CD117/c-KIT Expression in Phyllodes Tumor of the Breast and Its Correlation With Morphology and Clinical Outcome

Fetched: June 15th, 2021, 5:02am GMT by Sidra Jahangir

Cureus. 2021 May 9;13(5):e14914. doi: 10.7759/cureus.14914.

ABSTRACT

Introduction Breast phyllodes tumor's (PT) clinical behavior is difficult to predict on histology. There is limited amount of data available on the role of biological markers. The objective of this study was to assess the expression of CD117 (c-KIT) in PT of the breast and its relationship with morphology and clinical outcome. Methods A total of 78 patients having available clinical records between 2004 and 2014 with breast PT were retrieved from the cancer registry at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and were followed up. Immunohistochemical studies were performed on all the cases using mono-clonal antibody CD117 (DAKO A4502) using Leica Bond-Max automated biosystem (Leica Biosystems, Melbourne, Australia). Staining proportion and intensity of both epithelial and stromal elements were analyzed. Evaluation of the protein expression was determined and scored. Results Patients' mean age was 45.13 ± 11.4 years. Thirty-nine (50.0%) patients had tumor on right side, 38 (48.7%) had on left and only one (1.3%) was bilateral. Thirty-two (41.0%) patients had benign PT, 21 (26.9%) had borderline and 25 (32.1%) had malignant PT. Negative CD117 expression was observed in 20 (62.5%), eight (38.0%) and 12 (48.0%) of benign, borderline and malignant PTs, respectively. Positive CD117 expression was observed in 12 (37.5%) benign, 13 (61.9%) borderline and 13 (52.0%) malignant PTs. There was insignificant association between CD117 expression with respect to tumor sub-type, patient's age and clinical behavior (p-value > 0.05). Conclusion CD117 expression was not found to be associated with tumor type and was not associated with increased risk of recurrence in this sample of patients. Further work is needed to better understand the prognostic value of CD117 expression in breast PTs.

PMID:34123614 | PMC:PMC8189265 | DOI:10.7759/cureus.14914
A retrospective review of phyllodes tumors of the breast from a single institution

Fetched: June 8th, 2021, 5:01am GMT by Ayu Yuniandini

Breast Dis. 2021 May 28. doi: 10.3233/BD-219009. Online ahead of print.

ABSTRACT

BACKGROUND: Phyllodes tumors (PTs) are rare fibroepithelial breast tumors with diverse biological behavior.

OBJECTIVE: This study aimed to analyze the characteristics, management, and outcome of phyllodes tumors.

METHODS: Patients diagnosed with PTs in our institution from January 2013 to December 2017 were identified retrospectively by the ICD-10 code. Data were collected from medical records. The diagnosis of this tumor was based on histopathological results. Variables analyzed included age, tumor site, surgical option, axillary lymph nodes, chemotherapy and radiotherapy, metastases, disease-free survival (DFS), and overall survival (OS) rate.

RESULTS: Sixty-nine cases of PTs were diagnosed during the period, of which 31 were benign, 38 were malignant, and 1 was a case of bilateral metachronous tumors. We did not find any borderline pathologic cases. The patient's ages ranged from 20 to 71 years, with the highest number of cases (28) from the 40-49-year-old age group. The majority of patients (42) had PT on the right side. Simple mastectomy was the most performed treatment, with 53 such cases, including both benign and malignant. The axillary staging was carried out in 16 cases, of which none had nodal metastasis. Ten cases received chemotherapy, and 16 cases of malignant phyllodes received postoperative radiotherapy. We found 4 cases with distant metastases and 5 cases that developed local recurrence. The DFS rate reached 92.75%, and the overall 5-year survival rate was 84.21%.

CONCLUSIONS: The incidence of PTs is highest in women in the 3rd and fourth decades of age. Simple mastectomy and wide excision are the treatments of choice, with a low recurrence rate in both benign and malignant PTs cases.

PMID:34092583 | DOI:10.3233/BD-219009
Molecular characterization of pleomorphic liposarcomatous differentiation in malignant phyllodes tumor of the breast: A case report

Fetched: June 7th, 2021, 5:01am GMT by Peng Zhou

Pathol Res Pract. 2021 May 24;224:153489. doi: 10.1016/j.prp.2021.153489. Online ahead of print.

ABSTRACT

Phyllodes tumors of the breast are rare fibroepithelial tumors, and malignant phyllodes tumors occasionally exhibit heterogeneous differentiation. Here, we report a case of malignant phyllodes tumor with pleomorphic liposarcomatous differentiation, and examined the genomic features of both components using capture-based next-generation sequencing of 425 cancer-related genes. A 56-year-old woman presented with a palpable, asymptomatic nodule in the right breast measuring 4.0 cm × 3.0 cm. Based on the findings from microscopic examination, the lesions were identified as malignant phyllodes tumor and pleomorphic liposarcoma. The liposarcomatous differentiation component was positive for S-100, but had no MDM2 and CDK4 amplifications according to the results of fluorescence in situ hybridization. The malignant phyllodes tumor and liposarcomatous differentiation component had similar genetic mutations, such as TP53, TERT, EGFR, RARA, RB1, and MED12 mutations, all of which are common mutations in phyllodes tumors. These results indicate that the pathogenesis of the pleomorphic liposarcomatous differentiation was similar with that of phyllodes tumor, but was different from the pleomorphic liposarcoma in extramammary sites. Thus, the intratumoral heterogeneity may have independently evolved after tumorigenesis.

PMID:34091389 | DOI:10.1016/j.prp.2021.153489
Squamous Metaplasia in a Borderline Phyllodes Tumor-an Undocumented Histological Finding in Male Breast: Report of a Case and Review of Literature

Fetched: June 4th, 2021, 5:01am GMT by Chinmayee Panigrahi

Int J Surg Pathol. 2021 Jun 3:10668969211022017. doi: 10.1177/10668969211022017. Online ahead of print.

ABSTRACT

Phyllodes tumor is a paradigm of fibroepithelial neoplasm that accounts for <1% of the breast neoplastic lesions usually detected in females and uncommonly in the male breast. The World Health Organization classifies the tumor into benign, borderline, and malignant based on the predefined morphological criteria. Squamous differentiation in phyllodes tumor is epithelial metaplasia, which has been occasionally documented in English literature. We report the first undocumented case of a recurrent borderline phyllodes tumor with cystic squamous metaplastic change in a 32-year-old male patient. The histology was that of a fibroepithelial neoplasm with the typical leaf-like projections and cystic spaces lined by squamous epithelium containing keratin debris. The purpose of presenting this case is to elucidate the pathogenesis and discuss other malignant and benign breast lesions that may be included in the differential diagnosis when evaluating a breast lesion with squamous metaplasia, particularly in the context of fine-needle aspirates.

PMID:34080913 | DOI:10.1177/10668969211022017
A Giant, Complex Fibroepithelial Tumor of the Breast: Borderline Phyllodes Tumor Combined with Tubular Adenoma - a Rare Clinical Presentation of a Fibroepithelial Tumor of the Breast

Fetched: June 3rd, 2021, 5:02am GMT by Nermina Ibisevic

Acta Med Acad. 2021 Apr;50(1):218-220. doi: 10.5644/ama2006-124.337.

NO ABSTRACT

PMID:34075775 | DOI:10.5644/ama2006-124.337
Preoperative interventional artery embolization for the treatment of a giant malignant phyllodes tumor: A case report

Fetched: June 1st, 2021, 5:01am GMT by Yue Tian

Mol Clin Oncol. 2021 Jul;15(1):133. doi: 10.3892/mco.2021.2295. Epub 2021 May 11.

ABSTRACT

Phyllodes tumors (PTs) are rare but complex fibroepithelial lesions of the breast. The present report describes an unusual case of a giant malignant PT with a rich blood supply treated with dominant blood supply internal thoracic artery interventional embolization before surgery. A 41-year-old woman without underlying systemic disease presented with a tumor >20 cm in diameter growing rapidly in the left breast. Radiological results indicated a giant circular tumor with a clear boundary occupying the whole breast, possible invasion of the major pectoralis muscle and several enlarged lymph nodes in the left axillary region. Computed tomography angiography showed a large mass with a rich and powerful blood vessel supply and preoperative interventional embolization was performed to block the internal thoracic artery. Three days after artery embolization, mastectomy and grade I axillary lymph node dissection were performed. The giant tumor measured 17x16x11 cm. The surgery successfully treated the pain and tumor necrosis and the patient received chemotherapy and local radiotherapy. No recurrence was found at the 14-month follow-up.

PMID:34055348 | PMC:PMC8138852 | DOI:10.3892/mco.2021.2295
Phyllodes tumour arising in the ectopic axillary breast tissue, mimicking axillary lymphadenopathy

Fetched: May 28th, 2021, 5:01am GMT by Akihiro Fujimoto

BMJ Case Rep. 2021 May 26;14(5):e243341. doi: 10.1136/bcr-2021-243341.

NO ABSTRACT

PMID:34039555 | PMC:PMC8160160 | DOI:10.1136/bcr-2021-243341
High-risk lesions of the breast: concurrent diagnostic tools and management recommendations

Fetched: May 27th, 2021, 5:02am GMT by Francesca Catanzariti

Insights Imaging. 2021 May 26;12(1):63. doi: 10.1186/s13244-021-01005-6.

ABSTRACT

Breast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favored to reduce overtreatment and spare patients from unnecessary anxiety or high healthcare costs associated with surgical excision. The purpose of this work is to provide the reader with an accurate overview focused on the main high-risk lesions of the breast: atypical intraductal epithelial proliferation (atypical ductal hyperplasia), lobular neoplasia (including the subcategories lobular carcinoma in situ and atypical lobular hyperplasia), flat epithelial atypia, radial scar and papillary lesions, and phyllodes tumor. Beyond merely presenting the radiological aspects of these lesions and the recent literature, information about their potential upgrade rates is discussed in order to provide a useful guide for appropriate clinical management while avoiding the risks of unnecessary surgical intervention (overtreatment).

PMID:34037876 | PMC:PMC8155169 | DOI:10.1186/s13244-021-01005-6
NCCN Guidelines Insights: Breast Cancer, Version 4.2021

Fetched: May 26th, 2021, 5:02am GMT by William J Gradishar

J Natl Compr Canc Netw. 2021 May 1;19(5):484-493. doi: 10.6004/jnccn.2021.0023.

ABSTRACT

The NCCN Guidelines for Breast Cancer include up-to-date guidelines for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, male breast cancer, and breast cancer during pregnancy. These guidelines are developed by a multidisciplinary panel of representatives from NCCN Member Institutions with breast cancer-focused expertise in the fields of medical oncology, surgical oncology, radiation oncology, pathology, reconstructive surgery, and patient advocacy. These NCCN Guidelines Insights focus on the most recent updates to recommendations for adjuvant systemic therapy in patients with nonmetastatic, early-stage, hormone receptor-positive, HER2-negative breast cancer.

PMID:34030128 | DOI:10.6004/jnccn.2021.0023
Apatinib treatment is effective for metastatic malignant phyllodes tumors of the breast: a case report

Fetched: May 25th, 2021, 5:01am GMT by Xiaolu Wang

BMC Womens Health. 2021 May 22;21(1):218. doi: 10.1186/s12905-021-01359-5.

ABSTRACT

BACKGROUND: We report a rare case of malignant phyllodes tumors (MPT) with partial response to apatinib.

CASE PRESENTATION: A 26-year-old woman had a palpable mass in her right breast for over a year. After resection, pathology indicated malignant phyllodes tumor. Eleven months after surgery, she underwent reoperation for a lung nodule, which demonstrated lung metastasis. She refused chemotherapy and was rehospitalized six months later due to leg pain. Pelvic mass biopsy revealed metastatic malignant phyllodes tumor. After concurrent chemoradiotherapy of the pelvic mass, multiple lung metastases emerged. Subsequent treatment with apatinib 500 mg/day resulted in a reduction in mass size and partial response. She survived for more than 8 months.

CONCLUSION: The present case showed the potential therapeutic effects of apatinib in patients with MPT.

PMID:34022875 | PMC:PMC8141161 | DOI:10.1186/s12905-021-01359-5
Giant breast fibroadenoma in pregnancy

Fetched: May 23rd, 2021, 5:02am GMT by Krhovský M

Ceska Gynekol. 2021;86(2):114-117. doi: 10.48095/cccg2021114.

ABSTRACT

OBJECTIVE: To present unusual case of rapidly growing breast fibroadenoma during pregnancy.

CASE REPORT: Breast fibroadenomas are hormone-dependent tumors which can grow rapidly during pregnancy. We present a case of giant fibroadenoma, first detected before pregnancy, which grew rapidly under the influence of pregnancy hormones and was excised in the third trimester.

CONCLUSION: Fibroadenomas are benign breast lesions in young women. They are hormone-dependent tumors, which can grow rapidly especially during pregnancy and/ or lactation and imitate malignancy. In each case of a newly created breast lesion, it is necessary to proceed responsibly to the clinical examination, which is a base for further decision concerning the necessity of taking a biopsy for histological verification.

PMID:34020558 | DOI:10.48095/cccg2021114
Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Epidemiology, Diagnosis, Staging, and Histology-Specific Management Considerations

Fetched: May 20th, 2021, 5:01am GMT by George Z Li

Am Soc Clin Oncol Educ Book. 2021 Mar;41:390-404. doi: 10.1200/EDBK_321341.

ABSTRACT

Breast sarcomas arise from connective tissues of the breast and account for fewer than 1% of all breast malignancies. They can be subclassified as primary breast sarcomas, which arise de novo and are histologically diverse, and secondary breast sarcomas, which arise as a result of radiation or lymphedema and are most commonly angiosarcomas. Two other connective tissue neoplasms that occur within the breast include phyllodes tumors and desmoid tumors, which exhibit a spectrum of behaviors. Malignant phyllodes tumors are biologically similar to primary breast sarcomas, whereas desmoid tumors are technically benign but often locally aggressive. Patients with breast sarcomas often present with a rapidly growing mass or, in cases of radiation-associated angiosarcoma, violaceous cutaneous lesions. Core needle biopsy is generally required to confirm the diagnosis of sarcomas. Staging workup includes MRI and chest imaging, although these are not required in the case of benign phyllodes or desmoid tumors. In general, localized breast sarcomas should be resected, with the extent of resection tailored to histologic subtype. Radiation and chemotherapy can be used in the neoadjuvant or adjuvant setting, but data are limited, so treatment decisions should be made on an individualized basis. Systemic therapy options for metastatic disease and refractory breast desmoids mimic those used for the same histologies when present in other sites. Given the rarity and heterogeneity of breast sarcoma, as well as limited literature describing these entities, expert multidisciplinary evaluation is crucial for optimal decision making.

PMID:34010054 | DOI:10.1200/EDBK_321341
A Case of Phyllodes Tumor of the Breast with Mixed Liposarcoma: Case Report and Literature Review

Fetched: May 15th, 2021, 5:01am GMT by Mei Er Tu He Ta Mi Shi

Onco Targets Ther. 2021 May 6;14:3003-3011. doi: 10.2147/OTT.S298379. eCollection 2021.

ABSTRACT

Phyllodes tumors (PTs) account for less than 1% of breast tumors, and malignant PTs account for even less. Here, we described an unusual case of malignant PT with mixed liposarcoma (myxoid liposarcoma [MLP] and pleomorphic liposarcoma [PLP]). A 52-year-old woman discovered a small lump in her left breast. Twenty years later, the lump suddenly grew within 1 month. Mammography showed space-occupying lesions of the left breast. Histologically, the tumor was characterized by hypercellular stroma covering the epithelium and protrusion of the myoepithelium into the cyst to form a lobulated structure; regions of loose mucus and hypercellular structures alternated. A region of peripheral benign fibroadenoma was also observed, and many stellate and spindle cells or signet ring-like cells were identified in loose areas. Some areas showed a characteristic thin branching vascular pattern. In the cell-rich area, adipocytes and odd megakaryocytes were observed. Atypical mitotic figures were observed in the cell-rich and mucus areas (16 mitoses/10 high-power fields [HPF] and 2 mitoses/10 HPF, respectively). In the immunohistochemical analysis, a small number of tumor cells were positive for AE1/3 and vimentin, whereas all cells were negative for cytokeratin 34βE12, E-cadherin, p63, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and S-100, ruling out the possibility of metaplastic carcinoma. Interestingly, cyclin-dependent kinase 4, mouse double minute 2 (MDM2), and p16 were strongly positive in both loose mucus and cell-rich areas. However, the fluorescence in situ hybridization test results showed that MDM2 was not amplified. Combined with morphological characteristics, these findings supported that the tumor was a mixed malignant PT with MLP and PLP. Our patient did not receive radiation therapy, and after 47 months of follow-up, no recurrence or metastasis occurred. This case report serves to expand the morphologic spectrum of mixed malignant PT with liposarcoma.

