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Breast Care (Basel, Switzerland) Apr 2016This study was performed to compare the mammographic, sonographic, and magnetic resonance imaging (MRI) characteristics of phyllodes tumors and fibroadenomas, which may...
BACKGROUND
This study was performed to compare the mammographic, sonographic, and magnetic resonance imaging (MRI) characteristics of phyllodes tumors and fibroadenomas, which may resemble each other.
METHODS
Preoperative mammograms, B-mode and Doppler sonograms, and dynamic breast MRIs of 72 patients with pathologically proven fibroadenomas and 70 patients with pathologically proven phyllodes tumor were evaluated in this retrospective study. Statistical significance was evaluated using chi-square and Fisher's exact tests. Correlations in lesion size among radiological methods were examined by Pearson's correlation analysis.
RESULTS
The features that differed on mammogram were size, shape, and margin of the mass. Sonograms showed significant differences in size, shape, margin, echo pattern, and vascularization of the mass. Pearson's correlation analysis showed strong agreement among radiological methods in terms of assessment of size. Tumor size ≥ 3 cm, irregular shape, microlobulated margins, complex internal echo pattern, and hypervascularity were significant findings of phyllodes tumors. Internal cystic areas on MRI were frequently associated with phyllodes tumors.
CONCLUSION
Mammographic, sonographic, and MRI findings of fibroadenomas and phyllodes tumors could help radiologists to ascertain imaging-histological concordance and guide clinicians in their decision making regarding adequate follow-up or the necessity of biopsy.
PubMed: 27239174
DOI: 10.1159/000444377 -
Frontiers in Endocrinology 2021Phyllodes tumor (PT) is a special type of breast tumors, including three types: malignant, borderline, and benign. Most of these tumors form unilateral disease and can... (Review)
Review
Phyllodes tumor (PT) is a special type of breast tumors, including three types: malignant, borderline, and benign. Most of these tumors form unilateral disease and can rapidly increase in size. The occurrence of axillary lymph node metastasis is rare. Tumor-associated hypoglycemia can be divided into non-islet cell tumor and insulinoma. In non-islet cell tumor hypoglycemia (NICTH), a considerable high molecular weight form of insulin like growth factor 2 (IGF-2) is formed, which abnormally binds to insulin receptors in the tissues and causes hypoglycemia. Breast phyllodes tumors with NICTH are rare and first reported in 1983. Surgical resection is the main treatment and hypoglycemia symptoms usually resolve after surgery. Nevertheless, prior to surgery, intravenous glucose infusion is used to maintain blood glucose levels. A female patient presented with a rapidly growing breast mass and was diagnosed with a phyllodes tumor with NICTH at our hospital in August 2020; she was successfully treated through surgical resection. We reviewed the relevant literature to investigate and analyze the relationship between NICTH and phyllodes tumors, as well as optimize its diagnosis and treatment.
Topics: Blood Glucose; Breast Neoplasms; Female; Glucose; Humans; Hypoglycemia; Insulin-Like Growth Factor II; Magnetic Resonance Imaging; Middle Aged; Molecular Weight; Phyllodes Tumor; Skin; Ulcer
PubMed: 33841338
DOI: 10.3389/fendo.2021.651568 -
F1000Research 2024Phyllodes tumor is a rare fibroepithelial neoplasm of the breast, which is classified histologically as benign, borderline, or malignant. Accurate preoperative diagnosis...
BACKGROUND
Phyllodes tumor is a rare fibroepithelial neoplasm of the breast, which is classified histologically as benign, borderline, or malignant. Accurate preoperative diagnosis allows the correct surgical planning and reoperation avoidance.
OBJECTIVE
To describe the clinical presentation and radiologic features of phyllodes tumors and differentiate between benign and non-benign (borderline and malignant) groups.
METHODS
A retrospective study of 57 patients with a diagnosis of phyllodes tumor who had preoperative imaging (mammography, ultrasound, or CT chest) and histological confirmation. The data was collected from 1 June 2011 to 30 September 2021. The imaging features of the phyllodes tumors were described according to the 5th edition of the ACR BI-RADS lexicon. For comparing between two groups, the student t-test, Wilcoxon rank sum test, Chi-square test, and Fisher's exact test were used for statistical analyses. The logistic regression analysis was calculated for non-benign phyllodes tumor prediction.
RESULTS
From 57 patients, the pathologic results were benign for 43 cases and non-benign phyllodes tumors for 14 cases. There was no differentiation of mammographic and CT features between benign and non-benign groups. Non-benign phyllodes tumors had the statistical significance of menopausal status, entire breast involvement, tumor size larger than 10 cm, and heterogeneous echo on univariable analysis. After multivariable analysis, menopausal status (odd ratios=13.79, p=0.04) and presence of vessels in the rim (odd ratios=16.51, p=0.019) or absent vascularity (odd ratios=8.45, p=0.047) on doppler ultrasound were significantly increased possibility of non-benign phyllodes tumor.
