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Journal of Thoracic Disease Nov 2016Phyllodes tumors of the breast are rare tumor types that consist of 0.3-1.0% in all breast tumors. The naming and classification of breast phyllodes tumor have been... (Review)
Review
Phyllodes tumors of the breast are rare tumor types that consist of 0.3-1.0% in all breast tumors. The naming and classification of breast phyllodes tumor have been debated for years. Based on the classification criteria modified by WHO in 2003, this review mainly introduced the clinicopathologic characteristics, pre-operational diagnosis and the treatment of breast phyllodes tumors, and also summarized the prognostic factors related to tumor recurrence.
PubMed: 28066617
DOI: 10.21037/jtd.2016.11.03 -
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 -
International Journal of Surgery Case... 2018Malignant phyllodes tumor of the breast is an extremely rare entity usually presenting with similar clinical features with those of benign fibroadenoma. Due to its...
INTRODUCTION
Malignant phyllodes tumor of the breast is an extremely rare entity usually presenting with similar clinical features with those of benign fibroadenoma. Due to its scarcity and clinical presentation, it is quite difficult for clinicians to suspect and diagnose the disease at its early stage. There is currently no consensus regarding adjunctive radiotherapy, hormonal therapy and systemic chemotherapy recommended for malignant phyllodes tumors.
PRESENTATION OF CASE
This report presents a case of early-stage malignant phyllodes tumor treated by lumpectomy only without adjunctive chemoradiation therapy, but with an excellent outcome.
DISCUSSION
Early diagnosis and staging with high suspicion are crucial in malignant phyllodes tumor patients since they do not only improve the overall outcome of the disease after lumpectomy only but they also decrease morbidity and mortality with adjunctive chemoradiation therapy. This case report has been reported in line with the SCARE criteria (Agha et al., 2016 [1]).
PubMed: 29247967
DOI: 10.1016/j.ijscr.2017.12.013 -
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 -
International Journal of Surgery Case... 2015Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3-0.9% of all breast cancers. Phyllodes tumor are...
INTRODUCTION
Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3-0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10-30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount.
PRESENTATION OF CASE
We present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31cm in diameter and weighed over 10kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office.
CONCLUSION
Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.
PubMed: 25697402
DOI: 10.1016/j.ijscr.2014.12.041 -
Archives of Pathology & Laboratory... May 2009The morphologic spectrum of mammary fibroepithelial lesions ranges from fibroadenoma, a common benign neoplasm, to phyllodes tumor, an uncommon lesion that can sometimes... (Review)
Review
CONTEXT
The morphologic spectrum of mammary fibroepithelial lesions ranges from fibroadenoma, a common benign neoplasm, to phyllodes tumor, an uncommon lesion that can sometimes recur and metastasize.
OBJECTIVE
To focus on problems encountered in the diagnostic evaluation of fibroepithelial tumors, highlighting the diagnostically relevant morphologic features and providing an update on the immunohistochemical profile and genetic alterations of these rare neoplasms.
DATA SOURCES
A PubMed search of the English-language literature identified published reports on fibroepithelial lesions, with a special focus on phyllodes tumor. The results and conclusions of these studies form the basis of this review.
CONCLUSIONS
The distinction between fibroadenoma and phyllodes tumor is usually not problematic, especially in excision specimens. In some cases, however, the diagnostic evaluation of fibroepithelial lesions can be challenging, especially if only limited material is available. Morphologic predictors of local recurrence of phyllodes tumor include cellularity and cytologic atypia, mitotic activity, positive margins, infiltrative borders, fibroproliferative satellite nodules, and past history of fibroadenoma. Predictors of distant metastasis include size, tumor necrosis, and stromal overgrowth. None of these parameters, however, constitutes a definite marker of malignancy. Presently, molecular and immunohistochemical techniques play a limited role in the diagnosis of fibroepithelial lesions.
Topics: Biomarkers, Tumor; Breast Neoplasms; DNA, Neoplasm; Diagnosis, Differential; Female; Fibroadenoma; Gene Expression; Humans; Immunoenzyme Techniques; Neoplasm Recurrence, Local; Phyllodes Tumor
PubMed: 19415945
DOI: 10.5858/133.5.713 -
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 -
Giant malignant phyllodes tumor with distant metastases: a case report and review of the literature.Hippokratia 2022Phyllodes tumors (PTs) represent a rare type of breast tumor and are classified into benign, borderline, and malignant. Giant PTs, meaning those sized more than ten cm,...