PMID:33986601 | PMC:PMC8110257 | DOI:10.2147/OTT.S298379
Malignant Phyllodes of Breast

Fetched: May 15th, 2021, 5:01am GMT by Cha Kyong Yom

Adv Exp Med Biol. 2021;1187:601-612. doi: 10.1007/978-981-32-9620-6_32.

ABSTRACT

Phyllodes tumors of breast (PTB) have been known to an uncommon and particular disease to handle owing to diagnostic ambiguity and unpredictable clinical outcome. Malignant phyllodes tumors (MPT) are diagnosed when there are marked stromal hypercellularity, atypia, increased mitoses of ≥10/10 HPFs, permeative tumor borders, and stromal overgrowth. The presence of a malignant heterologous element (MHE) places the tumor into the malignant category regardless of other histological features. Excision with negative margins should be achieved for recurrent and malignant phyllodes tumor. An ideal margin width remains to be determined, and may need to be considered in relation to factors such as tumor size and cosmesis. Without the convincing evidence of survival benefit, adjuvant RT has revealed more favorable local control rate compared with observation group. Stromal expression of Twist and Foxc2, epithelial-mesenchymal transition marker, was associated with high tumor grade and poor prognosis. Tumor-associated macrophage drives myoblast differentiation and malignant progression of PTB through a CCL18-driven signaling cascade amenable to antibody disruption. Recent targeted sequencing on PTBs provided insights into the molecular pathogenesis and genetic characterization with potential clinical implications.

PMID:33983602 | DOI:10.1007/978-981-32-9620-6_32
Giant lactating adenoma

Fetched: May 11th, 2021, 5:01am GMT by Isac Ribeiro Moulaz

Autops Case Rep. 2021 Apr 15;11:e2021252. doi: 10.4322/acr.2021.252.

ABSTRACT

Lactating adenoma is a rare benign breast lesion that most often presents as a small (up to 3 cm), solid, well-circumscribed, solitary, painless, mobile, lobulated mass. The highest incidence occurs in primiparous women (20 to 40 years old) during the third trimester of pregnancy. However, in the rare case presented herein, in addition to its giant size (more than 10 centimeters on palpation), this lactating adenoma is distinctive due to the presence of multiple nodules, poorly defined ultrasonographic margins, worrisome radiologic features, growth since early pregnancy, presence of infarction and association with chronic mastitis. From the clinical-radiologic perspective, the differential diagnoses included abscess associated with puerperal mastitis, phyllodes tumor, and galactocele. Biopsy was performed, and pathologic examination revealed the classic characteristics of lactating adenoma with multiple infarcted areas, leading to an unexpected confirmed case of giant lactating adenoma.

PMID:33968827 | PMC:PMC8087397 | DOI:10.4322/acr.2021.252
A huge malignant phyllodes tumor of the breast with osteoclast-like giant cells: a case report

Fetched: May 11th, 2021, 5:01am GMT by Taiyuan Liu

Gland Surg. 2021 Apr;10(4):1508-1514. doi: 10.21037/gs-20-845.

ABSTRACT

The malignant phyllodes tumor (PT) of the breasts is a rare type of fibroepithelial neoplasm. Osteoclast-like giant cells (OLGCs) exist in many types of tumors. But malignant PTs with OLGCs were rarely reported. Here, we presented a case of a 49-year-old woman who had a 23 cm ×21 cm ×6 cm mass which was growing for 2 years in her left breast. The patient had moderate anemia due to the hemorrhage and exudation on the surface of the tumor. The imaging examinations such as PET-CT found no lymphatic involvement and distant metastasis. We performed mastectomy with a 2 cm surgical margin and free skin flap transplantation to restore the big wound. The vacuum assisted closure (VAC) system was used to promote wound healing. Histological examination of the surgical specimen showed atypical spindle-like stroma cells, marked nuclear pleomorphism, focal necrosis, and mitotic activity. Typical leaf-like architectures of PTs were observed in some regions. OLGCs were found in many sections of the tumor with a number of vascular proliferations. The final diagnosis was malignant PT with OLGCs. After a three-month follow-up, no local recurrence or metastasis was found. Autogenous skin grafts with VAC are available for large area skin defect after excising a huge breast tumor. The presence of OLGCs in malignant tumors may be related to necrosis and hemorrhage of the tumor. These findings also provide opportunities for understanding the mechanisms of tumor formation and development.

PMID:33968702 | PMC:PMC8102212 | DOI:10.21037/gs-20-845
Diagnostic Concordance of Phyllodes Tumour of the Breast

Fetched: May 10th, 2021, 5:01am GMT by Emad Rakha

Histopathology. 2021 May 9. doi: 10.1111/his.14397. Online ahead of print.

ABSTRACT

BACKGROUND: Phyllodes tumours (PT) are rare and distinct breast tumours, which span a morphological continuum. Classification into benign, borderline and malignant categories reflects their biology and clinical behaviour and is essential to guide management. This study aims to assess the diagnostic agreement of PT using the UK National Health Service Breast Screening Programme (NHSBSP) breast pathology external quality assurance (EQA) scheme data.

METHODS: 26 PTs were identified in the EQA scheme, which were diagnosed by an average of 607 participants/circulation. Data on diagnostic categories were collected, and representative slides were reviewed. The level of concordance between reporting pathologists was assessed.

RESULTS: There were 14 benign, 6 borderline and 6 malignant PT. The overall rate of diagnosis agreement was 86% when analysed as benign lesions, borderline PT and malignant lesions, which decreased to 79% when diagnosed as PT (irrespective of grade) and to 63% when the diagnosis was further refined to PT categories (benign, borderline and malignant PTs). The highest agreement rate was observed in malignant PT (86%) and the lowest in borderline PT (42%). Malignant heterologous elements, stromal overgrowth and leaf-like architecture are features associated with higher concordance rates. Lower priority features were stromal expansion, clefting, and multinodularity.

CONCLUSION: The concordance of PT diagnosis, as an entity, is high, but its classification into benign, borderline and malignant has variable agreement levels, with borderline tumours having the lowest concordance rate. More research to refine the diagnostic criteria for the categorisation of PT is warranted to improve concordance between pathologists.

PMID:33966296 | DOI:10.1111/his.14397
Differential diagnosis between small breast phyllodes tumors and fibroadenomas using artificial intelligence and ultrasound data

Fetched: May 4th, 2021, 5:01am GMT by Sihua Niu

Quant Imaging Med Surg. 2021 May;11(5):2052-2061. doi: 10.21037/qims-20-919.

ABSTRACT

BACKGROUND: It is challenging to differentiate between phyllodes tumors (PTs) and fibroadenomas (FAs). Artificial intelligence (AI) can provide quantitative information regarding the morphology and textural features of lesions. This study attempted to use AI to evaluate the ultrasonic images of PTs and FAs and to explore the diagnostic performance of AI features in the differential diagnosis of PTs and FAs.

METHODS: A total of 40 PTs and 290 FAs <5 cm in maximum diameter found in female patients were retrospectively analyzed. All tumors were segmented by doctors, and the features of the lesions were collated, including circularity, height-to-width ratio, margin spicules, margin coarseness (MC), margin indistinctness, margin lobulation (ML), internal calcification, angle between the long axis of the lesion and skin, energy, grey entropy, and grey mean. The differences between PTs and FAs were analyzed, and the diagnostic performance of AI features in the differential diagnosis of PTs and FAs was evaluated.

RESULTS: Statistically significant differences (P<0.05) were found in the height-to-width ratio, ML, energy, and grey entropy between the PTs and FAs. Receiver operating characteristic (ROC) curve analysis of single features showed that the area under the curve [(AUC) 0.759] of grey entropy was the largest among the four features with statistically significant differences, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.925, 0.459, 0.978, and 0.190, respectively. When considering the combinations of the features, the combination of height-to-width ratio, margin indistinctness, ML, energy, grey entropy, and internal calcification was the most optimal of the combinations of features with an AUC of 0.868, and a sensitivity, specificity, PPV, and NPV of 0.734, 0.900, 0.982, and 0.316, respectively.

CONCLUSIONS: Quantitative analysis of AI can identify subtle differences in the morphology and textural features between small PTs and FAs. Comprehensive consideration of multiple features is important for the differential diagnosis of PTs and FAs.

PMID:33936986 | PMC:PMC8047381 | DOI:10.21037/qims-20-919
Malignant Phyllodes Tumor of the Breast: A Practice Review

Fetched: May 1st, 2021, 5:02am GMT by Ângelo Bezerra de Souza Fede

Clin Pract. 2021 Apr 6;11(2):205-215. doi: 10.3390/clinpract11020030.

ABSTRACT

INTRODUCTION: Phyllodes tumor (PT) of the breast, particularly malignant phyllodes tumor (mPT), is a rare fibroepithelial neoplasm. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy.

OBJECTIVE: Our objective was to provide an overview of the clinical, pathologic, and therapeutic aspects of this rare tumor.

CONCLUSIONS: mPT is a rare presentation of breast cancer and a challenge in clinical practice. A multidisciplinary approach should take into account some aspects like pathogenic mutations and hereditary syndromes. Oncologic surgery is the fundamental approach, and the use of adjuvant therapies is still controversial due to the lack of clinical trials. Treatment recommendations should be individualized according to patient risk and preferences. Prospective studies are fundamental to clarifying the best treatment for these tumors.

PMID:33917271 | PMC:PMC8167791 | DOI:10.3390/clinpract11020030
Core needle biopsy in fibroepithelial tumors: predicting factors for phyllodes tumors

Fetched: April 23rd, 2021, 5:01am GMT by Yedda Nunes Reis

Clinics (Sao Paulo). 2021 Apr 16;76:e2806. doi: 10.6061/clinics/2021/e2806. eCollection 2021.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the clinical and imaging predictive factors for the diagnosis of phyllodes tumors in patients with inconclusive results from core needle biopsy (fibroepithelial lesions).

METHODS: We retrospectively analyzed data of patients who underwent surgical excision of breast lesions previously diagnosed as fibroepithelial lesions. Numeric variables were analyzed using the Shapiro-Wilk and t-tests, and categorical variables were analyzed using the chi-square and Fisher's exact tests. Multivariate logistic regression was performed to calculate odds ratios and detect predictive factors for the diagnosis of PT.

RESULTS: A total of 89 biopsy samples were obtained from 77 patients, of which 43 were confirmed as fibroadenomas, 43 as phyllodes tumors, and 3 as other benign, non-fibroepithelial breast lesions. The mean tumor size was 3.61 cm (range, 0.8-10 cm) for phyllodes tumors and 2.4 cm (range, 0.8-7.9 cm) for fibroadenomas. The predictive factor for phyllodes tumor diagnosis was lesion size >3 cm (p<0.001).

CONCLUSION: Our data indicate that fibroepithelial lesions of the breast larger than 3 cm are more likely to be phyllodes tumors.

PMID:33886790 | PMC:PMC8024926 | DOI:10.6061/clinics/2021/e2806
Phyllodes tumors of the breast: Adjuvant radiation therapy revisited

Fetched: April 18th, 2021, 5:01am GMT by Rimoun R Boutrus

Breast. 2021 Apr 7;58:1-5. doi: 10.1016/j.breast.2021.03.013. Online ahead of print.

ABSTRACT

BACKGROUND: Phyllodes tumors (PT) are rare entity and surgical resection is the cornerstone of treatment. No standard of care exists regarding adjuvant treatment especially radiation therapy (RT).

PATIENTS AND METHODS: We analyzed all patients with non-metastatic, resected phyllodes tumors who presented to our institution from January 2005 through December 2019. Primary study endpoints included local recurrence free survival (LRFS) and overall survival (OS).

RESULTS: One hundred and eight patients were analyzed (patients with incomplete treatment and follow up data were excluded). Fifty patients had benign phyllodes, 26 patients had borderline and 32 patients had malignant phyllodes. In the benign group, no significant difference in LRFS was observed between patients who received adjuvant RT (n = 3) and those who did not (5-year LRFS 100% vs. 85% respectively, p = 0.49). The 5 year OS for patients who received RT was 60% vs. 89% for those who did not (p 0.40). In the borderline/malignant group, adjuvant RT significantly improved five year LRFS (90% in the RT group vs. 42% in the no RT group, p = 0.005). The 5 year LRFS in patients treated with margin negative breast conserving surgery and RT was 100% vs. 34.3% in patients who did not receive RT (p 0.022). Patients treated with mastectomy and RT had a 5 year LRFS of 100% vs. 83% for patients who did not receive RT (p 0.24). On multivariate analysis, radiation therapy was independently associated with decreased hazard of local failure (HR 0.21, CI 0.05-0.89, p = 0.03). No difference in OS was found between the RT and no RT groups (5-year OS was 52% vs. 45% respectively, p 0.54).

CONCLUSION: The results of the current study confirm the excellent prognosis of benign phyllodes tumors; warranting no further adjuvant treatment after margin-negative surgical resection. For patients with borderline/malignant phyllodes tumors, adjuvant radiation therapy significantly improved LRFS after margin negative wide local excision; however, patients treated with mastectomy did not attain the same benefit from adjuvant irradiation.

PMID:33865208 | PMC:PMC8079270 | DOI:10.1016/j.breast.2021.03.013
TERT promoter hotspot mutations and gene amplification in metaplastic breast cancer

Fetched: April 18th, 2021, 5:01am GMT by Edaise M da Silva

NPJ Breast Cancer. 2021 Apr 16;7(1):43. doi: 10.1038/s41523-021-00250-8.

ABSTRACT

Metaplastic breast cancers (MBCs) are characterized by complex genomes, which seem to vary according to their histologic subtype. TERT promoter hotspot mutations and gene amplification are rare in common forms of breast cancer, but present in a subset of phyllodes tumors. Here, we sought to determine the frequency of genetic alterations affecting TERT in a cohort of 60 MBCs with distinct predominant metaplastic components (squamous, 23%; spindle, 27%; osseous, 8%; chondroid, 42%), and to compare the repertoire of genetic alterations of MBCs according to the presence of TERT promoter hotspot mutations or gene amplification. Forty-four MBCs were subjected to: whole-exome sequencing (WES; n = 27) or targeted sequencing of 341-468 cancer-related genes (n = 17); 16 MBCs were subjected to Sanger sequencing of the TERT promoter, TP53 and selected exons of PIK3CA, HRAS, and BRAF. TERT promoter hotspot mutations (n = 9) and TERT gene amplification (n = 1) were found in 10 of the 60 MBCs analyzed, respectively. These TERT alterations were less frequently found in MBCs with predominant chondroid differentiation than in other MBC subtypes (p = 0.01, Fisher's exact test) and were mutually exclusive with TP53 mutations (p < 0.001, CoMEt). In addition, a comparative analysis of the MBCs subjected to WES or targeted cancer gene sequencing (n = 44) revealed that MBCs harboring TERT promoter hotspot mutations or gene amplification (n = 6) more frequently harbored PIK3CA than TERT wild-type MBCs (n = 38; p = 0.001; Fisher's exact test). In conclusion, TERT somatic genetic alterations are found in a subset of TP53 wild-type MBCs with squamous/spindle differentiation, highlighting the genetic diversity of these cancers.

PMID:33863915 | PMC:PMC8052452 | DOI:10.1038/s41523-021-00250-8
Diagnostic challenges of benign breast phyllodes tumour: A rapid-growing tumour during pregnancy caused breast loss. A case report

Fetched: April 18th, 2021, 5:01am GMT by Lina Pankratjevaite

Int J Surg Case Rep. 2021 May;82:105866. doi: 10.1016/j.ijscr.2021.105866. Epub 2021 Apr 8.

ABSTRACT

INTRODUCTION: Phyllodes tumours are rare breast neoplasms. It is especially rare in pregnancy.