CONCLUSIONS
Menopausal status and presence of vessels in the rim or absent vascularity on Doppler ultrasound were important predictors for the diagnosis of non-benign phyllodes tumor.
Topics: Humans; Phyllodes Tumor; Female; Adult; Middle Aged; Breast Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Mammography; Aged; Young Adult
PubMed: 38845824
DOI: 10.12688/f1000research.145872.2 -
Scientific Reports Mar 2018Phyllodes tumor (PT) of the breast is a rare but clinically important fibroepithelial tumor with potential risks of recurrence and metastasis. Recent studies identified...
Phyllodes tumor (PT) of the breast is a rare but clinically important fibroepithelial tumor with potential risks of recurrence and metastasis. Recent studies identified recurrent TERT promoter mutations in PTs. However, the clinical significance of this alteration has not been fully examined. Two hundred and seven PTs from two intuitions were included. All cases were subjected to immunohistochemical analysis for TERT expression. Analysis of TERT promoter mutations was further performed by Sanger sequencing targeting the hotspot mutation region on cases from one of the involved institutions. The expression of TERT was correlated with clinicopathologic features, mutation status and recurrence. There was an association of TERT expression and its promoter mutation. Both stromal TERT expression and its promoter mutation correlated with PT grading and older patient age. Recurrence free survival (RFS) of PT patients with high stromal TERT expression was shorter if the excision margin was positive. Our findings suggested a possible pathogenic role of TERT alteration in PT malignancy. Currently there is no consensus for re-excision for PT patients with positive surgical margin, particularly for low grade cases. Stromal TERT expression could be potentially useful to guide management patients with benign PTs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Disease-Free Survival; Female; Humans; Margins of Excision; Middle Aged; Mutation; Neoplasm Grading; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Promoter Regions, Genetic; Retrospective Studies; Telomerase
PubMed: 29497099
DOI: 10.1038/s41598-018-22232-w -
World Journal of Surgical Oncology Dec 2004Phyllodes tumors (cystosarcoma phyllodes) are uncommon lesions in the female breast. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in...
BACKGROUND
Phyllodes tumors (cystosarcoma phyllodes) are uncommon lesions in the female breast. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in the literature, but has never been associated with lymph node metastases.
CASE PRESENTATION
A 26-year-old woman presented with a firm, mobile, non-tender mass in the left breast and palpable lymph nodes in the left axilla. The excised lesion appeared well circumscribed and lobulated, with variable fleshy and firm areas. Microscopic examination showed a circumscribed fibroepithelial lesion with a well developed leaf-like architecture, in keeping with a benign phyllodes tumor. The epithelial component showed extensive high grade ductal carcinoma in-situ (DCIS) and invasive carcinoma of no special type, located entirely within the phyllodes tumor. Subsequent axillary lymph node dissection revealed metastatic carcinoma in four lymph nodes.
CONCLUSIONS
Although rare, phyllodes tumors may harbor DCIS and invasive carcinoma, with potential for lymph node metastasis.
PubMed: 15601470
DOI: 10.1186/1477-7819-2-46 -
Cureus Sep 2023One of the rarest fibro-epithelial neoplasms of the breast during pregnancy is the phyllodes tumor (PT). It is typically a painless, bi-phasic, and rapidly growing...
One of the rarest fibro-epithelial neoplasms of the breast during pregnancy is the phyllodes tumor (PT). It is typically a painless, bi-phasic, and rapidly growing neoplasm that resembles fibroadenomas. It is still unclear if the neoplasm is hormone-dependent during pregnancy. It is often challenging to diagnose and treat PT. Herein, we report a case of a 30-year-old female at 31 weeks gestation who was diagnosed with a benign phyllodes tumor of her breast with concurrent mastitis. She was first seen during her third trimester where the neoplasm was around 5 cm as reported by the ultrasound (US) examination. Her biopsy report was suggestive of a PT and she was advised surgery with excision of the tumor margin, but she refused. Ten days after her delivery she presented to the emergency department with a fever and a hard, engorged, erythematous, and tender left breast. She was diagnosed with mastitis of the left breast. She then underwent incision and drainage of the left breast that drained purulent milk; additionally, large necrotic grape-like tissues were removed and were confirmed by the histopathology report as a benign phyllodes tumor of the breast.
PubMed: 37842397
DOI: 10.7759/cureus.45206 -
The Pan African Medical Journal 2016Phyllodes tumors of the breast are very rare and are exceptional in children and adolescents; their treatment is based on surgery and radiotherapy, with a good... (Review)
Review
Phyllodes tumors of the breast are very rare and are exceptional in children and adolescents; their treatment is based on surgery and radiotherapy, with a good prognosis. We report the case of a 12-year old teenage girl presenting with a mass in the left breast. The diagnosis of a phyllodes tumor was confirmed on the basis of clinical, imaging and histological examinations. Treatment consisted of a large tumorectomy without adjuvant therapy, with good evolution during a 2-year follow-up.
