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PloS One 2022To evaluate ultrasound characteristics in the prediction of malignant and benign phyllodes tumor of the breast (PTB) by using Logistic regression analysis.
OBJECTIVE
To evaluate ultrasound characteristics in the prediction of malignant and benign phyllodes tumor of the breast (PTB) by using Logistic regression analysis.
METHODS
79 lesions diagnosed as PTB by pathology were analyzed retrospectively. The ultrasound features of PTB were recorded and compared between benign and malignant tumors by using single factor and multiple stepwise Logistic regression analysis. Moreover, the Logistic regression model for malignancy prediction was also established.
RESULTS
There were 79 patients with PTB, including 39 benign PTBs and 40 malignant PTBs (33 borderline PTBs and 7 malignant PTBs by pathologic classification). The area under the ROC curve (AUC) of lesion size and age were 0.737 and 0.850 respectively. There were significant differences in age, lesion size, shape, internal echo, liquefaction, and blood flow between malignant and benign PTBs by using single-factor analysis (P<0.05). Age, internal echo, and liquefaction were significant features by using Logistic regression analysis. The corresponding regression equation In (p/(1 - p) = -3.676+2.919 internal echo +3.029 liquefaction +4.346 age).
CONCLUSION
Internal echo, age, and liquefaction are independent ultrasound characteristics in predicting the malignancy of PTBs.
Topics: Breast; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Logistic Models; Phyllodes Tumor; Retrospective Studies
PubMed: 35325009
DOI: 10.1371/journal.pone.0265952 -
Oncology (Williston Park, N.Y.) May 2004Primary nonepithelial malignancies of the breast comprise an important minority of breast neoplasms, including primary breast sarcomas, therapy-related breast sarcomas,... (Review)
Review
Primary nonepithelial malignancies of the breast comprise an important minority of breast neoplasms, including primary breast sarcomas, therapy-related breast sarcomas, the phyllodes tumors, and primary breast lymphomas. With widespread mammographic detection of breast lesions, these tumors represent critical elements of the differential diagnosis of even benign-appearing lesions. Each has a distinct clinical profile, including presentation, available therapeutic options, and prognosis, further underscoring the importance of timely recognition. The increasing incidence of breast carcinomas and the subsequent therapy thereof may be contributing to an increase in the number of therapy-related breast tumors. This review discusses various features of these uncommon malignancies and their treatment, with the goal of increasing understanding of their clinical behavior and management.
Topics: Breast Neoplasms; Hemangiosarcoma; Humans; Lymphoma; Neoplasm Staging; Neoplasms, Radiation-Induced; Phyllodes Tumor; Prognosis; Radiotherapy; Sarcoma
PubMed: 15209192
DOI: No ID Found -
Annals of Saudi Medicine 2013The challenging issue for the breast surgeons is local recurrence of phyllodes tumor. The histological criteria to predict local recurrence has been a controversial...
BACKGROUND AND OBJECTIVES
The challenging issue for the breast surgeons is local recurrence of phyllodes tumor. The histological criteria to predict local recurrence has been a controversial issue. The objective of this study was to determine pathological parameters and surgical margins that influence outcome of local recurrence and distant metastasis in phyllodes tumor (PT).
DESIGN AND SETTING
Retrospective review between January 2003 to August 2008 at King Hussein Cancer Center-Jordan.
PATIENTS AND METHODS
Forty-two female patients diagnosed as having PT were classified to benign, borderline and malignant. The medical records were reviewed in relation to the surgical management, recurrence, follow-up, the histological features of the tumor and grading of tumors based on the following histological parameters: mitotic count, stromal cellularity, stromal overgrowth, cellular pleomorphism, nuclear grade, tumor necrosis, tumor margin, and surgical margin status. All patients underwent wide local excision of the tumor or mastectomy.
RESULTS
Forty-two patients with PT (16 benign, 9 borderline, 17 malignant PT) were followed up for 30 months. The mean age was 39.8 years, and the average tumor size was 6.6 cm. The recurrence rate of PT in our study was 21% at a mean time of 11 months. Nine patients had local recurrence; 2 benign, 6 malignant and 1 borderline. Cellular pleomorphism had correlation with recurrence rate (P=.045). We had six patients (14%) with distant metastasis. All had malignant PT. Metastasis in PT has a relationship with histological grade (P=.02).
CONCLUSIONS
We conclude that patients with moderate and severe cellular pleomorphism had higher local recurrence, while metastatic PT occur more in patients with high nuclear grade.
Topics: Adolescent; Adult; Breast Neoplasms; Child; Female; Follow-Up Studies; Humans; Mastectomy; Middle Aged; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Recurrence, Local; Phyllodes Tumor; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 23563006
DOI: 10.5144/0256-4947.2013.162 -
Archives of Pathology & Laboratory... Oct 2006Phyllodes tumors (PTs) of the breast are biphasic neoplasms composed of epithelium and a spindle-cell stroma. Currently, PTs are classified as benign, borderline, or...
