Aggressive malignant phyllodes tumor

IntroductionOriginally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3–0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount.Presentation of caseWe present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31 cm in diameter and weighed over 10 kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office.ConclusionDespite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.     

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 tumor of the prostate

This is a report of a 70-year-old man with malignant phyllodes tumor of prostate. The retropubic prostatectomy was done. The stroma of the tumor was cellular and composed of elongated cells with spindle shaped nuclei and fragmented bizarre giant cells. After recovery from surgery, prophylatic radiotherapy was given over 2 months. A case report of a patient treated at our medical center and a review of the literature was done.     

Giant phyllodes tumor of the prostate

A 55 year-old man complained dysuria and visited to our hospital. Physical examination showed firm large mass occupying whole abdomen. Computed tomography (CT) demonstrated a huge retroperitoneal tumor which compressed intestine, liver, kidney, and urinary bladder. We performed extirpation of the tumor (8.6 kg, largest diameter 60 cm) which was composed of myxoid stromal region associated with cystic pattern. Histological examination revealed that the epithelium of the cystic region was positive for prostate specific antigen (PSA) immunostaining. The tumor was diagnosed phyllodes tumor of the prostate (prostatic stromal proliferation of uncertain malignancy, PSTUMP). Serum PSA was declined 3.9 ng/ml to 0.9 ng/ml; however, magnetic resonance imaging (MRI) demonstrated a residual (recurrent?) tumor in the pelvis one month after the operation. We carried out total prostatectomy and residual tumor resection. Phyllodes tumor of the prostate is histologically characterized with biphasic pattern of hyperplastic epithelial cysts and variably cellular spindle stroma. The tumor is considered to have malignant potential and several histological factors including cellularity, atypia, etc. are utilized to assess it. However diagnostic criteria and subsequent treatment modalities are not established thus far. Previous reports showed efficacy of total surgical removal rather than partial resection and that we performed radical extirpation of the entire tumor. Close follow up is needed against this frequently recurrent disease.     

Malignant phyllodes tumor of prostate

A case of malignant phyllodes tumor of the prostate, with clinical course of recurrence and pulmonary metastasis is described in a thirty-eight-year-old man. Histologically the tumor was characterized by a fibrosarcoma-like pattern with adjacent changes of fibroadenoma and phyllodes type of prostatic atypical hyperplasia. The pathology, histogenesis, differential diagnosis, and the role of immunohistochemistry in the diagnosis and demonstration of its components is reviewed.     

Explosive malignant transformation of a primarily benign phyllodes tumor

Summary The case of a patient with a phyllodes tumor of the breast who over a period of 12 years underwent 15 operations for local recurrences, finally succumbing to the disease, is presented. Occurring at the age of 42 as a benign lesion, the tumor underwent malignant sarcomatous transformation after prolonged surgical management. An attempted ultraradical resection failed, because the explosively growing tumor had passed the borders of resectability and also metastasized. Surgical management of the phyllodes tumor of the breast, a rare pathologic entity of variable behavior, is discussed with regard to the literature.     

Morbidity and mortality of local failure after definitive therapy for prostate cancer

We reviewed our experience with morbidity and mortality associated with clinical local failure after definitive therapy for adenocarcinoma of the prostate by interstitial 125iodine implantation, external beam radiation therapy or radical prostatectomy. Morbid complications included unilateral ureteral obstruction; bladder obstruction and/or incontinence requiring treatment by transurethral resection, or placement of a urethral or suprapubic catheter; hematuria requiring intervention for clot evacuation or fulguration, and perineal and/or pelvic pain. Lethal complications included bilateral ureteral obstruction or bowel obstruction. We treated 108 patients with 125iodine, 178 with external beam radiotherapy and 67 with radical prostatectomy. Clinical local failure occurred in 26 per cent of the 125iodine, 17 per cent of the external beam radiotherapy and 12 per cent of the radical prostatectomy groups. The total incidence of local failure with 125iodine was statistically higher than for radical prostatectomy. Stage C and poorly differentiated tumors were associated with a statistically higher incidence of local failure compared to lower stage and grade tumors. However, within each stage and grade there was no significant difference in local failure between treatment modalities. There was negligible morbidity or mortality secondary to local failure associated with stage A2, stage B1 or well differentiated tumors regardless of treatment modality. There was no difference in the morbidity and mortality between treatment modalities for stage C or poorly differentiated tumors. However, for stage B2 or moderately differentiated tumors treated by 125iodine implantation there was a statistically greater incidence of morbidity and mortality than that associated with external beam radiotherapy and radical prostatectomy. Our observations with regard to selection of primary monotherapy options that provide local tumor control are as follows. Stage A2, stage B1 or well differentiated tumors can be well controlled by all 3 treatment modalities. 125Iodine is associated with local failure-related morbidity and mortality for stage B2 or moderately differentiated tumors, which are statistically higher than for external beam radiotherapy and radical prostatectomy, and therefore, these latter are the preferred treatment. Radical prostatectomy and 125iodine for stage C tumors are associated with a trend to higher local failure, and related morbidity and mortality than is external beam radiotherapy. However, longer followup of the external beam radiotherapy series is necessary to confirm this observation.     

