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New sequencing technique reveals genetic clues to rare breast tumors
Phyllodes tumors represent about 1 percent of all types of breast tumors. Most are benign but they do have the potential to become metastatic. Currently, there are no good ways to reliably predict which tumors are likely to recur or spread after ...
What Your Mammogram Won't Tell You
I have a rare Phyllodes tumor; it's benign, at least for now. If you've never heard of Phyllodes, you're not alone — many doctors haven't, either. Phyllodes tumors are rare breast tumors that develop in the stroma (connective tissue) of the breast and ...
Update on the diagnosis and management of malignant phyllodes tumors of the breast.
Breast. 2017 Mar 16;33:91-96
Authors: Strode M, Khoury T, Mangieri C, Takabe K
Malignant phyllodes tumors of the breast are a rare entity. They occur infrequently but most often in younger women in comparison to typical epithelial-based breast cancers. Treatment of these tumors is not without controversy and in this review we will present an update on the diagnosis and management of malignant phyllodes tumors of the breast.
PMID: 28327352 [PubMed - as supplied by publisher]
Fibroepithelial Lesions in the Breast of Adolescent Females: A Clinicopathological Study of 54 Cases.
Breast J. 2017 Mar;23(2):182-192
Authors: Ross DS, Giri DD, Akram MM, Catalano JP, Olcese C, Van Zee KJ, Brogi E
Fibroepithelial lesions (FELs) are the most frequent breast tumors in adolescent females. The pubertal hormonal surge could impact the growth and microscopic appearance of FELs in this age group. In this study, we evaluate the morphology and clinical behavior of FELs in adolescents. We searched the 1992-2012 pathology data base for FELs in females 18 years old or younger (F ≤18 years). Seven FELs from 1975 to 1983 were also included. Three pathologists reviewed all available material. Patient (pt) characteristics and follow-up information were obtained from electronic medical records. Forty-eight F ≤18 years had 54 FELs with available slides. Thirty (67%) pts were Caucasian, 12 (27%) African-American, two (4%) Hispanic, one (2%) Asian; three were of unknown race/ethnicity. Median age at diagnosis was 16 years. Median age at menarche was 12 years; most (96%) FELs occurred after menarche (median interval 48 months). All patients underwent lumpectomy; one required subsequent mastectomy. The FELs were 34 fibroadenomas (FAs) (11 usual, 23 juvenile), and 20 phyllodes tumors (PTs) (16 benign, one borderline and three malignant). Eight (35%) juvenile FAs showed slight intratumoral heterogeneity. The mean mitotic rate was 1.3 mitoses/10 high-power fields (HPFs) (range, 0-6) in usual FAs, 1.8/10 HPFs in juvenile FAs, 3.1/10 HPFs in benign PTs, 10/10 HPFs in the borderline PT and 17/10 HPFs in malignant PTs. The mean follow-up for 29 pts with 33 FELs was 44 months. Two (10%) PTs recurred locally (a benign PT at 18 months, and a borderline PT at 11 months). Both recurrent PTs had microscopic margins <1 mm. Mitotic activity in FAs from adolescents can be substantial and this finding should be interpreted cautiously. Awareness of the morphologic features of FELs in adolescents is important to avoid overdiagnosis of PTs, which can lead to additional unnecessary and potentially disfiguring surgery.
PMID: 28299887 [PubMed - in process]
[Anogenital mammary-like glands and related lesions. Part 1. Benign tumors and tumor-like disorders].
Arkh Patol. 2017;79(1):43-51
Authors: Konstantinova AM, Belousova IE, Katserovska D, Mikhal M, Shelekhova KV, Kazakov DV
Anogenital mammary-like glands represent a normal anatomic constituent of the anogenital area and may give rise to many benign and malignant tumors that morphologically mimic similar breast diseases. The literature review is complemented by a description of 286 cases of benign tumors and tumor-like processes in the mammary-like glands. The paper presents the clinical and morphological characteristics of papillary hidradenoma, fibroadenoma, benign phyllodes tumor, lactating adenoma, sclerosing adenosis, pseudoangiomatous stromal hyperplasia, etc.
