with PT categories, suggesting that dysregulation of VCAN may be involved in the tumor progression of PTs.
Topics: Humans; Female; Phyllodes Tumor; Versicans; Stromal Cells; Breast; Breast Neoplasms
PubMed: 37423116
DOI: 10.1016/j.anndiagpath.2023.152176 -
International Journal of Surgery Case... 2019Phyllodes tumors are biphasic fibroepithelial tumors that account for fewer than 1% of mammary tumors. They usually appear in middle-aged women, with an average size of...
INTRODUCTION
Phyllodes tumors are biphasic fibroepithelial tumors that account for fewer than 1% of mammary tumors. They usually appear in middle-aged women, with an average size of 4-7 cm and rapid growth.
PRESENTATION OF CASE
A 25-year-old woman sought care after excision of recurrent nodules in the right breast, with a diagnosis of borderline phyllodes tumor. She had no new lesions on physical examination. Imaging studies revealed an anechoic collection and nodular areas in a previous surgical site, correlated with pathology. Immuno-histochemical examination was positive for vimentin, calponin, Ki-67 and estrogen receptor. Systemic staging did not show metastases. Skin-reducing mastectomy was performed on the right side, followed by reconstruction and left reduction mammaplasty for symmetry. At 8-month follow-up, there was no relapse of the lesions on clinical and ultrasonographic examinations.
DISCUSSION
Phyllodes tumors are rare neoplasms characterized by rapid growth, occurring in women between 35-55 years of age. They are classified as benign, borderline and malignant, according to histological parameters. There are reports of genetic mutations in TP53 associated with malignant phyllodes tumor. On immunohistochemistry, there is a greater tendency to malignancy in tumors with Ki-67 and estrogen receptor expression. Imaging methods may aid in diagnosis, which is only definitive after excision and histopathological analysis of the tumor. These tumors have high local recurrence rates and possibility of metastases, closely related to histology.
CONCLUSION
Phyllodes tumors are a great challenge to the surgeon. Treatment is surgical, with wide excision; radiotherapy and chemotherapy are controversial.
PubMed: 31195364
DOI: 10.1016/j.ijscr.2019.05.032 -
Preoperative embolization of a giant benign phyllodes tumor: A case report and review of literature.International Journal of Surgery Case... Dec 2021Phyllodes tumors (PT) account for less than 1% of all breast tumors. Giant PTs can lead to breast disfigurement, tumoral ulceration, and bleeding. Outright surgical...
INTRODUCTION AND IMPORTANCE
Phyllodes tumors (PT) account for less than 1% of all breast tumors. Giant PTs can lead to breast disfigurement, tumoral ulceration, and bleeding. Outright surgical excision can be challenging or unsafe. Preoperative transarterial embolization (TAE) has a role but data on its use in the management of PT is limited.
CASE PRESENTATION
A 43-year-old female presented with a 28 cm fungating, necrotic, benign PT on her left breast that eventually developed tumoral bleeding leading to hemodynamic instability. Preoperative TAE controlled the bleeding and allowed the safe performance of mastectomy. A literature review of preoperative TAE of PTs is also presented including the addition of a chemotherapeutic agent in malignant types.
CLINICAL DISCUSSION
PTs are rare and comprise only 2.5% of all fibroepithelial breast lesions. Tumoral bleeding causing severe anemia is one of the most common presentations of massive (≥20 cm) PTs, especially when neglected. Indications for preoperative TAE include (1) to halt rapid tumor growth, (2) to control active/persistent tumoral bleeding, and (3) to shrink the tumor size and allow successful resection with negative margins, and avoidance of skin grafting. Post-TAE side effects include fever, chest pain, gradual/expanding tumor necrosis, decrease in tumor weight, and diminished tumoral abscess/discharge, and loss of tumoral vessel elasticity.
CONCLUSION
Neglected PTs can reach an alarming size. Preoperative TAE is a safe and effective method of controlling life-threatening tumoral hemorrhage and decreasing the size of PTs thereby allowing definitive resection while avoiding skin grafting and/or flap reconstruction.
PubMed: 34784531
DOI: 10.1016/j.ijscr.2021.106602 -
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 -
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 -
Oncology Letters Nov 2019Phyllodes tumors of the breast (PTB) are uncommon stromal-epithelial neoplasms, with the main recommended treatment being surgical removal. However, even with adequate...
Phyllodes tumors of the breast (PTB) are uncommon stromal-epithelial neoplasms, with the main recommended treatment being surgical removal. However, even with adequate resection, the risk of recurrence in the malignant form remains as high as 40%, and there is no recognized consensus on the most effective drugs for PTB. In the present study, an model of malignant phyllodes and derived primary cell cultures were used to evaluate the effectiveness of a panel of different drugs, including the Bcl-2/Bcl-xL inhibitor ABT-263, salinomycin (SAL), doxorubicin (DOX), paclitaxel (TAX), vincristine (VCR), colchicine (COL) and cisplatin (CIS). ABT-263, SAL and DOX were highly effective towards phyllodes spindle cells when assessed in the model, contributing to ~98% tumor cell death. Furthermore, ABT-263 was highly selective for tumor cells in this system, and exhibited little toxic effect on adjacent normal epithelial cells. Furthermore, consistent with findings in the model, ABT-263 was significantly less toxic towards MCF 10A non-tumorigenic breast epithelial cells compared with SAL and DOX. A conditional reprogramming strategy was subsequently used, involving Rho kinase inhibition, to successfully generate primary phyllodes tumor cells that could be cultured for several passages. The primary cells were sensitive to DOX with an IC of 0.40±0.07 µM in a standard viability assay and the preliminary results were obtained indicating sensitivity to ABT-263 and SAL. The present study demonstrated the feasibility of using explants and primary cells for drug discovery, selectively targeting PTB cells.
PubMed: 31612021
DOI: 10.3892/ol.2019.10823 -
Clinics and Practice Jul 2011Fibroadenomas are benign solid tumor associated with aberration of normal lobular development. Juvenile giant fibroadenoma is usually single and >5 cm in size /or >500...
Fibroadenomas are benign solid tumor associated with aberration of normal lobular development. Juvenile giant fibroadenoma is usually single and >5 cm in size /or >500 gms in weight. Important differential diagnoses are: phyllodes tumor and juvenile gigantomastia. Simple excision is the treatment of choice.
PubMed: 24765310
DOI: 10.4081/cp.2011.e49