CONTEXT
Phyllodes tumors (PTs) of the breast are biphasic neoplasms composed of epithelium and a spindle-cell stroma. Currently, PTs are classified as benign, borderline, or malignant based on histopathologic features. However, histologic classification does not always predict outcome. Objective.-To determine the prognostic value of a variety of clinicopathologic features and immunoreactivities in PTs.
DESIGN
Sixteen benign, 8 borderline, and 6 malignant PTs with follow-up were examined for reactivity across a panel of immunohistochemical stains, including c-Kit, endothelin 1, p16, p21, p53, and Ki-67. Clinicopathologic features, including stromal cellularity, mitotic rate, and margin status, were also assessed. Tumor variables were compared among tumor subgroups and between tumors that did and did not recur.
RESULTS
Of the 30 PTs, 4 recurred (1 benign, 2 borderline, 1 malignant). One patient with a malignant tumor died of metastatic disease 34 months after initial diagnosis. The overall positive rate of c-Kit immunoreactivity was 13% in benign, 63% in borderline, and 67% in malignant PTs. Endothelin 1 epithelial cytoplasmic staining was seen in 100% of benign, 50% of borderline, and 17% of malignant PTs. Additionally, p16, p21, p53, and Ki-67 were differentially expressed among benign, borderline, and malignant tumors. Positive surgical resection margins was the only variable that significantly predicted recurrent disease (P = .02).
CONCLUSIONS
Stromal c-Kit positivity and epithelial endothelin 1 negativity are more often associated with malignant PTs; however, only positive margin status is significantly associated with tumor behavior.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Breast Neoplasms; Disease Progression; Endothelin-1; Epithelium; Female; Humans; Immunohistochemistry; Ki-67 Antigen; Mastectomy; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Proto-Oncogene Proteins c-kit; Staining and Labeling; Tumor Suppressor Protein p53
PubMed: 17090194
DOI: 10.5858/2006-130-1516-PTACAI -
Cureus Sep 2023Introduction Phyllodes tumor (PT) is an uncommon fibroepithelial neoplasm of the breast. It is a biphasic tumor with stromal and epithelial components, with a tendency...
Introduction Phyllodes tumor (PT) is an uncommon fibroepithelial neoplasm of the breast. It is a biphasic tumor with stromal and epithelial components, with a tendency to recur. Because of its wide range of disease manifestations, it has been subclassified into three categories, i.e., benign, borderline, and malignant, based on several histological parameters. This study was conducted to evaluate the clinicopathological features associated with malignancy in breast PTs. Methods We conducted a retrospective study at the Department of Histopathology at Liaquat National Hospital, Karachi, Pakistan. A total of 146 biopsy-proven cases of PTs were enrolled in the study. Clinical data were obtained from the clinical referral forms. Specimens were obtained from either lumpectomy or simple mastectomy. The specimens obtained were received at the laboratory where after gross examination, paraffin-embedded tissue blocks were prepared, which were sectioned, stained, and studied by a senior histopathologist. Pathological features, such as mitotic count, necrosis, stromal atypia, stromal overgrowth, and heterologous elements, were observed. Based on these features, the PTs were classified into benign, borderline, and malignant tumors. Results The mean age of the PTs in our setup was 40.65 ± 12.17 years with a mean size of 9.40 ± 6.49 cm. Malignant PT was found to be the most prevalent in our population, accounting for 63 (43.2%) cases, followed by borderline (51, 34.9%) and benign (32, 21.9%). A significant association was found between the tumor subtype and patient age, i.e., patients diagnosed with malignant and borderline PTs were found to be of older age (mean 42.82 ± 12.94 and 42.05 ± 11.31 years, respectively) than those diagnosed with benign PTs (mean age 34.12 ± 9.75 years). Moreover, malignant PTs were associated with larger tumor size (mean 11.46 ± 6.08) compared with the other two subtypes. Conclusion We found a significant association among patient age, tumor size, and PT subtype. Therefore, apart from the usual histological parameters, patient age and tumor size are important parameters for predicting the behavior of breast PT and should be considered for management.
PubMed: 37908929
DOI: 10.7759/cureus.46168 -
Canadian Journal of Surgery. Journal... Feb 2019Phyllodes breast tumours are fairly uncommon, and they can be benign, borderline or malignant. General surgeons usually encounter them following the surgical excision of... (Review)
Review
Phyllodes breast tumours are fairly uncommon, and they can be benign, borderline or malignant. General surgeons usually encounter them following the surgical excision of a breast lump that had the appearance of a fibroepithelial lesion. The surgeon is then faced with the question of what to do to establish an acceptable treatment margin. In this discussion, we recommend a plan for the management of Phyllodes tumours based on a review of the recent literature, confirmed by a retrospective review of the results from our centre. A negative margin is acceptable treatment following a lumpectomy for Phyllodes tumours. Only patients with a positive margin should undergo a revision.
