A large benign phyllodes tumour of the breast: A case report and literature review

IntroductionPhyllodes tumours are uncommon fibroepithelial lesions that typically grow up to 4 cm in size but 10 cm tumours known as giant phyllodes tumours have been described. We present a case report of a 20 cm benign phyllodes tumour and a literature review.Presentation of caseA 54 years old lady with an enlarging left breast mass measuring 20 cm of 6 months duration presented to our outpatient breast clinic. She also had an incidental right parotid lump. Core biopsy of the left breast mass returned as a cellular fibroepithelial lesion. A mastectomy and axillary lymph node sampling were done and skin cover was obtained from a split skin graft from the thigh. Final histology returned as a benign phyllodes tumour. Her post-operative recovery was uneventful.DiscussionPhyllodes tumours are suspected in middle age women with rapidly enlarging painless breast masses. Though there are some suggestive features on ultrasound and MRI, the key to diagnosis is still histopathology. However, a pre-operative diagnosis may not always be possible as the interpretation of stromal cellularity and degree of atypia needed to differentiate cellular fibroadenoma from a phyllodes tumour is subjective. When a phyllodes tumour is suspected, adequate margins should be taken for optimal outcome.ConclusionSuccessful management of phyllodes tumour involves obtaining a pre-operative diagnosis via a core biopsy when possible and planning for adequate margins.     

良性与交界性叶状肿瘤局部复发风险的分析

目的探讨良性和交界性乳腺叶状肿瘤的复发率以及手术切缘宽度与复发风险的关系。方法回顾性性分析2008年1月至2015年12月在我院行手术切除的良性及交界性叶状肿瘤的患者。收集的数据包括:年龄、原发肿瘤大小、组织分级、手术方式和局部复发情况。结果共入组118名患者,其中为良性81例,交界性37例。患者平均年龄为48.3岁,肿瘤平均大小为4.6cm,平均随访时间3.5年,共有18例患者出现复发,其中良性肿瘤的复发率为13.5%,交界性肿瘤复发率为18%,但缺少足够的数据说明手术切缘多少最合适。结论交界性比良性叶状肿瘤复发率高,但乳腺肿物广泛切除并不能预防非恶性乳腺叶状肿瘤的复发。     

Malignant phyllodes tumor of the prostate

We report a case of malignant phyllodes tumor of the prostate which is the eleventh reported case in the world. Phyllodes tumor of the prostate is extremely rare and histologically resembles mammary phyllodes tumor. Phyllodes tumor of the prostate is classified into benign, borderline and malignant, but health professionals should carefully follow up the borderline cases in case they take a malignant clinical course. This case was the first to be treated by pre- and postoperative radiation therapy. Although the patient had a slight response to radiation therapy, he eventually developed metastasis. Because malignant phyllodes tumor of the prostate is a very aggressive tumor, people with the condition should undergo systemic chemotherapy as adjuvant therapy.     

Malignant phyllodes tumor of the prostate

We report the case of a 47-year-old male patient who suffered from a malignant phyllodes tumor of the prostate with invasion to the rectum and urinary bladder. The local recurrence at the left scrotum was identified 6 years after radical cystoprostatectomy. Another 2 years after radical orchiectomy showed no evidence of secondary local recurrence or distant metastasis. Histopathologically, both primary and recurrent tumors showed an admixture of stromal and glandular components. However, while extensive squamous metaplasia was identified in the primary tumor, the recurrent tumor had only focal and mild squamous metaplasia. No dependable prognostic factor has been found to date. Here, we describe the morphological features and immunohistochemical presentations of malignant phyllodes tumor of the prostate and review the literature.     