BACKGROUND
Phyllodes tumors (PTs) represent a rare type of breast tumor and are classified into benign, borderline, and malignant. Giant PTs, meaning those sized more than ten cm, are even rarer, most commonly malignant, and usually have a dismal prognosis due to the high metastatic potential.
CASE REPORT
We report the case of a 55-year-old woman who underwent modified radical mastectomy and left axillary lymphadenectomy for a rapidly growing, giant, ulcerated mass of the left breast. Histopathologic examination revealed a malignant phyllodes tumor (MPT). Over one year after the initial surgery, the patient was found to have extensive thoracic and retroperitoneal metastases.
CONCLUSION
Although giant PTs are uncommon, clinical suspicion should be high in rapidly growing breast mass patients. A comprehensive review of all metastatic giant MPT cases reported in the English literature emphasizes the lack of consensus regarding appropriate treatment. In the case of metastatic foci, pathologists need to be aware of the previous history to make a definitive diagnosis. Also, a comparative histopathologic study of the primary and metastatic tumors is sometimes necessary. HIPPOKRATIA 2022, 26 (1):41-45.
PubMed: 37124283
DOI: No ID Found -
World Journal of Oncology Dec 2023Phyllodes tumor (PT) is considered a rare fibroepithelial tumor. Very few series have been reported in children and adolescents. Based on histopathological features, it...
Phyllodes tumor (PT) is considered a rare fibroepithelial tumor. Very few series have been reported in children and adolescents. Based on histopathological features, it can be classified as benign, borderline, or malignant, with the latter having a more aggressive clinical behavior. We report the case of a 10-year-old female who began with an asymptomatic mobile right breast mass. An initial fine needle biopsy (FNB) concluded fibroadenoma (FA). Months later, the mass kept growing, with the appearance of pain and nipple discharge. Benign PT was demonstrated in a new biopsy. A total mastectomy was performed. The post-surgical histopathological examination was compatible with a borderline PT. The patient is now symptom-free and with no signs of relapse. Not all breast masses in the pediatric or adolescent age bracket are FA. Attention is warranted when the clinical behavior does not follow the usual outline. PT has to be considered as a possible diagnosis and treated accordingly.
PubMed: 38022409
DOI: 10.14740/wjon1716 -
European Journal of Breast Health Jan 2020Phyllodes tumors are biphasic tumors consisting of epithelial and stromal components that account for less than 1% of all breast tumors. According to the World Health...
OBJECTIVE
Phyllodes tumors are biphasic tumors consisting of epithelial and stromal components that account for less than 1% of all breast tumors. According to the World Health Organization (WHO) phyllodes tumors are classified into three categories as benign, borderline and malignant. It has been reported that these tumors are usually benign and both the stromal component and the epithelial component may progress to malignancy. In this descriptive study, it was aimed to present the cases of phyllodes tumor and to evaluate the clinicopathological features of these tumors in the light of the literature.
MATERIALS AND METHODS
In our study, 55 cases of phyllodes tumor diagnosed between 2005-2018 in the Department of Medical Pathology were retrospectively studied. A total of 55 cases were included in the study.
RESULTS
All cases were female with a mean age of 39.7+15.2 years. Fifty-seven tumors diagnosed in 55 cases were classed as benign in 20 cases (35.1%), borderline in 14 cases (24.6%) and malignant phyllodes tumors in 23 cases (40.3%). Ductal carcinoma in situ (solid and cribriform type) were detected in one case with malignant phyllodes tumor, whereas invasive ductal carcinoma was detected in one case. Bilateral ductal carcinoma in situ was present in the patient with invasive ductal carcinoma.
CONCLUSION
These tumors which rapidly grow into large masses can be clinically and pathologically confused with benign lesions, macroscopic and microscopic evaluation of concomitant in situ-invasive carcinomas should be considered. Phyllodes tumors have an important role in breast surgery and pathology.
PubMed: 31912011
DOI: 10.5152/ejbh.2019.4709