Successful resection of giant solitary pulmonary metastasis from a phyllodes tumor

Phyllodes tumors are rare fibroepithelial tumors that make up less than 1% of all breast tumors. Malignant phyllodes tumors are associated with a 25% incidence of distant metastasis, which is invariably fatal within 24 months. We report successful resection of a solitary pulmonary metastasis in the left chest in a 50-year-old woman 7 years after a right-sided mastectomy for malignant phyllodes tumor.     

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).     

Case report: Malignant phyllodes tumor of prostate

Malignant phyllodes tumor of prostate is described in a 78 year old man. He had symptoms of prostatism since six months before developing acute urinary retention, which was relieved by suprapubic cystostomy. Transabdominal ultrasonography showed a few hypoechoic areas in a 120 gm prostate. Serum prostate specific antigen was 2.7 ng/ml. Transrectal trucut biopsy was inconclusive. With a diagnosis of benign hyperplasia of prostate. Transvesical prostatectomy was performed. Postoperative biopsy showed phyllodes tumor of the prostate with metastastic deposits in the anterior abdominal wall. He received chemotherapy with Vincristine, Mitomycin C, Adriamycin and Cisplatin every 21st day for six cycles in addition to orchiectomy. Routine follow up by transabdominal ultrasound at ten months showed space occupying lesions in the liver. Patient succumbed to his disease a few days later.     

Pulmonary artery obstruction due to a metastatic malignant phyllodes tumor of the breast

A 65-year-old woman with a 9-year surgical history of a left breast phyllodes tumor was admitted with progressive chest pain on effort. Computed tomography showed severe stenosis of the main pulmonary artery, with the mass originating from the ventricular septum. We planned to resect the tumor the next day. However, the next morning a pulmonary artery embolism occurred, and she developed dyspnea and lost consciousness. After carrying out cardiopulmonary resuscitation, we performed a life-saving operation. We successfully resected the huge tumor as far as possible from the right ventricle via a right atrial (RA)-tomy. However, her consciousness did not improve to better than Glasgow Coma Scale grade 7. She died from suffocation caused by metastasis invading her airway despite undergoing tracheotomy on the 77th postoperative day.     

前列腺交界性叶状肿瘤一例报告并文献复习

目的 探讨前列腺叶状肿瘤的分型、临床表现、病理特征、治疗方法及预后情况.方法 2006年10月收治前列腺交界性叶状肿瘤患者1例.患者32岁,因渐进性排尿困难2周、尿潴留1 d入院.直肠指诊示前列腺明显增大,质软、囊性感,表面光滑.血清PSA 20.62 ng/ml.B超及MRI显示前列腺右侧叶多囊性肿大结节,前列腺穿刺活检考虑为良性间叶源性肿瘤,分化欠成熟.结果硬膜外麻醉下行前列腺肿瘤剜除术,切除标本约40 g.病理报告为前列腺交界性叶状肿瘤,肿瘤由上皮和间质成分构成,间质细胞明显增生,细胞有异型性,可见核分裂象;上皮细胞增多,无明显异型性;免疫组化染色Vimentin强阳性,PSA和PAP阳性,SMA阴性.术后40 d患者肿瘤复发,遂行前列腺根治切除术.病理报告为前列腺低度恶性叶状肿瘤,未侵及被膜外,前列腺尿道切端可见肿瘤组织;细胞增生活跃.术后1个月行体外盆腔放射治疗.随访6个月患者生存良好,仍在随访中.结论前列腺叶状肿瘤由增生的上皮和间质成分组成,穿刺活检很难穿到增生的上皮成分而不能确诊;复发恶性度增高,前列腺根治性切除术是目前最可靠的治疗方法.     