Malignant phyllodes tumors of the breast: A comprehensive literature review

Malignant phyllodes tumors (MPT) have always been a great deal of controversy among fibroepithelial tumors of the breast. Genetics, histopathology, and tumor behavior on the cellular scale shape their extent of aggressiveness. Diagnosis is based on radiological and pathological findings. Cure is surgical excision. This article reveals the most common clinical indices, which should raise the surgeon's concerns on a benign‐looking tumor to further investigate its nature, and the importance of an adequate surgical intervention, preferably done by an oncoplastic breast surgeon, in order to accomplish the ideal outcome for the patient.     

Low local recurrence rates in young Asian patients with phyllodes tumours: less is more

Background: Phyllodes tumours are increasingly being discovered incidentally in young patients after excision of a seemingly innocuous breast lump. The clinical course of this group of patients has not been well‐described, especially in the Asian population. Methods: A retrospective review of 44 consecutive patients below 25 years of age undergoing surgery for phyllodes tumours at our institution from 1992 to 2010 was conducted. Clinico‐pathological data, local recurrence rates and margin involvement were recorded. Results: The majority of the patients had benign lesions treated with simple enucleation, and there were no local recurrences documented after a mean and median length of follow‐up of 47.6 and 29.5 months, respectively. Conclusion: We conclude that in young Asian patients who present with benign phyllodes tumours, simple excision, followed by close follow‐up is sufficient, regardless of surgical margin status.     

Bilateral and multifocal phyllodes tumours of the breast: A case report

Phyllodes tumours are rare breast neoplasms that present as painless breast masses. They are classified as benign, malignant and borderline. More rare presentations of these tumours include bilateral asynchronous disease and unilateral multifocal disease. Surgical excision with clear margins remains the treatment of choice for these tumours. The present case report is the first to be discussed in the literature. It describes a patient presenting with synchronous bilateral, multifocal breast phyllodes tumours who underwent immediate reconstruction with tissue expanders at the time of her mastectomies.     

乳腺叶状肿瘤的诊断与治疗

乳腺叶状肿瘤是一种少见的乳腺肿瘤,属于纤维上皮性疾病。临床酷似纤维腺瘤,但缺乏特异特征。术前临床诊断主要依靠病理组织检查。空芯针穿刺为最佳方法。叶状肿瘤临床分为良性、交界性和恶性肿瘤。治疗方法以外科手术为惟一首选方法,但手术要求切缘净。叶状肿瘤主要并发症是局部复发,其原因为手术技术所致。辅助治疗尚无大样本临床资料,仅为个案报道。     

Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast

The purpose of this study was to evaluate the role of adjuvant chemotherapy in malignant phyllodes tumors of the breast treated at the Instituto Nacional de Cancerología of Mexico. Twenty-eight patients with malignant phyllodes tumors of the breast enrolled in a observational study from January 1993 to December 2003 to receive four cycles of adjuvant chemotherapy with doxorubicin 65 mg/m(2) over 48 hours intravenous infusion and dacarbazine 960 mg/m(2) over 48 hours intravenous infusion (n = 17) versus observation (n = 11). All patients had surgical resection, and 38% had an axillary dissection. Seven patients (25%) received adjuvant radiotherapy. Log-rank test was used to test for differences in recurrence-free survival (RFS). The median patient age was 42 years (range, 23-76 years). The median tumor size was 13 cm (range, 3-30 cm), and 46% of the tumors were in the left breast. At a median follow-up of 15 months (range, 2-81 months), there were seven recurrences and five deaths. The 5 year RFS rate was 58% (95% CI = 36% and 92%) for the patients who received adjuvant therapy and 86% (95% CI = 63% and 100%) for the patients who did not (p = 0.17). The median survival after recurrence was 6.5 months. Adjuvant chemotherapy with doxorubicin and dacarbazine did not affect patient survival. Future studies to identify relevant molecular targets should be implemented in order to define effective therapies for phyllodes tumors of the breast.     