Topics: Adult; Breast Neoplasms; Cohort Studies; Female; Humans; Margins of Excision; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Rare Diseases; Retrospective Studies; Risk Assessment; Treatment Outcome
PubMed: 30694037
DOI: 10.1503/cjs.005718 -
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 -
Indian Journal of Medical and... 2017Phyllodes tumor is a rare fibroepithelial biphasic tumor of the breast composed of hypercellular mesenchymal stroma and double-layered epithelial component, arranged in...
Phyllodes tumor is a rare fibroepithelial biphasic tumor of the breast composed of hypercellular mesenchymal stroma and double-layered epithelial component, arranged in clefts with leaf-like projections. Phyllodes tumor with coincidental presence of invasive carcinoma or ductal carcinoma in the same or distinct breast is a rare occurrence, documented by some reports. Invasive carcinoma can be seen within or outside the phyllodes tumor. Skin ulceration by malignant phyllodes tumor with coexisting invasive carcinoma as collision tumor is extremely rare. Here, we report an extremely rare presentation of malignant phyllodes tumor as a giant fungating mass with distinct invasive carcinoma in the same breast in a 51-year-old female.
PubMed: 28469344
DOI: 10.4103/0971-5851.203499 -
Indian Journal of Surgical Oncology Sep 2014Concomitant occurrence of phyllodes tumor with an in situ or invasive carcinoma in the breast is an uncommon phenomenon and has been reported sparingly. We describe a...
Concomitant occurrence of phyllodes tumor with an in situ or invasive carcinoma in the breast is an uncommon phenomenon and has been reported sparingly. We describe a rare case of simultaneous bilateral intraductal and infiltrating duct carcinoma with coexisting fibroadenomas and phyllodes tumor. To the best of our knowledge, only 19 cases of invasive carcinoma with phyllodes tumor have been reported so far and lymph node metastases has been described only once. A 43 year-old woman presented with multiple bilateral breast lumps. Core biopsies revealed phyllodes tumor in the right breast and invasive duct carcinoma of the left breast. Simple mastectomy done for right breast showed foci of invasive carcinoma arising in phyllodes tumor. Metastasis was detected in the left axillary lymph nodes. This case is being reported to create awareness of this rare transformation, which has significant prognostic and therapeutic implications.
PubMed: 25419062
DOI: 10.1007/s13193-014-0338-z -
Annals of the Royal College of Surgeons... May 2022A recent Association of Breast Surgery summary statement on fibroadenoma management recommends excision only for cellular fibroepithelial lesions and rapidly growing...
INTRODUCTION
A recent Association of Breast Surgery summary statement on fibroadenoma management recommends excision only for cellular fibroepithelial lesions and rapidly growing lesions with a core biopsy diagnosis of fibroadenoma; persistent pain is a relative indication for excision.
METHODS
This retrospective study looked at the impact this approach would have on the diagnosis of phyllodes tumours.
RESULTS
From 2014 to 2018, there were 1,058 core biopsy diagnoses of fibroadenoma; 112 lesions were excised, of which 98 were fibroadenomas, 4 were hamartomas and 10 were phyllodes tumours. In this group, an excision diagnosis of phyllodes tumour was associated with size more than 40 mm, age more than 40 years and radiological suspicion of phyllodes tumour or carcinoma. One hundred and sixty-six excised fibroepithelial lesions with no previous core biopsy included eight phyllodes tumours; in this group, rapid growth was associated with phyllodes tumour diagnosis. Twelve of the 26 fibroepithelial lesions classified as B3 (cellular fibroepithelial lesion or phyllodes tumour) were diagnosed as phyllodes tumours on excision. Using a combination of radiological, clinical and pathological features it was possible to create an excision policy that would recommend excision of 22 of the 31 phyllodes tumours in this period. Eight of the nine 'missed' phyllodes tumours were benign.
CONCLUSION
The Association of Breast Surgery summary statement will reduce the number of fibroadenomas excised, but may also result in delayed diagnosis of some phyllodes tumours. Appropriate safety netting advice should be provided to identify rapidly growing lesions.
Topics: Adult; Biopsy, Large-Core Needle; Breast Neoplasms; Diagnosis, Differential; Female; Fibroadenoma; Humans; Phyllodes Tumor; Retrospective Studies
PubMed: 34939848
DOI: 10.1308/rcsann.2021.0208