Topics: Breast Neoplasms; Child; Female; Follow-Up Studies; Humans; Mastectomy, Segmental; Phyllodes Tumor; Prognosis; Treatment Outcome
PubMed: 28154712
DOI: 10.11604/pamj.2016.25.20.10219 -
BMC Surgery Aug 2020Phyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported... (Review)
Review
BACKGROUND
Phyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported in up to 22% of malignant PTs, with most metastases being discovered in the lungs. PTs of the breast rarely metastasize to the gastrointestinal tract, and reported cases are scarce. To date, a review of the English literature revealed only 3 cases, including our case, of PTs metastasis to stomach.
CASE PRESENTATION
An 82-year-old female patient had 10-year-duration of palpable huge tumor on left breast which was in rapid growth in recent months. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Adjuvant radiotherapy was suggested while she declined out of personal reasons initially. For PTs recurred locally on left chest wall 2 months later, and excision of the recurrent PTs was performed. She, at length, completed adjuvant radiation therapy since then. Six months later, she was diagnosed of metastasis to stomach due to severe anemia with symptom of melena. Gastrostomy with tumor excision was performed for uncontrollable tumor bleeding.
CONCLUSION
For PTs presenting as anemia without known etiologies, further studies are suggested to rule out possible gastrointestinal tract metastasis though such cases are extremely rare. Management of metastatic gastric tumor from PTs should be done on a case-to-case basis, surgical intervention may be needed if there is persistent active bleeding despite medical treatment. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely.
Topics: Aged, 80 and over; Anemia; Breast Neoplasms; Female; Gastrointestinal Hemorrhage; Humans; Mastectomy; Neoplasm Recurrence, Local; Phyllodes Tumor; Radiotherapy, Adjuvant; Stomach Neoplasms
PubMed: 32799838
DOI: 10.1186/s12893-020-00846-0 -
International Journal of Surgery Case... 2020Phyllodes tumors are rare fibroepithelial breast tumors, accounting for less than 1% of all breast tumors. Most Phyllodes tumors are benign. However, about 10% are...
INTRODUCTION
Phyllodes tumors are rare fibroepithelial breast tumors, accounting for less than 1% of all breast tumors. Most Phyllodes tumors are benign. However, about 10% are malignant. The Mean age of presentation for the Malignant Phyllodes tumors is 40 years. This case report describes an unusual presentation of Phyllodes tumor in a young female with an unusual site and presentation of the tumor.
PRESENTATION OF CASE
A 23-year-old female presented with multiple left breast rapidly growing masses. Imaging showed two intra-parenchymal left breast masses and one mass lying posterior to the left pectoralis major muscle, anterior to the chest wall. Diagnosed as phyllodes tumor. Nipple areola sparing mastectomy was performed with excision of the tumor and immediate reconstruction using a silicone implant, followed by radiotherapy.
CONCLUSION
Phyllodes tumor usually presents in patients between 35-55 years old as a single breast mass. Yet, in rare cases, multifocal disease can happen, and disease can present in younger ages. The sub-pectoral presentation of phyllodes tumor is not mentioned in the literature before this case.
PubMed: 32480338
DOI: 10.1016/j.ijscr.2020.05.014 -
Anemia and jejunal intussusception: An unusual presentation for a metastatic phyllodes breast tumor.International Journal of Surgery Case... 2012Phyllodes tumor of the breast is a rare cause of breast cancer, accounting for less than 0.5% of breast cancers. These tumors are classified as benign, borderline, or...
INTRODUCTION
Phyllodes tumor of the breast is a rare cause of breast cancer, accounting for less than 0.5% of breast cancers. These tumors are classified as benign, borderline, or malignant, with malignant tumors compromising nearly 25% of cases. Metastases occur in 20% of malignant tumors, lungs, bones, liver and brain being the frequent sites of metastases.
PRESENTATION OF CASE
We present a case of a metastatic phyllodes tumor to the small bowel causing jejunal intussusception, symptomatic anemia, and small bowel obstruction.
DISCUSSION
Patients with phyllodes tumor of the breast can develop disease recurrence even years after initial treatment. Phyllodes tumor metastasizing to the small bowel is extremely rare, with only three known previously described case reports in the literature.
CONCLUSION
High risk patients, with a past medical history of phyllodes breast cancer, should be monitored closely. Even years after breast cancer treatment, these patients may present with gastrointestinal complaints such as obstruction or bleeding, and therefore metastatic disease to the small bowel should be considered on the differential with subsequent abdominal imaging obtained.
PubMed: 22288047
DOI: 10.1016/j.ijscr.2011.10.015