Phyllodes tumors of the breast: A clinicopathological study of 118 cases

The clinical and pathological features of phyllodes tumors of the breast were evaluated through a study of 118 cases: 110 benign tumors, four borderline tumors, and four malignant tumors. Local excision was utilized in 105 patients (88%) and radical mastectomy was performed in 10 patients (8%) as the initial treatment. Estrogen receptor (ER) status was positive in seven (50%) of 14 cases and progesterone receptor (PgR) status was positive in nine (75%) of 12 cases. Local recurrence developed in eight patients, six of those having benign tumors, and two having malignant tumors, all of whom were treated by local excision. Of the four patients with malignant tumors, one died of lung and liver metastases 47 months after her first operation. We believe that excision with sufficient free margin may be the treatment of choice for most benign or borderline phyllodes tumors, whereas an Auchincloss modified radical mastectomy or a total glandectomy with lymph node dissection is recommended for patients with malignant tumors. However, a number of problems regarding the treatment of patients with distant metastasis remain yet to be addressed.     

乳腺叶状囊肉瘤的诊断和治疗

目的 提高乳腺叶状囊肉瘤的诊治水平。方法 对我院1987—2001年间12例乳腺叶状囊肉瘤病例分别采用全乳切除术、全乳切除加腋淋巴结清扫、乳房大部切除术和乳房肿块切除术。其中1例发生纵隔转移再次手术切除。结果 12例均预后良好。结论 乳腺叶状囊肉瘤是一种罕见疾病，诊断主要靠病理组织学，病理可分为良性、恶性和临界型。主要的治疗方法是手术，良性肿瘤可选择包括肿瘤并距其边缘相当距离的健康组织在内的广泛局部切除术或全乳切除术，恶性选择全乳切除术更为合适。     

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目的 总结也腺叶状囊肉瘤的诊治经验。方法 回顾分析３０例的诊断、治疗和随访结果。结果 ３０全名有１２例（４０％）曾诊断为腺纤维瘤或巨纤维瘤而经历１～３次局部切除术。行乳房切除术２３例,乳房切除并腋淋巴结清除６例,局部扩大切除１鲍。随访２～１５年（中位５．２年）。５年生存率９７％,局部复发率３．３％。结论 乳腺巨腺纤维瘤为叶状囊肉瘤的一前期疾病,局部切除后反复复发者应行乳房切除。叶状囊肉瘤预后与肿瘤     

乳房叶状肿瘤53例诊治分析

目的探讨乳房叶状肿瘤的临床表现、诊断和治疗方法。方法对53例乳房叶状肿瘤的资料进行回顾性分析。结果53例患者均进行手术治疗，其中肿块扩大切除34例；保留乳头乳晕的乳腺切除2例；单纯性乳房切除14例；乳房切除加同侧腋窝淋巴结清扫3例。随访1-6年，8例患者术后局部复发行二次手术，其中5例二次手术后行辅助放射治疗。53例患者均健在，无一例远处转移，临床疗效满意。结论乳房叶状肿瘤均以乳房肿块为首发体征，影像学检查可以明确肿瘤的大小、位置、形态，唯有术后病理可以明确诊断，手术切除是该病的主要治疗方法，辅助放疗对术后复发或不能手术切除的叶状肿瘤具有良好的治疗效果，辅助内分泌治疗有其理论依据，但其疗效有待于进一步观察。     

乳腺叶状囊肉瘤24例临床分析

目的探讨乳腺叶状囊肉瘤的临床特点、外科治疗方法及影响预后的因素。方法对24例乳腺叶状囊肉瘤患者采用局部切除11例,单侧乳房切除术10例,乳房切除并腋窝淋巴结清除3例,其中5例(20%)曾诊断为乳腺腺纤维瘤或巨纤维瘤因术后肿瘤复发而经历2~3次局部切除术。结果术后病检证实:低度恶性11例,中度恶性9例,高度恶性4例。随访1~10年(平均5.2年),局部复发率29.1%,5年生存率97%。结论乳腺叶状囊肉瘤发病率低,易误诊;手术切除是其首选的治疗方法,局部切除术后复发应行乳房切除;多数乳腺叶状囊肉瘤恶性程度较低,进展缓慢,预后较好;乳腺叶状囊肉瘤预后与肿瘤的病理类型、肿瘤大小和手术切除是否彻底有关。     

Update on the diagnosis and management of malignant phyllodes tumors of the breast

Malignant phyllodes tumors of the breast are a rare entity. They occur infrequently but most often in younger women in comparison to typical epithelial-based breast cancers. Treatment of these tumors is not without controversy and in this review we will present an update on the diagnosis and management of malignant phyllodes tumors of the breast.     

乳腺叶状囊肉瘤24例临床分析

目的探讨乳腺叶状囊肉瘤的临床特点、外科治疗方法及影响预后的因素。方法对我院收治的24例乳腺叶状囊肉瘤患者根据患者年龄、原发肿瘤大小、有无腋淋巴结转移等因素选择局部包块切除术或单乳切除术进行治疗,并对术后治疗结果进行随访。结果本组24例中行局部切除11例,单侧乳房切除术9例,乳房切除并腋窝淋巴结清除4例,其中5例(20％)曾诊断为腺纤维瘤或巨纤维瘤因术后肿瘤复发而经历2-3次局部切除术。术后病理学检查证实:良性11例,交界性9例,恶性4例。随访1-10年(中位5．2年),5年生存率97％,局部复发率31．3％。结论乳腺叶状囊肉瘤发病率低,多数病例病理分化较好,病程进展缓慢,手术切除是其首选的治疗措施,局部切除后反复复发者应行乳房切除;叶状囊肉瘤预后与肿瘤的病理类型、肿瘤大小和手术切除是否彻底有关。     

Radiation therapy for malignant phyllodes tumor of the breast: An analysis of SEER data

PurposeMalignant phyllodes tumor of the breast (MPTB) accounts for less than 1% of whole breast neoplasm. Surgery is regarded as the primary treatment of choice in patients with MPTB, but the necessity of postoperative radiation therapy (RT) has been a subject of debate. Our aim was to evaluate effects of postoperative RT for MPTB using a large population database.MethodsUsing the Surveillance, Epidemiology, and End Results Program (SEER) database (1983–2013), clinico-pathologic prognostic factors were evaluated. Postoperative RT, tumor extent, grade, and lymph node (LN) metastasis were included in the analysis. Univariate and multivariate Cox proportional hazards regressions were performed to evaluate prognostic power of variables on cancer specific survival (CSS).ResultsA total of 1974 patients with MPTB were reviewed. Of these, 825 (42%) and 1149 (58%) patients underwent mastectomy and breast conserving surgery (BCS), respectively. In each group, 130 (16%) and 122 (11%) patients received postoperative RT. For patients with adverse risk factors including high grade and large tumor size, postoperative RT was more likely to be performed. In multivariate analysis, age, ethnicity, tumor size, tumor extension and LN status were correlated with prognosis in mastectomy group, while postoperative RT did not affect CSS. In BCS group, age and grade were significant prognostic factors on CSS, meanwhile postoperative RT did not impact CSS in multivariate analysis.ConclusionAlthough patients with more adverse prognostic factors underwent postoperative RT, RT groups were not inferior to non-RT group on CSS regardless of surgery (mastectomy or BCS).     

Clinical predictors of renal mass pathological features

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Widespread use of abdominal imaging has changed the landscape of kidney lesions with an increase in serendipitously detected small renal masses (SRMs) that represent a new epidemiological entity that requires further understanding and potentially reconsideration of current treatment schemes. We identified specific preoperative factors associated with renal mass pathological features, and specifically with an increased risk of malignant, potentially aggressive disease. These factors should be considered when evaluating potential candidates for active surveillance and ablative techniques.

OBJECTIVE

? To evaluate the influence of radiographic tumour size and other preoperative variables on the pathological characteristics of the lesion to determine the distribution of pathological features and assess preoperative risk factors for potentially aggressive versus probably indolent renal lesions.

