Tumor filodes bilateral, una rara forma de manifestación clínica: reporte de caso / Bilateral phyllodes tumor, a rare form of clinical presentation: A case report

Resumen ANTECEDENTES: La incidencia de tumores filodes es del 0.3 al 1% de todos los tumores primarios de la mama. Su presentación bilateral puede ser sincrónica o asincrónica y es excepcional. Estos tumores se clasifican (OMS) en fibroepiteliales, benignos, limítrofes o malignos. Aparecen en mujeres con límites muy amplios de edad, aunque lo más frecuente es entre los 35 y 55 años. El diagnóstico definitivo se establece con base en el reporte histopatológico. Su tratamiento es quirúrgico. CASO CLