Borderline Phyllodes Tumor in a Child

Fetched: December 1st, 2023, 5:02am GMT by Esperanza Millan-Arreola

World J Oncol. 2023 Dec;14(6):584-588. doi: 10.14740/wjon1716. Epub 2023 Oct 21.

ABSTRACT

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.

PMID:38022409 | PMC:PMC10681785 | DOI:10.14740/wjon1716
Distinguishing Fibroepithelial Lesions Requires Clinical, Imaging, and Pathology Correlation

Fetched: December 1st, 2023, 5:02am GMT by Megan Bradley

Cureus. 2023 Oct 25;15(10):e47673. doi: 10.7759/cureus.47673. eCollection 2023 Oct.

ABSTRACT

Phyllodes tumor (PT) is a rare tumor that can present as benign, borderline, or malignant. These tumors arise from the breast stroma, similar to fibroadenomas. Phyllodes tumors and fibroadenomas often have overlapping features in both radiological imaging and pathologic analysis. As a result, these two lesions are often difficult to differentiate and require the correlation of multiple modalities, including clinical context, radiologic imaging, and histological evaluation. This article presents a case of a borderline phyllodes tumor in a 51-year-old female, with the inclusion of its radiologic and pathologic images and performed treatment. The goal of this article is to provide a review of the clinical presentation, diagnostic imaging and pathology features, treatment, and management of a phyllodes tumor and compare and contrast this against the more common fibroadenomas, in order to provide aid for differentiating these two breast lesions.

PMID:38021664 | PMC:PMC10672401 | DOI:10.7759/cureus.47673
Metabolic coupling in phyllodes tumor of the breast and its association with tumor progression

Fetched: December 1st, 2023, 5:02am GMT by Nah Ihm Kim

Oncol Lett. 2023 Nov 3;26(6):545. doi: 10.3892/ol.2023.14132. eCollection 2023 Dec.

ABSTRACT

There are markers of metabolic coupling in breast cancer. Loss of caveolin-1 (Cav-1) and upregulation of monocarboxylate transporters (MCTs), especially MCT1 and MCT4, serve an important role in metabolic coupling necessary for release and uptake of metabolites. However, the occurrence of these phenomena in phyllodes tumors (PTs) of the breast is unclear. A total of 101 PTs (60 benign, 26 borderline and 15 malignant) and nine breast tissue samples with no pathological lesions were analyzed. Immunohistochemical staining for Cav-1, MCT1 and MCT4 was performed using tissue microarray and their expression in both stromal and epithelial components was assessed. Cav-1 expression in PTs demonstrated a significant decrease in the stromal component compared with that in the normal breast tissues (P<0.001). MCT1 expression in both epithelial and stromal components was significantly increased in PTs, compared with that in normal breast tissues (both P<0.001). Stromal MCT1 and MCT4 expression were different depending on tumor grade of PTs, and stromal MCT1 expression significantly increased with increasing tumor grade (P<0.001). Although not statistically significant, stromal Cav-1 expression notably decreased with increases in PT grade. High stromal MCT1 expression was significantly associated with lower disease-free survival rate in comparison with low stromal MCT1 expression (P<0.05). These results suggested that changes in protein expression of Cav-1, MCT1 and MCT4 may be associated with tumorigenesis and progression of PTs of the breast.

PMID:38020291 | PMC:PMC10660424 | DOI:10.3892/ol.2023.14132
Precise diagnosis of breast phyllodes tumors using Raman spectroscopy: Biochemical fingerprint, tumor metabolism and possible mechanism

Fetched: November 19th, 2023, 5:02am GMT by Yifan Wu

Anal Chim Acta. 2023 Dec 1;1283:341897. doi: 10.1016/j.aca.2023.341897. Epub 2023 Oct 15.

ABSTRACT

BACKGROUND: Breast fibroadenomas and phyllodes tumors are both fibroepithelial tumors with comparable histological characteristics. However, rapid and precise differential diagnosis is a tough point in clinical pathology. Given the tendency of phyllodes tumors to recur, the difficulty in differential diagnosis with fibroadenomas leads to the difficulty in optimal management for these patients.

METHOD: In this study, we used Raman spectroscopy to differentiate phyllodes tumors from breast fibroadenomas based on the biochemical and metabolic composition and develop a classification model. The model was validated by 5-fold cross-validation in the training set and tested in an independent test set. The potential metabolic differences between the two types of tumors observed in Raman spectroscopy were confirmed by targeted metabolomic analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS: A total of 204 patients with formalin-fixed paraffin-embedded (FFPE) tissue samples, including 100 fibroadenomas and 104 phyllodes tumors were recruited from April 2014 to August 2021. All patients were randomly divided into the training cohort (n = 153) and the test cohort (n = 51). The Raman classification model could differentiate phyllodes tumor versus fibroadenoma with cross-validation accuracy, sensitivity, precision, and area under curve (AUC) of 85.58 % ± 1.77 %, 83.82 % ± 1.01 %, 87.65 % ± 4.22 %, and 93.18 % ± 1.98 %, respectively. When tested in the independent test set, it performed well with the test accuracy, sensitivity, specificity, and AUC of 83.50 %, 86.54 %, 80.39 %, and 90.71 %. Furthermore, the AUC was significantly higher for the Raman model than that for ultrasound (P = 0.0017) and frozen section diagnosis (P < 0.0001). When it came to much more difficult diagnosis between fibroadenoma and benign or small-size phyllodes tumor for pathological examination, the Raman model was capable of differentiating with AUC up to 97.45 % and 95.61 %, respectively. On the other hand, targeted metabolomic analysis, based on fresh-frozen tissue samples, confirmed the differential metabolites (including thymine, dihydrothymine, trans-4-hydroxy-l-proline, etc.) identified from Raman spectra between phyllodes tumor and fibroadenoma.

SIGNIFICANCE AND NOVELTY: In this study, we obtained the molecular information map of breast phyllodes tumors provided by Raman spectroscopy for the first time. We identified a novel Raman fingerprint signature with the potential to precisely characterize and distinguish phyllodes tumors from fibroadenoma as a quick and accurate diagnostic tool. Raman spectroscopy is expected to further guide the precise diagnosis and optimal treatment of breast fibroepithelial tumors in the future.

PMID:37977771 | DOI:10.1016/j.aca.2023.341897
Primary malignant phyllodes tumors of the breast: A retrospective analysis from a referral center

Fetched: November 19th, 2023, 5:02am GMT by Carmine Valenza

Eur J Cancer. 2023 Nov 10;196:113423. doi: 10.1016/j.ejca.2023.113423. Online ahead of print.

ABSTRACT

BACKGROUND: The treatment for primary malignant phyllodes tumors of the breast (B-MPT) consists of wide local excision with negative margins (≥1 cm). However, because of their rarity, prognostic factors, type of surgery and adjuvant treatments are still a matter of debate.

METHODS: We conducted a single-center retrospective study to describe outcomes and prognostic factors of patients with primary B-MPT, who underwent breast surgery from January 2000 to December 2021. The primary endpoint was the cumulative incidence of any recurrence. Secondary endpoints were the cumulative incidences of distant and local recurrences.

RESULTS: 131 patients were included, of whom all received surgery, 5 adjuvant anthracycline-based chemotherapy and 15 radiation therapy. After a median follow-up of 6.4 years, the cumulative incidences at 5-years of any, local and distant recurrences were of 26% (95% Confidence Interval [CI], 4-34%), 16% (95%CI, 10-24%) and 10% (95%CI, 5.3-16%), respectively. Tumor size ≥ 5 cm was associated with higher distant recurrences (p = 0.05); instead, among small tumors (<5 cm), distant recurrences were higher in those with heterologous differentiation and/or multifocal disease (p = 0.06). Type of breast surgery (mastectomy vs. lumpectomy/excision) was not found to be significantly associated with distant (p = 0.32) or local (p = 0.17) recurrence, even after controlling local recurrence incidence for negative pathologic prognostic factors (p = 0.17).

CONCLUSIONS: The natural history of B-MPT is burdened by local and distant recurrences. Pathologic prognostic factors (i.e., tumor size, heterologous differentiation and multifocal disease) more than the type of wide breast surgery (mastectomy vs. lumpectomy) seem to represent the most significant prognostic factor for recurrences.

PMID:37977104 | DOI:10.1016/j.ejca.2023.113423
18F-FDG PET/CT Versus 18F-FAPI PET/CT in a Case of Recurrent Malignant Phyllodes Breast Tumor

Fetched: November 15th, 2023, 5:03am GMT by Shuqin Jiang

Clin Nucl Med. 2023 Nov 13. doi: 10.1097/RLU.0000000000004936. Online ahead of print.

ABSTRACT

A 52-year-old woman with medical history of surgery for left malignant phyllodes breast tumor found a mass on the left chest 3 months ago. A suspicion of recurrent malignant phyllodes breast tumor was made. The patient was enrolled in the clinical trial of 18F-FAPI PET/CT in recurrent sarcoma (no. NCT05485792). 18F-FAPI PET/CT and 18F-FDG PET/CT were performed, and the images demonstrated intense uptake in a huge mass in the left anterior chest wall. Then the patient underwent extended resection of left chest wall tumor. The tumor proved to be recurrent malignant phyllodes breast tumor pathologically.

PMID:37962169 | DOI:10.1097/RLU.0000000000004936
Epithelial carcinomas arising within phyllodes tumours of the breast: a review of their histopathological, pathophysiological and molecular characteristics

Fetched: November 13th, 2023, 5:02am GMT by William Cook

Pathobiology. 2023 Nov 11. doi: 10.1159/000533745. Online ahead of print.

ABSTRACT

Epithelial proliferation is a common feature of phyllodes tumours (PT) but epithelial malignancy is rare. This review seeks to further our understanding of epithelial malignancy within phyllodes tumours by analysing their histopathological and molecular characteristics in previously reported cases in the literature. PubMed was searched for case reports, case series and literature reviews of in situ and invasive carcinoma within phyllodes tumours. Only cases where the carcinoma was within the PT were included. Cases of synchronous carcinoma in the ipsilateral or contralateral breast were excluded. Eighty-six cases of in situ or invasive carcinoma within a PT were identified. Across the grades of phyllodes tumours there was a similar proportion of invasive carcinomas compared to in situ lesions. The malignant stroma correlates with a higher likelihood of epithelial malignancy, and molecular studies support a possible causal pathophysiological relationship. Malignant phyllodes tumours as compared to benign appear to have a greater likelihood to contain either an in-situ or invasive epithelial malignancy. This higher likelihood suggests that interactions between the malignant stroma and the transforming epithelium may play a significant role in the phenomenon which remains to be elucidated.

PMID:37952521 | DOI:10.1159/000533745
ASO Visual Abstract: Management of Benign Phyllodes Tumors: A Dutch Population-Based Retrospective Cohort Between 1989 and 2022

Fetched: November 9th, 2023, 5:02am GMT by Josefien P van Olmen

Ann Surg Oncol. 2023 Dec;30(13):8486. doi: 10.1245/s10434-023-14283-9.

NO ABSTRACT

PMID:37728823 | DOI:10.1245/s10434-023-14283-9
ASO Author Reflections: The Management of Benign Phyllodes Tumors

Fetched: November 9th, 2023, 5:02am GMT by Josefien P van Olmen

Ann Surg Oncol. 2023 Dec;30(13):8457-8458. doi: 10.1245/s10434-023-14239-z. Epub 2023 Aug 28.

NO ABSTRACT

PMID:37639028 | DOI:10.1245/s10434-023-14239-z
Association between CD10 expression and phyllodes tumor: A retrospective case control study

Fetched: November 9th, 2023, 5:02am GMT by Fang Tian

Medicine (Baltimore). 2023 Nov 3;102(44):e35677. doi: 10.1097/MD.0000000000035677.

ABSTRACT

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.

PMID:37933030 | PMC:PMC10627699 | DOI:10.1097/MD.0000000000035677
GMIA-Breast Oncoplastic and Reconstruction Society consensus on operative standards of breast cancer surgery

Fetched: November 8th, 2023, 5:02am GMT by Guangdong Medical Industry Association(GMIA)

Nan Fang Yi Ke Da Xue Xue Bao. 2023 Oct 20;43(10):1827. doi: 10.12122/j.issn.1673-4254.2023.10.24.

ABSTRACT

The Breast Cancer Surgery Operative Standards Consensus Conference aimed to establish industry technical standards and improve breast cancer surgery practices by addressing controversial and operative breast cancer surgery-related issues in clinical practice.The conference was led by the Breast Oncoplastic and Reconstruction Branch of Guangdong Medical Industry Association (GMIA) and involved 85 breast surgeons with expertise in breast cancer conserving, oncoplastic, and reconstructive surgery.Consensus was reached through 3 meetings.The first meeting brought up the topics of interest, and evidence summaries were presented for debate during the second meeting; the third meeting was held to reach consensus recommendation for selected topics.Pre-defined consensus criteria required that the consensus was reached only when more than 70% of the panelists agreed on the topic.Out of the 57 questions set for voting, 11 operative standards were recommended as Preferred, and one was recommended as Considered.Preferred operative standards included surgical details in breast conserving surgery, mastectomy, reconstructive surgery, surgical treatment of phyllodes tumor.Selected topics that did not reach consensus among the panelists were also discussed.These Preferred operative standards could help guide clinical surgical practice in routine patient care.

PMID:37933662 | PMC:PMC10630210 | DOI:10.12122/j.issn.1673-4254.2023.10.24
Breast development and disorders in children and adolescents

Fetched: November 2nd, 2023, 5:02am GMT by Fatima Mubarak

Curr Probl Pediatr Adolesc Health Care. 2023 Oct 30:101441. doi: 10.1016/j.cppeds.2023.101441. Online ahead of print.

ABSTRACT

Breast masses are infrequently encountered in pediatric and adolescent populations. Most breast masses in children are benign entities arising from embryological defects which can be managed once breast development is complete. Diagnostic and management dilemmas arise when fibroepithelial lesions of the breast are seen in clinical practice. Differentiation between a fibroadenoma and a phyllodes tumor is important to guide management. Breast cancer in children under 18 years of age is extremely rare and invasive diagnostic testing and aggressive management is only recommended when clinical suspicion of malignancy is very high. Patient and caregiver counseling plays an important role in the management of these diseases. While adult-onset breast diseases have been studied very closely, there is a dearth of literature on pediatric breast anomalies. This review aims to provide a scoping overview of the available literature on benign, fibroepithelial, and malignant lesions of the breast in pediatric and adolescent populations to help guide physicians and surgeons with decision-making regarding the diagnosis and management of pediatric breast diseases.

PMID:37914550 | DOI:10.1016/j.cppeds.2023.101441
Clinicopathological Parameters Predicting Malignancy in Phyllodes Tumor of the Breast

Fetched: November 2nd, 2023, 5:02am GMT by Atif A Hashmi

Cureus. 2023 Sep 28;15(9):e46168. doi: 10.7759/cureus.46168. eCollection 2023 Sep.

ABSTRACT

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.

PMID:37908929 | PMC:PMC10613785 | DOI:10.7759/cureus.46168
A rapidly growing fibroadenoma in a pregnant woman: A case report

Fetched: October 30th, 2023, 5:02am GMT by I M Brouwer de Koning

Breast Dis. 2023;42(1):325-330. doi: 10.3233/BD-230030.

ABSTRACT

BACKGROUND: Fibroadenomas are the most common benign breast lesions in women. They present as a unilateral mass and can rapidly enlarge in size through hormonal changes. Fibroadenomas could be classified as small or giant, and as simple or complex. They are classified as 'giant' when the size exceeds 5 cm and/or weight 500 gram; and as 'complex' if one of the following characteristics is present: cysts with a size >3 mm, epithelial calcifications, sclerosing adenosis and papillary apocrine metaplasia. Giant fibroadenomas can cause compression of surrounding breast tissue or breast asymmetry, requiring surgical excision in order to preserve a normal breast shape.

CASE: A 26-year-old pregnant woman was referred with a palpable mass of her right breast. The mass rapidly increased in size to a diameter of 13 cm during the second trimester of her pregnancy. A tru-cut biopsy confirmed a fibroadenoma. The rapid growth and compression of normal breast tissues indicated a lumpectomy during her pregnancy. The mass was easily excised without any consequences for the pregnancy. Pathological examination showed a complex giant fibroadenoma.

CONCLUSION: A unique case of a pregnant woman with rapid progression of a fibroadenoma that met the criteria of a complex and giant fibroadenoma, was presented. This case emphasizes the importance of timely surgical intervention, even during pregnancy, to prevent permanent breast tissue damage.

PMID:37899052 | DOI:10.3233/BD-230030
Extremely Rare Type of Breast Cancer-Dedifferentiated Breast Liposarcoma-Diagnosis and Treatment

Fetched: October 28th, 2023, 5:02am GMT by Andrada-Elena Țigăran

J Pers Med. 2023 Sep 29;13(10):1451. doi: 10.3390/jpm13101451.

ABSTRACT

Primary liposarcoma of the breast is an uncommon soft tissue malignant tumor, comprising only 0.003% of all malignant breast tumors. The main differential diagnosis of this mass consists of malignant phyllodes tumor and metaplastic breast carcinoma. The objective of this paper is to report a case of dedifferentiated breast liposarcoma, therapeutic approach and outcome. We present a case of a 79-year-old woman complaining of a large mass in her left breast which had increased in size over the last 6 months. Physical examination revealed an enlarged left breast, and a total body CT scan showed a large tumor in contact with the musculature of the anterior thoracic wall, with no metastatic lesions. The histopathology report of a fine needle biopsy described a high-grade sarcoma. The Oncological Tumor Board recommended neoadjuvant radiotherapy sessions and reevaluation by MRI and CT scans. The patient underwent radical mastectomy with latissimus dorsi myo-cutaneous flap reconstruction. The final histopathology diagnosis was a grade 3 dedifferentiated liposarcoma (FNCLCC), with certain response to radiotherapy and positive MDM2, CDK4 markers. The postoperative period was uneventful; 12 months after surgery, the follow-up CT scan showed multiple pulmonary lesions with metastatic characteristics. Liposarcoma is a very rare type of breast cancer, and the most important treatment for breast sarcoma is surgery, the role of axillary lymph node removal, chemotherapy and radiotherapy still being controversial. Considering such cases are scarce and the development of surgical guidelines is difficult, reporting any new case is crucial.

PMID:37888062 | PMC:PMC10608349 | DOI:10.3390/jpm13101451
Ileal metastasis from Phyllodes breast tumor

Fetched: October 28th, 2023, 5:02am GMT by Montserrat Rovira Argelagués

Rev Esp Enferm Dig. 2023 Oct 26. doi: 10.17235/reed.2023.9958/2023. Online ahead of print.

ABSTRACT

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.

PMID:37882213 | DOI:10.17235/reed.2023.9958/2023
CD146 promotes malignant progression of breast phyllodes tumor through suppressing DCBLD2 degradation and activating the AKT pathway

Fetched: October 20th, 2023, 5:02am GMT by Jiewen Chen

Cancer Commun (Lond). 2023 Nov;43(11):1244-1266. doi: 10.1002/cac2.12495. Epub 2023 Oct 19.

ABSTRACT

BACKGROUND: As a rapid-progressing tumor, breast malignant phyllodes tumors (PTs) are challenged by the lack of effective therapeutic strategies and suitable prognostic markers. This study aimed to clarify the role and mechanism of CD146 on promoting PTs malignant progression, and to identify a novel prognosis marker and treatment target of breast malignant PTs.

METHODS: The expression and prognostic significance of CD146 in PTs was detected through single-cell RNA-sequencing (scRNA-seq), immunostaining, real-time PCR and other methodologies. Functional experiments including proliferation assay, colony formation assay, transwell assay, and collagen contraction assay were conducted to validate the role of CD146 in malignant progression of PTs. The efficacy of anti-CD146 monoclonal antibody AA98 against malignant PTs was corroborated by a malignant PT organoid model and a PT patient-derived xenograft (PDX) model. Transcriptome sequencing, proteomic analysis, co-immunoprecipitation, and pull-down assay was employed to identify the modulating pathway and additional molecular mechanism.

RESULTS: In this study, the scRNA-seq analysis of PTs disclosed a CD146-positive characteristic in the α-SMA⁺ fibroblast subset. Furthermore, a progressive elevation in the level of CD146 was observed with the malignant progression of PTs. More importantly, CD146 was found to serve as an independent predictor for recurrence in PT patients. Furthermore, CD146 was found to augment the viability and invasion of PTs. Mechanistically, CD146 acted as a protective "shield" to prevent the degradation of Discoidin, CUB, and LCCL domain-containing protein 2 (DCBLD2), thereby activating the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway and enhancing malignant behaviors of PT cells. In the malignant PT organoid and PDX model, a significant suppression of malignant PT growth was observed after the application of AA98.

CONCLUSIONS: These findings suggested that CD146 served as an efficacious marker for predicting PT malignant progression and showed promise as a prognosis marker and treatment target of breast malignant PTs. The study further unveiled the essential role of the CD146-DCBLD2/PI3K/AKT axis in the malignant progression of PTs.

PMID:37856423 | PMC:PMC10631482 | DOI:10.1002/cac2.12495
Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation

Fetched: October 20th, 2023, 5:02am GMT by Meng Zhang

Radiographics. 2023 Nov;43(11):e230051. doi: 10.1148/rg.230051.

ABSTRACT

Fibroepithelial lesions (FELs) are among the most common breast masses encountered by breast radiologists and pathologists. They encompass a spectrum of benign and malignant lesions, including fibroadenomas (FAs) and phyllodes tumors (PTs). FAs are typically seen in young premenopausal women, with a peak incidence at 20-30 years of age, and have imaging features of oval circumscribed hypoechoic masses. Although some FA variants are especially sensitive to hormonal influences and can exhibit rapid growth (eg, juvenile FA and lactational adenomas), most simple FAs are slow growing and involute after menopause. PTs can be benign, borderline, or malignant and are more common in older women aged 40-50 years. PTs usually manifest as enlarging palpable masses and are associated with a larger size and sometimes with an irregular shape at imaging compared with FAs. Although FA and FA variants are typically managed conservatively unless large and symptomatic, PTs are surgically excised because of the risk of undersampling at percutaneous biopsy and the malignant potential of borderline and malignant PTs. As a result of the overlap in imaging and histologic appearances, FELs can present a diagnostic challenge for the radiologist and pathologist. Radiologists can facilitate accurate diagnosis by supplying adequate tissue sampling and including critical information for the pathologist at the time of biopsy. Understanding the spectrum of FELs can facilitate and guide appropriate radiologic-pathologic correlation and timely diagnosis and management of PTs. Published under a CC BY 4.0 license. Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

PMID:37856317 | DOI:10.1148/rg.230051
Phyllodes Tumor of the Breast Complicated With Mastitis

Fetched: October 17th, 2023, 5:02am GMT by Siddharth Sankar Das

Cureus. 2023 Sep 14;15(9):e45206. doi: 10.7759/cureus.45206. eCollection 2023 Sep.

ABSTRACT

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.

PMID:37842397 | PMC:PMC10576221 | DOI:10.7759/cureus.45206
Case Report: A 13-year-old adolescent diagnosed as malignant phyllodes tumor combined with rhabdomyosarcoma differentiation

Fetched: October 17th, 2023, 5:02am GMT by Jie Lian

Front Oncol. 2023 Sep 27;13:1233208. doi: 10.3389/fonc.2023.1233208. eCollection 2023.

ABSTRACT

Phyllodes tumor (PT) is an infrequent type of breast neoplasm, constituting a mere 0.5%-1.5% of the entirety of breast tumors. The malignant phyllodes tumor (MPT) comprises only 15% of all phyllodes tumors, and its transformation into rhabdomyosarcoma (RMS) is exceedingly rare in clinical practice. Given its insensitivity to chemotherapy and radiotherapy, treatment options for MPT patients are limited, leaving complete surgical resection as the only option. Therefore, it is imperative to investigate the effective utilization of the heterogeneous differentiation characteristics of MPT to expand treatment alternatives for these patients. In this case report, we represent a 13-year-old adolescent diagnosed with giant breast MPT with RMS differentiation and pulmonary metastasis. The initial step in the treatment process involved radical surgical resection, followed by the administration of four cycles of VDC/IC chemotherapy, which is widely recognized as the standard chemotherapy for RMS. Regrettably, the delay in initiating chemotherapy resulted in minimal observable changes in the size of the pulmonary metastatic nodule. Additionally, a comprehensive literature review on the characterization of MPT with heterogeneous differentiation was conducted to enhance comprehension of the diagnosis and treatment of this uncommon disease in clinical practice. Meanwhile, this case also reminds the doctors that when we diagnose a patient as MPT, it is crucial to consider its heterogenous nature and promptly initiate adjuvant treatment. By targeting the differentiation element of MPT, it becomes feasible to overcome the previously perceived limitation of surgical intervention as the sole treatment option.

PMID:37841438 | PMC:PMC10569689 | DOI:10.3389/fonc.2023.1233208
Small Bowel Metastases From Malignant Phyllodes Breast Tumor Detected by 18F-FDG PET/CT

Fetched: October 6th, 2023, 5:02am GMT by Meng Yuan

Clin Nucl Med. 2023 Nov 1;48(11):967-968. doi: 10.1097/RLU.0000000000004854. Epub 2023 Sep 18.

ABSTRACT

The most common sites of distant metastases are lung, bone, pleura, and mediastinum in malignant phyllodes breast tumors. However, small bowel metastasis from malignant phyllodes breast tumors is rare. We reported that using CT and FDG PET/CT imaging we identified a case with small bowel metastasis from breast cancer. PET/CT scan showed that high 18 F-FDG uptake occurred in the duodenum and jejunum. Histopathology and immunohistochemistry analyses further confirmed that malignant phyllodes tumors are derived from the breast.

PMID:37796182 | DOI:10.1097/RLU.0000000000004854
Disseminated malignant phyllodes: Presentation after a decade

Fetched: October 4th, 2023, 5:03am GMT by S Binitta Sherin

J Cancer Res Ther. 2023 Jul-Sep;19(5):1439-1442. doi: 10.4103/jcrt.jcrt_715_21.

ABSTRACT

Phyllodes tumors are rare biphasic fibroepithelial lesions of the breast and account for 0.3%-0.5% of primary breast tumors. Malignant phyllodes tumor has a 10%-26% risk of distant metastasis. The most common site of metastasis is lungs followed by bone and soft tissue. This is a rare case of a 42-year-old female with a previous history of malignant phyllodes tumor breast. She presented after 10 years with metastases to multiple sites including lung, abdominal wall, retroperitoneum, bone, and brain. These tumors have a poor overall survival. Accurate diagnosis and aggressive management of malignant phyllodes tumors can help in effective treatment at diagnosis and for close follow-up of the patients.

PMID:37787325 | DOI:10.4103/jcrt.jcrt_715_21
Benign Phyllodes Tumors: Comparison of Prognosis among Three Different Surgical Approaches

Fetched: September 30th, 2023, 5:02am GMT by Ying Jiang

Breast J. 2023 Sep 20;2023:1682084. doi: 10.1155/2023/1682084. eCollection 2023.

ABSTRACT

PURPOSE: To evaluate the prognosis of patients with benign phyllodes tumors (PTs) treated by different surgical methods and to explore the influencing factors of local recurrence.

METHODS: We retrospectively analyzed 215 benign PTs from 193 patients who underwent surgery at Chinese PLA General Hospital between October 2008 and December 2020. We stratified our analysis according to surgical factors and explored the clinicopathological factors to influence local recurrence.

RESULTS: Among 193 patients, a total of 17 (8.8%, 17/193) recurred during follow-up. There were 89 patients in the US-VAE group, of whom 6 (6.7%) recurred; 8 of 57 patients (14%) in the local lumpectomy group recurred, while 3 of 47 patients (6.4%) in the extended lumpectomy group recurred (P=0.252). Multivariate logistic regression analysis showed that tumor diameter, mitosis, and history of breast myoma were independent risk factors for tumor recurrence (P=0.005, P=0.006, and P=0.004, respectively). The intraoperative blood loss, operation time, and scar length of the US-VAE group were shorter than those of the other two groups (P < 0.05).

CONCLUSION: Negative surgical margins of benign PTs can obtain similar prognosis as negative surgical margins >10 mm. Therefore, we recommend that a follow-up observation policy be adopted for patients with unexpected benign PTs, rather than unnecessary open surgical resection. Patients' maximum tumor diameter, mitosis, and fibroadenoma history were independent predictors for recurrence of benign PTs.

PMID:37771427 | PMC:PMC10533258 | DOI:10.1155/2023/1682084
Malignant phyllodes tumour with lymph node metastasis: a diagnostic conundrum resolved by next generation DNA sequencing

Fetched: September 29th, 2023, 5:02am GMT by Christopher J Schwartz

Histopathology. 2023 Sep 14. doi: 10.1111/his.15046. Online ahead of print.

ABSTRACT

A malignant neoplasm with spindle cell and chondroid differentiation in the breast, metastatic to lymph node. In this context, a metaplastic carcinoma is typically favored given the exceptional nature of lymph node metastases in malignant phyllodes tumors (MPT). However, we demonstrate pathognomonic hotspot mutations in MED12 and the promoter of the TERT gene by targeted next-generation DNA sequencing, supporting a diagnosis of MPT.

PMID:37706238 | DOI:10.1111/his.15046
Malignant Phyllodes Tumour with Osteoclast-type Giant Cells in Young Females: A Rare Histology and Differential Diagnoses

Fetched: September 16th, 2023, 5:02am GMT by Saman Muhammad Amin

J Coll Physicians Surg Pak. 2023 Jan;33(1):14-17. doi: 10.29271/jcpspcr.2023.14.

ABSTRACT

Phyllodes tumour (PT) is a biphasic fibroepithelial tumour of the breast that accounts for 0.3-1% of all primary breast neoplasms. It is subdivided into benign, borderline, and malignant categories based on histologic features including stromal overgrowth, stromal hypercellularity, mitotic count, degree of atypia, and type of margins. Malignant PT (MPT) is characterised by infiltrative margins, marked stromal overgrowth, increased stromal hypercellularity, greater than 10 mitoses/10 high-power fields (HPFs), and moderate to severe atypia. It shows aggressive behaviour with a high risk of local recurrence and metastasis. Surgery with adequate margins is the recommended treatment. Heterologous differentiation is not an uncommon phenomenon in MPT. In addition to classic phyllodes histology, the tumour shows areas of benign/malignant mesenchymal differentiation. MPT containing multinucleated osteoclast-type giant cells (OGCs) is extremely rare. We herein report cases of MPT with OGCs in two young females who had a history of swelling in unilateral breast for two-three years. Histologic examination revealed classic phyllodes areas admixed with a sarcomatous stromal component with OGCs. Key Words: Malignant phyllodes tumour, Breast, Osteoclast-type giant cells.

PMID:37710925 | DOI:10.29271/jcpspcr.2023.14
Borderline phyllodes tumour of the breast with eosinophilic inclusion bodies: Case report and molecular sequencing

Fetched: September 13th, 2023, 5:02am GMT by Ngoc My Lam

Int J Surg Case Rep. 2023 Oct;111:108776. doi: 10.1016/j.ijscr.2023.108776. Epub 2023 Sep 7.

ABSTRACT

INTRODUCTION AND IMPORTANCE: The presence of eosinophilic inclusion bodies in the breast is very rare and fewer than 20 cases were described in the literature. Herein we report the first case of borderline phyllodes tumour associated with this kind of cells. To the best of our knowledge, this is also the first time that a molecular sequencing is made targeting the stroma cells with inclusion bodies.

CASE PRESENTATION: A 33-yr-old woman presented a large mass in the right breast. Imaging techniques by mammogram and ultrasonographic examination were performed. After multidisciplinary approach, a breast conserving surgery has been decided. Microscopic analysis, immunohistochemical stains and molecular tests were performed on the lesion. The proposed diagnosis is borderline phyllodes tumour with eosinophilic inclusion bodies.

CLINICAL DISCUSSION: Inclusion bodies are typically found in the infantile digital fibromatosis. Finding them in extradigital fibromatosis is rare. Their signification is still unclear. Some studies suggest a disturbance in the metabolism of proliferating myofibroblasts.

CONCLUSION: The presence of inclusion bodies in breast tumour do not seem to have a prognosis impact. It might be interesting to perform others molecular tests on lesions with eosinophilic inclusion bodies to discover potential mutations.

PMID:37699283 | PMC:PMC10498175 | DOI:10.1016/j.ijscr.2023.108776
Comprehensive Clinical-Pathologic Assessment of Malignant Phyllodes Tumors: Proposing Refined Diagnostic Criteria

Fetched: September 12th, 2023, 5:02am GMT by Gulisa Turashvili

Am J Surg Pathol. 2023 Nov 1;47(11):1195-1206. doi: 10.1097/PAS.0000000000002109. Epub 2023 Sep 9.

ABSTRACT

The latest World Health Organization classification of breast tumors recommends diagnosing malignant phyllodes tumors (MPTs) when all 5 morphologic features are present: permeative borders, marked stromal cellularity, marked stromal cytologic atypia, ≥10 mitoses per 10 high-power fields (HPF), and stromal overgrowth. We assessed the performance of this recommendation to capture MPTs and features predictive of distant metastasis in a multi-institutional retrospective study. Of 65 MPTs, most cases had at least focally permeative borders (58, 89%), with marked stromal cellularity in 40 (61.5%), marked atypia in 38 (58.5%), ≥10 mitoses per 10 HPF in 50 (77%), and stromal overgrowth in 56 (86%). Distant metastases were observed in 20 (31%) patients (median follow-up 24.5 mo, 1 to 204). Only 13 of 65 (20%) cases had all 5 morphologic features, while only 7 of 20 (35%) cases with distant metastases had all 5 features. In univariate analysis, only marked stromal atypia ( P =0.004) and cellularity ( P =0.017) were associated with decreased distant metastasis-free survival. In multivariate Cox regression, the combination of stromal overgrowth, marked stromal cellularity, and atypia (C-index 0.721, 95% CI: 0.578, 0.863) was associated with decreased distant metastasis-free survival. The current World Health Organization recommendation will miss a significant number of MPTs with distant metastases. We propose refined diagnostic criteria for MPTs: (1) stromal overgrowth combined with ≥1 feature(s) (marked cellularity, marked atypia, or ≥10 mitoses per 10 HPF), or (2) in the absence of stromal overgrowth, marked cellularity combined with ≥1 feature(s) (permeative borders, marked atypia, or ≥10 mitoses per 10 HPF).

PMID:37694517 | DOI:10.1097/PAS.0000000000002109
The phyllodes menace-Variation in course, therapy, and appearance of phyllodes tumors in a case series of three patients

Fetched: September 5th, 2023, 5:02am GMT by Daniel Schiltz

Clin Case Rep. 2023 Sep 1;11(9):e7836. doi: 10.1002/ccr3.7836. eCollection 2023 Sep.

ABSTRACT

KEY CLINICAL MESSAGE: Early and complete surgical resection is the most important therapeutic and diagnostic measure. Adjuvant radiation is suggested for malign phyllode tumors, phyllode tumors larger than 10 cm or those with a low distance to the resection margins.

ABSTRACT: Phyllodes tumors are rare fibroepithelial tumors of the breast. Histologically, they are usually classified as benign, borderline or malignant, though these classifications do not necessarily reflect the clinical course of the disease. These tumors may stay undetected for years, or show sudden and rapid progression. There is currently no consistent therapy recommendation based upon histological findings, the localization of the tumor and/or whether it is recurrent. Using the examples of three patients, we show how courses and therapy may differ widely, and discuss this in the context of the current state of the literature.

PMID:37663819 | PMC:PMC10474313 | DOI:10.1002/ccr3.7836
Management of Benign Phyllodes Tumors: A Dutch Population-Based Retrospective Cohort Between 1989 and 2022

Fetched: August 29th, 2023, 5:02am GMT by Josefien P van Olmen

Ann Surg Oncol. 2023 Dec;30(13):8344-8352. doi: 10.1245/s10434-023-14128-5. Epub 2023 Aug 28.

ABSTRACT

BACKGROUND: Phyllodes tumors (PTs) are rare tumors of the breast. The current National Comprehensive Cancer Network (NCCN) guidelines recommend excision of benign PTs, accepting close or positive margins. Controversy about the optimal treatment for benign PTs remains, especially regarding the preferred margin width after surgical excision and the need for follow-up evaluation.

METHODS: A nationwide retrospective study analyzed the Dutch population from 1989 to 2022. All patients with a diagnosis of benign PT were identified through a search in the Dutch nationwide pathology databank (Palga). Information on age, year of diagnosis, size of the primary tumor, surgical treatment, surgical margin status, and local recurrence was collected.

RESULTS: The study enrolled 1908 patients with benign PT. The median age at diagnosis was 43 years (interquartile range [IQR], 34-52 years), and the median tumor size was 30 mm (IQR, 19-40 mm). Most of the patients (95%) were treated with breast-conserving surgery (BCS). The overall local recurrence rate was 6.2%, and the median time to local recurrence was 31 months (IQR, 15-61 months). Local recurrence was associated with bilaterality of the tumor (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.95-28.30) and positive margin status (OR, 2.51; 95% CI 1.36-4.63). The local recurrence rate was 8.9% for the patients with positive excision margins and 4.0% for the patients with negative excision margins. Notably, for 27 patients (22.6%) who experienced a local recurrence, histologic upgrading of the recurrent tumor was reported, 7 (5.9%) of whom had recurrence as malignant lesions.

CONCLUSIONS: This nationwide series of 1908 patients showed a low local recurrence rate of 6.2% for benign PT, with higher recurrence rates following positive margins.

PMID:37639031 | DOI:10.1245/s10434-023-14128-5
Benign Biphasic Tumors of the Mullerian Tract - a Mimic of Phyllodes Tumor. A Clinical-Pathologic Description of 21 Cases

Fetched: August 29th, 2023, 5:02am GMT by Jonathan Wawire

Ann Clin Lab Sci. 2023 Jul;53(4):641-646.

ABSTRACT

OBJECTIVE: A review of the clinical-pathologic characteristics and outcomes of biphasic polyps occurring in the female genital tract, not meeting the diagnostic criteria of Mullerian Adenosarcoma (MA).

METHODS: An archival database search was run, after IRB approval, between 2001 and 2019, using terminology such as "Mullerian adenofibroma," "atypical Mullerian adenofibroma," "polypoid adenofibroma," and "atypical polyp with increased stromal cellularity." Two pathologists (JW and MRQ) reviewed all the retrieved cases and documented the morphologic features with particular emphasis on the presence of any features of Mullerian adenosarcoma. Follow-up data were also abstracted.

RESULTS: Twenty-one cases, 12 cervical and 9 endometrial lesions, constituted the study cohort. Patients ranged from 26 to 64 years (median 49 years). On review, 20 of 21 of those cases showed Phyllodes-like architectural patterns. However, only one case showed all four features of MA, all of which were focal and inconspicuous. Follow-up (median duration of 5 years) did not document any recurrences in any of the 21 cases after excision.

CONCLUSION: This series adds to the growing body of literature affirming the existence of benign biphasic Mullerian polyps encountered in the endometrium and cervix that fall short of the Mullerian adenosarcoma diagnosis.

PMID:37625832
Clinical perspectives and outcomes of the giant breast phyllodes tumor and sarcoma: a real-world retrospective study

Fetched: August 28th, 2023, 5:02am GMT by Naiquan Liu

BMC Cancer. 2023 Aug 28;23(1):801. doi: 10.1186/s12885-023-11279-2.

ABSTRACT

BACKGROUND: Giant breast malignant phyllodes tumor or sarcoma (GBPS) are rare entities with diameter larger than 10 cm and variously histological pleomorphisms. This disease poses a significant threat to the quality of life of individuals, and its prognosis remains unclear. This study aimed to explore the differential diagnosis, treatment, and prognosis of GBPS in a real-world retrospective cohort.

METHODS: We collected GBPS (diameter > 10 cm, n = 10) and BPS (diameter ≤ 10 cm, n = 126) from patients diagnosed with sarcoma or malignant phyllodes tumor between 2008 and 2022. We analyzed clinical characteristics, histological status, treatment, and local recurrence using the Fisher's exact test between GBPS (diameter > 10 cm) and BPS (diameter ≤ 10 cm) cohort. We described overall survival (OS) and disease-free survival (DFS) using Kaplan-Meier curves and identified risk factors for local recurrence using logistic regression. The tumor size, age at diagnosis, and differential immunohistochemistry markers of breast sarcoma or phyllodes tumor to determine the prognosis of GBPS.

RESULTS: In our retrospective analysis of breast malignancies, we identified 10 cases of GBPS and 126 cases of BPS, corresponding to a GBPS prevalence of 0.17% (10/6000). The median age was 38.5 years (inter-quartile range, IQR: 28.25-48.5 years). During the follow-up of period (median: 80.5 months, IQR: 36.75-122 months), the local recurrence (LR) rate was 40% and 20.6%, respectively. Clinical characteristics of young age (HR:2.799, 95%CI -00.09276-0.017, p < 0.05) and cytological characteristics of marked stromal atypia (HR:0.88, 95% CI 0.39-1.40, p < 0.05) were risk factors for the poor prognosis of GBPS by COX regression model analysis. The Kaplan-Meier curves of GBPS 5-year disease-free survival (DFS) and overall survival (OS) were 31.5 months and 40 months, respectively, and were not associated with adjuvant radiation or chemotherapy.

CONCLUSION: We recommend mastectomy with a clear surgical margin as the preferred treatment for GBPS. Age and stromal atypia are significantly associated with recurrence. Adjuvant radiation therapy is advised; however, there was no improvement in overall survival. There is no consensus on the effectiveness of adjuvant chemotherapy and genetic methods, highlighting the need for further research into this aggressive tumor. We recommend a multidisciplinary approach involving a dedicated team for the management of GBPS.

PMID:37635229 | PMC:PMC10463853 | DOI:10.1186/s12885-023-11279-2
Metastatic and Malignant Phyllodes Tumors of the Breast: An Update for Current Management

Fetched: August 24th, 2023, 5:02am GMT by Brandon Goodwin

Am Surg. 2023 Aug 23:31348231198114. doi: 10.1177/00031348231198114. Online ahead of print.

ABSTRACT

Metastatic, malignant phyllodes tumor (PT) of the breast is a rare and aggressive neoplasm. Currently, there is no agreed upon consensus as to best management practices. A systematic review of literature was conducted investigating surgical, chemotherapeutic, and radiotherapeutic management for metastatic PT. Databases employed to identify articles included Embase, PubMed, and SAGE Journals. Diagnosis of metastatic PT has been of significant difficulty to radiologists as it is often confused with fibroadenomas. Surgically, metastatectomy has been correlated with increased overall survival (of 25.9 versus 9.9 months; P = .01). Radiotherapy has often been associated with palliation and pain control in metastatic, malignant neoplasia. However, one study showed that in malignant PT, radiation was associated with significantly lower rates of local recurrence (OR: 0.048 versus 0.209). Anthracycline containing chemotherapy regimens has been associated with improved overall survival (22.4 months versus 13.2 months; P = .040). Further research must be conducted into this rare malignancy to elucidate accurate diagnosis and care for patients with advanced metastatic or malignant phyllodes tumors.

PMID:37611540 | DOI:10.1177/00031348231198114
Giant breast phyllodes tumor with silent thromboembolism: A case report

Fetched: August 17th, 2023, 5:02am GMT by Qinbo Wang

Cancer Rep (Hoboken). 2023 Sep;6(9):e1865. doi: 10.1002/cnr2.1865. Epub 2023 Aug 14.

ABSTRACT

BACKGROUND: Phyllodes tumor (PT) is a solid fibroepithelial breast lesion with proliferation of stromal and epithelial elements, usually presents with a rapidly expanding feature. Venous thromboembolism (VTE) have been reported to increase the burden in terms of mortality and morbidity of malignant tumor, and associate with worsened survival. However, benign PTs with silent thromboembolism that have not yet been reported, we report an unusual case of massive benign PT that grew on the left side of the breast in a cauliflower-shaped form and presented severe chronic blood loss and deep VTE.

CASE: A 37-year-old woman with uncontrolled pain presented a rapidly enlarging left breast mass, measuring approximately 30 × 20 × 15 cm³ that first started 25 years ago. color Doppler ultrasound showed a large mass lesion on the left breast and deep VTE, several enlarged lymph nodes in the left axilla and mediastinum, which presented a malignant character. However, the biopsies of the mass did not show evidence of malignancy and the pathology result was considered to be benign PT. The patient was treated with an inferior vena cava and anticoagulation, the operation was arranged according to the surgical procedure, the patient recovered very well after mastectomy.

CONCLUSION: This case is unique in that the giant breast mass presented with malignant character, was eventually pathologically confirmed to be benign PT, and it's rare that the benign tumor accompanied with silent thromboembolism. This finding describes the atypia features of giant benign PT and reminds the surgeon to consider the factor of VTE and risk when encountering ulcerative benign breast tumor and avoid excessive treatment.

PMID:37580942 | PMC:PMC10480408 | DOI:10.1002/cnr2.1865
Phyllodes Tumors of the Breast: Addressing the Gaps in Consensus Recommendations for Clinical Management

Fetched: August 15th, 2023, 5:02am GMT by Anna D Louie

Ann Surg Oncol. 2023 Oct;30(11):6296-6298. doi: 10.1245/s10434-023-14147-2. Epub 2023 Aug 14.

NO ABSTRACT

PMID:37580616 | DOI:10.1245/s10434-023-14147-2
Approach to the growing breast lump during lactation

Fetched: August 15th, 2023, 5:02am GMT by Wen Guang Benson Ang

BMJ Case Rep. 2023 Aug 14;16(8):e254750. doi: 10.1136/bcr-2023-254750.

ABSTRACT

Physiological changes during pregnancy and lactation result in increased lumpiness of the breast. This makes the evaluation of the breast challenging. Although most self-detected lumps, during this period, tend to be benign, the priority in these patients is to exclude tumours that may require prompt management. We present a case of phyllodes tumour that occurred during lactation and discussed the resultant pitfalls that may occur during the triple assessment of a breast lump in a lactating mother.

PMID:37580097 | PMC:PMC10432625 | DOI:10.1136/bcr-2023-254750
Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Turning the Magnifying Glass on Rare and Aggressive Entities

Fetched: August 13th, 2023, 5:02am GMT by Miguel Esperança-Martins

Cancers (Basel). 2023 Aug 2;15(15):3933. doi: 10.3390/cancers15153933.

ABSTRACT

Breast sarcomas (BSs), phyllodes tumors (PTs), and desmoid tumors (DTs) are rare entities that arise from connective tissue. BSs can be classified as either primary or secondary, whether they develop de novo or after radiation exposure or lymphedema. PIK3CA seems to play an important common role in different BS. Malignant PTs show similar behavior to BSs, while DTs are locally aggressive but rarely metastasize. BSs usually present as unilateral, painless, rapidly growing masses with rare nodal involvement. The diagnosis should be based on magnetic resonance imaging and a core needle biopsy. Staging should comprise a chest computed tomography (CT) scan (except for benign PT and DT), while abdominal and pelvic CT scans and bone scans should be added in certain subtypes. The mainstay of treatment for localized BS is surgery, with margin goals that vary according to subtype. Radiotherapy and chemotherapy can be used as neoadjuvant or adjuvant approaches, but their use in these settings is not standard. Advanced BS should be treated with systemic therapy, consistent with recommendations for advanced soft tissue sarcomas of other topographies. Given the rarity and heterogeneity of these entities, multidisciplinary and multi-institutional collaboration and treatment at reference centers are critical.

PMID:37568749 | PMC:PMC10416994 | DOI:10.3390/cancers15153933
68Ga-DOTA-FAPI-04 Imaging of Bilateral Phyllodes Tumor

Fetched: August 12th, 2023, 5:02am GMT by Göksel Alçın

Clin Nucl Med. 2023 Oct 1;48(10):e480-e482. doi: 10.1097/RLU.0000000000004782. Epub 2023 Aug 3.

ABSTRACT

We present a case of bilateral Phyllodes tumor located in both breasts in a 41-year-old woman who was detected with increased uptake on 68 Ga-FAPI-04 (fibroblast activation protein inhibitor) and 18 F-FDG PET/CT imaging. The tumor filling up the right breast was identified as borderline Phyllodes. The tumor with mild uptake in the left breast was reported as a benign Phyllodes tumor.

PMID:37565817 | DOI:10.1097/RLU.0000000000004782
Myxoid Liposarcoma of the Breast Mimicking Phyllodes Tumor: A Case Report

Fetched: August 11th, 2023, 5:02am GMT by Se Jin Lee

J Korean Soc Radiol. 2023 Jul;84(4):952-957. doi: 10.3348/jksr.2022.0146. Epub 2023 Jul 14.

ABSTRACT

Myxoid liposarcoma is an extremely rare malignant breast tumor. We report the case of a 44-year-old woman who had myxoid liposarcoma of the breast with a history of phyllodes tumor and describe the imaging findings on US, mammography, and MRI. Before surgery, the mass was considered to be a recurrent phyllodes tumor. However, using US, we retrospectively identified some differences between myxoid liposarcomas and phyllodes tumors.

PMID:37559820 | PMC:PMC10407076 | DOI:10.3348/jksr.2022.0146
ASO Visual Abstract: Phyllodes Tumors of the Breast: Canadian National Consensus Document Using Modified Delphi Methodology

Fetched: August 10th, 2023, 5:02am GMT by Jessica Bogach

Ann Surg Oncol. 2023 Oct;30(11):6400. doi: 10.1245/s10434-023-14011-3.

NO ABSTRACT

PMID:37556013 | DOI:10.1245/s10434-023-14011-3
Phyllodes Tumors of the Breast: Canadian National Consensus Document Using Modified Delphi Methodology

Fetched: August 10th, 2023, 5:02am GMT by Jessica Bogach

Ann Surg Oncol. 2023 Oct;30(11):6386-6397. doi: 10.1245/s10434-023-13912-7. Epub 2023 Aug 9.

ABSTRACT

PURPOSE: Phyllodes tumors are rare breast neoplasms with limited prospective data to guide treatment, leading to heterogeneous management of this disease. We developed National consensus statements using modified Delphi methodology including patients and practitioners across Canada.

METHODS: Statements were developed based on a literature review. Two iterations of surveys were distributed with a planned virtual consensus meeting. Panelists were invited from surgery, radiation oncology, medical oncology, pathology, radiology, and plastic surgery.

RESULTS: Twenty-three participants attended the virtual conference. One hundred statements regarding diagnostics, pathology, surgical planning, adjuvant therapies, recurrence, surveillance, and patient support were approved with an a priori defined consensus of ≥ 80%. Two tables on locoregional management were developed and approved. The management of borderline phyllodes tumors was a source of uncertainty, and recommendations reflect the lack of evidence in this rare presentation.

CONCLUSION: A consensus document containing all approved statements for the care and management of phyllodes tumors was developed to help guide practice and future research.

PMID:37556009 | DOI:10.1245/s10434-023-13912-7
Borderline phyllodes tumor arising in ectopic breast tissue in the axilla: Report of a rare case with brief review of literature

Fetched: August 8th, 2023, 5:02am GMT by Mohammad Jaseem Hassan

Breast Dis. 2023;42(1):245-249. doi: 10.3233/BD-230007.

ABSTRACT

Development of a neoplasm in an ectopic breast is uncommon, while the development of phyllodes tumor in an ectopic breast in the axilla is even rarer. We report a rare case of a 51-year-old female who presented with a complain of swelling and pain in the right axilla with no associated complaints in other organs. Magnetic resonance imaging suggested a possibility of metastatic lymphadenopathy. Complete excision of the right axillary mass was performed and sent for histopathological examination which was examined thoroughly and sections were given. On microscopic examination, stromal proliferation in a leaf-like pattern with mild stromal atypia and focal permeation of borders were seen, and a diagnosis of Ectopic borderline phyllodes tumor in axilla was made, which is extremely rare and needs to be differentiated from its close differentials like fibroadenoma and periductal stromal sarcoma.

PMID:37545203 | DOI:10.3233/BD-230007
Malignant phyllodes tumor in a pubertal girl: A report of a case

Fetched: August 7th, 2023, 5:02am GMT by Koji Ota

J Pediatr Adolesc Gynecol. 2023 Aug 4:S1083-3188(23)00375-3. doi: 10.1016/j.jpag.2023.07.011. Online ahead of print.

ABSTRACT

BACKGROUND: Malignant phyllodes tumor (MPT) is a rare breast disease that is extremely rare in children. A few cases of pediatric malignant phyllodes tumors have been reported, including some with a poor prognosis.

CASE: A 14-year-old girl presented with a growing lump on her right breast. On the basis of imaging tests and a core needle biopsy, MPT was diagnosed, and right mastectomy was performed. The postoperative course was uneventful.

SUMMARY AND CONCLUSION: MPT is an infrequent disease in adult females and is extremely rare in pubertal females. It occasionally shows rapid growth, metastasis, and recurrence with a poor prognosis. Early surgical resection is necessary to obtain a cure. When a rapidly growing breast tumor is observed in pubertal females, MPT should be considered.

PMID:37543241 | DOI:10.1016/j.jpag.2023.07.011
The Genetic Landscape of Fibroepithelial Lesions of the Breast

Fetched: August 5th, 2023, 5:02am GMT by Farnaz Dadmanesh

Adv Anat Pathol. 2023 Nov 1;30(6):415-420. doi: 10.1097/PAP.0000000000000407. Epub 2023 Aug 4.

ABSTRACT

Fibroepithelial lesions of the breast encompass a broad spectrum of lesions from fibroadenomas and their variants to phyllodes tumors, including their clinical range of benign, borderline, and malignant. Classification of this spectrum of neoplasms has historically and currently been based purely on morphology, although the nomenclature has shifted over the years largely due to the significant histologic overlap that exists primarily within the cellular fibroadenomas to borderline malignant phyllodes tumor categories. A review of the current diagnostic challenge, proposed ancillary studied and their value in prognostic significance, is provided. This article highlights the most recent molecular and genetic findings as well as the limitations of the studies, in the context of practical and available applications for the diagnostician and managerial implications for the clinician.

PMID:37539688 | DOI:10.1097/PAP.0000000000000407
Initial Imaging Findings of Breast Liposarcoma: A Case Report

Fetched: July 30th, 2023, 5:02am GMT by Sharifa Khalid Alduraibi

Diagnostics (Basel). 2023 Jul 20;13(14):2428. doi: 10.3390/diagnostics13142428.

ABSTRACT

Liposarcoma of the breast is a rare form of cancerous tumor that can be mistaken for primary breast cancer. A recent instance involved a woman who was 54 years old and went in for her annual screening mammogram. The mammogram revealed that she had a 1 cm focal asymmetry of equal density in her right axillary tail, approximately 9 cm from the nipple. After nine months, the patient observed a rapidly growing mass even though the initial ultrasound scan did not detect anything unusual. A targeted mammogram demonstrated a large and dense mass confined to the right axillary tail, followed by an ultrasound scan that revealed a heterogeneous hyperechoic, echogenic mass. Histopathology after surgery showed that the patient had an undifferentiated pleomorphic breast liposarcoma. This diagnosis was reached after the patient underwent surgery.Liposarcoma of the breast is a concerning condition that needs careful management and close monitoring, although it is relatively uncommon. Early detection of the patient's condition and prompt treatment can help improve the patient's prognosis. This can be accomplished by remaining vigilant with routine screenings and following up on any unusual findings or changes in breast tissue. However, it is possible to diagnose this condition as primary breast cancer incorrectly; consequently, healthcare providers need to conduct comprehensive evaluations to ensure diagnostic accuracy and the delivery of appropriate treatment.

PMID:37510172 | PMC:PMC10378085 | DOI:10.3390/diagnostics13142428
Cystic squamous metaplasia in a giant benign phyllodes tumor of the breast: a case report

Fetched: July 29th, 2023, 5:01am GMT by Evrard Niyonkuru

J Surg Case Rep. 2023 Jul 26;2023(7):rjad402. doi: 10.1093/jscr/rjad402. eCollection 2023 Jul.

ABSTRACT

Phyllodes tumor is a rare tumor of the breast, which encompasses both stromal and epithelial components. In these components, metaplastic changes can be observed occasionally. We report the case of a 51-year-old woman nulligest menopaused who presented a huge mass, largely ulcerated in her right breast. The radiological examination revealed a large tumor with microcalcifications classified as Breast Imaging and Reporting Data System Category 5. The patient undergone right mastectomy and the histological analysis revealed benign phyllodes tumor with cystic squamous metaplasia. Therefore, we aim to present this uncommon event occasionally occurring in phyllodes tumor of the breast.

PMID:37502602 | PMC:PMC10371490 | DOI:10.1093/jscr/rjad402
Aesthetic results were more satisfactory after oncoplastic surgery than after total breast reconstruction according to patients and surgeons

Fetched: July 25th, 2023, 5:02am GMT by Fabiana Christina Araújo Pereira Lisboa

Breast. 2023 Oct;71:47-53. doi: 10.1016/j.breast.2023.07.006. Epub 2023 Jul 15.

ABSTRACT

INTRODUCTION: Patient satisfaction after breast cancer surgery has an impact on body image, sexual function, self-esteem, and quality of life and may differ from the perception of the attending physician. This study aimed to compare the aesthetic outcomes and satisfaction with conservative oncoplastic surgeries, mastectomies, and total breast reconstruction.

METHODS: We included 760 women diagnosed with invasive breast carcinoma or phyllodes tumors who returned at least 6 months after surgery or radiotherapy at two public hospitals and a private clinic between 2014 and 2022. Data was collected prospectively from patients and retrospectively from their medical records using a specific form after obtaining their informed consent. Aesthetic outcomes and quality of life were assessed using the BREAST-Q©, Harris Scale, and BCCT.core software. Data were evaluated using the SPSS statistical software. Statistical significance was set at p < 0.05. This study was approved by the hospital ethics committees.

RESULTS: A total of 405 (53.29%) partial and 355 (46.71%) total reconstructions were included. Patients who underwent partial reconstruction were older and had higher body mass index. Patients who underwent total reconstruction had larger tumors with advanced clinical and pathological stages. Clinical and surgical complications occurred more frequently in the total reconstruction group. A greater number of reparative surgeries and lipofilling procedures were required for total reconstruction. According to the BREAST-Q, the partial reconstruction group showed significantly higher levels of women's satisfaction with their breasts, the surgical outcomes, psychosocial and sexual well-being, provision of information, and the reconstructive surgeon. Only physical well-being was slightly higher in the total reconstruction group. In most cases, the results were rated good or excellent. Physicians considered partial reconstructions to have better results than total reconstructions, although this difference was not perceived by the BCCT.core software.

CONCLUSION: Women who underwent partial breast reconstruction had higher levels of satisfaction in several domains, lower frequency of complications, and required fewer surgeries to complete their reconstruction than women who underwent total reconstruction. Physicians were also more satisfied with the results of partial reconstructions.

PMID:37487426 | PMC:PMC10374858 | DOI:10.1016/j.breast.2023.07.006
Differentiation Between Phyllodes Tumors and Fibroadenomas of Breast Using Mammography-based Machine Learning Methods: A Preliminary Study

Fetched: July 23rd, 2023, 5:01am GMT by Xue-Ying Deng

Clin Breast Cancer. 2023 Oct;23(7):729-736. doi: 10.1016/j.clbc.2023.07.002. Epub 2023 Jul 7.

ABSTRACT

OBJECTIVE: To investigate the diagnostic performance of a mammography-based radiomics model for distinguishing phyllodes tumors (PTs) from fibroadenomas (FAs) of the breast.

MATERIALS AND METHODS: A total of 156 patients were retrospectively included (75 with PTs, 81 with FAs) and divided into training and validation groups at a ratio of 7:3. Radiomics features were extracted from craniocaudal and mediolateral oblique images. The least absolute shrinkage and selection operator (LASSO) algorithm and principal component analysis (PCA) were performed to select features. Three machine learning classifiers, including logistic regression (LR), K-nearest neighbor classifier (KNN) and support vector machine (SVM), were implemented in the radiomics model, imaging model and combined model. Receiver operating characteristic curves, area under the curve (AUC), sensitivity and specificity were computed.

RESULTS: Among 1084 features, the LASSO algorithm selected 17 features, and PCA further selected 6 features. Three machine learning classifiers yielded the same AUC of 0.935 in the validation group for the radiomics model. In the imaging model, KNN yielded the highest accuracy rate of 89.4% and AUC of 0.947 in the validation set. For the combined model, the SVM classifier reached the highest AUC of 0.918 with an accuracy rate of 86.2%, sensitivity of 83.9%, and specificity of 89.4% in the training group. In the validation group, LR yielded the highest AUC of 0.973. The combined model had a relatively higher AUC than the radiomics model or imaging model, especially in the validation group.

CONCLUSIONS: Mammography-based radiomics features demonstrate good diagnostic performance for discriminating PTs from FAs.

PMID:37481337 | DOI:10.1016/j.clbc.2023.07.002
ASO Author Reflections: Development of Canadian National Consensus Statements on Phyllodes Tumors of the Breast

Fetched: July 16th, 2023, 5:01am GMT by Jessica Bogach

Ann Surg Oncol. 2023 Oct;30(11):6398-6399. doi: 10.1245/s10434-023-13919-0. Epub 2023 Jul 15.

NO ABSTRACT

PMID:37454018 | DOI:10.1245/s10434-023-13919-0
A Large Phyllodes Tumor With Axillary Lymph Node Involvement: A Case Report

Fetched: July 14th, 2023, 5:02am GMT by Kirstie Mundok

Cureus. 2023 Jun 11;15(6):e40252. doi: 10.7759/cureus.40252. eCollection 2023 Jun.

ABSTRACT

Malignant phyllodes tumors of the breast are uncommon and complex to treat. This case involves a 39-year-old woman with a rapidly growing mass in her right breast measuring 32cm. The patient underwent a bilateral mastectomy with a right sentinel node biopsy and right chest wall reconstruction. The final pathology of the tumor revealed a malignant phyllodes tumor, with one of two right axillary lymph nodes positive for metastatic phyllodes tumor. Malignant phyllodes tumors should be taken into consideration in any rapidly growing breast mass. Further studies analyzing the treatment of malignant phyllodes tumors are necessary to reduce the risk of tumor recurrence and metastasis.

PMID:37440819 | PMC:PMC10335032 | DOI:10.7759/cureus.40252
Versican core protein aids in the diagnosis and grading of breast phyllodes tumor

Fetched: July 10th, 2023, 5:02am GMT by Lu Zhang

Ann Diagn Pathol. 2023 Oct;66:152176. doi: 10.1016/j.anndiagpath.2023.152176. Epub 2023 Jul 4.

ABSTRACT

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.

PMID:37423116 | DOI:10.1016/j.anndiagpath.2023.152176
Management and Outcomes of Metastatic and Recurrent Malignant Phyllodes Tumors of the Breast: A Systematic Literature Review

Fetched: July 8th, 2023, 5:02am GMT by Elaheh Samii

Eur J Breast Health. 2023 Jul 3;19(3):191-200. doi: 10.4274/ejbh.galenos.2023.2023-3-2. eCollection 2023 Jul.

ABSTRACT

To summarize the evidence on the current management and outcomes for metastatic and recurrent malignant phyllodes tumors (MPTs) of the breast. A systematic literature review of all cases of metastatic or recurrent MPTs of the breast published between 2010 and 2021 was performed. In total, 66 patients from 63 articles were included. Fifty-two (78.8%) had distant metastatic disease (DMD subgroup), and 21 (31.8%) showed locoregional recurrent/progressive disease (LRPR subgroup). Locoregional recurrences in patients with no distant metastases were treated with surgical excision in all cases. Radiotherapy was administered in 8/21 cases (38.1%) and was combined with chemotherapy in 2/21 cases (9.5%). Metastatic disease was managed through metastases surgical excision, chemotherapy, radiotherapy, or a combination of these three in 84.6% of cases, while the remaining patients received no oncological treatments. Chemotherapy was proposed in 75.0% of cases. Anthracycline and alkylating agent-based combination regimens were most frequently administered. The median survival time was 24 (2.0-152.0) months, and 72.0 (2.5-98.5) months in the DMD and LRPR subgroups, respectively. Management of recurrent or metastatic MPTs is challenging. Surgery is the fundamental approach, but the use of adjuvant radio- and chemo-therapy remains controversial due to the lack of scientific evidence. Further studies and international registers are needed to implement new and more efficient treatment strategies.

PMID:37415652 | PMC:PMC10320634 | DOI:10.4274/ejbh.galenos.2023.2023-3-2
Low-grade fibromyxoid sarcoma of the breast: genetic characterization and immunohistochemical comparison to morphologic mimics

Fetched: July 2nd, 2023, 5:02am GMT by Jeffrey M Cloutier

Hum Pathol. 2023 Sep;139:17-26. doi: 10.1016/j.humpath.2023.06.012. Epub 2023 Jun 29.

ABSTRACT

Spindle cell lesions of the breast elicit a specific, relatively limited differential diagnosis, and accurate classification often requires careful morphologic evaluation and immunohistochemical workup. Low-grade fibromyxoid sarcoma (LGFMS) is a rare malignant fibroblastic tumor with deceptively bland spindle cell morphology. Involvement of the breast is exceedingly rare. We examined the clinicopathologic and molecular characteristics of three cases of breast/axillary LGFMS. In addition, we interrogated the immunohistochemical expression of MUC4, a commonly used marker of LGFMS, in other breast spindle cell lesions. LGFMS presented in women at 23, 33, and 59 years of age. Tumor size ranged from 0.9 to 4.7 cm. Microscopically, they were circumscribed nodular masses composed of bland spindle cells with fibromyxoid stroma. Immunohistochemically, tumors were diffusely positive for MUC4 and negative for keratin, CD34, S100 protein, and nuclear beta-catenin. Fluorescence in-situ hybridization demonstrated FUS (n = 2) or EWSR1 (n = 1) rearrangements. Next-generation sequencing identified FUS::CREB3L2 and EWSR1::CREB3L1 fusions. MUC4 immunohistochemistry performed on 162 additional breast lesions demonstrated only weak and limited expression in a subset of cases of fibromatosis (10/20, ≤30% staining), scar (5/9, ≤10%), metaplastic carcinoma (4/23, ≤5%), and phyllodes tumor (3/74, ≤10%). MUC4 was entirely negative in cases of pseudoangiomatous stromal hyperplasia (n = 9), myofibroblastoma (n = 6), periductal stromal tumor (n = 3), and cellular/juvenile fibroadenoma (n = 21). LGFMS can rarely occur in the breast and should be considered in the differential diagnosis of breast spindle cell lesions. Strong and diffuse MUC4 expression is highly specific in this histologic context. Detection of an FUS or EWSR1 rearrangement can confirm the diagnosis.

PMID:37392946 | DOI:10.1016/j.humpath.2023.06.012
High grade phyllodes tumor with osteosarcomatous differentiation: Case report and review of the literature

Fetched: July 1st, 2023, 5:02am GMT by Rachel R Hall

Radiol Case Rep. 2023 Jun 24;18(9):3127-3134. doi: 10.1016/j.radcr.2023.05.074. eCollection 2023 Sep.

ABSTRACT

Phyllodes tumors (PTs) are rare fibroepithelial malignancies of the breast, accounting for less than 1% of malignant breast tumors. PTs are usually solitary tumors but can be associated with other malignancies, such as DCIS or invasive carcinomas and sarcomas. Osteosarcomatous differentiation of a malignant phyllodes tumor is rare, and differentiation of this rare breast tumor from other entities is of vital importance to clinicians due for appropriate treatment and prognosis. We present a case of rare high-grade phyllodes tumor with osteosarcomatous differentiation presenting on mammogram as a calcified lobulated mass; ultrasound revealed a 1.5 cm irregularly calcified mass, suggestive of bone. An ultrasound-guided core biopsy and subsequent lumpectomy revealed a cellular stroma with osteoid stromal matrix and cytologic atypia with bone formation. At 18 months postprocedure, a recurrence was identified at the previous surgical site, and the patient underwent a mastectomy. Here we present a single case of high-grade PT with osteosarcomatous differentiation and a comprehensive literature review, highlighting the mammographic and histologic characteristics of this rare presentation.

PMID:37388537 | PMC:PMC10302161 | DOI:10.1016/j.radcr.2023.05.074
Bilateral hydatid cyst of the breast: a case report and review of the literature

Fetched: June 27th, 2023, 5:02am GMT by Aiman Al Sharei

Ann Med Surg (Lond). 2023 Apr 20;85(6):2981-2984. doi: 10.1097/MS9.0000000000000642. eCollection 2023 Jun.

ABSTRACT

Hydatid cyst disease is a parasitic infestation caused by the tapeworm Echinococcus granulosus. The incidence of the disease is 1-200 cases per 100 000. The usual presentation is the formation of fluid-filled cysts in the liver or lungs and, less commonly, in the brain. The breast is a rare site of presentation for this disease. An isolated hydatid cyst in the breast is very rare, even in endemic regions, occurring in only 0.27% of all hydatid cases. Although these cases are very rare, they should be considered severe. A hydatid breast cyst may mimic a fibroadenoma, phyllodes tumor, chronic abscess, or even carcinoma. Therefore, a high incidence of misdiagnosis may occur. Preoperative diagnosis can be made using needle aspiration and imaging facilities such as breast ultrasonography, mammograms, and computerized topographic images. Nevertheless, in most cases, the final diagnosis cannot be made until the pathological report is obtained postsurgery. This paper reports the first case of a bilateral hydatid cyst of the breast that was diagnosed preoperatively by radiological facilities. We present the patient history, physical examination, and investigations, discuss the risk factors, and present our treatment plan.

PMID:37363452 | PMC:PMC10289724 | DOI:10.1097/MS9.0000000000000642
Mammary stromal-epithelial lesions with myofibroblastic stroma and HMGA2 overexpression linked smooth muscle differentiation, a case series from single institution

Fetched: June 25th, 2023, 5:02am GMT by Evi Abada

Pathol Res Pract. 2023 Aug;248:154626. doi: 10.1016/j.prp.2023.154626. Epub 2023 Jun 20.

ABSTRACT

Fibroadenoma and phyllodes tumor are the prototypical mammary fibroepithelial lesions (FELs). Recently, a subset of FELs, identified as stromal-epithelial lesion (SEL) with myofibroblastic stroma have been labelled as myofibroepithelial nodule (MFN). The MFN stromal cells are diffusely positive for SMA immunostaining and frequently show unusual histological features including irregular borders. There is limited literature on FELs with myofibroblastic or smooth muscle stroma. The etiology of the variation in the FEL stromal histology and its clinical significance is unknown. In this short report we describe clinicopathologic features of six FELs with myofibroblastic and/or smooth muscle stroma. We also report immunohistochemical overexpression of HMGA2 in 2 FELs that contained stromal smooth muscle differentiation suggesting a link to mammary myoid hamartoma. On limited follow up all the 6 FELs with myofibroblastic or smooth muscle stroma had benign outcome. The HMGA2 overexpressing FEL with smooth muscle stroma and myoid hamartoma of the breast show overlapping etiology, and histological features.

PMID:37352786 | DOI:10.1016/j.prp.2023.154626
Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Fetched: June 18th, 2023, 5:03am GMT by Constanze Elfgen

Virchows Arch. 2023 Jul;483(1):5-20. doi: 10.1007/s00428-023-03566-x. Epub 2023 Jun 17.

ABSTRACT

The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.

PMID:37330436 | PMC:PMC10326140 | DOI:10.1007/s00428-023-03566-x
The application of clinical variable-based nomogram in predicting overall survival in malignant phyllodes tumors of the breast

Fetched: June 17th, 2023, 5:02am GMT by Wei Li

Front Genet. 2023 May 30;14:1133495. doi: 10.3389/fgene.2023.1133495. eCollection 2023.

ABSTRACT

Background: We aimed to explore prognostic risk factors in patients with malignant phyllodes tumors (PTs) of the breast and construct a survival prediction model. Methods: The Surveillance, Epidemiology, and End Results database was used to collect information on patients with malignant breast PTs from 2004 to 2015. The patients were randomly divided into training and validation groups using R software. Univariate and multivariate Cox regression analyses were used to screen out independent risk factors. Then, a nomogram model was developed in the training group and validated in the validation group, and the prediction performance and concordance were evaluated. Results: The study included 508 patients with malignant PTs of the breast, including 356 in the training group and 152 in the validation group. Univariate and multivariate Cox proportional hazard regression analyses showed that age, tumor size, tumor stage, regional lymph node metastasis (N), distant metastasis (M) and tumor grade were independent risk factors for the 5-year survival rate of patients with breast PTs in the training group (p < 0.05). These factors were used to construct the nomogram prediction model. The results showed that the C-indices of the training and validation groups were 0.845 (95% confidence interval [CI] 0.802-0.888) and 0.784 (95% CI 0.688-0.880), respectively. The calibration curves of the two groups were close to the ideal 45° reference line and showed good performance and concordance. Receiver operating characteristic and decision curve analysis curves showed that the nomogram has better predictive accuracy than other clinical factors. Conclusion: The nomogram prediction model constructed in this study has good predictive value. It can effectively assess the survival rates of patients with malignant breast PTs, which will aid in the personalized management and treatment of clinical patients.

PMID:37323673 | PMC:PMC10265739 | DOI:10.3389/fgene.2023.1133495
Differentiation between Phyllodes Tumors and Fibroadenomas through Breast Ultrasound: Deep-Learning Model Outperforms Ultrasound Physicians

Fetched: June 12th, 2023, 5:02am GMT by Zhaoting Shi

Sensors (Basel). 2023 May 26;23(11):5099. doi: 10.3390/s23115099.

ABSTRACT

The preoperative differentiation of breast phyllodes tumors (PTs) from fibroadenomas (FAs) plays a critical role in identifying an appropriate surgical treatment. Although several imaging modalities are available, reliable differentiation between PT and FA remains a great challenge for radiologists in clinical work. Artificial intelligence (AI)-assisted diagnosis has shown promise in distinguishing PT from FA. However, a very small sample size was adopted in previous studies. In this work, we retrospectively enrolled 656 breast tumors (372 FAs and 284 PTs) with 1945 ultrasound images in total. Two experienced ultrasound physicians independently evaluated the ultrasound images. Meanwhile, three deep-learning models (i.e., ResNet, VGG, and GoogLeNet) were applied to classify FAs and PTs. The robustness of the models was evaluated by fivefold cross validation. The performance of each model was assessed by using the receiver operating characteristic (ROC) curve. The area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated. Among the three models, the ResNet model yielded the highest AUC value, of 0.91, with an accuracy value of 95.3%, a sensitivity value of 96.2%, and a specificity value of 94.7% in the testing data set. In contrast, the two physicians yielded an average AUC value of 0.69, an accuracy value of 70.7%, a sensitivity value of 54.4%, and a specificity value of 53.2%. Our findings indicate that the diagnostic performance of deep learning is better than that of physicians in the distinction of PTs from FAs. This further suggests that AI is a valuable tool for aiding clinical diagnosis, thereby advancing precision therapy.

PMID:37299826 | PMC:PMC10255878 | DOI:10.3390/s23115099
Better survival was found in patients treated with breast-conserving surgery compared with mastectomy in malignant phyllodes tumor of the breast

Fetched: June 9th, 2023, 5:02am GMT by Chu-Ying Chen

Updates Surg. 2023 Jun 8. doi: 10.1007/s13304-023-01547-y. Online ahead of print.

ABSTRACT

Malignant phyllodes tumor of the breast (MPTB) is a rare type of breast cancer. The prognosis between breast-conserving surgery (BCS) and mastectomy remains unclear in MPTB. Therefore, long-term survival was investigated between BCS and mastectomy in MPTB via the Surveillance, Epidemiology, and End Results (SEER) database. MPTB patients with T1-2/N0 stage between 2000 and 2015 from SEER database were retrospectively reviewed. Prognosis between different surgical approaches was assessed by Kaplan-Meier curves and Cox proportional hazards analysis. A total of 795 patients were enrolled with a median follow-up of 126 months. BCS was associated with significantly increased 10-year overall survival (OS) (89.2% vs. 81.1%, p = 0.002) and breast cancer-specific survival (BCSS) (95.2% vs. 90%, p = 0.004) compared with mastectomy. Multivariate analysis showed better OS (HR = 0.587, 95% CI 0.406-0.850, p = 0.005) and BCSS (HR = 0.463, 95%CI 0.267-0.804, p = 0.006) in the BCS group than the mastectomy group. After 1:1 propensity score matching (PSM), improved 10-year OS (89.2% vs.81%, p = 0.023) and BCSS (95.8% vs. 90.1%, p = 0.033) were observed in BCS compared with mastectomy. This study found the survival benefit of BCS over mastectomy in patients with early-stage MPTB. BCS should be recommended as a priority in MPTB patients when both surgical approaches are feasible.

PMID:37289397 | DOI:10.1007/s13304-023-01547-y
Large language model (ChatGPT) as a support tool for breast tumor board

Fetched: May 31st, 2023, 5:02am GMT by Vera Sorin

NPJ Breast Cancer. 2023 May 30;9(1):44. doi: 10.1038/s41523-023-00557-8.

ABSTRACT

Large language models (LLM) such as ChatGPT have gained public and scientific attention. The aim of this study is to evaluate ChatGPT as a support tool for breast tumor board decisions making. We inserted into ChatGPT-3.5 clinical information of ten consecutive patients presented in a breast tumor board in our institution. We asked the chatbot to recommend management. The results generated by ChatGPT were compared to the final recommendations of the tumor board. They were also graded independently by two senior radiologists. Grading scores were between 1-5 (1 = completely disagree, 5 = completely agree), and in three different categories: summarization, recommendation, and explanation. The mean age was 49.4, 8/10 (80%) of patients had invasive ductal carcinoma, one patient (1/10, 10%) had a ductal carcinoma in-situ and one patient (1/10, 10%) had a phyllodes tumor with atypia. In seven out of ten cases (70%), ChatGPT's recommendations were similar to the tumor board's decisions. Mean scores while grading the chatbot's summarization, recommendation and explanation by the first reviewer were 3.7, 4.3, and 4.6 respectively. Mean values for the second reviewer were 4.3, 4.0, and 4.3, respectively. In this proof-of-concept study, we present initial results on the use of an LLM as a decision support tool in a breast tumor board. Given the significant advancements, it is warranted for clinicians to be familiar with the potential benefits and harms of the technology.

PMID:37253791 | PMC:PMC10229606 | DOI:10.1038/s41523-023-00557-8
Fibroepithelial Lesion Spectrum: A Case Report Documenting a Possible Transformation to a Malignant Phyllodes Tumor

Fetched: May 31st, 2023, 5:02am GMT by Amanda Felsen

Cureus. 2023 Apr 28;15(4):e38252. doi: 10.7759/cureus.38252. eCollection 2023 Apr.

ABSTRACT

We discuss the radiological-pathological aspects of a rare case of transformation of a presumed fibroadenoma (FA) to a malignant phyllodes tumor (PT) and review the literature. Phyllodes tumors often show heterogeneous histologic features with some areas indistinguishable on core needle biopsy. A core biopsy is often a small representation of a larger lesion. As such, a complete excisional biopsy is often needed for a definitive pathologic diagnosis. Careful clinical and imaging correlation and follow-up are necessary, even in a benign fibroepithelial lesion (FEL).

PMID:37252609 | PMC:PMC10225156 | DOI:10.7759/cureus.38252
Clinico-Pathological Factors Determining Recurrence of Phyllodes Tumors of the Breast: The 25-Year Experience at a Tertiary Cancer Centre

Fetched: May 29th, 2023, 5:02am GMT by Baijaeek Sain

J Pers Med. 2023 May 21;13(5):866. doi: 10.3390/jpm13050866.

ABSTRACT

BACKGROUND: Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence.

AIMS AND OBJECTIVES: This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors associated with a recurrence of PTs of the breast.

METHODOLOGY: A retrospective cohort and observational study was conducted, which entailed analyzing the clinicopathological data of patients who were previously diagnosed or presented with PTs of the breast between 1996 and 2021. Data included the total number of patients diagnosed with PTs of the breast and their ages, tumor grade on initial biopsy, tumor location (left or right breast), tumor size, therapeutic interventions carried out (including surgery-either mastectomy or lumpectomy-and adjuvant radiotherapy), final tumor grade, recurrence status, type of recurrence, and time to recurrence.

RESULTS: We analyzed data on a total of 87 patients who were pathologically proven to have PTs, and 46 patients (52.87%) were found to have recurrences. All patients were female, with a mean age at diagnosis of 39 years (range 15-70). Patients aged <40 years had the highest incidence of recurrence, with a rate of 54.35% (n = 25/46), followed by patients aged >40 years, with a rate of recurrence of 45.65% (n = 21/46). A total of 55.4% of patients presented with primary PTs and 44.6% had recurrent PTs at presentation. The average time to local recurrence (LR) from the completion of treatment was 13.8 months, whereas for systemic recurrence (SR), it was 15.29 months. Surgery (mastectomy/lumpectomy) was the major determinant for local recurrence (p < 0.05).

CONCLUSION: Patients who received adjuvant radiotherapy (RT) had a minimal recurrence of PTs. Patients who were found to have a malignant biopsy on initial diagnosis (triple assessment) had a higher incidence of PTs and were more prone to SR than LR. Surgery was a determining factor in the increased rate of LR, with lumpectomy associated with a higher incidence of LR than mastectomy.

PMID:37241036 | PMC:PMC10221551 | DOI:10.3390/jpm13050866
Gene Expression Profiling of Fibroepithelial Lesions of the Breast

Fetched: May 29th, 2023, 5:02am GMT by Xiaomo Li

Int J Mol Sci. 2023 May 20;24(10):9041. doi: 10.3390/ijms24109041.

ABSTRACT

Fibroepithelial lesions of the breast (FELs) are a heterogeneous group of neoplasms exhibiting a histologic spectrum ranging from fibroadenomas (FAs) to malignant phyllodes tumors (PTs). Despite published histologic criteria for their classification, it is common for such lesions to exhibit overlapping features, leading to subjective interpretation and interobserver disagreements in histologic diagnosis. Therefore, there is a need for a more objective diagnostic modality to aid in the accurate classification of these lesions and to guide appropriate clinical management. In this study, the expression of 750 tumor-related genes was measured in a cohort of 34 FELs (5 FAs, 9 cellular FAs, 9 benign PTs, 7 borderline PTs, and 4 malignant PTs). Differentially expressed gene analysis, gene set analysis, pathway analysis, and cell type analysis were performed. Genes involved in matrix remodeling and metastasis (e.g., MMP9, SPP1, COL11A1), angiogenesis (VEGFA, ITGAV, NFIL3, FDFR1, CCND2), hypoxia (ENO1, HK1, CYBB, HK2), metabolic stress (e.g., UBE2C, CDKN2A, FBP1), cell proliferation (e.g., CENPF, CCNB1), and the PI3K-Akt pathway (e.g., ITGB3, NRAS) were highly expressed in malignant PTs and less expressed in borderline PTs, benign PTs, cellular FAs, and FAs. The overall gene expression profiles of benign PTs, cellular FAs, and FAs were very similar. Although a slight difference was observed between borderline and benign PTs, a higher degree of difference was observed between borderline and malignant PTs. Additionally, the macrophage cell abundance scores and CCL5 were significantly higher in malignant PTs compared with all other groups. Our results suggest that the gene-expression-profiling-based approach could lead to further stratification of FELs and may provide clinically useful biological and pathophysiological information to improve the existing histologic diagnostic algorithm.

PMID:37240386 | PMC:PMC10219050 | DOI:10.3390/ijms24109041
Osteosarcoma Originating From a Malignant Phyllodes Tumor: A Case Report of a Rare Malignancy

Fetched: May 23rd, 2023, 5:02am GMT by Nishi Jha

Cureus. 2023 Apr 17;15(4):e37737. doi: 10.7759/cureus.37737. eCollection 2023 Apr.

ABSTRACT

Fibroepithelial tumors are common in the breast; however, the frequency of malignancy is much less as compared to the epithelial counterpart. Malignant phyllodes are infrequent, and the proportion undergoing heterologous differentiation is very rare. Extensive sampling and astute examination are of utmost importance so as not to miss this lesion. The prognosis of these tumors is worse compared to cases where no heterologous transformation is seen.

PMID:37213960 | PMC:PMC10198583 | DOI:10.7759/cureus.37737
Organoid models derived from patients with malignant phyllodes tumor of the breast

Fetched: May 20th, 2023, 5:02am GMT by Xinyu Chu

Breast Cancer Res Treat. 2023 Jul;200(2):193-201. doi: 10.1007/s10549-023-06973-5. Epub 2023 May 19.

ABSTRACT

PURPOSE: Phyllodes tumor of the breast is a kind of rare neoplasm, which accounts for less than 1% of all breast tumors. Malignant phyllodes tumor (MPT) is the highest risk subtype of phyllodes tumor, and is characterized by the tendency of local recurrence and distant metastasis. The prediction of prognosis and the individual therapy for MPT is still challenging. It's urgent to develop a new reliable in vitro preclinical model in order to understand this disease better and to explore appropriate anticancer drugs for individual patients.

METHODS: Two surgically resected MPT specimens were processed for organoid establishment. MPT organoids were subsequently subjected to H&E staining, immunohistochemical analysis and drug screening, respectively.

RESULTS: We successfully established two organoid lines from different patients with MPT. The MPT organoids can well retain the histological features and capture the marker expression in original tumor tissues, including p63, vimentin, Bcl-2, CD34, c-Kit, and Ki-67, even after a long-term culture. The dose titration tests of eight typical chemotherapeutic drugs (paclitaxel, docetaxel, vincristine, doxorubicin, cisplatin, gemcitabine, cyclophosphamide, ifosfamide) on the two MPT organoid lines showed patient-specific drug responses and varying IC50 values. Of all the drugs, doxorubicin and gemcitabine showed the best anti-tumor effect on the two organoid lines.

CONCLUSION: Organoids derived from MPT may be a novel preclinical model for testing personalized therapies for patients with MPT.

PMID:37204665 | DOI:10.1007/s10549-023-06973-5
Bilateral Concurrent Benign Phyllodes Tumor in a 43-Year-Old Female: A Case Report

Fetched: May 17th, 2023, 5:02am GMT by Andres Francisco

Cureus. 2023 Apr 14;15(4):e37588. doi: 10.7759/cureus.37588. eCollection 2023 Apr.

ABSTRACT

Phyllodes tumor is considered a rare form of breast tissue neoplasm that presents as a rapidly growing painless mass. This neoplasm is classified as benign, borderline, or malignant and standard treatment consists of surgical excision with clear margins. The vast majority of reported cases have described the unilateral presentation of this tumor, making bilateral presentation a rare find. Our case describes a 43-year-old Hispanic woman with a history of fibroadenomas who was found to have concurrent benign bilateral phyllodes tumors.

PMID:37193438 | PMC:PMC10183234 | DOI:10.7759/cureus.37588
Breast Phyllodes Tumor: A Tumor With Unpredictable Clinical Behavior

Fetched: May 17th, 2023, 5:02am GMT by Ana Isabel Tomé

Cureus. 2023 Apr 13;15(4):e37537. doi: 10.7759/cureus.37537. eCollection 2023 Apr.

ABSTRACT

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.

PMID:37193421 | PMC:PMC10182856 | DOI:10.7759/cureus.37537
Breast Sarcomas-How Different Are They from Breast Carcinomas? Clinical, Pathological, Imaging and Treatment Insights

Fetched: May 17th, 2023, 5:02am GMT by Iulian Radu

Diagnostics (Basel). 2023 Apr 7;13(8):1370. doi: 10.3390/diagnostics13081370.

ABSTRACT

Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease in the form of a retrospective case series study including discussion of clinical, imaging, and pathological features and treatment. We also compare the main clinical and biological features of six cases of BS (phyllodes tumors were excluded) with a cohort of 184 patients with unilateral breast carcinoma (BC) from a previous study performed at our institution. Patients with BS were diagnosed at a younger age, presented no evidence of lymph node invasion or distant metastases, had no multiple or bilateral lesions, and underwent a shorter length of hospital stay versus the breast carcinoma group. Where recommended, adjuvant chemotherapy consisted of an anthracycline-containing regimen, and adjuvant external radiotherapy was delivered in doses of 50 Gy. The comparison data obtained from our BS cases and the ones with BC revealed differences in diagnosis and treatment. A correct pathological diagnosis of breast sarcoma is essential for the right therapeutic approach. We still have more to learn about this entity, but our case series could add value to existing knowledge in a meta-analysis study.

PMID:37189471 | PMC:PMC10137511 | DOI:10.3390/diagnostics13081370
Stromal Ki67 Expression Might be a Useful Marker for Distinguishing Fibroadenoma From Benign Phyllodes Tumor of the Breast

Fetched: May 10th, 2023, 5:02am GMT by Men Yuan

Int J Surg Pathol. 2023 May 8:10668969231171132. doi: 10.1177/10668969231171132. Online ahead of print.

ABSTRACT

Background. Fibroadenoma (FA) and benign phyllodes tumor (PT) of the breast often have similar appearances on imaging. While an exact diagnosis of biopsy specimens is required to choose adequate treatment, including surgical procedures, it is sometimes difficult to pathologically differentiate these 2 tumors due to histological resemblances. To elucidate markers for distinguishing FA from benign PT, we analyzed clinical samples immunohistochemically. Methods. We retrospectively investigated 80 breast fibroepithelial lesions. As a discovery set, 60 surgical excision samples (30 FA and 30 benign PT) were examined. Twenty biopsy samples (10 FA and 10 benign PT) were examined as a validation set. To determine targets for immunohistochemistry, we first tested some proteins based on previous reports. As a result, Ki67 was chosen for differentiating FA and PT; thus further examinations were conducted with this protein. Results. Among the proteins examined, stromal Ki67 was significantly higher in PT than in FA. Benign PT had significantly higher stromal Ki67 expression both at random and at hotspots (p < .001 and <.001, respectively). The receiver operating characteristic curve analysis identified 3.5% and 8.5% (at random spots and hotspots, respectively) as the optimal cutoff values of stromal Ki67 for distinguishing between these 2 tumors. In the validation cohort employing needle biopsy specimens, we confirmed that these 2 cutoff values properly classified these 2 tumors (p = .043 and .029, respectively). Conclusion.We revealed that stromal Ki67 might be a potential marker for distinguishing FA from benign PT.

PMID:37157807 | DOI:10.1177/10668969231171132
Clinicohistopathological study of benign breast lesions in surgically excised specimens in a tertiary care hospital

Fetched: May 7th, 2023, 5:02am GMT by Saswati Boral

J Cancer Res Ther. 2023 Apr;19(Supplement):S116-S120. doi: 10.4103/jcrt.JCRT_688_20.

ABSTRACT

BACKGROUND: Distinguishing benign breast diseases (BBDs) from malignant breast diseases is a worrisome entity and should also have knowledge of the pattern of occurrence of the disorders in their geographical location. This research aimed to study the clinical and histopathological pattern of BBD in Indian patients.

MATERIALS AND METHODS: The study was conducted on 153 specimens from lumpectomy, core needle biopsy, and mastectomy. Data regarding patients' age, sex, presenting complaints, duration of the complaints, and history of menstrual cycles and lactation were collected from the biopsy requisition forms and case papers. The tissue bits were processed and stained with hematoxylin and eosin, and a histopathological examination was performed.

RESULTS: Most of the patients in the present study were females (n = 151, 98.7%). The mean age of the patients was 30.45 years. Most of the BBD cases (n = 118, 77.14%) were benign, of which fibroadenoma (101 cases) accounted for 66%. Majority of the lesions were in the upper outer quadrant (39.22%). Of the 153 cases, 94 cases of fibroadenoma, one case of breast abscess, nine cases of fibrocystic change, four cases of phyllodes, three cases of lipoma, and one case of gynecomastia diagnosed clinically correlated well with histopathology (n = 112, 73%).

CONCLUSION: BBDs are mostly seen in female patients in the age group of 21-30 years. Fibroadenoma is the most common BBD. Clinical assessment followed by histopathological examination provided an accurate diagnosis. The clinical diagnosis correlated well with histopathology.

PMID:37147991 | DOI:10.4103/jcrt.JCRT_688_20
Mammary not otherwise specified-type sarcoma with CD10 expression

Fetched: May 7th, 2023, 5:02am GMT by Soumya Sucharita

J Cancer Res Ther. 2023 Apr;19(Supplement):S0. doi: 10.4103/jcrt.jcrt_459_21.

ABSTRACT

Although mammary carcinoma is one of the most common malignancies among women, sarcoma taking origin from the breast tissue is extremely rare. Most of the mammary sarcomas represent a specific entity such as malignant phyllodes tumor, liposarcoma, or angiosarcoma. However, some cases do not fit into any specific category of sarcoma. These cases are diagnosed with breast sarcoma-not otherwise specified (NOS) type. They constantly express CD10 and are called as NOS type sarcoma with CD10 expression. Herein, we report a case of primary mammary sarcoma-NOS type with CD10 expression in an 80-year-old male. It was misdiagnosed with carcinoma breast on fine-needle aspiration. However, on histology, it was a high-grade tumor without any specific differentiation. Immunohistochemical results showed diffuse strong expression of vimentin and CD10, whereas pancytokeratin, desmin, and CD34 were negative. These tumors are considered a variant of sarcoma with myoepithelial differentiation.

PMID:37147950 | DOI:10.4103/jcrt.jcrt_459_21
Phyllodes tumour initially diagnosed as keloid

Fetched: May 3rd, 2023, 5:02am GMT by Sanjana Shivalingappa Ibrahimpur

BMJ Case Rep. 2023 May 2;16(5):e250546. doi: 10.1136/bcr-2022-250546.

ABSTRACT

It is unusual to find a breast tumour in a keloid, as the management of both is distinct. In this case, a young woman was operated on 4 years ago, for a right chest wall swelling, situated near the inframammary fold. The histopathological report revealed a granuloma, for which anti-tuberculosis treatment was given. However, the swelling recurred and progressed in size over the next 3 years. Then, she consulted the dermatology department, where the swelling was managed as a keloid. There was no remission. Consequently, the possibility of a breast tumour was suspected, and the patient was referred to breast services (subdivision of the surgery department).Triple assessment of the breast lump was suggestive of a phyllodes tumour (PT). Surgical excision of the tumour was done, which showed a malignant PT. Radiotherapy was given and delayed breast reconstruction was planned.

PMID:37130642 | PMC:PMC10163419 | DOI:10.1136/bcr-2022-250546
Refining the classification of breast phyllodes tumours

Fetched: April 23rd, 2023, 5:01am GMT by Puay Hoon Tan

Pathology. 2023 Jun;55(4):437-448. doi: 10.1016/j.pathol.2023.02.001. Epub 2023 Mar 21.

ABSTRACT

Phyllodes tumours of the breast are uncommon fibroepithelial neoplasms that pose recurrent classification challenges, in large part due to the multiple histological parameters of stromal hypercellularity and atypia, stromal mitotic count, stromal overgrowth and tumour borders, that are used for grading. While the World Health Organization (WHO) Classification of Breast Tumours provides recommendations on diagnostic features, defining criteria are not always applied in routine practice. Lack of concordance among pathologists in typing and grading further underscores the classification difficulties, especially in the borderline category. Although there has been significant molecular information on phyllodes tumours in recent years which has been diagnostically helpful, it has not been translated into daily clinical practice. In order to refine the classification of phyllodes tumours into one that is simple yet comprehensive, reproducible and prognostically precise, a multipronged approach is needed that leverages on global contributions of the International Fibroepithelial Consortium, support by the International Collaboration on Cancer Classification and Research (IC³ R) in amalgamating evidence translation, and guidance from the International Collaboration on Cancer Reporting (ICCR) for standardised reporting. It is hoped that the evidence generated can be used towards refining the classification of phyllodes tumours for the future.

PMID:37085395 | DOI:10.1016/j.pathol.2023.02.001
Clinical outcomes and biomarkers of phyllodes tumors of the breast: A single-center retrospective study

Fetched: April 22nd, 2023, 5:02am GMT by Keyu Chen

Cancer Med. 2023 May;12(10):11363-11374. doi: 10.1002/cam4.5849. Epub 2023 Apr 20.

ABSTRACT

PURPOSE: Phyllodes tumors (PTs) are rare neoplasms with a certain risk of recurrence and/or metastasis. In clinical practice, there is a lack of high-quality clinical studies and unified guidelines to guide the treatment.

MATERIALS AND METHODS: All malignant and recurrence/metastasis PTs were retrospectively collected, which were diagnosed from 2008 to 2022.

RESULTS: A total of 82 patients were enrolled, including 69 malignant and 13 borderline tumors. 96.3% (79/82) received surgical treatment. During a median follow-up of 55.5 months, 20 patients (20/82, 24.4%) had distant metastasis (DM), while 32 (32/82, 39.0%) had local recurrence (LR). Univariate analysis showed the survival of PTs was associated with surgical methods (p < 0.001), tumor size (p = 0.026), and biological behavior (p = 0.017), but not age at diagnosis. In relapsed borderline PTs, we did not find deaths due to disease progression. Patients with DM were all malignant PTs, with disease-progression occurring within 3 years in more than 80% of patients. Among salvage treatments, the combination of antiangiogenic drugs improved the prognosis to some extent, with a significant increase in mPFS (2.77 vs. 1.53 months), but no significant statistical results were obtained (p = 0.168). Lactate dehydrogenase (LDH) was an independent predictor of the prognosis for malignant PTs (p = 0.001, HR = 1.203, 95%CI, 1.082-1.336).

CONCLUSION: Borderline PTs rarely metastasize, and even if LR occurs, surgical resection can lead to long-term survival. In metastatic phyllodes tumors (MPT), systemic therapy is not effective, but antiangiogenic drugs may prolong survival. LDH is an independent prognostic factor for malignant PTs to identify high-risk tumors.

PMID:37081723 | PMC:PMC10242863 | DOI:10.1002/cam4.5849
Malignant phyllodes tumors of the breast: the malignancy grading and associations with prognosis

Fetched: April 19th, 2023, 5:02am GMT by Junjun Liu

Breast Cancer Res Treat. 2023 Jun;199(3):435-444. doi: 10.1007/s10549-023-06933-z. Epub 2023 Apr 18.

ABSTRACT

PURPOSE: This study aimed to correlate clinicopathological parameters with survival outcomes in a cohort of patients diagnosed with malignant phyllodes tumors (MPTs). We also analyzed the malignancy grade of MPTs and investigated the prognostic significance of the malignancy grading system.

METHODS: Clinicopathological parameters, malignancy grades, and clinical follow-up data of 188 women diagnosed with MPTs in a single-institution were analyzed. MPTs of the breast were grouped according to stromal atypia, stromal overgrowth, mitotic count, tumor differentiation, and necrosis. A Fleiss' kappa statistic was calculated to test the agreement between the pathologists for the grading of MPTs. Disease-free survival (DFS), distant metastasis-free survival (DMFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Cox regression was carried out to identify factors predictive of locoregional recurrence (LRR), distant metastasis (DM) and death.

RESULTS: A total of 188 MPTs were classified according to the malignancy grading system: 88 (46.8%) as low grade, 77 (41%) as an intermediate grade, and 23 (12.2%) as high grade. Excellent agreement between pathologists for the grading of MPTs (Fleiss' kappa 0.807). In our study population, the occurrence of DM and death were associated with the malignancy grade of MPTs (P < 0.001). Based on the DFS curves, the presence of heterologous elements (P = 0.025) and younger age (P = 0.014) were independent prognostic indicators. Additionally, the malignancy grade retained independent prognostic significance for predicting DMFS and OS (P < 0.001 and P = 0.009).

CONCLUSIONS: Higher malignancy grade, presence of heterologous elements, younger age, larger tumor size, and recent rapid tumor growth are poor prognostic factors for MPTs of the breast. The malignancy grading system may be generalized in the future.

PMID:37071267 | DOI:10.1007/s10549-023-06933-z
Percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions): a preliminary single-centre Italian experience

Fetched: April 9th, 2023, 5:02am GMT by Giulia Bicchierai

Radiol Med. 2023 May;128(5):528-536. doi: 10.1007/s11547-023-01626-5. Epub 2023 Apr 8.

ABSTRACT

PURPOSE: In recent years vacuum-assisted excision (VAE) has been described as an alternative treatment for some B3 lesions. This study aims to assess the effectiveness of using VAE to manage selected B3 lesions by quantifying the number of B3 lesions undergoing VAE, the malignant upgrade rate, and the complications encountered.

MATERIALS AND METHODS: Our department evaluated all B3 lesions diagnosed between January 2019 and October 2021 and treated them with VAE. The data were collected during the initial biopsy and final histology based on VAE image guidance, also considering initial lesions and complications. The exclusion criteria were: B3 lesion of size > 20 mm, presence of a concomitant malignant lesion, lesion < 5.0 mm distant from the skin, nipple or pectoral muscle, phyllodes tumours or indeterminate B3 lesions. Lesions that upgraded to malignancy underwent surgical excision, while benign lesions performed radiological follow-ups.

RESULTS: From 416 B3 lesions diagnosed, 67 (16.1%) underwent VAE. VAE was performed under X-ray (50/67) or ultrasound guidance (17/67). Five cases (7.5%) upgraded to a malignant lesion, 2 ADH, 2 LIN and one papillary lesion that underwent surgery. No malignancy or new lesions has occurred at the site of the VAE, with an average radiological follow-up of 14.9 months.

CONCLUSIONS: VAE could be a safe and effective pathway for managing selected B3 lesions. Lesions initially subjected to CNB with ADH and LN outcome, before undergoing VAE, should perform a VAB for better tissue characterization and management.

PMID:37029852 | DOI:10.1007/s11547-023-01626-5
Case report: Osteosarcomatous differentiation in the lung metastasis of a malignant phyllodes tumor

Fetched: April 8th, 2023, 5:01am GMT by Ruijing Liu

Front Med (Lausanne). 2023 Mar 21;10:1141353. doi: 10.3389/fmed.2023.1141353. eCollection 2023.

ABSTRACT

Malignant phyllodes tumor is a rare breast tumor, with distant metastases and heterologous differentiation in a few cases. We report a case of malignant phyllodes tumor with liposarcomatous differentiation in the primary tumor and osteosarcomatous differentiation in the lung metastatic tumor. A middle-aged female presented with a well-defined mass in the upper lobe of the right lung measuring 5.0 × 5.0 × 3.0 cm. The patient had a history of malignant phyllodes tumor in the breast. The patient underwent a right superior lobectomy. Histologically, the primary tumor was a typical malignant phyllodes tumor with pleomorphic liposarcomatous differentiation, while the lung metastasis showed osteosarcomatous differentiation without original biphasic features. The phyllodes tumor and heterologous components showed CD10 and p53 expression, and were negative for ER, PR, and CD34. Exome sequencing revealed TP53, TERT, EGFR, RARA, RB1, and GNAS mutations in all three components. Although the lung metastasis were morphologically different from the primary breast tumor, their common origin was demonstrated through immunohistochemical and molecular characterization. Cancer stem cells give rise to tumor heterogeneous cells, and heterologous components in malignant phyllodes tumors may indicate unfavorable prognosis and a greater risk of early recurrence and metastasis.

PMID:37025961 | PMC:PMC10070992 | DOI:10.3389/fmed.2023.1141353
Phyllodes Tumor of the Bladder in a 2-Year-Old Boy - An Exceptional Finding

Fetched: March 31st, 2023, 5:02am GMT by Taycir Cheikhrouhou

Fetal Pediatr Pathol. 2023 Aug;42(4):699-705. doi: 10.1080/15513815.2023.2193274. Epub 2023 Mar 30.

ABSTRACT

Background: Breast phyllodes tumor has a distinct histologic appearance. There are no pediatric phyllodes tumors of the bladder in English literature reported. Case report: A 2-year-old boy presented with a urinary infection and obstructive urinary symptoms. A 3-cm slow-growing bladder mass revealed by repeated transabdominal ultrasonography was initially considered a ureterocele. Cystoscopic and laparoscopic exploration using pneumovesicum confirmed the diagnosis of a bladder neck tumor. Histologically, the features were of a benign phyllodes tumor, morphologically similar to those seen in breast tissue. The patient received no further treatment and showed no recurrence or metastasis. Conclusion: Phyllodes tumor can cause a pediatric bladder tumor.

PMID:36995095 | DOI:10.1080/15513815.2023.2193274
Malignant phyllodes tumor of the breast with heterologous osteosarcoma and chondrosarcomatous differentiation: A rare case report with imaging findings

Fetched: March 31st, 2023, 5:02am GMT by Su Yeon Ko

Radiol Case Rep. 2023 Mar 20;18(5):1982-1988. doi: 10.1016/j.radcr.2023.02.039. eCollection 2023 May.

ABSTRACT

Phyllodes tumors of the breast are rare fibroepithelial neoplasms accounting for 0.3%-1.5% of all female breast tumors [1,2]. Malignant transformations occur in 10%-20% of phyllodes tumors, often in the form of stroma. Heterologous osteosarcoma and chondrosarcomatous differentiation of phyllodes tumor are extremely rare, and little is known about their imaging findings. Here, we report a rare case of a 52-year-old woman with no history of previous surgery or radiation therapy, who presented with a rapidly growing right breast mass that was diagnosed as a malignant phyllodes tumor with heterologous osteosarcoma and chondrosarcomatous differentiation. The patient underwent modified radical mastectomy.

PMID:36994218 | PMC:PMC10040453 | DOI:10.1016/j.radcr.2023.02.039
Rethinking on the management strategy of malignant phyllodes tumor of the breast: An analysis based on the SEER database

Fetched: March 25th, 2023, 5:01am GMT by Chang Chen

Medicine (Baltimore). 2023 Mar 24;102(12):e33326. doi: 10.1097/MD.0000000000033326.

ABSTRACT

Malignant phyllodes tumor of the breast (MPTB) is a rare breast neoplasm that has a high recurrence rate and its optimal treatment strategies remain controversial. Our study used the most up-to-date database to determine prognostic factors that predict cancer-specific survival (CSS) and to evaluate the effects of different treatment strategies for MPTB. We performed a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Women who were diagnosed with MPTB from 2000 to 2019 were included. Kaplan-Meier method and Cox proportional hazards regressions were used to evaluate the prognostic power of variables on CSS. A total of 1902 women with MPTB were included in the study, with a median follow-up duration of 87.5 months. Age was found not to independently predict CSS in patients with tumors larger than 10 cm (P = .235). Mastectomy was performed on a total of 898 (47.2%) patients including 210 women (23.4%) undergoing radiotherapy after surgery. Mastectomy showed worse CSS when compared with breast-conserving surgery in patients with tumors smaller than 10 cm. Patients undergoing radiotherapy were not inferior to non-radiotherapy patients on CSS when patients were stratified by tumor size. Breast-conserving surgery showed survival benefits for patients with small tumors (T1 and T2). Patients with radiotherapy were not inferior to non-radiotherapy patients on CSS. Treatment of patients with MPTB should be carefully selected based on different tumor sizes.

PMID:36961178 | PMC:PMC10036047 | DOI:10.1097/MD.0000000000033326
Skin reducing nipple sparing mastectomy with immediate breast reconstruction for huge borderline phyllodes tumor of the breast: Case report

Fetched: March 23rd, 2023, 5:02am GMT by Lubna Mushtaque Vohra

Int J Surg Case Rep. 2023 Apr;105:107996. doi: 10.1016/j.ijscr.2023.107996. Epub 2023 Mar 20.

ABSTRACT

INTRODUCTION: Borderline phyllodes tumors are very infrequent breast tumors encountered by surgeons.

CASE PRESENTATION: We present a case of a young woman with a very large borderline phyllodes tumor measuring 20 cm × 20 cm, involving almost all of the breast, causing gross asymmetry of the breasts.

DISCUSSION: The patient wished to maintain symmetry following the surgery as a result of which a simple mastectomy followed by implant based Immediate breast reconstruction was planned. The patient had an uneventful recovery postoperatively with equal breast size bilaterally.

CONCLUSION: Implant based immediate breast reconstruction thus provides a comprehensive solution and excellent cosmesis for women with very large borderline phyllodes requiring mastectomy.

PMID:36948053 | PMC:PMC10040697 | DOI:10.1016/j.ijscr.2023.107996
ASO Visual Abstract: Recurrence is Not Associated with␣Margin Status in␣Phyllodes Tumor

Fetched: March 23rd, 2023, 5:02am GMT by Kyung-Hwak Yoon

Ann Surg Oncol. 2023 Apr;30(4):2162. doi: 10.1245/s10434-022-13078-8.

NO ABSTRACT

PMID:36709243 | DOI:10.1245/s10434-022-13078-8
Phyllodes Tumor Of The Breast

Fetched: March 22nd, 2023, 5:02am GMT by Faten Limaiem

2023 Jan 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.

ABSTRACT

Phyllodes tumor of the breast is an infrequently encountered fibroepithelial neoplasm, which accounts for 0.3% to 1% of all tumors. Phyllodes tumor presents a morphologic continuum from benign to malignant. Based on histologic features, including nuclear atypia, stromal cellularity, mitotic activity, tumor margin appearance, and stromal overgrowth, the World Health Organization (WHO) classifies Phyllodes tumors benign, borderline, and malignant. Phyllodes tumors have an inherent recurrence and/or metastatic potential, which varies based on histologic grade. Their diagnosis is mainly established based on histopathological examination. However, the differential diagnosis between benign phyllodes tumors and fibroadenoma remains challenging, especially on core biopsy specimens.

PMID:31082182 | Bookshelf:NBK541138
The utility of diffusion-weighted imaging for differentiation of phyllodes tumor from fibroadenoma and breast cancer

Fetched: March 21st, 2023, 5:02am GMT by Jinzhi Fang

Front Oncol. 2023 Mar 2;13:938189. doi: 10.3389/fonc.2023.938189. eCollection 2023.

ABSTRACT

OBJECTIVE: To evaluate the utility of apparent diffusion coefficient (ADC) values for differentiating breast tumors.

METHODS: The medical records of 17 patients with phyllodes tumor [PT; circular regions of interest (ROI-cs) n = 171], 74 patients with fibroadenomas (FAs; ROI-cs, n = 94), and 57 patients with breast cancers (BCs; ROI-cs, n = 104) confirmed by surgical pathology were retrospectively reviewed.

RESULTS: There were significant differences between PTs, FAs, and BCs in ADCmean, ADCmax, and ADCmin values. The cutoff ADCmean for differentiating PTs from FAs was 1.435 × 10^-3 mm²/s, PTs from BCs was 1.100 × 10^-3 mm²/s, and FAs from BCs was 0.925 × 10^-3 mm²/s. There were significant differences between benign PTs, borderline PTs, and malignant PTs in ADCmean, ADCmax, and ADCmin values. The cutoff ADCmean for differentiating benign PTs from borderline PTs was 1.215 × 10^-3 mm²/s, and borderline PTs from malignant PTs was 1.665 × 10^-3 mm²/s.

CONCLUSION: DWI provides quantitative information that can help distinguish breast tumors.

PMID:36937381 | PMC:PMC10018141 | DOI:10.3389/fonc.2023.938189
Predicting the recurrence-free survival of phyllodes tumor of the breast: a nomogram based on clinicopathology features, treatment, and surgical margin

Fetched: March 15th, 2023, 5:02am GMT by Yufan Wei

Gland Surg. 2023 Feb 28;12(2):152-164. doi: 10.21037/gs-22-542. Epub 2023 Feb 13.

ABSTRACT

BACKGROUND: Grading based on histopathologic indicators cannot accurately assess the prognosis of phyllodes tumor (PT) of the breast. This article aimed to investigate the correlation between PT prognosis and clinicopathological features, treatment, and surgical margin.

METHODS: The clinicopathological data of patients with pathologically confirmed PT at our institution were retrospectively collected. Univariate and multivariate Cox proportional risk models were employed to test the effects of different variables on the prognosis of PT. A nomogram to predict the 1-, 3-, 5-, and 10-year recurrence-free survival (RFS) of PT was proposed, and its discriminative ability and calibration were tested using the concordance index (C-index), area under the curve (AUC), and calibration plots. All statistical analyses were performed using R.

RESULTS: A total of 342 PT patients were included, including 242 benign (70.8%), 75 borderline (21.9%) and 25 malignant (7.3%) cases. The median follow-up period was 64.5 months (range, 3-179 months), 66 PT patients had local recurrence (LR), and four patients had distant metastasis. The 1-, 3-, 5-, and 10-year RFS of the PT patients were 90.8%, 81.8%, 78%, and 76.7%, respectively. Age, fibroadenoma (FA) surgery history, treatment, mitotic activity, and surgical margin were selected as the independent factors for PT prognosis. The nomogram showed good discriminative ability and calibration, as indicated by the C-index [0.78, 95% confidence interval (CI): 0.75-0.11].

CONCLUSIONS: Independent predictors related to PT prognosis were selected to establish a nomogram for predicting the RFS of PT. This nomogram was able to objectively stratify PT patients into prognostic groups and performed well in the internal validation.

PMID:36915816 | PMC:PMC10005977 | DOI:10.21037/gs-22-542
New Staging System and Prognostic Model for Malignant Phyllodes Tumor Patients without Distant Metastasis: A Development and Validation Study

Fetched: March 12th, 2023, 5:02am GMT by Zhaohui Ruan

J Clin Med. 2023 Feb 27;12(5):1889. doi: 10.3390/jcm12051889.

ABSTRACT

PURPOSE: To build a new staging system and new prognostic models for MPTB.

METHODS: We performed a comprehensive analysis of the data from the SEER database.

RESULTS: We discussed the characteristics of MPTB by comparing 1085 MPTB cases with 382,718 invasive ductal carcinoma cases. We established a new stage- and age-stratification system for MPTB patients. Furthermore, we built two prognostic models for MPTB patients. The validity of these models was confirmed through multifaceted and multidata verification.

CONCLUSIONS: Our study provided a staging system and prognostic models for MPTB patients, which can not only help to predict patient outcomes, but also enhance the understanding of the prognostic factors associated with MPTB.

PMID:36902676 | PMC:PMC10003404 | DOI:10.3390/jcm12051889
Giant Juvenile Fibroadenoma: Case Report and Review of the Literature

Fetched: March 12th, 2023, 5:02am GMT by Anna Eleftheriades

J Clin Med. 2023 Feb 26;12(5):1855. doi: 10.3390/jcm12051855.

ABSTRACT

Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. An extensive PubMed search of the literature in English up until August 2022 was performed. In addition, a rare case of a gigantic fibroadenoma in an 11-year-old premenarchal girl who was referred to our adolescent gynecology center is presented here. Eighty-seven cases of giant juvenile fibroadenomas have been reported in the literature along with our case. Patients with giant juvenile fibroadenoma presented at a mean age of 13.92 years and usually after menarche. Juvenile fibroadenomas are usually unilateral, occurring either in the right or the left breast; the majority of them are diagnosed when they are already more than 10 cm in size, and they are most frequently treated with total lump excision. Differential diagnosis includes phyllodes tumors and pseudo-angiomatous stromal hyperplasia. Conservative management is feasible, but surgical excision is recommended to patients with suspicious imaging features or when the mass grows rapidly.

PMID:36902642 | PMC:PMC10003210 | DOI:10.3390/jcm12051855
A Diagnostic Revelation: Case of a Mucinous Carcinoma of the Breast

Fetched: March 10th, 2023, 5:01am GMT by Sheena Wadhwa

Indian J Surg Oncol. 2023 Mar;14(1):144-149. doi: 10.1007/s13193-022-01638-z. Epub 2022 Sep 2.

ABSTRACT

Mucinous or colloid cancers are a rare subtype of invasive ductal carcinoma, making up only 2-3% of infiltrating carcinomas. Prevalence of pure mucinous breast cancer(PMBC) among infiltrating duct carcinomas in less than 60 year olds is 2-7%, and in less than 35 year olds, it is 1%. Mucinous carcinoma of the breast is divided into 2 subtypes, the pure type and mixed type. PMBC is characterized by a lower incidence of nodal involvement, favourable histological grade, and higher ER/PR expression. Axillary metastases are rare, though found in 12-14%. It has a better prognosis than infiltrative ductal cancer with 10-year survival being more than 90%. Here is the case of a 70-year-old female who presented with lump in the left breast since 3 years. On examination, we detected a left breast lump occupying the whole breast except lower outer quadrant, measuring 10 × 8 cm with overlying skin stretched with puckering and engorged veins seen, nipple displaced laterally and higher by 1 cm, firm to hard in consistency, and mobile with breast tissue. Sonomammography, mammography, FNAC and biopsy were suggestive of benign phyllodes tumour. Patient was hence posted for simple mastectomy on the left side with removal of attached lymph nodes (near axillary tail). Histopathological examination revealed pure mucinous breast carcinoma with nine lymph nodes, free from tumour and showing reactive hyperplasia. Immunohistochemistry studies demonstrated ER + , PR + , HER-2-NEU-. The patient was started on hormonal therapy. Therefore, mucinous carcinoma of the breast is a rare entity with imaging features sometimes mimicking a benign tumour such as Phyllodes tumour, hence making it important to include it as a differential diagnosis in our daily practice. It is especially important in the subtyping of carcinoma of the breast since it carries a favourable risk profile with less chances of lymph node involvement, higher hormone receptor positivity and good response to endocrine treatment.

PMID:36891453 | PMC:PMC9986366 | DOI:10.1007/s13193-022-01638-z
Malignant Phyllodes Tumor with Heterologous Osteosarcomatous and Rhabdomyosarcomatous Elements: A Case Report and Literature Review

Fetched: March 9th, 2023, 5:03am GMT by Haval Ali

Ann Clin Lab Sci. 2023 Jan;53(1):159-163.

ABSTRACT

Phyllodes tumor (PT) is an uncommon fibroepithelial lesion of the breast. PT can be classified as benign, borderline, and malignant based on semi-quantitative assessment of stromal hypercellularity and overgrowth, cytologic atypia, mitotic activity, tumor border, and presence of malignant heterologous elements. PT is considered malignant by default, if malignant heterologous elements are encountered. The heterologous elements include liposarcoma, angiosarcoma, osteosarcoma, chondrosarcoma, and rhabdomyosarcoma. Malignant PT (MPT) with rhabdomyosarcomatous component is extremely rare, and only a few cases are reported. Here, we present a case of MPT with mixed osteosarcomatous and rhabdomyosarcomatous elements in a 51-year-old female, with review of the literatures and discussion of the differential diagnosis.

PMID:36889758
Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists

Fetched: March 7th, 2023, 5:02am GMT by Carl Sars

Breast Cancer Res Treat. 2023 Jun;199(2):293-304. doi: 10.1007/s10549-023-06896-1. Epub 2023 Mar 6.

ABSTRACT

PURPOSE: Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking.

METHODS: We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents.

RESULTS: A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types.

CONCLUSIONS: This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.

PMID:36879102 | PMC:PMC9988205 | DOI:10.1007/s10549-023-06896-1
Mammography-based radiomics analysis and imaging features for predicting the malignant risk of phyllodes tumours of the breast

Fetched: March 5th, 2023, 5:01am GMT by H-J Wang

Clin Radiol. 2023 May;78(5):e386-e392. doi: 10.1016/j.crad.2023.01.017. Epub 2023 Feb 18.

ABSTRACT

AIM: To determine whether the mammography (MG)-based radiomics analysis and MG/ultrasound (US) imaging features could predict the malignant risk of phyllodes tumours (PTs) of the breast.

MATERIALS AND METHODS: Seventy-five patients with PTs were included retrospectively (39 with benign PTs, 36 with borderline/malignant PTs) and divided into thetraining (n=52) and validation groups (n=23). The clinical information, MG and US imaging characteristics, and histogram features were extracted from craniocaudal (CC) and mediolateral oblique (MLO) images. The lesion region of interest (ROI) and perilesional ROI were delineated. Multivariate logistic regression analysis was performed to determine the malignant factors of PTs. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC), sensitivity, and specificity were calculated.

RESULTS: There was no significant difference found in the clinical or MG/US features between benign and borderline/malignant PTs. In the lesion ROI, variance in the CC view and mean and variance in the MLO view were independent predictors. The AUC was 0.942, sensitivity and specificity were 96.3% and 92%, respectively, in the training group. In the validation group, the AUC was 0.879, the sensitivity was 91.7%, and the specificity was 81.8%. In the perilesional ROI, the AUCs were 0.904 and 0.939, sensitivities were 88.9% and 91.7%, and the specificities were 92% and 90.9% in the training and validation groups, respectively.

CONCLUSIONS: MG-based radiomic features could predict the risk of malignancy of patients with PTs and may be used as a potential tool to differentiate benign and borderline/malignant PTs.

PMID:36868973 | DOI:10.1016/j.crad.2023.01.017
Prognostic factors of breast phyllodes tumors

Fetched: March 4th, 2023, 5:02am GMT by Eunah Shin

Histol Histopathol. 2023 Aug;38(8):865-878. doi: 10.14670/HH-18-600. Epub 2023 Feb 27.

ABSTRACT

BACKGROUND: Phyllodes tumor (PT) is a relatively rare breast tumor, accounting for <1% of all breast tumors.

MAIN BODY: Adjuvant therapy with chemotherapy or radiation therapy, other than surgical excision, has not been established yet. PT, similar to other breast tumors, is classified as benign, borderline, and malignant according to the World Health Organization classification system, depending on stromal cellularity, stromal atypia, mitotic activity, stromal overgrowth, and tumor border. However, this histological grading system cannot effectively or fully reflect the clinical prognosis of PT. Several studies have investigated prognostic factors for PT as some PTs recur or metastasize to distant sites, and thus, prediction of prognosis is clinically imperative.

CONCLUSION: This review discusses clinicopathological factors, immunohistochemical markers, and molecular factors that have been investigated in previous studies to have an impact on the clinical prognosis of PT.

PMID:36866915 | DOI:10.14670/HH-18-600
Convolution Neural Network for Breast Cancer Detection and Classification Using Deep Learning

Fetched: March 2nd, 2023, 5:02am GMT by Basem S Abunasser

Asian Pac J Cancer Prev. 2023 Feb 1;24(2):531-544. doi: 10.31557/APJCP.2023.24.2.531.

ABSTRACT

OBJECTIVE: Early detection and precise diagnosis of breast cancer (BC) plays an essential part in enhancing the diagnosis and improving the breast cancer survival rate of patients from 30 to 50%. Through the advances of technology in healthcare, deep learning takes a significant role in handling and inspecting a great number of X-ray, MRI, CTR images. The aim of this study is to propose a deep learning model (BCCNN) to detect and classify breast cancers into eight classes: benign adenosis (BA), benign fibroadenoma (BF), benign phyllodes tumor (BPT), benign tubular adenoma (BTA), malignant ductal carcinoma (MDC), malignant lobular carcinoma (MLC), malignant mucinous carcinoma (MMC), and malignant papillary carcinoma (MPC).

METHODS: Breast cancer MRI images were classified into BA, BF, BPT, BTA, MDC, MLC, MMC, and MPC using a proposed Deep Learning model with additional 5 fine-tuned Deep learning models consisting of Xception, InceptionV3, VGG16, MobileNet and ResNet50 trained on ImageNet database. The dataset was collected from Kaggle depository for breast cancer detection and classification. That Dataset was boosted using GAN technique. The images in the dataset have 4 magnifications (40X, 100X, 200X, 400X, and Complete Dataset). Thus we evaluated the proposed Deep Learning model and 5 pre-trained models using each dataset individually. That means we carried out a total of 30 experiments. The measurement that was used in the evaluation of all models includes: F1-score, recall, precision, accuracy.

RESULTS: The classification F1-score accuracies of Xception, InceptionV3, ResNet50, VGG16, MobileNet, and Proposed Model (BCCNN) were 97.54%, 95.33%, 98.14%, 97.67%, 93.98%, and 98.28%, respectively.

CONCLUSION: Dataset Boosting, preprocessing and balancing played a good role in enhancing the detection and classification of breast cancer of the proposed model (BCCNN) and the fine-tuned pre-trained models' accuracies greatly. The best accuracies were attained when the 400X magnification of the MRI images due to their high images resolution.

PMID:36853302 | PMC:PMC10162639 | DOI:10.31557/APJCP.2023.24.2.531
Periductal Stromal Tumor of the Breast with a TERT Promoter Mutation: First Case Report with Comprehensive Molecular Analysis

Fetched: February 25th, 2023, 5:02am GMT by Blaire Anderson

Int J Surg Pathol. 2023 Feb 23:10668969231157306. doi: 10.1177/10668969231157306. Online ahead of print.

ABSTRACT

The molecular pathogenesis of breast fibroepithelial tumors continues to be elucidated. Recently, highly recurrent MED12 mutations arising in exon 2 at codon 44 were discovered in fibroadenomas and phyllodes tumors. In addition, a high prevalence of TERT promoter mutations in two hotspots (124 and 126 bp upstream from the translation start site) was discovered in up to 65% of phyllodes tumors. Breast periductal stromal tumors are a potentially distinct category of fibroepithelial lesions that are exceptionally rare with controversial classification and pathogenesis. Herein, we report the first comprehensive molecular genetic workup of a breast periductal stromal tumor that harbored a TERT promoter -124C > T mutation, supporting a relation to phyllodes tumors.

PMID:36823780 | DOI:10.1177/10668969231157306
Single-institution outcomes after excision of benign phyllodes tumors: low recurrence risk even with positive margins

Fetched: February 23rd, 2023, 5:02am GMT by Zainab Balogun

Breast Cancer Res Treat. 2023 Apr;198(3):569-572. doi: 10.1007/s10549-023-06885-4. Epub 2023 Feb 20.

ABSTRACT

PURPOSE: Benign phyllodes tumors (BPT) are rare breast neoplasms with clinical behavior that poses low recurrence risk. Guidelines regarding appropriate margins recommend surgical excision to negative margins, sometimes requiring re-excision surgery. Contemporary experience suggests that re-excision in the face of positive margins may not be needed.

METHODS: This is a retrospective review of a single-institution experience with BPT from 2010 to 2019 with 102 patients. Demographics, outcomes and follow-up were analyzed.

RESULTS: The median age was 37 years. 95% had a pre-operative biopsy and only 6% were confirmed BPT before surgery.56% had positive margins and were more likely to be younger and have a pre-operative diagnosis of fibroadenoma. The median follow-up was 33 months. Between the positive and negative margin groups, recurrence rates were not significantly different (p = 0.87).

CONCLUSION: Positive margins on excision of BPT poses a low recurrence risk and re-excision surgery is not necessary.

PMID:36807012 | DOI:10.1007/s10549-023-06885-4
Pseudoangiomatous Stromal Hyperplasia: Radiologic-Pathologic Correlation

Fetched: February 14th, 2023, 5:02am GMT by Megan E Speer

J Breast Imaging. 2022 Sep 14;5(1):67-72. doi: 10.1093/jbi/wbac051. eCollection 2023 Jan-Feb.

ABSTRACT

Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. PASH is postulated to be hormonally induced and predominantly occurs in premenopausal women and postmenopausal women on menopausal hormone therapy. Clinical presentation varies from screen-detected lesions to palpable masses. Imaging findings of PASH are nonspecific. The most common mammographic findings are an oval or round circumscribed non-calcified mass or developing asymmetry. On US, PASH is often seen as an oval hypoechoic mass that may be circumscribed and can have an echogenic rim, or, when manifest as mammographic asymmetry, US may show a corresponding non-mass focal area of echogenic tissue. Limited studies have investigated the MRI appearance, with PASH most often manifesting as non-mass enhancement, or, less often, as an oval or irregular mass with persistent kinetics. Histopathologically, PASH can be mistaken for a fibroadenoma or phyllodes tumor and has features overlapping low-grade angiosarcoma. Assessment of radiologic-pathologic concordance is particularly important as PASH is often an incidental finding, adjacent to the targeted lesion at histopathology. Surgical excision or repeat core-needle biopsy is necessary for discordant suspicious cases. After a benign, concordant diagnosis of PASH, the patient may resume routine screening.

PMID:36778653 | PMC:PMC9901424 | DOI:10.1093/jbi/wbac051
High-Risk Breast Lesions Diagnosed by Ultrasound-Guided Vacuum-Assisted Excision

Fetched: February 9th, 2023, 5:02am GMT by Ping He

World J Surg. 2023 May;47(5):1247-1252. doi: 10.1007/s00268-023-06930-9. Epub 2023 Feb 8.

ABSTRACT

PURPOSE: The aim of this study was to analyze the role of ultrasound-guided vacuum-assisted excision (US-guided VAE) in the treatment of high-risk breast lesions and to evaluate the clinical and US features of the patients associated with recurrence or development of malignancy.

MATERIALS AND METHODS: Between April 2010 and September 2021, 73 lesions of 73 patients underwent US-guided VAE and were diagnosed with high-risk breast lesions. The incidence of recurrence or development of malignancy for high-risk breast lesions was evaluated at follow-up period. The clinical and US features of the patients were analyzed to identify the factors affecting the recurrence or development of malignancy rate.

RESULTS: Only benign phyllodes tumors on US-guided VAE showed recurrences, while other high-risk breast lesions that were atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ), radial scar, and flat epithelial atypia did not show recurrences or malignant transformation. The recurrence rate of the benign phyllodes tumor was 20.8% (5/24) in a mean follow-up period of 34.3 months. The recurrence rate of benign phyllodes tumor with distance from nipple of less than 1 cm was significantly higher than that of lesions with distance from nipple of more than 1 cm (75% vs. 10%, p < 0.05).

CONCLUSIONS: Benign phyllodes tumors without concurrent breast cancer could be safely followed up instead of surgical excision after US-guided VAE when the lesions were classified as BI-RADS 3 or 4A by US.

PMID:36752860 | DOI:10.1007/s00268-023-06930-9
RARE CASE OF PHYLLODES TUMOUR OF BREAST WITH CARDIAC AND PANCREATIC METASTASES. FINDINGS ON FDG PET-CT

Fetched: February 8th, 2023, 5:02am GMT by Parneet Singh

J Nucl Med Technol. 2023 Jun;51(2):156-157. doi: 10.2967/jnmt.122.265212. Epub 2023 Feb 7.

ABSTRACT

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 ¹⁸F-FDG PET/CT scan of one such case of phyllodes tumor showing cardiac and pancreatic metastases, which are an extremely rare occurrence.

PMID:36750379 | DOI:10.2967/jnmt.122.265212
Pathological features and clinicopathological significance of TERT promoter mutation in breast fibroepithelial tumors without definite diagnosis

Fetched: February 8th, 2023, 5:02am GMT by J G Wang

Zhonghua Bing Li Xue Za Zhi. 2023 Feb 8;52(2):153-159. doi: 10.3760/cma.j.cn112151-20220506-00366.

ABSTRACT

Objective: To investigate the pathological features and the clinicopathological significance of TERT detection in those tumors that were difficult to diagnosis. Methods: A total of 93 cases of fibroepithelial tumors without definite diagnosis were collected from the Affiliated Hospital of Qigndao University between 2013 and 2021. The clinical details such as patients' age and tumor size were collected. All slides were re-reviewed and the pathologic parameters, including stromal cellularity, stromal cell atypia, stromal cell mitoses, and stromal overgrowth were re-interpreted. Sanger sequencing was used to detect TERT promoter status, and immunohistochemistry was performed to detect TERT protein expression. The relationship between TERT promoter mutation as well as protein expression levels and the clinicopathological parameters were also analyzed. Results: The patients' ages ranged from 30 to 71 years (mean of 46 years); the tumor size ranged from 1.2 to 8.0 cm (mean 3.8 cm). These tumors showed the following morphologic features: leafy structures in the background of fibroadenoma, or moderately to severely abundant stromal cells. The interpretations of tumor border status were ambiguous in some cases. The incidence of TERT promoter mutation was high in patients of age≥50 years, tumor size≥4 cm, and stromal overgrowth at ×4 or ×10 objective, and these clinicopathologic features were in favor of diagnosis of phyllodes tumors. TERT protein expression levels was not associated with the above clinicopathologic parameters and its promoter mutation status. Conclusions: The diagnostic difficulty for the breast fibroepithelial tumors is due to the difficulty in recognition of the leafy structures or in those cases with abundant stromal cells. A comprehensive evaluation combined with morphologic characteristics and molecular parameters such as TERT promoter may be helpful for the correct diagnosis and better evaluating recurrence risk.

PMID:36748136 | DOI:10.3760/cma.j.cn112151-20220506-00366
Bilateral Breast Phyllodes Tumor in Androgen Insensitivity Syndrome

Fetched: February 7th, 2023, 5:01am GMT by Aishwarya Sunil Dutt

Surg J (N Y). 2023 Feb 3;9(1):e23-e27. doi: 10.1055/s-0042-1758668. eCollection 2023 Jan.

ABSTRACT

Phyllodes is a rare tumor found exclusively in females. It can be classified into benign, intermediate, or malignant variety based on the aggressive nature of the disease. With adequate preoperative clinical assessment combined with histopathology and radiological investigations the adequate treatment strategy can be formulated to avoid future recurrences. Complete androgen insensitivity syndrome (CAIS) is associated with a genotypic male, which can be confirmed by karyotyping, with phenotypic female characteristics. The present case is the first case of bilateral breast phyllodes tumor in a patient with CAIS. Preoperative assessment was suggestive of bilateral phyllodes tumor with bilateral gonads in the inguinal region which was confirmed to be testis postoperatively on histopathological analysis. A brief case report with review of literature is presented.

PMID:36742156 | PMC:PMC9897893 | DOI:10.1055/s-0042-1758668

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