PATIENTS AND METHODS

? Retrospective review of records for 768 patients who underwent surgery for single, sporadic renal mass between 2000 and 2008 in a tertiary academic institution. ? Demographic, radiographic and pathological variables were recorded and analysed with regression analyses for risk factors for potentially aggressive pathological features (malignant pathology, high Fuhrman grade, lymphovascular invasion and extracapsular extension).

RESULTS

? Malignancy was pathologically confirmed in 628 (81.8%) specimens. ? Radiographic size was significantly associated with malignancy (versus benign pathology; OR = 1.13, P= 0.001), high Fuhrman grade (OR = 1.21, P < 0.0001), vascular invasion (OR = 1.19, P < 0.0001) and extracapsular extension (OR = 1.23, P < 0.0001). ? Age, symptomatic presentation, solid appearance and radiographic size were independent predictors of potentially aggressive disease, whereas for male gender (OR = 1.43, P= 0.062) a trend toward statistical significance was noted.

CONCLUSIONS

? Age, male gender, radiographic size and appearance, as well as symptomatic presentation, are associated with an increased risk of malignant, potentially aggressive disease. ? These factors should be considered when evaluating management options for a solitary enhancing renal mass.     

Magnetic resonance imaging of benign phyllodes tumors of the breast

Magnetic resonance imaging (MRI) has the potential to become a useful adjunct in breast imaging. Contrast-enhanced breast MRI has demonstrated a high sensitivity in the detection of benign and malignant breast disease. Our study aimed to correlate the dynamic contrast-enhanced MRI appearance of benign phyllodes tumor of the breast with histopathologic findings. We retrospectively reviewed the MRI findings in eight patients with benign phyllodes tumor of the breast to describe the image characteristics of this disease. The architectural features and enhancement patterns of this tumor were assessed and compared with other breast diseases. MRIs demonstrated some characteristics for large benign phyllodes tumors (more than 3 cm in size). On T(2)-weighted images, they were imaged as spotted tumors in high to iso signal intensity with cystic components or septations inside. In the time-signal intensity curve for the eight patients in our study who underwent dynamic MRI, we demonstrated two patterns of their curve: rapidly and gradually enhanced. In conclusion, MRI findings in benign phyllodes tumor include dynamic curves of gradually and rapidly enhancing types, and a low and inhomogeneous signal intensity on T(2)-weighted images compared with fibroadenoma. These findings appear to be useful for diagnosis.     

Clinicopathology and treatment of a giant malignant phyllodes tumor of the breast: A case report and literature review

IntroductionPhyllodes tumors (PTs) of the breast are extremely rare accounting for less than 1% of all breast tumors globally. Case records at the Trinidad and Tobago Cancer Registry show that only 0.003% of the reported breast cancer cases between 1995 and 2009 were PTs.Presentation of the caseWe report a 45-year-old woman who presented with swelling of the left breast. Ultrasound, mammogram and computed tomography imaging confirmed the presence of a mass in the right upper inner quadrant of the left breast. A biopsy revealed features supportive of a benign phyllodes tumor. A wide local excision was performed with the removal of a 19 × 11 × 10 cm mass. Histopathological analysis revealed features consistent with malignant phyllodes tumor. A complete mastectomy of the left breast was subsequently performed. Follow up over a 5-year period did not reveal any evidence of local recurrence or residual disease. To the best of our knowledge, this is the first case report of a malignant PT from the Caribbean and Latin America.DiscussionPhyllodes tumors are classified as benign, borderline, or malignant based on histologic features including presence of a clear margin, cellularity, stromal overgrowth, tumor necrosis and mitotic index. The clinical challenge is to assess the risk of local tumor and metastatic recurrence in the context of fluid classifications.ConclusionOur case management approach shows that for patients with malignant PT, a thorough preoperative workup regimen followed by appropriate surgical intervention can result in a desirable prognosis.