前列腺恶性叶状肿瘤(附一例报告并文献复习)

目的　探讨前列腺恶性叶状肿瘤的临床、病理特征及治疗方法。　方法　分析 2 0 0 3年1月收治的 1例前列腺恶性叶状肿瘤患者的临床资料 ,并进行文献复习。患者 6 0岁 ,因排尿困难伴间歇性肉眼血尿 1年 ,TURP术后症状复发 2个月入院。直肠指诊示前列腺 5cm× 6cm ,质软 ,表面光滑。血清PSA 1.2 5ng/ml,CT检查示前列腺密度不均。复阅病理切片后诊断为前列腺肉瘤 ,全麻下行根治性前列腺切除术。　结果　术后病理检查肿瘤类似乳腺叶状囊肉瘤 ,由上皮和间质成分构成 ,其中间质细胞明显增多 ,细胞有异型性 ,可见核分裂相。上皮细胞增生 ,但无明显异型性。由上皮细胞形成的囊腔被增多的间质成分挤压、拉长形成类似叶状的裂隙。精囊及膀胱颈部均有肿瘤细胞浸润 ,诊断前列腺恶性叶状肿瘤 ,标本切缘阴性。免疫组化染色检查 :间质细胞Vimentin( ) ,Actin( - ) ,上皮细胞CK( ) ,PSA( ) ,AE1/AE3( ) ,基底细胞CK34BE12 ( )。患者于术后 6个月肿瘤复发 ,拒绝进一步治疗 ,目前仍在随访中。　结论　前列腺恶性叶状肿瘤罕见 ,确诊依靠其特异性临床及病理表现 ,根治性前列腺切除术是目前最可靠的治疗方法     

Underutilization of local salvage therapy after radiation therapy for prostate cancer

ObjectiveTo evaluate the rates at which patients are offered and receive local salvage therapy (LST) after failure of primary radiotherapy for localized prostate cancer, as it is the only potentially curative treatment for localized recurrence but appears to be underutilized when compared with androgen-deprivation therapy (ADT) or observation.Materials and methodsPatients with localized prostate cancer who received primary radiotherapy with curative intent between 1999 and 2000 were identified in the British Columbia Tumour Registry. Exclusion criteria included patient age >72 years, prostate-specific antigen>40 ng/ml, and clinical stage T4 at diagnosis. Data on clinicopathologic features, primary therapy, prostate-specific antigen kinetics, and salvage therapy were collected retrospectively. Radiation failure was defined as biochemical recurrence according to the Phoenix criteria or by initiation of salvage therapy.ResultsOf 1,782 patients treated in the study period, 1,067 met inclusion criteria. Of these, 257 failed radiation therapy. Radiation therapy failure was managed with observation (>12 mo) in 126 patients and ADT in 119. Of the observed patients, 66 subsequently received ADT. Five patients (1.8%) received LST (3 radical prostatectomy and 2 brachytherapy).ConclusionsOnly 2% of patients relapsing after radiation therapy for localized prostate cancer received LST. Although the benefits of LST are unproven, these findings reveal a possible underutilization of LST and indicate a need for enhanced collaboration between specialties to optimize care of this challenging cohort.     

Hormonal therapy options for biochemical recurrence of prostate cancer after local therapy

Recurrence after local prostate cancer treatment detectable only by a rise in serum prostate specific antigen (PSA) is a very common problem facing clinicians. Given that the majority of these men are relatively young and otherwise healthy, treatment of PSA-only recurrence requires approaches that not only improve survival but also preserve quality of life. For radical prostatectomy patients, a PSA-only recurrence is broadly defined as persistent or rising PSA in the postoperative period. For radiation-treated patients, the 1997 American Society for Therapeutic Radiology and Oncology guidelines specify three consecutive elevations of PSA after the post-treatment nadir PSA is achieved. Traditional hormonal therapy is the mainstay of systemic treatment for PSA-only recurrence, although nontraditional approaches such as intermittent and oral-only hormonal therapy are under study.