PRESENTATION OF CASE: We report a case of a 37-year-old woman with left breast benign phyllodes tumour, which started to grow very fast during pregnancy. The tumour was too big for breast-conserving surgery and it was necessary to remove the whole left breast. Patient underwent successful nipple-skin-sparing mastectomy with immediate silicone implant reconstruction.

CONCLUSION: Breast phyllodes are classified as benign, borderline, and malignant. Standard treatment of breast phyllodes is surgery. The choice of surgery type depends on the tumour factors and breast size. We highlight that, inadequate treatment of phyllodes tumour can result to recurrence, growth, or even metastatic spread, when tumour has malignant potential.

PMID:33862409 | PMC:PMC8076702 | DOI:10.1016/j.ijscr.2021.105866
Phyllodes tumor of the vulva: A case report and literature review highlighting a novel manifestation of Cowden syndrome

Fetched: April 15th, 2021, 5:02am GMT by Sahana Somasegar

Gynecol Oncol Rep. 2021 Mar 23;36:100752. doi: 10.1016/j.gore.2021.100752. eCollection 2021 May.

ABSTRACT

Cowden syndrome is a rare hereditary cancer syndrome characterized by a germline PTEN mutation which results in an increased risk of developing breast, thyroid, and endometrial carcinoma, as well as widespread benign hamartomas. Phyllodes tumor (PT) is a rare fibroepithelial tumor that accounts for less than 1% of all breast tumors. As mammary-type glands can be found in the anogenital region, PTs can rarely arise in this location. We describe the presentation, workup and management of a PT of the vulva that developed in a patient with Cowden syndrome. This report represents the first time a vulvar PT has been described in association with Cowden syndrome and should be considered in the differential diagnosis of a slow-growing vulvar mass.

PMID:33850997 | PMC:PMC8024594 | DOI:10.1016/j.gore.2021.100752
Intra-mammary lymph nodes, an overlooked breast cancer prognostic tool?

Fetched: April 15th, 2021, 5:02am GMT by Tarek Hashem

World J Surg Oncol. 2021 Apr 13;19(1):114. doi: 10.1186/s12957-021-02219-0.

ABSTRACT

BACKGROUND: Due to the high variability of incidence and prevalence of intra-mammary lymph nodes (IMLNs), they might be overlooked during clinical and radiological examinations. Properly characterizing pathological IMLNs and detecting the factors that might influence their prevalence in different stages of breast cancer might aid in proper therapeutic decision-making and could be of possible prognostic value.

METHODS: Medical records were reviewed for all breast cancer patients treated at the National Cancer Institute of Cairo University between 2013 and 2019. Radiological, pathological, and surgical data were studied.

RESULTS: Intra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phyllodes tumors and two cases had ductal carcinoma in situ (DCIS). All ten cases were excluded. The remaining 90 cases all had invasive breast cancer and were divided into two groups: one group for patients with malignant IMLNs (48) and another for patients with benign IMLNs (42). Pathological features of the malignant IMLN group included larger mean tumor size in pathology (4.7 cm), larger mean size of the IMLN in pathology (1.7 cm), higher incidence of lympho-vascular invasion (65.9%), and higher rate of extracapsular extension in axillary lymph nodes (57.4%). In addition, the pathological N stage was significantly higher in the malignant IMLN group.

CONCLUSION: Clinicians frequently overlook intra-mammary lymph nodes. More effort should be performed to detect them during preoperative imaging and during pathological processing of specimens. A suspicious IMLN should undergo a percutaneous biopsy. Malignant IMLNs are associated with advanced pathological features and should be removed during surgery.

PMID:33849561 | PMC:PMC8045254 | DOI:10.1186/s12957-021-02219-0
Management of Pediatric Breast Masses: A Multi-institutional Retrospective Cohort Study

Fetched: April 13th, 2021, 5:02am GMT by Amy E Lawrence

J Surg Res. 2021 Apr 9;264:309-315. doi: 10.1016/j.jss.2021.01.041. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of our study was to describe the workup, management, and outcomes of pediatric patients with breast masses undergoing operative intervention.

MATERIALS AND METHODS: A retrospective cohort study was conducted of girls 10-21 y of age who underwent surgery for a breast mass across 11 children's hospitals from 2011 to 2016. Demographic and clinical characteristics were summarized.

RESULTS: Four hundred and fifty-three female patients with a median age of 16 y (IQR: 3) underwent surgery for a breast mass during the study period. The most common preoperative imaging was breast ultrasound (95%); 28% reported the Breast Imaging Reporting and Data System (BI-RADS) classification. Preoperative core biopsy was performed in 12%. All patients underwent lumpectomy, most commonly due to mass size (45%) or growth (29%). The median maximum dimension of a mass on preoperative ultrasound was 2.8 cm (IQR: 1.9). Most operations were performed by pediatric surgeons (65%) and breast surgeons (25%). The most frequent pathology was fibroadenoma (75%); 3% were phyllodes. BI-RADS scoring ≥4 on breast ultrasound had a sensitivity of 0% and a negative predictive value of 93% for identifying phyllodes tumors.

CONCLUSIONS: Most pediatric breast masses are self-identified and benign. BI-RADS classification based on ultrasound was not consistently assigned and had little clinical utility for identifying phyllodes.

PMID:33845414 | DOI:10.1016/j.jss.2021.01.041
SETD2 alterations and histone H3K36 trimethylation in phyllodes tumor of breast

Fetched: April 13th, 2021, 5:02am GMT by Julia Y Tsang

Breast Cancer Res Treat. 2021 Jun;187(2):339-347. doi: 10.1007/s10549-021-06181-z. Epub 2021 Apr 12.

ABSTRACT

PURPOSE: SETD2 is one of the key epigenetic regulatory genes involved in histone modifications. Its alterations were potentially oncogenic and commonly found in cancers. Interestingly, SETD2 is one of the most frequent mutated genes found exclusively in phyllodes tumor of the breast (PT). However, little has been done to further characterize SETD2 alterations in PT.

METHODS: In this study, we examined the alterations of SETD2 gene and protein expression in a large cohort of PTs. Their correlations with SETD2 downstream target, H3K36me3 expression, and clinicopathologic features in PT were also assessed.

RESULTS: SETD2 mutation was found in 15.9% of our cases and was mostly predicted to be damaging mutations. Interestingly, SETD2 mutations were associated with lower H3K36me3 expression, particularly those with damaging mutations (p = .041). Neither SETD2 mutations nor H3K36me3 expression was associated with PT grading and other clinicopathological features. By contrast, the SETD2 protein expression cannot reflect its mutation status and showed a different trend of clinicopathological correlations from H3K36me3.

CONCLUSIONS: Our findings may suggest a potential involvement of epigenetic regulation via SETD2 alterations and downstream H3K36me3 on PT development. SETD2 mutations may occur early in the pathogenic process of PTs and its loss per se may not be sufficient for progression to malignancy. Exclusive alterations of SETD2 in PT can be used as markers for the diagnosis of fibroepithelial lesions. The association of H3K36me3 with SETD2 mutations may also indicate the value of evaluation of H3K36me3 expression in the diagnosis of fibroepithelial lesions.

PMID:33844099 | DOI:10.1007/s10549-021-06181-z
A Giant Borderline Phyllodes Tumor of Breast With Skin Ulceration Leading to Non-Insular Tumorigenic Hypoglycemia: A Case Report and Literature Review

Fetched: April 13th, 2021, 5:02am GMT by Jinlu Zhao

Front Endocrinol (Lausanne). 2021 Mar 25;12:651568. doi: 10.3389/fendo.2021.651568. eCollection 2021.

ABSTRACT

Phyllodes tumor (PT) is a special type of breast tumors, including three types: malignant, borderline, and benign. Most of these tumors form unilateral disease and can rapidly increase in size. The occurrence of axillary lymph node metastasis is rare. Tumor-associated hypoglycemia can be divided into non-islet cell tumor and insulinoma. In non-islet cell tumor hypoglycemia (NICTH), a considerable high molecular weight form of insulin like growth factor 2 (IGF-2) is formed, which abnormally binds to insulin receptors in the tissues and causes hypoglycemia. Breast phyllodes tumors with NICTH are rare and first reported in 1983. Surgical resection is the main treatment and hypoglycemia symptoms usually resolve after surgery. Nevertheless, prior to surgery, intravenous glucose infusion is used to maintain blood glucose levels. A female patient presented with a rapidly growing breast mass and was diagnosed with a phyllodes tumor with NICTH at our hospital in August 2020; she was successfully treated through surgical resection. We reviewed the relevant literature to investigate and analyze the relationship between NICTH and phyllodes tumors, as well as optimize its diagnosis and treatment.

PMID:33841338 | PMC:PMC8027481 | DOI:10.3389/fendo.2021.651568
Updated WHO classification of tumors of the breast: the most important changes

Fetched: April 7th, 2021, 5:02am GMT by Annette Lebeau

Pathologe. 2021 May;42(3):270-280. doi: 10.1007/s00292-021-00934-9. Epub 2021 Apr 6.

ABSTRACT

The development of the WHO classification of tumors of the breast is driven by new knowledge from research whose translation into daily practice is considered clinically relevant. The fifth edition represents an update of the fourth edition and essentially follows the previously known systematics. The histologic features of the lesions continue to form the basis of the classification in the update. This also applies to the definition of invasive tumor types. However, several new molecular classifications as well as additional prognostic and predictive factors are presented and discussed, which improve prognosis estimation and therapy decisions. This paper aims to present the main changes in the current WHO classification. These include the revised definition of mixed invasive carcinomas, the introduction of new special invasive entities (tall cell carcinoma with reversed polarity, mucinous cystadenocarcinoma), the deletion of special invasive types and their classification as variants of invasive carcinoma, NST (no special type, including medullary, lipid-rich, glycogen-rich, among others), the typing of primary neuroendocrine neoplasms of the breast by analogy with other organ systems, changes in the dignity criteria of phyllodes tumors, and the revised subtyping of lobular carcinoma in situ (LCIS). In addition to improvements in the fifth edition of the classification, flaws are also highlighted. A section is devoted to new molecular parameters.

PMID:33822251 | DOI:10.1007/s00292-021-00934-9
Clinical Features of Breast Cancer in South Korean Patients with Germline TP53 Gene Mutations

Fetched: April 6th, 2021, 5:02am GMT by Hassan Alyami

J Breast Cancer. 2021 Apr;24(2):175-182. doi: 10.4048/jbc.2021.24.e16. Epub 2021 Mar 12.

ABSTRACT

PURPOSE: Li-Fraumeni syndrome (LFS) is a rare autosomal cancer syndrome caused by a germline mutation in the TP53 gene. Breast cancer in LFS patients is of various subtypes; however, limited data are available on the clinicopathological features of these subtypes and their appropriate treatments. This study aimed to review the clinical features and treatments for breast cancer in South Korean patients with germline TP53 mutations.

METHODS: Data on the clinicopathological features and treatment of all breast cancer patients with LFS were collected retrospectively from the available database of 4 tertiary hospitals in the Republic of Korea.

RESULTS: Twenty-one breast cancer cases in 12 unrelated women with confirmed germline TP53 mutations were included in the study. The median age at diagnosis was 33.5 years. The histopathological diagnosis included invasive ductal carcinoma (n = 16), ductal carcinoma in situ (n = 3), and malignant phyllodes tumor (n = 2). While 42% and 31% of the cases were positive for estrogen and progesterone receptors, respectively, 52.6% were human epidermal growth factor receptor 2 (HER2) positive, and 21% were triple-negative. The treatments included mastectomy (52%) and breast-conserving surgery (38%). Five patients underwent radiotherapy (RT). The median follow-up period was 87.5 (8-222) months. There were 3 ipsilateral and 4 contralateral breast recurrences during the follow-up, and 8 patients developed new primary cancers. In the post-RT subgroup, there were 2 ipsilateral and 2 contralateral breast recurrences in 1 patient, and 4 patients had a new primary cancer.

CONCLUSION: As reported in other countries, breast cancer in LFS patients in South Korea had an early onset and were predominantly but not exclusively positive for HER2. A multidisciplinary approach with adherence to the treatment guidelines, considering mastectomy, and avoiding RT is encouraged to prevent RT-associated sequelae in LFS patients.

PMID:33818021 | PMC:PMC8090805 | DOI:10.4048/jbc.2021.24.e16
Report of Two Cases with Simultaneously Detected Tubular Carcinoma and Phyllodes Tumor of the Breast

Fetched: April 3rd, 2021, 5:01am GMT by Burak İlhan

Eur J Breast Health. 2020 Dec 24;17(1):80-83. doi: 10.5152/ejbh.2020.5551. eCollection 2021 Jan.

ABSTRACT

Tubular carcinoma (TC) is a subtype of invasive breast carcinoma with better prognosis, and phyllodes tumors (PT) are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows for correct surgical planning and avoidance of reoperation for these breast neoplasms. A database was created by analyzing the archives of Department of General Surgery of the İstanbul Faculty of Medicine between September 2006 and November 2017, and a total of 105 PTs and 55 TCs were collected. Two cases with concurrence of TC and PT were identified and examined in detail. The first patient was a 33-year-old woman with a 20×12 mm² TC and a 65×32 mm² malignant PT in the left breast. The second patient was a 28-year-old woman with two masses in the right breast. The first mass was 38×16 mm² on the upper outer quadrant, and the second mass was 10×8 mm² in size in the lower inner quadrant, accompanied by a 16×10 mm² TC and a 33×26 mm² borderline PT. Both cases were treated by mastectomies due to patient's decisions or insufficient margin control. This study extrapolated that if two tumors are detected simultaneously, margin control can become more difficult, and breast-conserving surgery should be thoroughly reviewed.

PMID:33796835 | PMC:PMC8006781 | DOI:10.5152/ejbh.2020.5551
Phyllodes Tumors of the Breast: A Single-Center Experience

Fetched: April 3rd, 2021, 5:01am GMT by Sevda Yılmaz

Eur J Breast Health. 2020 Dec 24;17(1):36-41. doi: 10.4274/ejbh.2020.5961. eCollection 2021 Jan.

ABSTRACT

OBJECTIVE: We aimed to analyze the clinicopathological findings, treatment approach, and treatmen outcomes in patients diagnosed with phyllodes tumor (PT).

MATERIALS AND METHODS: The clinicopathological data of 26 patients with PT, who were treated between 2008 and 2019, were retrospectively analyzed.

RESULTS: Mean age was 35.07±13.95 years (range: 14-71), while mean tumor size was 54.76±29.24 mm (range: 25-135). Benign, borderline, and malignant PT were detected in 18 (69.2%), 3 (11.5%), and 5 (19.2%) patients, respectively. Marginless excision was performed in 20 patients (76.9%), while six (23.1%) patients underwent mastectomy. A statistically significant correlation of tumor type with mean tumor size and mean age was observed (p=0.041 and p=0.013, respectively). Margin positivity on first excision was more frequent in the malignant tumors (p=0.02). No statistically significant correlation of PT type with presence of breast cancer in the family history, and tumor localization was observed (p=0.79 and p=0.13, respectively). Mean postoperative follow-up duration was 56 months (range: 6-147). Local recurrence was not observed in any of the patients. Lung and left vastus lateralis muscle metastases were encountered. The patient with lung metastasis became exitus because of the same reason 6 months after detection of the metastasis.

CONCLUSION: PT is a rare fibroepithelial tumor of the breast that is characterized by a mixed histology seen in younger ages when compared to the classical breast tumors. The probability of PT should be considered in the presence of a rapid-growing mass in the breast. In addition, it should also be considered that the contribution of imaging techniques may be limited.

PMID:33796829 | PMC:PMC8006783 | DOI:10.4274/ejbh.2020.5961
Predictive Factors of Early Recurrence in Patients with Phyllodes Tumor of the Breast

Fetched: April 3rd, 2021, 5:01am GMT by Bharadhwaj Ravindhran

Eur J Breast Health. 2020 Dec 24;17(1):10-14. doi: 10.5152/ejbh.2020.5712. eCollection 2021 Jan.

ABSTRACT

OBJECTIVE: Phyllodes tumor (PT) is a rare entity accounting for 1% of breast neoplasms with a high propensity of recurrence. This study aimed to identify factors that are predictive of early recurrence in patients with PT.

MATERIALS AND METHODS: This study reviewed clinical data of patients with PT (n=57) treated at our tertiary care referral center in South India between February 2010 and December 2019. The Pearson χ² test was used to investigate the relationship between patient's clinical features and tumor histotypes. Survival curves were obtained using the Kaplan-Meier method based on the log-rank test. Multivariate Cox regression analyses were performed to identify predictors of early recurrence or local recurrence-free-interval (LRFI).

RESULTS: The mean age was 38.3 [standard deviation (SD)=13.6] years, and the mean follow-up was 18 (SD=13.5) months. The median tumor size was 5 cm (interquartile range 3 and range: 3-22 cm). Moreover, 64.9% (n=37) of the tumors were benign, 21.1% (n=12) were borderline, and 14% (n=8) were malignant. Of the 57 patients, 17 (29.8%) developed local recurrence and one developed distant metastasis. Of the 17 patients, three were unwilling to undergo completion surgery. The median LRFI was 20 (range: 7-60) months. Multivariate cox regression analyses showed that mitotic rate >10/high power field [hazard ratio (HR) 0.147; p=0.04], stromal overgrowth (HR: 4.904; p=0.05), margin status (HR: 0.037; p<0.001), and preoperative neutrophil-to-lymphocyte ratio [(NLR), HR: 4.891; p=0.04)] were significant predictors of LRFI.

CONCLUSION: A high mitotic rate, positive margin, stromal overgrowth, and NLR >3.5 were associated with early recurrence. These attributes mandate stringent follow-up, especially in a resource-limited setting.

PMID:33796825 | PMC:PMC8006786 | DOI:10.5152/ejbh.2020.5712
A Case of a Malignant Phyllodes Tumor in the Breast with Lymph Node Metastasis

Fetched: April 2nd, 2021, 5:01am GMT by Tamami Morisaki

Gan To Kagaku Ryoho. 2021 Mar;48(3):437-439.

ABSTRACT

A 52-year-old woman experienced right breast pain and detected a mammary tumor 6 months ago. She then noticed rapid enlargement of the tumor, which was suspected to be a borderline malignant phyllodes tumor. The tumor size was approximately 15 cm and presented with skin congestion but without infiltration. The tumor showed internal heterogeneous echo and rich blood flow signals on breast ultrasonography. Ultrasonography also showed swelling of the axillary lymph node. Lymph node cytology revealed the presence of atypical cells in the lymph node, and CT scan showed lymph node metastasis in the right axilla and no distant metastases. We performed mastectomy with lymph node sampling. Pathological examination of the specimens confirmed a malignant phyllodes tumor and a metastatic lymph node. One month later, a subcutaneous mass and multiple pulmonary nodules were identified on a chest CT scan. Chest wall irradiation(45 Gy)and chemotherapy were performed, but the number of pulmonary nodules, pleural effusion, and size of the subcutaneous mass continued to increase. Although she underwent another chemotherapeutic treatment, she died 5 months after the surgery. Thus, we report a case of a malignant phyllodes tumor with an extremely rare lymph node metastasis, which rapidly progressed even though multimodal therapy was performed.

PMID:33790180
Malignant phyllodes tumour of the breast mimicking endometriosis

Fetched: March 31st, 2021, 5:01am GMT by Andrew H S Lee

Virchows Arch. 2021 Mar 29. doi: 10.1007/s00428-021-03086-6. Online ahead of print.

ABSTRACT

A 63-year-old woman presented with a clinically malignant mass. Core biopsy showed features resembling endometriosis. The glands were GATA3 and oestrogen receptor positive consistent with mammary origin and had no myoepithelial layer. The excision also showed a fibroepithelial component with stromal overgrowth, frequent mitoses and invasive margin consistent with a malignant phyllodes tumour. KMT2D and SETD2 mutations were present in both the conventional phyllodes tumour and endometriosis-like areas and are also described in endometriosis raising interesting questions about these lesions. This unusual pattern is a potential diagnostic pitfall, so it is helpful to be aware of it.

PMID:33782741 | DOI:10.1007/s00428-021-03086-6
Phyllodes patients' perceptions of care: Do they trust their doctors?

Fetched: March 30th, 2021, 5:01am GMT by Suellen Li

Breast J. 2021 Mar 28. doi: 10.1111/tbj.14229. Online ahead of print.

NO ABSTRACT

PMID:33779019 | DOI:10.1111/tbj.14229
Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature

Fetched: March 30th, 2021, 5:01am GMT by Ricardo Fernández-Ferreira

Case Rep Oncol. 2021 Mar 1;14(1):123-133. doi: 10.1159/000510741. eCollection 2021 Jan-Apr.

ABSTRACT

Phyllodes tumor of the breast is an infrequently encountered fibroepithelial neoplasm, which accounts for 0.3-1% of all tumors. Few case reports have described the occurrence of giant phyllodes tumor. To our knowledge, about 20% of phyllodes tumors would be considered giant benign. Complete surgical excision is the standard of care for giant benign phyllodes tumors; axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes. We report the case of a 40-year-old Mexican woman with giant mammary tumor who underwent a right total mastectomy. The pathology results showed a benign phyllodes tumor 4,857 g in weight and 40.2 × 36.3 × 15 cm in size. We do not suggest adjuvant radiation therapy for patients with benign phyllodes tumors that are widely excised. A review of the pertinent literature was performed.

PMID:33776693 | PMC:PMC7983586 | DOI:10.1159/000510741
Retrospective study of malignant phyllodes tumors of the breast: Younger age, prior fibroadenoma surgery, malignant heterologous elements and surgical margins may predict recurrence

Fetched: March 29th, 2021, 5:01am GMT by Yang Li

Breast. 2021 Jun;57:62-70. doi: 10.1016/j.breast.2021.03.001. Epub 2021 Mar 17.

ABSTRACT

PURPOSE: The potential recurrence rate of malignant phyllodes tumors (MPTs) of the breast is high, and the prognostic factors are still unclear. We therefore aim to study the factors affecting the outcome of MPTs.

METHODS: A retrospective review of MPT patients treated from 2006 to 2020 at our institution was conducted. Univariate and multivariate Cox proportional hazard models were used to examine the influence of different variables on RFS. Moreover, significant prognostic factors were combined to construct the nomogram to predict the probability of relapse occurring in MPT patients. The 5-year and 10-year RFS rates were estimated using the Kaplan-Meier method.

RESULTS: During the study period, 188 MPT patients were identified. The presence of malignant heterologous elements was observed in 23 (12.2%) patients with MPT, and the patients with malignant heterologous elements who received chemotherapy had longer RFS, which could reduce the risk of recurrence (p = 0.022). Recurrence occurred in 56/188 (29.8%) patients, of whom 47 experienced local recurrence and 11 experienced distant metastases. The 5-year and 10-year cumulative RFS rates were 77.5% and 70.1%, respectively. Age (p = 0.041), fibroadenoma surgery history (p = 0.004), surgical margins (p = 0.001) and malignant heterologous elements (p < 0.001) were independent risk factors for postoperative RFS. Subsequently, a nomogram was built, with a C-index of 0.64 (95% CI: 0.629-0.661), to predict the risk of recurrence.

CONCLUSION: The results of this study showed that younger age, fibroadenoma surgery history, malignant heterologous elements and surgical margins <1 cm predict a higher incidence of recurrence in MPT patients. Patients with malignant heterologous elements treated with chemotherapy could have a reduced risk of recurrence.

PMID:33774460 | PMC:PMC8027899 | DOI:10.1016/j.breast.2021.03.001
GATA binding protein 3 (GATA3) as a marker for metaplastic spindle cell carcinoma of the breast

Fetched: March 28th, 2021, 5:01am GMT by Cao Jin

Pathol Res Pract. 2021 May;221:153413. doi: 10.1016/j.prp.2021.153413. Epub 2021 Mar 20.

ABSTRACT

Spindle cell lesions of the breast comprise a diverse set of tumors; harboring significant histological and immunohistochemical (IHC) overlap. Accurate diagnosis and classification of spindle cell lesions in the breast remains challenging, especially in core biopsies. In the current study, we evaluated a spectrum of spindle cell lesion of the breast with a panel of IHC antibodies in an effort to differentiate metaplastic spindle cell carcinoma from its benign and malignant mimickers. Our study included 92 patients who underwent breast core biopsies or breast resections at Northwell Health who were diagnosed with benign and malignant tumor/tumor-like spindle cell lesions. Tumors subtypes in this the study included: angiosarcoma, nodular fasciitis, fibromatosis, myofibroblastoma, phyllodes tumors (benign, borderline and malignant), primary sarcomas and metaplastic spindle cell carcinoma. Our biomarker panel included high molecular weight keratin (HMWK), CAM5.2, AE1/AE3, p63, CD34 and GATA3. GATA3 expression was significantly higher in metaplastic carcinomas (88.9 % vs 4.1 %, p < 0.001), when compared to other spindle cell lesions. The sensitivity and specificity for detecting metaplastic carcinomas reached 84.2 % and 97.3 %, respectively. Regarding cytokeratin panels, none of the three individual markers were as sensitive or specific for metaplastic breast carcinoma. GATA3 is the most specific and sensitive marker forfor the identification of metaplastic spindle cell carcinoma of the breast.

PMID:33770555 | DOI:10.1016/j.prp.2021.153413
Sliding window based deep ensemble system for breast cancer classification

Fetched: March 27th, 2021, 5:01am GMT by Amin Alqudah

J Med Eng Technol. 2021 May;45(4):313-323. doi: 10.1080/03091902.2021.1896814. Epub 2021 Mar 26.

ABSTRACT

Breast cancer is a severe problem for women around the world especially in developing countries, according to recent reports from the World Health Organization (WHO). High accuracy and early detection of breast cancer reduces the mortality rate, in the other hand, recognition of breast cancer is a complicated issue. Various studies and methods have been carried out to overcome this problem and to obtain accurate screening of breast cancer. One of the most recent methods with high performance is deep learning; it has been used to classify breast cancer using mammograms or histopathological images. This paper proposes a new using the concept of sliding window, and using the ensemble of four pre-trained convolutional neural networks (CNN) in order to classify breast cancer into eight classes. In this study, each image produces 4 non-overlapped sliding windows which are fed to GoogleNet, AlexNet, ResNet50, and DenseNet-201 CNNs, and an ensemble is then done to find the major class of each window, the ensemble is then applied again to find the class of the whole histopathological image. Breast Cancer Histopathological Database (BreakHis) database has been employed in this paper with eight classes (Adenosis, Ductal Carcinoma, Fibroadenoma, Lobular Carcinoma, Mucinous Carcinoma Papillary Carcinoma, Phyllodes Tumour, Tubular Adenoma). The proposed method is applied to four magnification cases: 40x, 100x, 200x, and 400x images. The proposed ensemble technique achieved an accuracy of 99.3325%. The results of the proposed system are comparable to recent studies results.

PMID:33769183 | DOI:10.1080/03091902.2021.1896814
Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation - A case report

Fetched: March 25th, 2021, 5:02am GMT by Sana Zeeshan

Int J Surg Case Rep. 2021 Feb;79:450-454. doi: 10.1016/j.ijscr.2021.01.094. Epub 2021 Jan 28.

ABSTRACT

INTRODUCTION: Fibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5-2% of all fibroadenomas.

PRESENTATION OF CASE: In this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan.

DISCUSSION: Surgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases.

CONCLUSION: The diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility.

PMID:33757260 | PMC:PMC7851354 | DOI:10.1016/j.ijscr.2021.01.094
Management and outcomes of phyllodes tumours - 10 year experience

Fetched: March 23rd, 2021, 5:01am GMT by P A Boland

Breast Dis. 2021 Mar 19. doi: 10.3233/BD-201059. Online ahead of print.

ABSTRACT

INTRODUCTION: Phyllodes tumours represent 0.3-1% of breast tumours, typically presenting in women aged 35-55 years. They are classified into benign, borderline and malignant grades and exhibit a spectrum of features. There is significant debate surrounding the optimal management of phyllodes tumour, particularly regarding appropriate margins.

METHODS: This is a retrospective review of a prospectively maintained database of patients who underwent surgical management for phyllodes tumours in a single tertiary referral centre from 2007-2017. Patient demographics, tumour characteristics, surgical treatment and follow-up data were analysed. Tumour margins were classified as positive (0 mm), close (≤2 mm) and clear (>2 mm).

RESULTS: A total of 57 patients underwent surgical excision of a phyllodes tumour. The Mean age was 37.7 years (range: ages 14-91) with mean follow-up of 38.5 months (range: 0.5-133 months). There were 44 (77%) benign, 4 (7%) borderline and 9 (16%) malignant phyllodes cases. 54 patients had breast conserving surgery (BCS) and 3 underwent mastectomy. 30 (53%) patients underwent re-excision of margins. The final margin status was clear in 32 (56%), close in 13 (23%) and positive in 12 (21%). During follow-up, 4 patients were diagnosed with local recurrence (2 malignant, 1 borderline and 1 benign pathology on recurrence samples).

CONCLUSION: There are no clear guidelines for the surgical management and follow-up of phyllodes tumours. This study suggests that patients with malignant phyllodes and positive margins are more likely to develop local recurrence. There is a need for large prospective studies to guide the development of future guidelines.

PMID:33749634 | DOI:10.3233/BD-201059
Quantitative proteome profiling stratifies fibroepithelial lesions of the breast

Fetched: March 23rd, 2021, 5:01am GMT by Aviral Kumar

Oncotarget. 2021 Mar 2;12(5):507-518. doi: 10.18632/oncotarget.27889. eCollection 2021 Mar 2.

ABSTRACT

Breast fibroepithelial lesions (FELs) include heterogeneous pathological tumors, involving indolent fibroadenoma (FAD) to potentially aggressive phyllodes tumors (PTs). The current grading system remains unreliable in differentiating these tumors due to histological heterogeneity and lack of appropriate markers to monitor the sudden and unpredictable malignant transformation of PTs. Thus, there exists an imminent need for a marker-based diagnostic approach to augment the conventional histological platform that could lead to accurate diagnosis and distinction of FELs. The high- throughput quantitative proteomic analysis suggested that FAD and PTs form distinct clusters away from borderline and malignant though there exist marked differences between them. Interestingly, over-expression of extracellular matrices (ECM) related proteins and epithelial-mesenchymal transition (EMT) markers in borderline PTs led us to hypothesize a model of deposition and degradation leading to ECM remodeling and EMT acquisition triggering its malignant transformation. We also identified three candidate biomarkers such as MUCL1, HTRA1, and VEGDF uniquely expressed in FAD, borderline, and malignant PTs, respectively, which were further validated using immunohistochemistry. The present work shed light on a brief mechanistic framework of PTs aggressive nature and present potential biomarkers to differentiate overlapping FELs that would be of practical utility in augmenting existing diagnosis and disease management for this rare tumor.

PMID:33747363 | PMC:PMC7939526 | DOI:10.18632/oncotarget.27889
Rare case of gigantic ulcerating phyllodes tumour in developed country with a review of the literature

Fetched: March 20th, 2021, 5:01am GMT by Yi Th'ng Seow

J Surg Case Rep. 2021 Mar 13;2021(3):rjab060. doi: 10.1093/jscr/rjab060. eCollection 2021 Mar.

ABSTRACT

Phyllodes tumour (PT) is a rare type of fibroepithelial breast tumour that can present in a wide spectrum of biological behaviours, accounting for <1% of breast malignancies. Herein, we present a case of a rare gigantic ulcerating PT in a middle-aged woman from regional Western Australia, who presented with a rapidly growing right breast mass. Core biopsy showed spindle cell lesion with differentials being PT of at least borderline variety or metaplastic carcinoma. The ulcerations over the fungating tumour showed heavy growth of Staphylococcus aureus. The treating team subsequently proceeded to right total mastectomy with level 1 and 2 axillary clearance. This report emphasizes the rare presentation of PT, dilemma in investigations and the difficulties in managing non-compliant patient where treatment protocol needs to be modified.

PMID:33738091 | PMC:PMC7955714 | DOI:10.1093/jscr/rjab060
The significance of enhancer of zeste homolog 2 (EZH2) expression in spindle cell lesions of the breast

Fetched: March 18th, 2021, 5:02am GMT by Iskender Sinan Genco

Pathol Int. 2021 Jun;71(6):415-419. doi: 10.1111/pin.13093. Epub 2021 Mar 17.

ABSTRACT

Spindle cell lesions of the breast are rare entities and pose a diagnostic challenge for pathologists due to overlapping morphologic and immunohistochemical features. We evaluated EZH2 expression in various benign (fibromatosis (n = 8), myofibroblastoma (n = 7), neurofibroma (n = 1), nodular fasciitis (n = 5), benign phyllodes tumor (n = 18)) and malignant (malignant phyllodes tumor (n = 8), metaplastic breast carcinoma (n = 16) and angiosarcoma (n = 8)) spindle cell lesions as a potential diagnostic and therapeutic marker. The EZH2 expression was evaluated semi-quantitatively to categorize the cases as 'low' and 'high' expression. All benign lesions showed low EZH2 expression, whereas high EZH2 expression was observed in the majority (28/32; 88%) of malignant lesions. The study results suggest that EZH2 may be used both as an additional diagnostic tool to reach an accurate diagnosis of the spindle cell lesions of the breast and as a therapeutic target for the malignant lesions.

PMID:33730427 | DOI:10.1111/pin.13093
Genetic differences between benign phyllodes tumors and fibroadenomas revealed through targeted next generation sequencing

Fetched: March 18th, 2021, 5:02am GMT by Cedric Chuan Young Ng

Mod Pathol. 2021 Mar 16. doi: 10.1038/s41379-021-00787-w. Online ahead of print.

ABSTRACT

Breast fibroepithelial lesions are biphasic tumors which comprise the common benign fibroadenomas (FAs) and the rarer phyllodes tumors (PTs). This study analyzed 262 (42%) conventional FAs, 45 (7%) cellular FAs, and 321 (51%) benign PTs contributed by the International Fibroepithelial Consortium, using a previously curated 16 gene panel. Benign PTs were found to possess a higher number of mutations, and higher rates of cancer driver gene alterations than both groups of FAs, in particular MED12, TERT promoter, RARA, FLNA, SETD2, RB1, and EGFR. Cases with MED12 mutations were also more likely to have TERT promoter, RARA, SETD2, and EGFR. There were no significant differences detected between conventional FAs and cellular FAs, except for PIK3CA and MAP3K1. TERT promoter alterations were most optimal in discriminating between FAs and benign PTs. Our study affirms the role of sequencing and key mutations that may assist in refining diagnoses of these lesions.

PMID:33727697 | DOI:10.1038/s41379-021-00787-w
Identification of PKHD1 mutations in Brain, Breast and Rectal tumors by Next Generation DNA Sequencing

Fetched: March 16th, 2021, 5:02am GMT by Duaa Mohammed Almehmadi

Gulf J Oncolog. 2021 Jan;1(35):42-53.

ABSTRACT

INTRODUCTION: It is well established that the PKHD1 mutations are associated with autosomal recessive polycystic kidney disease (ARPKD). Although, PKHD1 mutations are also detected in certain cancer types, to our knowledge in rare tumors such as, atypical teratoid rhabdoid tumor (ATRT), primary neuro-ectodermal tumor (PNET), atypicalchoroid plexus papilloma (a-CPP), amelanotic ano-rectal melanoma (AMM), and breast phyllodes tumors PKHD1 mutations profiling is not reported.

METHODS: In order to determine the PKHD1 gene mutation patterns in the brain, rectal, and breast tumors we have analyzed these tumor DNA by Ion Proton Next generation DNA sequencing.

RESULTS: Next-generation DNA sequencing on Ion Proton identified unique and common missense mutations in the brain, breast and ano-rectal tumors. All mutations were benign, and only one pathogenic mutation in p. (Cys3346Arg) found in AMM tumor. In phyllodes tumor of breast, two unique missense variants were detected (rs113562492) p. (Met2841Val); and (rs137972270) in p. (Arg589Cys) and these variants are not present in other tumors tested. The variant rs137972270 was reported only in two cases sofar in ClinVar database. Missense variants such as rs115045643, rs116809571, rs115338476, and rs76895755 are found only in PNET, and a variant rs62406032 in a-CPP, another one rs35445653 in ATRT cases were unique for these tumors, which are not present in other tumors. Several synonymous and intronic variants of PKHD1 gene were also found in these tumors. A synonymous variant p. (Asp395Asp), rs1896976 and two intronic SNPs viz., rs1326605, and rs1571084 were found in all tumors tested. The SNP rs9395699 in IVS66 was found uniquely in IPC breast tumor only in this study. Allele coverage, allele ratio, p-value, Phred qual score, sequencing coverage, alleles frequencies were also analysed, the p-values and Phred quality score were significantly higher.

CONCLUSION: These tumors did not have any insertion/ deletion mutations, nonsense, or truncated mutations in it. The screening of PKHD1 gene revealed signature mutations for the solid tumors studied by NGS method. This investigation may help in understanding these tumor pathology at molecular level.

PMID:33716212
Value of conventional magnetic resonance imaging texture analysis in the differential diagnosis of benign and borderline/malignant phyllodes tumors of the breast

Fetched: March 14th, 2021, 5:01am GMT by Xiaoguang Li

Cancer Imaging. 2021 Mar 12;21(1):29. doi: 10.1186/s40644-021-00398-3.

ABSTRACT

BACKGROUND: The purpose of this study was to determine the potential value of magnetic resonance imaging (MRI) texture analysis (TA) in differentiating between benign and borderline/malignant phyllodes tumors of the breast.

METHODS: The preoperative MRI data of 25 patients with benign phyllodes tumors (BPTs) and 19 patients with borderline/malignant phyllodes tumors (BMPTs) were retrospectively analyzed. A gray-level histogram and gray-level cooccurrence matrix (GLCM) were used for TA with fat-suppressed T2-weighted imaging (FS-T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) images, and 2- and 7-min postcontrast T1W images on dynamic contrast-enhanced MRI (DCE-T1WI2min and DCE-T1WI7min) between BPTs and BMPTs. Independent sample t-test and Mann-Whitney U test were performed for intergroup comparison. A regression model was established by using binary logistic regression analysis, and receiver operating characteristic (ROC) curve analysis was carried out to evaluate diagnostic efficiency.

RESULTS: For ADC images, the texture parameters angular second moment (ASM), correlation, contrast, entropy and the minimum gray values of ADC images (ADCMinimum) showed significant differences between the BPT group and BMPT group (all p<0.05). The parameter entropy of FS-T2WI and the maximum gray values and kurtosis of the tumor solid region of DCE-T1WI7min also showed significant differences between these two groups. Except for ADCMinimum, angular second moment of FS-T2WI (FS-T2WIASM), and the maximum gray values of DCE-T1WI7min (DCE-T1WI7min-Maximum) of the tumor solid region, the AUC values of other positive texture parameters mentioned above were greater than 0.75. Binary logistic regression analysis demonstrated that the contrast of ADC images (ADCContrast) and entropy of FS-T2WI (FS-T2WIEntropy) could be considered independent texture variables for the differential diagnosis of BPTs and BMPTs. Combined, the AUC of these parameters was 0.891 (95% CI: 0.793-0.988), with a sensitivity of 84.2% and a specificity of up to 89.0%.

CONCLUSION: Texture analysis could be helpful in improving the diagnostic efficacy of conventional MR images in differentiating BPTs and BMPTs.

PMID:33712070 | PMC:PMC7953576 | DOI:10.1186/s40644-021-00398-3
Risk factors associated with loss to follow-up of breast cancer patients: A retrospective analysis

Fetched: March 14th, 2021, 5:01am GMT by Qian Ouyang

Breast. 2021 Jun;57:36-42. doi: 10.1016/j.breast.2021.02.012. Epub 2021 Mar 2.

ABSTRACT

BACKGROUND: Loss to follow-up (LTFU) during post-operative surveillance of breast cancer patients is detrimental. The pattern of LTFU and its risk factors in Chinese breast cancer patients remains unknown.

METHOD: Eligible non-metastatic breast cancer patients who underwent surgery at our institution between 2009 and 2012 were included. The clinicopathological features, as well as the LTFU status, were retrieved from the REDCap database. LTFU was defined as the absence of patients for at least 12 months since her last contact. 5-year LTFU was defined as the LTFU status of each patients at 5 years after surgery. The incidence and potential risk factors of LTFU were analyzed. A LTFU-risk score was developed to quantify the risk of LTFU.

RESULTS: A total of 1536 patients with breast cancer were included, and 411(26.8%) patients were 5-year LTFU. 198 patients were LTFU in the first year. Univariate and multivariate analysis revealed that age (younger and older), a lack of medical insurance, longer distance from residence to the hospital, pathology (DCIS/Paget's/Phyllodes), lymph node metastasis, the absence of endocrine therapy and fewer than five contact numbers were significantly and independently associated with the risk of LTFU. A LTFU-risk score was developed and was predictive of LTFU.

CONCLUSIONS: A series of risk factors were significantly associated with post-operative LTFU of breast cancer patients. Patients with different risks of LTFU could possibly be identified, and surveillance plans could be individualized for different patients, so as to effectively reduce the overall LTFU rate, and optimize the allocation of medical resources.

PMID:33711698 | PMC:PMC7970119 | DOI:10.1016/j.breast.2021.02.012
Fatal outcome of malignant phyllodes tumor of the breast in pregnancy: a case and literature review

Fetched: February 27th, 2021, 5:02am GMT by Wen-Xiang Zhang

Gland Surg. 2021 Jan;10(1):371-377. doi: 10.21037/gs-20-538.

ABSTRACT

Phyllodes tumor of the breast (PTB) is a rare fibroepithelial breast neoplasm that accounts for less than 1% of breast tumors. Only a few cases related to pregnancy have been reported. It is not known how pregnancy affects the diagnosis, treatment and prognosis of breast tumors. Here we report a case of a 38-year-old female patient with a small, mobile palpable lump in the left breast for about 15 years. it was considered a benign lesion and no surgical treatment was performed at the beginning. The left breast mass became larger suddenly during pregnancy, However, she did not see the doctor and receive any treatment in time. The lump was resected one year after labor and confirmed to be malignant phyllodes of the breast by histopathology and immunohistochemistry. Unfortunately, local recurrence occurred within six months after the first operation, and lung metastasis occurred eight months later. And this patient finally died 13 months after the operation due to tumor progression. This is the first report of pregnancy-related malignant PTB, with local recurrence and distant metastasis in a short period. This case report highlights a situation: the patient should be diagnosed early and treated in time when she has a previous breast fibroadenoma, but suddenly increased during pregnancy.

PMID:33633994 | PMC:PMC7882345 | DOI:10.21037/gs-20-538
Epithelial-mesenchymal transition and cancer stem cell interactions in breast phyllodes tumours: immunohistochemical evaluation of EZH2, EZR, HMGA2, CD24 and CD44 in correlation with outcome analysis

Fetched: February 26th, 2021, 5:02am GMT by Syed Salahuddin Ahmed

J Clin Pathol. 2021 Feb 24:jclinpath-2020-207068. doi: 10.1136/jclinpath-2020-207068. Online ahead of print.

ABSTRACT

AIM: Phyllodes tumours (PTs) categorised as benign, borderline and malignant, account for 1% of all breast tumours. Histological assessment does not always predict tumour behaviour, hindering determination of the clinical course and management.Epithelial-mesenchymal transition (EMT) is an important process during embryogenesis. Dysregulation of EMT causes loss of cell polarity, decreased intercellular adhesion, increased motility and invasiveness, promoting tumour progression. Similarly, cancer stem cells (CSCs) promote tumour growth, resistance and recurrence. The aim of this study is to evaluate expression of CSC markers; enhancer of zeste homolog 2 (EZH2), CD24 and CD44 and EMT associated proteins; ezrin (EZR) and high-mobility group AT-hook 2 (HMGA2) in PTs.

METHOD: Uing tissue microarray sections, immunohistochemistry was performed on 360 PTs. Epithelial and stromal expressions of EZH2, EZR, HMGA2, CD24 and CD44 were evaluated to assess their impact on disease progression and behaviour in correlation with clinicopathological parameters.

RESULTS: Stromal expression of EZH2, EZR and HMGA2 was observed in 73 (20.3%), 53 (14.7%) and 28 (7.8%) of tumours, epithelial expression in 121 (35.9%), 3 (0.8%) and 351 (97.5%) tumours, respectively. CD24 and CD44 staining was absent in both components.

CONCLUSION: Expression of biomarkers correlated significantly with aggressive tumour traits such as stromal hypercellularity, atypia, mitoses and permeative tumour borders.Stromal expression of EZH2 and EZR shortened disease-free survival and overall survival; HMGA2 expression did not alter patient survival. EZH2 and EZR may thus be useful in predicting PT behaviour.

PMID:33627375 | DOI:10.1136/jclinpath-2020-207068
Impact of RASSF1A gene methylation on clinico-pathological features of tumor and non-tumor tissue of breast cancer

Fetched: February 24th, 2021, 5:02am GMT by Vivek Gupta

Ann Diagn Pathol. 2021 Jun;52:151722. doi: 10.1016/j.anndiagpath.2021.151722. Epub 2021 Feb 11.

ABSTRACT

BACKGROUND: Breast cancer is the most common malignancy in women caused by genetic and epigenetic changes. Promoter DNA methylation in tumor suppressor gene plays a major role in breast cancer. The study determined the association of promoter DNA methylation of RASSF1A gene with clinicopathological features in tumor and non-tumor tissue.

MATERIALS AND METHODS: A cross sectional study was conducted in the Department of Pathology, Government Institute of Medical Sciences, Greater Noida and Molecular Pathology Laboratory, Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences. Two sections, one from tumor and the other from non-tumor tissue, were obtained and processed for DNA extraction and bisulphite conversion. Methylation specific PCR was done and results of RASSF1A promoter methylation were statistically correlated with clinicopathological features.

RESULTS: Of the 27 breast cancer tissue, 22 showed invasive ductal carcinoma, one showed invasive lobular carcinoma, another showed ductal carcinoma in situ and three cases showed malignant phyllodes tumor of breast. DNA promoter methylation was found in all the cases. 93% of tumor tissue samples and 67% of the non-tumor tissue samples were found to be aberrantly methylated. Tumor size and histological grade were found to be significantly (p-val <0.05) associated with the RASSF1A gene promoter methylation.

CONCLUSION: A significant association of higher tumor size and tumor histological grade with promoter methylation of RASSF1A gene exists suggestive of its being an important determinant of prognostic staging. This critical event in tumorigenesis may be of clinical utility in assessing breast cancer progression.

MICRO ABSTRACT: The study focuses on the RASSF1A gene promoter methylation and its impact on the clinicopathological features in Indian breast cancer patients highlighting the differences from other genetically different population. We found that RASFF1A gene methylation has significant impact on tumor size and tumor grade. The work carries high significance because it addresses the DNA methylation of tumor suppressor gene in relevance of breast cancer. It may also be the first such report on Indian patients with breast cancer.

PMID:33621744 | DOI:10.1016/j.anndiagpath.2021.151722
The malignant degeneration of a phyllode tumour in man: A case report

Fetched: February 24th, 2021, 5:02am GMT by Mohamed Boudou

Int J Surg Case Rep. 2021 Mar;80:105644. doi: 10.1016/j.ijscr.2021.105644. Epub 2021 Feb 13.

ABSTRACT

INTRODUCTION: Malignant phyllodes tumours of the breast represent less than 1% of all breast cancers. Few cases of phyllodes tumours have been reported in men.

CASE PRESENTATION: We present the case of a 60-year-old man who was operated on one year ago for a breast tumour that had undergone a lumpectomy with an anatomopathological study in favour of a grade 2 phylloid tumour. He was admitted to hospital with a palpable mass in his right breast. The lumpectomy enlarged to the right pectoralis major muscle was then performed with clear surgical margins. Microscopic examination revealed high-grade malignant phyllodes. Postoperatively, after 3 months, the patient was given a breast MRI and a PET/CT scan which returned without abnormalities. The patient is followed for eight months and has shown no signs of recurrence.

DISCUSSION: Malignant phyllodes tumours of the breast show clinical and mammographic signs comparable to those of benign lesions. The diagnosis is confirmed by histology, treatment is based on surgery, which may be a large lumpectomy or mastectomy, and the prognosis depends on several factors, the most important of which is the margin for surgical resection.

CONCLUSION: The best treatment is a wide local excision with a safety margin of 1 cm, unless it is metastatic. Early diagnosis and surgery improves the prognosis.

PMID:33621729 | PMC:PMC7907805 | DOI:10.1016/j.ijscr.2021.105644
Incidental Pathologic Findings in Young Adult Reduction Mammaplasty

Fetched: February 24th, 2021, 5:02am GMT by Jenna Maroney

Plast Reconstr Surg. 2021 Mar 1;147(3):391-400. doi: 10.1097/PRS.0000000000007609.

ABSTRACT

BACKGROUND: This study aims to characterize incidental microscopic findings in this population to determine whether there is a benefit to routine histopathologic examination of breast tissue in young women.

METHODS: A retrospective review of young women who underwent reduction mammaplasty between June of 2010 and May of 2018 was performed at a single institution to identify demographics, age at the time of surgery, breast cancer risk factors, and pathologic data. Histologic reevaluation was performed when diagnostic clarification was needed. Descriptive, univariate, and multivariable statistical analyses were performed.

RESULTS: A total of 798 young women were included. At the time of surgery, the mean patient age was 17.5 ± 2.0 years, the mean body mass index was 28.7 ± 5.7 kg/m2, and the mean resection weight was 685 ± 339 g/breast. The majority of patients were reported to have pathologically normal tissue [n = 704 (88.2 percent)]. Of the 94 patients (11.8 percent) with abnormal findings, 21 (2.6 percent) had benign nonproliferative changes, 64 (8.0 percent) had proliferative lesions without atypia, nine (1.1 percent) had proliferative lesions with atypia, and a single patient (0.1 percent) had a borderline phyllodes tumor. Univariate and multivariate analyses revealed that age at menarche younger than 12 years was significantly associated with increased incidence of proliferative lesions.

CONCLUSIONS: Over 10 percent of young women with reduction mammaplasty have histopathologic findings. Although this study demonstrated an overall low incidence of atypical lesions, because early identification offers potential for improved surveillance, the authors continue to advocate for routine pathologic evaluation, particularly for women with early menarche.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

PMID:33620923 | DOI:10.1097/PRS.0000000000007609
Treatment Regimens for Breast Cancer in Elderly Patients in Whom the Diagnosis Was Switched from Malignant Phyllodes Tumor to Spindle-Cell Carcinoma after Surgery

Fetched: February 24th, 2021, 5:02am GMT by Keiko Hayashi

Gan To Kagaku Ryoho. 2020 Dec;47(13):2047-2049.

ABSTRACT

The patient was a 79-year-old woman with a left breast mass. Magnetic resonance imaging showed a cystic mass with a diameter of 10×8 cm and an ulcer in the upper outer quadrant and the nipple-areola region of the left breast. Intracystic carcinoma was thus suspected. A mass with a diameter of 1 cm was found in the upper outer quadrant of the right breast. Needle biopsy revealed that a cystic mass in the left breast was diagnosed as a malignant phyllodes tumor. A mass in the right breast was diagnosed as Luminal A breast cancer. The clinical tumor stage was T1N0M0. Computed tomography showed no enlarged bilateral axillary lymph nodes. In the left breast, mastectomy was performed with extensive skin excision above the tumor. In the right breast, partial mastectomy was performed with sentinel lymph node biopsy. On postoperative pathological examination, the diagnosis of left breast tumor was triple-negative spindle-cell carcinoma. The pathological tumor stage was diagnosed as T4bNxM0. Taking into consideration treatment according to breast cancer stage and age, we selected 4 courses of weekly-paclitaxel, endocrine therapy, irradiation to the left chest wall, and irradiation to the residual right breast. The preoperative diagnosis was malignant phyllodes tumor. The postoperative diagnosis was switched from malignant phyllodes tumor to spindle-cell carcinoma. It was therefore difficult to determine the presence or absence of additional resection and postoperative treatment regimens. Even though the preoperative diagnosis was a malignant phyllodes tumor, surgical procedures such as sentinel lymph-node biopsy should be considered, taking into account the possibility of breast cancer.

PMID:33468796
Study of Phyllodes Tumor of the Breast in 44 Cases of Resection

Fetched: February 24th, 2021, 5:02am GMT by Tetsutaro Miyoshi

Gan To Kagaku Ryoho. 2020 Dec;47(13):1972-1973.

ABSTRACT

Phyllodes tumor is a rare interstitial and epithelial mixed tumor which constitutes 0.3-0.9% of all breast tumors. It is classified into benign, borderline malignant, and malignant. Differentiating this from fibroadenoma is difficult, however, when diagnosed, complete surgical resection is recommended. Patients and results: Forty-four patients who underwent surgery between April 2009 and April 2020 and were diagnosed with phyllodes tumors and the median observation period was 44 months. The average tumor diameter was 39.2 mm, and the surgical procedures performed were mastectomy in 3 cases, partial resection in 26 cases, and extirpation in 15 cases. The surgical margin was positive in 6 cases. Intra-breast recurrence occurred in 4 cases, of which the initial surgery in 3 cases was extirpation. The pathological diagnosis was malignant in 4 cases, malignant in 15 cases, and benign in 25 cases. Conclusion: In this study, intra-breast recurrence occurred in many cases treated by extirpation, and it was considered that the surgical technique for complete resection such as partial resection should be selected.

PMID:33468770
Prognosis analysis of local recurrence after excision of breast phyllodes tumors

Fetched: February 24th, 2021, 5:02am GMT by Y Peng

Zhonghua Wai Ke Za Zhi. 2021 Feb 1;59(2):116-120. doi: 10.3760/cma.j.cn112139-20201012-00748.

ABSTRACT

Objective: To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence. Methods: This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People's Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30^th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm (M(QR)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results: According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% (P=0.300). Conclusion: Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.

PMID:33378803 | DOI:10.3760/cma.j.cn112139-20201012-00748
Malignant phyllodes tumor with liposarcomatous differentiation: Diagnosed on cytology

Fetched: February 24th, 2021, 5:02am GMT by Devi Anu Kuppusamy

Diagn Cytopathol. 2020 Dec 30:e24681. doi: 10.1002/dc.24681. Online ahead of print.

ABSTRACT

Phyllodes tumor (PT) accounts for less than 1% of all primary tumors of the breast and 2% to 3% of all fibroepithelial lesions. We report a case of heterologous liposarcomatous elements in a malignant PT of the breast on Fine needle aspiration cytology (FNAC) and later confirmed by histopathological examination. A 58-years-old woman presented with a huge breast mass for which FNAC was done. Cytology showed features of malignant PT with a good representation of heterologous liposarcomatous areas. The cytological findings were in concordance with the histologic features. Malignant PT and its various heterologous elements of stroma can be diagnosed on FNA cytology when performed optimally. They can be vital for the preoperative assessment of patients suspected with malignancy to formulate the surgical plan accordingly.

PMID:33378115 | DOI:10.1002/dc.24681
Recurrence prediction for breast phyllodes tumours: validation of the Singapore nomogram in Korean women

Fetched: February 24th, 2021, 5:02am GMT by Jung Eun Choi

J Clin Pathol. 2020 Dec 29:jclinpath-2020-207093. doi: 10.1136/jclinpath-2020-207093. Online ahead of print.

ABSTRACT

AIM: The Singapore nomogram was developed to predict recurrence risk of phyllodes tumours (PTs) of the breast based on histological features of stromal atypia, stromal mitoses, stromal overgrowth and surgical margin status. We aimed to validate the utility of the Singapore nomogram in a Korean PT cohort.

METHODS: One hundred and twenty-four patients with Korean PT who underwent surgical resection between 1996 and 2015 were included in this study. Pathology reports and slides were reviewed to obtain histopathologic features and acquire Singapore nomogram scores. The probability of concordance between predicted and observed survivals by means of the Singapore nomogram was evaluated using a concordance index (C-index).

RESULTS: Of the 124 cases, 57 (46%) were diagnosed as benign, 50 (40.3%) as borderline and 17 (13.7%) as malignant. Recurrences occurred in 25 (20.2%) patients. Univariate analysis showed PTs with higher stromal mitotic counts, marked stromal cellularity, stromal overgrowth, positive surgical margin, marked stromal atypia or a malignant grade presented higher risks of recurrence. Multivariate analysis showed stromal mitoses and surgical margin status independently predicted recurrence-free survival. Patients with high nomogram scores were at greater risk of recurrence (HR=1.05, 95% CI: 1.02 to 1.07, p<0.001) with a C-index of 0.762.

CONCLUSION: The Singapore nomogram provided a useful means of predicting PT outcomes in a Korean PT cohort.

PMID:33376198 | DOI:10.1136/jclinpath-2020-207093
Germline TP53 Testing in Breast Cancers: Why, When and How?

Fetched: February 24th, 2021, 5:02am GMT by D Gareth Evans

Cancers (Basel). 2020 Dec 14;12(12):3762. doi: 10.3390/cancers12123762.

ABSTRACT

Germline TP53 variants represent a main genetic cause of breast cancers before 31 years of age. Development of cancer multi-gene panels has resulted in an exponential increase of germline TP53 testing in breast cancer patients. Interpretation of TP53 variants, which are mostly missense, is complex and requires excluding clonal haematopoiesis and circulating tumour DNA. In breast cancer patients harbouring germline disease-causing TP53 variants, radiotherapy contributing to the development of subsequent tumours should be, if possible, avoided and, within families, annual follow-up including whole-body MRI should be offered to carriers. We consider that, in breast cancer patients, germline TP53 testing should be performed before treatment and offered systematically only to patients with: (i) invasive breast carcinoma or ductal carcinoma in situ (DCIS) before 31; or (ii) bilateral or multifocal or HER2+ invasive breast carcinoma/DCIS or phyllode tumour before 36; or (iii) invasive breast carcinoma before 46 and another TP53 core tumour (breast cancer, soft-tissue sarcoma, osteosarcoma, central nervous system tumour, adrenocortical carcinoma); or (iv) invasive breast carcinoma before 46 and one first- or second-degree relative with a TP53 core tumour before 56. In contrast, women presenting with breast cancer after 46, without suggestive personal or familial history, should not be tested for TP53.

PMID:33327514 | PMC:PMC7764913 | DOI:10.3390/cancers12123762
Correlations of morphological features and surgical management to clinical outcome in a multicentre study of 241 phyllodes tumours of the breast

Fetched: February 24th, 2021, 5:02am GMT by Raluca Mihai

Histopathology. 2020 Dec 16. doi: 10.1111/his.14316. Online ahead of print.

ABSTRACT

AIMS: Phyllodes tumours (PTs) represent an unusual but complex group of breast lesions with a tendency to recur locally and, less commonly, metastasise. On core biopsies, their appearances can be difficult to discriminate from those of other fibroepithelial lesions, which may compromise their surgical management. The aims of this study were to assess the preoperative diagnosis of PTs and to evaluate the impacts of surgical management and morphological features on their behaviour.

METHODS AND RESULTS: We combined datasets from three centres over two decades, including core biopsies, excision specimens, and follow-up. Core biopsy results were compared with final excision specimens. The relationships of surgical procedure and morphological features with local recurrence (LR) and metastasis were assessed. Two hundred and forty-one PTs were studied. Core biopsy resulted in a diagnosis of possible or definite PT in 76% of cases. Malignant tumours were more likely to be larger, occurred at an older age, and were surgically more challenging, with difficulties being encountered in achieving negative margins. There were 12 cases (5%) that showed LR alone, and another six cases (2.5%) that had distant metastases. Morphological features associated with adverse outcome were grade of PT, increased mitotic counts, necrosis, infiltrative margins, stromal atypia, and heterologous components. Both LR and metastatic behaviour correlated with larger size and distance to margins.

CONCLUSIONS: Our results suggest that excision margins have a significant impact on LR of PT, whereas metastatic behaviour is influenced by tumour biology. We add to the evidence base on histological features of tumours that contribute to long-term outcomes of PT patients.

PMID:33325544 | DOI:10.1111/his.14316
Recurrent phyllodes tumour of breast infiltrating the latissimus dorsi reconstruction flap

Fetched: February 24th, 2021, 5:02am GMT by Pradeep Saxena

BMJ Case Rep. 2020 Dec 13;13(12):e238306. doi: 10.1136/bcr-2020-238306.

ABSTRACT

Phyllodes tumour is a rare breast tumour with potential of malignancy. Recurrence in phyllodes tumour may also be suggestive of malignant transformation. We report a case of 29-year-old woman with recurrent phyllodes tumour infiltrating the latissimus dorsi reconstruction flap. Re-excision of the tumour along with excision of latissimus dorsi flap was done. Histopathology confirmed malignant phyllode tumour. A significantly higher incidence of recurrence is seen in phyllodes tumour of large size, tumours with infiltrative borders, increased mitotic activity, malignant histology and positive margins. Surgeons should always take into consideration the risk factors for recurrence before planning reconstructive breast surgery in recurrent phyllodes tumour. A preoperative MRI imaging and incisional biopsy are essential in planning surgery for these patients.

PMID:33318256 | PMC:PMC7737035 | DOI:10.1136/bcr-2020-238306
Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines

Fetched: February 24th, 2021, 5:02am GMT by Laura H Rosenberger

J Clin Oncol. 2021 Jan 20;39(3):178-189. doi: 10.1200/JCO.20.02647. Epub 2020 Dec 10.

ABSTRACT

PURPOSE: Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary.

METHODS: We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR).

RESULTS: Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96).

CONCLUSION: In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.

PMID:33301374 | DOI:10.1200/JCO.20.02647
Gross genetic alterations and genetic heterogeneity in a periductal stromal tumor of the breast

Fetched: February 24th, 2021, 5:02am GMT by Carsten Holzmann

Mol Cytogenet. 2020 Nov 23;13(1):49. doi: 10.1186/s13039-020-00516-z.

ABSTRACT

BACKGROUND: Periductal stromal tumors of the breast are exceedingly rare biphasic breast tumors with close morphological relationship to phyllodes tumors. So far, results of genetic analyses on these tumors have not been reported.

CASE PRESENTATION: A 50 year old female patient was admitted to the hospital because of a palpable lump in her right breast with a diameter of approximately 5-6 cm which was surgically removed by lumpectomy. Histologic examination revealed a biphasic breast tumor classified as periductal stromal tumor. Array analysis showed a pseudotetraploid tumor with a copy number of 4 for most of the chromosomes. In addition, further changes of chromosomes 1, 5, and 6 were noted but there were no mutations of MED12 as those frequently seen in fibroadenomas or phyllodes tumors.

CONCLUSIONS: The genetic alterations observed indicate karyotypic evolution leading to marked heterogeneity which fits with the tumor´s histologic and cytologic appearance as well as with its malignant behavior. Because of the absence of genetic similarities with phyllodes tumors, the case does not offer evidence for a common entity but rather suggests the existence of two independent entities.

PMID:33292379 | PMC:PMC7686689 | DOI:10.1186/s13039-020-00516-z
Malignant phyllodes tumor of the breast with rapid progression: a case report

Fetched: February 24th, 2021, 5:02am GMT by Hajime Abe

Surg Case Rep. 2020 Dec 7;6(1):308. doi: 10.1186/s40792-020-00986-8.

ABSTRACT

BACKGROUND: Malignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period.

CASE PRESENTATION: A 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin-ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy.

CONCLUSIONS: A standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.

PMID:33284362 | PMC:PMC7721958 | DOI:10.1186/s40792-020-00986-8
Pancreatic metastases and first reported gallbladder metastasis from phyllodes tumor of the breast

Fetched: February 24th, 2021, 5:02am GMT by Salsabil Nasri

Rare Tumors. 2020 Nov 18;12:2036361320972866. doi: 10.1177/2036361320972866. eCollection 2020.

ABSTRACT

Distant metastases from breast phyllodes tumor (PT) are very rare. They usually occur in lung and bones. We report a case of a 51-year-old woman who was hospitalized in the digestive surgical department for atypical epigastric pain. Her medical history started 2 years ago when she underwent a curative left mastectomy for a malignant PT of the breast. Radical surgery was indicated to her resectable pancreatic tumor diagnosed on computed tomography. Histological exam confirmed that it was pancreatic metastases of her breast PT. Adjuvant chemotherapy was indicated. Three months after the surgery, the patient developed gallbladder and brain metastases. She died 5 weeks later. With this case, we enrich the literature with another example of pancreatic metastasis from PT and we report, for the first time, gallbladder metastasis. The very high aggressiveness of this tumor suggests that markers of tumor malignancy need to be sought after by subsequent studies.

PMID:33282161 | PMC:PMC7682197 | DOI:10.1177/2036361320972866
Detection of MED12 mutations in mesenchymal components of uterine adenomyomas

Fetched: February 24th, 2021, 5:02am GMT by Masahiko Kito

Hum Pathol. 2021 Mar;109:31-36. doi: 10.1016/j.humpath.2020.11.013. Epub 2020 Nov 28.

ABSTRACT

Adenomyoma of the uterus is a biphasic nodular lesion composed of a mesenchymal component with smooth muscle differentiation and a glandular epithelium. The neoplastic nature of uterine adenomyomas has been controversial because some are considered to be nodular adenomyosis. MED12 mutations are involved in the pathogenesis of uterine smooth muscle tumors (leiomyomas and leiomyosarcomas) and biphasic tumors of the breast (fibroadenomas and phyllodes tumor). To investigate the histogenesis of uterine adenomyomas, we performed pathological and genetic analyses, including Sanger sequencing of MED12. In total, 15 cases of uterine adenomyomas were retrieved and assessed for clinicopathological factors. Immunohistochemistry for smooth muscle actin, desmin, and CD10 was performed. Exon 2 of MED12 was Sanger sequenced using DNA obtained by macrodissection of the adenomyomas. For cases that were positive for somatic MED12 mutations, we next performed microdissection of the mesenchymal and epithelial components. The DNA extracted from each component was further analyzed for MED12 mutations. MED12 mutations were detected in two adenomyomas (2/15, 13%), all in a known hot spot (codon 44). In both lesions, MED12 mutations were detected in multiple spots of the mesenchymal component. The epithelial component did not harbor MED12 mutations. The relatively low frequency of MED12 mutations suggests that not all adenomyomas are leiomyomas with entrapped glands. However, the results of our study suggest that a subset of uterine adenomyomas are true mesenchymal neoplasms.

PMID:33259844 | DOI:10.1016/j.humpath.2020.11.013
Expression of lymphoid enhancer-binding factor 1 in breast fibroepithelial lesions

Fetched: February 24th, 2021, 5:02am GMT by Po-Han Chen

Hum Pathol. 2021 Feb;108:68-75. doi: 10.1016/j.humpath.2020.11.009. Epub 2020 Nov 24.

ABSTRACT

Phyllodes tumors (PTs) are rare epithelial-mesenchymal tumors of the breast with malignant potential. Here, we evaluate the nuclear expression of lymphoid enhancer-binding factor 1 (LEF-1), a transcription factor downstream of Wnt/β-catenin signaling, in fibroepithelial lesions of the breast. Excised fibroepithelial lesions of the breast were retrospectively reviewed, blinded to the original diagnosis, and classified according to World Health Organization (WHO) criteria. A tissue microarray (TMA) was composed with two representative cores from each case, including 24 benign lesions, 11 borderline phyllodes, and 8 malignant PTs. β-Catenin, LEF-1, p120, and E-cadherin immunohistochemistry was performed on the TMA, and staining was quantified. The malignant/borderline PTs showed higher stromal LEF-1 expression than benign tumors (P < 0.001). Stromal cells expressed LEF-1 in 100% (16/16 of core TMA) of malignant phyllodes, compared with 73% (16/22) borderline and 27% (13/48) benign tumors. The average LEF-1 H-score was 24.9, 6.1, and 1.5 for malignant, borderline, and benign tumors, respectively. Nuclear expression of β-catenin in the stromal component was more often seen in malignant than in borderline and benign tumors (44% versus 32% and 23%, respectively). Nine TMA cores of malignant tumors without nuclear β-catenin staining demonstrated LEF-1 expression. Both LEF-1 and nuclear β-catenin showed expression in the majority of borderline/malignant PTs suggesting a biological progression of Wnt/β-catenin pathway activation in the stromal component from benign to malignant tumors. Inhibitors for the Wnt/β-catenin pathway may provide alternative treatment options in the future for malignant or metastatic PTs.

PMID:33245988 | DOI:10.1016/j.humpath.2020.11.009
Pancreatic metastasis from malignant phyllodes tumor of the breast

Fetched: February 24th, 2021, 5:02am GMT by Seung Eun Lee

Yeungnam Univ J Med. 2021 Jan;38(1):78-82. doi: 10.12701/yujm.2020.00759. Epub 2020 Nov 27.

ABSTRACT

Pancreatic metastasis from malignant phyllodes tumor (PT) of the breast is rare, and only a few cases have been reported in the literature. Here, we report a case of pancreatic metastasis from malignant PT of the breast in a 48-year-old woman. She had had three episodes of recurrence of malignant PT in her right breast. She presented with epigastric pain for 2 months. Computed tomography and magnetic resonance imaging revealed a 6 cm-sized, well-defined, heterogeneous mass with peripheral enhancement in the body of the pancreas. Endoscopic ultrasonography-guided fine-needle aspiration was performed, and the pathologic report suggested spindle cell mesenchymal neoplasm. Subsequently, surgical excision was performed, and the mass was confirmed as a metastatic malignant PT. The imaging findings are discussed and the literature is briefly reviewed in this report.

PMID:33242383 | PMC:PMC7787903 | DOI:10.12701/yujm.2020.00759
A case of recurrent malignant phyllodes tumor undergoing nipple-sparing mastectomy with immediate breast reconstruction

Fetched: February 24th, 2021, 5:02am GMT by Emi Morioka

Surg Case Rep. 2020 Nov 25;6(1):297. doi: 10.1186/s40792-020-01022-5.

ABSTRACT

BACKGROUND: Although the primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR).

CASE PRESENTATION: A 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size. She underwent tumor excision and a histological diagnosis of marked degenerative and necrotic induration suggested benign PT. One year later, however, she was found to have recurrent masses in the left breast on follow-up mammography and sonography. Needle biopsy was performed and the tumor was diagnosed as borderline or malignant PT. She underwent NSM and sentinel lymph-node biopsy with IBR using a tissue expander. Histological examination of the mastectomy specimen showed multiple fibroepithelial tumors with marked stromal overgrowth, focal necrosis, and hemorrhage. Stromal cells showed pleomorphism and a maximal mitotic rate of approximately 25 per 10 high-power fields. The tumor was diagnosed as malignant PT. She did not receive adjuvant chemotherapy or radiation treatment. At 3-year follow-up, the patient remains free of disease and highly satisfied with the cosmetic results.

CONCLUSIONS: NSM with IBR is not a contraindication for malignant PT. It is both curative and can offer an appealing cosmetic option for localized malignant PT.

PMID:33237380 | PMC:PMC7688876 | DOI:10.1186/s40792-020-01022-5
Early-onset malignant phyllodes breast tumor in a patient with germline pathogenic variants in NF1 and BRCA1 genes

Fetched: February 24th, 2021, 5:02am GMT by Francesca Gensini

Fam Cancer. 2020 Nov 19. doi: 10.1007/s10689-020-00217-x. Online ahead of print.

ABSTRACT

We present a 24-year-old female patient affected by neurofibromatosis type 1 (NF1) who developed a malignant phyllodes tumor of the breast. The molecular studies showed that the patient carried a heterozygous inactivating deleterious variant in BRCA1 inherited from the father associated with a germline de novo pathogenic alteration in NF1; the tumor presented a biallelic inactivation of both genes. Therefore, tumor analyses helped to establish that the germline NF1 and BRCA1 variants were in cis on the paternal chromosome. This last information is important to provide adequate genetic counselling regarding the risk of recurrence in the offspring, as well as opportunity for early intervention. In conclusion, we present the first case of a malignant phyllodes tumor of the breast in patient carrying pathogenic variants in NF1 and BRCA1. Further studies will be necessary to understand if the phyllodes histotype represents a very rare component of NF1-associated breast cancer.

PMID:33210232 | DOI:10.1007/s10689-020-00217-x
Phyllodes Tumor Of The Breast

Fetched: February 24th, 2021, 5:02am GMT by Faten Limaiem

2020 Nov 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 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
Recurrent giant phyllodes tumour in a 17-year-old female: a rare case report

Fetched: February 24th, 2021, 5:02am GMT by James J Yahaya

Oxf Med Case Reports. 2020 Oct 23;2020(10):omaa089. doi: 10.1093/omcr/omaa089. eCollection 2020 Oct.

ABSTRACT

Phyllodes tumours (PTs) are rare fibroepithelial tumours of the breast with incidence accounting for <1% in the general population. Availability of reports on PTs with size of 31 cm or more in diameter in the literature are extremely rare. Herein, the case of a 17-year-old female patient with a giant recurrent right breast PT is reported. Histologically, the tumour showed proliferation of stromal tumour cells consisting of spindle cells with uniform nuclear chromatin, inconspicuous nucleoli, abundant eosinophilic cytoplasm and proliferation labelling index for Ki67 of <10%. PTs require meticulous surgical excision due to the fact that they have a high rate of recurrence and status of surgical margins must be included in the pathology report. This is because recurrent cases of PTs tend to grow faster than the primary ones with a high chance of transforming to malignancy.

PMID:33133622 | PMC:PMC7583418 | DOI:10.1093/omcr/omaa089
Giant malignant phyllodes tumor of the breast: Insights into optimal management and reconstructive options for a rare and challenging entity

Fetched: February 24th, 2021, 5:02am GMT by Germana Lissidini

Breast J. 2020 Dec;26(12):2400-2402. doi: 10.1111/tbj.14095. Epub 2020 Oct 27.

NO ABSTRACT

PMID:33108821 | DOI:10.1111/tbj.14095
Prognostic Molecular and Biological Characteristics of Phyllodes Tumors of the Breast

Fetched: February 24th, 2021, 5:02am GMT by I K Vorotnikov

Bull Exp Biol Med. 2020 Oct;169(6):806-810. doi: 10.1007/s10517-020-04985-5. Epub 2020 Oct 24.

ABSTRACT

Prognosis for some histological variants of a rare breast disease, phyllodes tumors, is evaluated. The prognostic potential of some molecular biological factors significantly correlating with breast cancer prognosis is evaluated on a unique clinical material (244 cases with benign, intermediate, and malignant phyllodes tumors). The development of benign phyllodes tumor relapse directly correlated with the number of G0/1-phase cells and inversely correlated with the number of cells in the G2+M and S phases. The level of steroid hormone receptors in phyllodes tumors cannot serve as a prognostic marker predicting the disease course. The presence of somatic mutations of TP53 gene and loss of heterozygosity of specific intragenic loci in the tumor correlate with the development of disease relapse (p<0.05).

PMID:33098518 | DOI:10.1007/s10517-020-04985-5
Epithelial-Myoepithelial Carcinoma of the Breast with Rhabdoid Features

Fetched: February 24th, 2021, 5:02am GMT by Karl Grenier

Case Rep Pathol. 2020 Oct 7;2020:8879035. doi: 10.1155/2020/8879035. eCollection 2020.

ABSTRACT

Epithelial-myoepithelial carcinoma of the breast is a rare biphasic tumor composed of intermixed malignant epithelial and myoepithelial components. Myoepithelial cells are known to adopt varied morphologies, including spindle, chondroid, clear cell, and rhabdoid morphologies, and can represent a diagnostic challenge when isolated on biopsy. Rhabdomyosarcoma, phyllodes tumor, metaplastic carcinoma, and myoepithelial carcinoma are primary breast tumors that all have been shown to exhibit rhabdoid features, whether representing true differentiation or morphological mimic. We here report an epithelial-myoepithelial carcinoma of the breast with rhabdoid features in a 76-year-old woman. The rhabdoid-appearing myoepithelial cells are negative for myogenin, consistent with a rhabdoid-like morphology rather than a true rhabdoid differentiation, comparably to previously described myoepithelial carcinoma with rhabdoid features. To our knowledge, this is the first reported case of epithelial-myoepithelial carcinoma of the breast with rhabdoid features and thus adds another entity to the differential diagnosis of breast lesions with rhabdoid features.

PMID:33083078 | PMC:PMC7563038 | DOI:10.1155/2020/8879035
Bilateral Phyllodes Giant Tumor. A Case Report Analyzed by Array-CGH

Fetched: February 24th, 2021, 5:02am GMT by Francesco Fortarezza

Diagnostics (Basel). 2020 Oct 15;10(10):825. doi: 10.3390/diagnostics10100825.

ABSTRACT

The breast phyllodes tumor is a biphasic tumor that accounts for less than of 1% of all breast neoplasms. It is classified as benign, borderline, or malignant, and can mimic benign masses. Some recurrent alterations have been identified. However, a precise molecular classification of these tumors has not yet been established. Herein, we describe a case of a 43-year-old woman that was admitted to the emergency room for a significant bleeding from the breast skin. A voluminous ulcerative mass of the left breast and multiple nodules with micro-calcifications on the right side were detected at a physical examination. A left total mastectomy and a nodulectomy of the right breast was performed. The histological diagnosis of the surgical specimens reported a bilateral giant phyllodes tumor, showing malignant features on the left and borderline characteristics associated with a fibroadenoma on the right. A further molecular analysis was carried out by an array-Comparative Genomic Hybridization (CGH) to characterize copy-number alterations. Many losses were detected in the malignant mass, involving several tumor suppressor genes. These findings could explain the malignant growth and the metastatic risk. In our study, genomic profiling by an array-CGH revealed a greater chromosomal instability in the borderline mass (40 total defects) than in the malignant (19 total defects) giant phyllodes tumor, reflecting the tumor heterogeneity. Should our results be confirmed with more sensitive and specific molecular tests (DNA sequencing and FISH analysis), they could allow a better selection of patients with adverse pathological features, thus optimizing and improving patient's management.

PMID:33076253 | PMC:PMC7602371 | DOI:10.3390/diagnostics10100825
Preoperative radiological and histological features predict phyllodes tumor grade

Fetched: February 24th, 2021, 5:02am GMT by Zhiyan Yan

Breast J. 2020 Oct;26(10):2122-2124. doi: 10.1111/tbj.13983. Epub 2020 Oct 16.

NO ABSTRACT

PMID:33064334 | DOI:10.1111/tbj.13983
Residual Breast Sarcoma Left to Heal by Secondary Intention Following Wide Local Excision: An Unorthodox Approach to a Rare Malignancy

Fetched: February 24th, 2021, 5:02am GMT by Talal Almas

Cureus. 2020 Sep 13;12(9):e10433. doi: 10.7759/cureus.10433.

ABSTRACT

Breast sarcomas remain a rare malignancy and are noted to portend a particularly dismal prognosis. Due to their high rates of recurrence, a surgical excision with negative margins remains the preferred treatment modality. Nevertheless, their sparse prevalence often poses a diagnostic conundrum. In this report, we chronicle the case of a 46-year-old female with a recurrent breast sarcoma that was treated with wide local excision. Interestingly, no flap reconstruction, skin graft surgery, or primary wound closure was performed, and the resultant wound was left to heal by secondary intention. The patient continues to do well to date, with no postoperative complications.

PMID:33062546 | PMC:PMC7556687 | DOI:10.7759/cureus.10433
Fibroepithelial Lesion Initially Believed to Be Fibroadenoma, but Interval Growth Consistent With Phyllodes Tumor

Fetched: February 24th, 2021, 5:02am GMT by Quan D Nguyen

Cureus. 2020 Sep 10;12(9):e10363. doi: 10.7759/cureus.10363.

ABSTRACT

Fibroepithelial lesions of the breast are commonly encountered tumors comprised of stromal and epithelial components. Fibroadenoma and phyllodes tumor are both fibroepithelial lesions, but their management differs. Phyllodes tumor requires surgical excision, whereas fibroadenoma requires no further workup. Both have many overlapping histological features making it difficult to distinguish between a benign fibroadenoma versus the more aggressive phyllodes tumor. This case details a breast mass that was initially believed to be a fibroadenoma, but interval growth at one year follow up resulted in surgical excision with final pathology revealing phyllodes tumor.

PMID:33062486 | PMC:PMC7549856 | DOI:10.7759/cureus.10363
Isolated liver metastasis from a malignant phyllodes presenting with hemoperitoneum

Fetched: February 24th, 2021, 5:02am GMT by Krislyn N Miller

Breast J. 2020 Nov;26(11):2246-2247. doi: 10.1111/tbj.14076. Epub 2020 Oct 13.

NO ABSTRACT

PMID:33051939 | DOI:10.1111/tbj.14076
Droplet-digital PCR reveals frequent mutations in TERT promoter region in breast fibroadenomas and phyllodes tumours, irrespective of the presence of MED12 mutations

Fetched: February 24th, 2021, 5:02am GMT by Kazutaka Otsuji

Br J Cancer. 2021 Jan;124(2):466-473. doi: 10.1038/s41416-020-01109-8. Epub 2020 Oct 13.