PMID: 28295007 [PubMed - in process]
Resection and reconstruction following recurrent malignant phyllodes-Case report and review of literature.
Ann Med Surg (Lond). 2017 Apr;16:14-18
Authors: Rajesh A, Farooq M
INTRODUCTION: Phyllodes tumors are uncommon biphasic fibroepithelial neoplasms of the breast of varying malignant potential occurring in middle aged women. They exhibit diverse biological behavior. Margin free excision is the mainstay of treatment.
CASE PRESENTATION: A 27 year-old lady was referred with a painless ulceroproliferative right breast lesion which had rapidly progressed over six months. Three years back, she had been diagnosed with a borderline phyllodes tumor and underwent a wide local excision followed by a right mastectomy for recurrence. The resection margins were positive hence she underwent postoperative radiation. We performed a radical resection of the chest wall and reconstruction using a composite mesh (inner PTFE and outer vypro), pedicled latissimus dorsi flap and a split skin graft for the recurrent malignant tumor. She recovered uneventfully thereafter.
DISCUSSION: Malignant phyllodes tumor is uncommon and treatment principles are from case reports and retrospective studies. Aggressive resection of the lesion and reconstruction of the chest wall with bone cement and two meshes-a composite mesh (inner layer -polytetrafluroethylene and outer layer of polypropylene) and a Vypro mesh is a possibility. This case highlights the challenges encountered in managing these patients and presents a radical solution.
CONCLUSION: Treatment of phyllodes tumor necessitates adequate excision of the tumor and adjacent tissues to ensure tumor free margins. Pathological evolution from intermediate to malignant histology may be exhibited. A full-thickness chest wall resection and reconstruction although radical is a feasible option as these tumors rarely respond to other modalities of cancer management.
PMID: 28275427 [PubMed]
Radiotherapy in Phyllodes Tumour.
J Clin Diagn Res. 2017 Jan;11(1):XC01-XC03
Authors: Varghese SS, Sasidharan B, Manipadam MT, Paul MJ, Backianathan S
INTRODUCTION: Phyllodes Tumour (PT) of the breast is a relatively rare breast neoplasm (<1%) with diverse range of pathology and biological behaviour.
AIM: To describe the clinical course of PT and to define the role of Radiotherapy (RT) in PT of the breast.
MATERIALS AND METHODS: Retrospective analysis of hospital data of patients with PT presented from 2005 to 2014 was done. Descriptive statistics was used to analyze the results. Simple description of data was done in this study. Age and duration of symptoms were expressed in median and range. Percentages, tables and general discussions were used to understand the meaning of the data analyzed.
RESULTS: Out of the 98 patients, 92 were eligible for analysis. The median age of presentation was 43 years. A total of 64/92 patients were premenopausal. There was no side predilection for this tumour but 57/92 patients presented as an upper outer quadrant lump. Fifty percent of the patients presented as giant (10 cm) PT. The median duration of symptoms was 12 months (range: 1-168 months). A 60% of patients had Benign (B), 23% had Borderline (BL) and 17% had malignant (M) tumours. The surgical treatment for benign histology included Lumpectomy (L) for 15%, Wide Local Excision (WLE) for 48%, and Simple Mastectomy (SM) for 37%. All BL and M tumours were treated with WLE or SM. There was no recurrence in B and BL group when the margin was ≥1 cm. All non-metastatic M tumours received adjuvant RT irrespective of their margin status. Total 3/16 patients with M developed local recurrence. Total 6/16 M patients had distant metastases (lung or bone). Our median duration of follow up was 20 months (range: 1-120 months).
CONCLUSION: Surgical resection with adequate margins (>1 cm) gave excellent local control in B and BL tumours. For patients with BL PT, local radiotherapy is useful, if margins are close or positive even after the best surgical resection. There is a trend towards improved local control with adjuvant radiotherapy for malignant PT. Metastatic malignant PT has a poor outcome.
PMID: 28274029 [PubMed - in process]
Role of CD10 Immunoexpression in Grading Phyllodes Tumour of the Breast.
J Clin Diagn Res. 2017 Jan;11(1):EC14-EC16
Authors: Kulkarni MM, Khandeparkar SG, Joshi AR, Kothikar V, Nasare A, Patil S, Niraspatil S, Dhande B
INTRODUCTION: Fibroepithelial tumours are a heterogeneous group of biphasic neoplasms consisting of a proliferation of both epithelial and stromal components. Fibroadenoma (FA) and Phyllodes Tumour (PT) constitute the major entities. It is crucial to distinguish benign from borderline PT (low grade malignant PT), because the former do not metastasize, have a lesser risk of local recurrence and initial local recurrences are histologically benign in almost all instances. Multiple Immunohistochemical (IHC) markers are being studied to find their utility in grading the PT accurately for planning proper treatment.
AIM: To study, the IHC expression of CD10 in the stromal cells of a series of PTs and FA, with the aim of determining whether the degree of CD10 expression in the stromal cells is related to the grade of the tumour.
MATERIALS AND METHODS: Records of 28 cases of PT and 35 cases of FA received in the Department of Pathology in a tertiary care hospital were obtained. Histopathology reports and slides of all the cases were reviewed and clinical data such as age and histomorphological features such as tumour cellularity, stromal overgrowth, mitotic count and nuclear atypia were noted. Representative block of the tumour with maximum cellularity was subjected to CD10 staining. For FA and benign PT a technique of tissue microarray was used. For borderline and malignant PT, representative section was used. Stromal cell staining was assessed, using cytoplasmic staining of the breast myoepithelium as internal control.
RESULTS: Present study included 35 cases of FA, 20 cases of benign PT, five cases of borderline PT and three cases of malignant PT. The mean age of the patients increased with the increasing tumour grade of PT and this was also observed for FA and benign PT. The mean age increased with increase in tumour grade of PT and was statistically significant (p<0.05). The mean size did not increase with the increasing tumour grade of PT and was statistically insignificant (p=0.0429). Mean tumour size was more in benign PT as compared to FA and was highly statistically significant (p<0.01). CD10 staining was diffuse (Grade-3) and strong in malignant PT. The staining intensity was strong but patchy (Grade-2) in borderline PT. Weak and patchy (Grade-1) CD10 staining was seen in four benign PT and six FA. Other cases of benign PT and FA were negative for CD10 immunoreactivity.
CONCLUSION: Our study showed that CD10 expression strongly correlates with the PT grade, which can help in the differentiation between benign and malignant variants of PT.
PMID: 28273972 [PubMed - in process]
First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability?
Eur J Radiol. 2017 Apr;89:226-233
Authors: Marcon M, Frauenfelder T, Becker AS, Dedes KJ, Boss A
OBJECTIVES: To evaluate the outcome of repeated short-term follow-up with ultrasound in no high-risk young patients with a BI-RADS3 lesion at first examination.
METHODS: In this IRB-approved study 492 women, aged 18-34 years (mean±standard deviation, 28±4.5years) with first breast ultrasound examination in 2012-2014 were retrospectively evaluated. Inclusion criteria were: at least one BI-RADS3 lesion and (a) biopsy/surgical excision or (b) follow-up of at least 18 months (including a 6-month follow-up). BI-RADS category assigned during follow-up and pathologic findings in cases undergoing biopsy/surgical excision were collected. At the 6- and 18-month follow-up the recommended biopsy rates (RBR) and the corresponding positive predictive value (PPV) were calculated.
RESULTS: In 97 patients, 151 BI-RADS3 lesions were identified. Biopsy/surgical excision was initially performed in 25/151 (16.5%) lesions. After 6-month, category was downgraded to BI-RADS1/2 in 23/126 (15.3%) and upgraded to BI-RADS4 in 9/126 lesions (7.1%). Pathological diagnosis of these lesions was fibroadenoma in 5 and benign phyllodes tumor in 4 cases (RBR 7%, PPVbio 44.4%). After 18-month one lesion was classified BI-RADS4 and pathological diagnosis was fibroadenoma (RBR 1.1%, PPVbio 0%).
CONCLUSIONS: Our preliminary data show that follow-up imaging performed after 18 months from a first BI-RADS3 diagnosis does not affect clinical treatment and 6-month follow-up may be sufficient to assess the stability of probably benign lesions.
PMID: 28267544 [PubMed - in process]
Genetic Analysis of Uterine Adenosarcomas and Phyllodes Tumors of the Breast.
Mol Oncol. 2017 Mar 07;:
Authors: Geyer FC, Burke KA, Piscuoglio S, Ng CK, Papanastasiou AD, Marchiò C, Selenica P, Edelweiss M, Murray MP, Brogi E, Soslow RA, Rubin BP, Norton L, Reis-Filho JS, Weigelt B
Uterine adenosarcomas and breast phyllodes tumors (PTs) are morphologically similar, being composed of stromal projections in a leaf-like fashion lined by epithelial cells. Here we investigated whether their histologic similarities would be mirrored at the genetic level. The previously reported repertoires of somatic genetic alterations found in 19 adenosarcomas and 22 PTs (six benign, six borderline and 10 malignant) were compared. Phyllodes tumors significantly more frequently displayed mutations affecting MED12, the TERT gene promoter and bona fide cancer genes; whereas adenosarcomas harbored a higher rate of MDM2/CDK4 and TERT gene amplifications. Pathway analyses based on the genes affected by somatic genetic alterations in these tumors indicated that Wnt signaling likely plays a role in the biology of adenosarcomas and benign/borderline PTs. In conclusion, despite the differences at the gene level, PTs and adenosarcomas share remarkable morphologic similarities and enrichment for somatic genetic alterations affecting Wnt pathway-related genes.
PMID: 28267263 [PubMed - as supplied by publisher]
Diffusion-Weighted Imaging-guided MR Spectroscopy in Breast Lesions using Readout-Segmented Echo-Planar Imaging.
Eur Radiol. 2016 Jun;26(6):1565-74
Authors: Sun K, Chai W, Fu C, Zhan Y, Shen K, Luo X, Yan F
PURPOSE: To investigate the feasibility and effectiveness of diffusion-weighted imaging (DWI)-guided magnetic resonance spectroscopy (MRS) using readout-segmented echo-planar imaging (RS-EPI) to characterise breast lesions.
MATERIALS AND METHODS: A total of 258 patients with 258 suspicious breast lesions larger than 1 cm in diameter were examined using DWI-guided, single-voxel MRS with RS-EPI. The mean total choline-containing compound (tCho) signal-to-noise ratio (SNR) and concentration were used for the interpretation of MRS data. T-tests, χ(2)-tests, receiver operating characteristic (ROC) curve analyses and Pearson correlations were conducted for statistical analysis.
RESULTS: Histologically, 183 lesions were malignant, and 75 lesions were benign. Both the mean tCho SNR and concentration of malignant lesions were higher than those of benign lesions (6.23 ± 3.30 AU/mL vs. 1.26 ± 1.75 AU/mL and 3.17 ± 2.03 mmol/kg vs. 0.86 ± 0.83 mmol/kg, respectively; P < 0.0001). For a tCho SNR of 2.0 AU/mL and a concentration of 1.76 mmol/kg, the corresponding areas under the ROC curves were 0.93 and 0.90, respectively. The mean tCho SNR and concentration negatively correlated with apparent diffusion coefficients calculated from RS-EPI, with correlation coefficients of -0.54 and -0.48, respectively.
CONCLUSION: DWI-guided MRS using RS-EPI is feasible and accurate for characterising breast lesions.
KEY POINTS: • The mean tCho SNR and concentration negatively correlated with ADCs. • DWI-guided MRS using RS-EPI is feasible. • DWI-guided MRS using RS-EPI accurately characterises breast lesions.
PMID: 26385807 [PubMed - indexed for MEDLINE]