ABSTRACT

BACKGROUND: Breast fibroadenoma (FA) and phyllodes tumour (PT) often have variations of gene mediator complex subunit 12 (MED12) and mutations in the telomerase reverse transcriptase promoter region (TERTp). TERTp mutation is usually tested by Sanger sequencing. In this study, we compared Sanger sequencing and droplet-digital PCR (ddPCR) to measure TERTp mutations in FA and PT samples.

METHODS: FA and PT samples were collected from 82 patients who underwent surgery at our institution from 2005 to 2016. MED12 mutations for all cases and TERTp mutations for 17 tumours were detected by Sanger sequencing. ddPCR was performed to analyse TERTp mutation in all cases.

RESULTS: A total of 75 samples were eligible for analysis. Sanger sequencing detected MED12 mutations in 19/44 FA (42%) and 21/31 PT (68%). Among 17 Sanger sequencing-tested samples, 2/17 (12%) were TERTp mutation-positive. In ddPCR analyses, a significantly greater percentage of PT (19/31, 61%) was TERTp mutation-positive than was FA (13/44, 30%; P = 0.0046). The mutation positivity of TERTp and MED12 did not correlate, in either FA or PT.

CONCLUSIONS: ddPCR was more sensitive for detecting TERTp mutation than Sanger sequencing, being able to elucidate tumorigenesis in FA and PT.

PMID:33046803 | PMC:PMC7852881 | DOI:10.1038/s41416-020-01109-8
En Bloc Excision of Phyllodes Tumor of the Breast: Radical Approach Heralds Better Outcome

Fetched: February 24th, 2021, 5:02am GMT by Nita S Nair

Clin Breast Cancer. 2020 Sep 9:S1526-8209(20)30217-2. doi: 10.1016/j.clbc.2020.09.002. Online ahead of print.

ABSTRACT

INTRODUCTION: Surgery is the primary treatment of phyllodes tumor of the breast, and margins are the most important risk factor associated with local recurrence. We conducted a retrospective audit of 433 patients treated at our center.

PATIENTS AND METHODS: Women who presented with phyllodes tumors between 1999 and 2017 were included in the analysis. Data was collected from the hospital medical records, telephonic interviews, and electronic mail.

RESULTS: Of the 433 women included in this study, 177 (40.9%) had benign phyllodes tumors, 84 (19.4%) were borderline, 131 (30.3%) were malignant, and 41 (9.5%) had sarcoma. A history of previous excision was noted in 154 (35.6%) patients, of which 104 presented with local recurrence. Of the total patients, 209 (48.3%) underwent breast conservation surgery; the median pT was 6 cm. At a median follow-up of 37.9 months, the 5-year disease-free survival (DFS) was 82.9%. On multivariate analysis, the factors that impacted DFS were histology (hazard ratio, 4.1; 95% confidence interval [CI], 1.5-10.9; P = .005) and history of previous excision biopsy (hazard ratio, 3.39; 95% CI, 1.76-6.52; P < .001). We analyzed 231 women who presented without any prior excision separately, wherein at a median follow-up of 44.1 months, the DFS was 92.1% (95% CI, 92.05%-92.15%). In addition, less recurrences were noted in this cohort (5.6% [13/231] in no-excision biopsy vs. 12.5% with surgery done prior to presentation to our institute).

CONCLUSION: A previous history of excision and the histologic subtype of phyllodes tumor are factors that have an impact on DFS, thus emphasizing the need for appropriate surgical planning and en bloc excision of the phyllodes at presentation.

PMID:33046357 | DOI:10.1016/j.clbc.2020.09.002
Immunohistochemical detection of paralogous 13 HOX genes in phyllodes tumor of the breast as a useful diagnostic tool

Fetched: February 24th, 2021, 5:02am GMT by Sabrina Sarno

Int J Clin Exp Pathol. 2020 Sep 1;13(9):2348-2351. eCollection 2020.

ABSTRACT

Phyllodes tumor of the breast is a rare fibroepithelial lesion characterized by a propensity for local recurrence and distant metastasis. Its histologic classification, based on morphology, mitotic index and tumor margin, includes malignant, borderline, and benign. These tumors show similar cellular morphology, which may contribute to difficulty in classifying them histologically and in prediction of their clinical behavior. Thus, the identification of new biomarkers detectable also by in situ methods has become indispensable. Paralogous HOX13 genes (HOX A13, HOX B13, HOX C13 and HOX D13) play a relevant role in tumor development and progression in particular in breast cancer. In this study we analyzed the immunohistochemical expression of paralogous HOX13 homeoproteins on a phyllodes tumor case series to validate their usefulness in histologic classification.

PMID:33042341 | PMC:PMC7539888
Localization and hypersecretion of nerve growth factor in breast phyllodes tumors: Evidence from a preliminary study

Fetched: February 24th, 2021, 5:02am GMT by Ashutosh Kumar

Cancer Rep (Hoboken). 2021 Feb;4(1):e1300. doi: 10.1002/cnr2.1300. Epub 2020 Oct 7.

ABSTRACT

BACKGROUND: The pathophysiology of the breast phyllodes tumors is uncertain. Currently, wide surgical removal is the only available treatment option. The histopathological diagnosis of phyllodes tumors is often confused with that of fibroadenomas due to a striking histological resemblance.

AIM: To identify a distinctive biomarker for phyllodes tumors of the breast.

METHODS AND RESULTS: Fresh human breast tissue was obtained from surgically excised breast phyllodes and fibroadenoma tumors (test), breast cancer (positive control) and normal breast tissue (negative control). Immunohistochemistry and Sandwich ELISA were performed for the detection of nerve growth factor (NGF) in test and control tissues. A marked difference in NGF expression was detected in phyllodes tumors compared to fibroadenomas. The maximum NGF expression was observed in phyllodes tissue followed by cancer tissue, and the least expression in fibroadenomas (3-5 times less than in phyllodes; comparable with normal breast tissue).

CONCLUSION: NGF secretion by a benign breast tumor is not known in literature. This study reports abundant NGF secretion by breast phyllodes, raising the possibility of its potential role in tumor pathogenesis and progression that can be exploited therapeutically. Additionally, NGF may be used as a distinct biomarker of phyllodes tumors, for differentiating them from fibroadenomas during histopathology.

PMID:33026185 | DOI:10.1002/cnr2.1300
Prognostic factors in phyllodes tumours of the breast: retrospective study on 166 consecutive cases

Fetched: February 24th, 2021, 5:02am GMT by Elisabetta Di Liso

ESMO Open. 2020 Oct;5(5):e000843. doi: 10.1136/esmoopen-2020-000843.

ABSTRACT

BACKGROUND: Phyllodes tumours (PTs) are rare fibroepithelial tumours accounting for <1% of all breast tumours. We assessed clinicopathological features and their prognostic effect in a single-institution patients' cohort.

METHODS: Patients diagnosed with PT between 2001 and 2018 at our institution were identified. Clinical, surgical and pathological features were collected. Phyllodes-related relapse was defined as locoregional or distant recurrence (contralateral excluded), whichever first.

RESULTS: A total of 166 patients were included: 115 with benign, 30 with borderline and 21 with malignant PTs. Features associated with malignant PT were younger age, larger T size, higher mitotic count, marked cytological atypia, stromal overgrowth, stromal hypercellularity, necrosis and heterologous differentiation (all p<0.01). The majority of patients with malignant PT underwent mastectomy (63.2% vs 3% of benign/borderline, p<0.001) and had negative surgical margins (83.3%). 4-year cumulative phyllodes-related relapse incidence was 7% for benign/borderline PT and 21.3% for malignant PT (p=0.107). In the entire cohort, marked cellular atypia and heterologous differentiation were associated with worse phyllodes-related relapse-free survival (HR 14.10, p=0.036 for marked vs mild atypia; HR 4.21, p=0.031 for heterologous differentiation present vs absent). For patients with benign PT, larger tumour size was associated with worse phyllodes-related relapse-free survival (HR 9.67, p=0.013 for T>5 cm vs T≤2 cm). Higher tumour-infiltrating lymphocytes (TILs) were associated with borderline and malignant PT (p=0.023); TILs were not associated with phyllodes-related relapse-free survival (HR 0.58, p=0.361 for TILs>2% vs≤2%). Overall, four patients died because of PT: three patients with malignant and one with borderline PT.

CONCLUSIONS: Patients with malignant PT had increased rates of phyllodes-related relapse and phyllodes-related death. Cellular atypia and heterologous differentiation were poor prognostic factors in the entire cohort; large tumour size was associated with an increased risk of phyllodes-related relapse in benign PT.

PMID:33020219 | PMC:PMC7537333 | DOI:10.1136/esmoopen-2020-000843
Outcomes of systemic therapy in metastatic phyllodes tumor of the breast.

Fetched: February 14th, 2021, 5:01am GMT

Breast Cancer Res Treat. 2021 Apr;186(3):871-882. doi: 10.1007/s10549-021-06116-8. Epub 2021 Feb 11.

ABSTRACT

PURPOSE: Metastatic phyllodes tumors of the breast (MPT) are rare breast neoplasms, limiting development of standardized treatment approaches. We sought to characterize the largest group of MPT thus far reported, evaluating systemic therapy outcomes.

METHODS: Adult patients diagnosed with MPT between 1993 and 2015 and followed at MD Anderson Cancer Center were selected for retrospective chart review. Systemic therapy was sorted into: adriamycin/ifosfamide (AI), other anthracycline regimens, other ifosfamide regimens, gemcitabine-based regimens, and other. Given one patient may have received more than one regimen, we assumed that the effects of each regimen were independent from previous therapy. Median overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Log-rank test was performed to evaluate the difference in OS between patient characteristics groups, and the differences in PFS between the five chemotherapy regimens.

RESULTS: We identified 50 MPT patients, with 31 patients receiving 61 systemic regimens. Median OS was 10.7 months (95% CI: 8.67, 16.5). AI had a PFS of 9.10 months (95% CI: 5.03, 14.2), other ifosfamide regimens had a PFS of 5.10 months (95% CI: 0.67, 12.1), other anthracycline regimens had a PFS of 3.65 months (95% CI: 1.17, 7.90), gemcitabine-based regimens had a PFS of 2.80 months (95% CI: 1.83, 4.60), and other regimens had a PFS of 1.67 months (95% CI: 1.13, 7.77).

CONCLUSION: MPT patients are a unique population with limited characterization to date. Our study demonstrates activity of multiple sarcoma-directed chemotherapy regimens, with ifosfamide-containing regimens having the longest PFS.

PMID:33575859 | DOI:10.1007/s10549-021-06116-8
Chemotherapy and targeted treatments of breast sarcoma by histologic subtype.

Fetched: February 10th, 2021, 5:01am GMT

Expert Rev Anticancer Ther. 2021 Mar 12:1-14. doi: 10.1080/14737140.2021.1880327. Online ahead of print.

ABSTRACT

Introduction: Breast sarcomas (BS) are uncommon and often present both diagnostic and therapeutic challenges. Historically, radical surgery has been the mainstay of treatment for localized breast sarcomas. On the other hand, in advanced disease, since they are a heterogeneous group of neoplasms consisting of several different subtypes including angiosarcoma, phyllodes tumor, and pleomorphic undifferentiated sarcoma, there is a lack of proven specific therapy. As a result, their treatment is based on the soft tissue sarcoma (STS) paradigm, whereas histotype-tailored approaches apply to specific subtypes like dermatofibrosarcoma protuberans. To date, advanced stages constitute an incurable form of disease and chemotherapy remains the cornerstone of treatment with the aim of palliation of symptoms and increase in survival.Areas covered: In this manuscript, we review the clinicopathologic characteristics of the most common subtypes of BS, as well as the current treatment landscape of BS, with a particular focus on opportunities and challenges provided by new targeted molecules and immunotherapy.Expert opinion: The treatment approach of advanced BS is based on the pathologic subtype. A true breakthrough has still to be obtained, as the development of new agents in BS suffers from the same weaknesses as in other STS.

PMID:33554686 | DOI:10.1080/14737140.2021.1880327

1 2

← Pancreas PMP and Mucinous Tumors →

Rare Cancer News & Clinical Trials » Phyllodes

Feeds

Phyllodes (188 unread)

Posted: June 14th, 2021, 5:19pm GMT

Posted: June 14th, 2021, 5:07pm GMT

Posted: May 31st, 2021, 5:00am GMT

Posted: May 22nd, 2021, 1:12pm GMT

Posted: May 22nd, 2021, 11:43am GMT

Posted: May 14th, 2021, 7:03am GMT

Posted: May 5th, 2021, 7:22pm GMT

Posted: May 5th, 2021, 6:48pm GMT

Posted: May 5th, 2021, 5:00am GMT

Posted: April 26th, 2021, 8:40am GMT

Posted: April 21st, 2021, 10:34am GMT

Posted: April 19th, 2021, 5:00am GMT

Posted: April 19th, 2021, 3:25am GMT

Posted: April 19th, 2021, 3:25am GMT

Posted: April 2nd, 2021, 4:00am GMT

Posted: April 2nd, 2021, 4:00am GMT

Posted: April 2nd, 2021, 4:00am GMT

Posted: March 23rd, 2021, 5:00am GMT

Posted: March 19th, 2021, 10:09pm GMT

Posted: March 18th, 2021, 5:00am GMT

Posted: March 9th, 2021, 6:00am GMT

Posted: March 6th, 2021, 6:00am GMT

Posted: February 24th, 2021, 6:00am GMT

Posted: February 19th, 2021, 6:00am GMT

Posted: February 18th, 2021, 7:23pm GMT

Posted: January 7th, 2021, 6:00am GMT

Posted: December 23rd, 2020, 9:45am GMT

Posted: October 29th, 2020, 5:00am GMT

Posted: October 22nd, 2020, 5:00am GMT

Posted: September 29th, 2020, 5:00am GMT

Posted: September 29th, 2020, 5:00am GMT

Posted: September 6th, 2020, 5:00am GMT

Posted: August 28th, 2020, 5:00am GMT

Posted: August 28th, 2020, 5:00am GMT

Posted: August 28th, 2020, 5:00am GMT

Posted: August 28th, 2020, 5:00am GMT

Posted: August 12th, 2020, 5:00am GMT

Posted: June 30th, 2020, 5:00am GMT

Posted: June 10th, 2020, 5:00am GMT

Posted: June 10th, 2020, 5:00am GMT

Posted: June 7th, 2020, 5:00am GMT

Posted: February 27th, 2020, 6:00am GMT

Posted: February 25th, 2020, 6:00am GMT

Posted: January 10th, 2020, 6:00am GMT

Posted: January 10th, 2020, 6:00am GMT

Posted: October 19th, 2019, 5:00am GMT

Posted: October 10th, 2019, 5:00am GMT

Posted: October 7th, 2019, 5:00am GMT

Posted: October 5th, 2019, 5:00am GMT

Posted: September 12th, 2019, 5:00am GMT

Posted: August 24th, 2019, 5:00am GMT

Posted: August 19th, 2019, 5:00am GMT

Posted: August 7th, 2019, 5:00am GMT

Posted: August 6th, 2019, 5:00am GMT

Posted: June 27th, 2019, 5:00am GMT

Posted: June 21st, 2019, 5:00am GMT

Posted: May 29th, 2019, 5:00am GMT

Posted: April 16th, 2019, 5:00am GMT

Posted: February 27th, 2019, 6:00am GMT

Posted: February 1st, 2019, 6:00am GMT

Posted: January 23rd, 2019, 6:00am GMT

Posted: November 29th, 2018, 6:00am GMT

Posted: November 2nd, 2018, 5:00am GMT

Posted: November 2nd, 2018, 5:00am GMT

Posted: October 30th, 2018, 5:00am GMT

Posted: September 13th, 2018, 5:00am GMT

Posted: July 24th, 2018, 5:00am GMT

Posted: May 10th, 2018, 2:38pm GMT

Posted: May 10th, 2018, 11:45am GMT

Posted: May 9th, 2018, 4:19pm GMT

Posted: April 6th, 2018, 5:00am GMT

Posted: March 22nd, 2018, 5:00am GMT

Posted: February 21st, 2018, 6:00am GMT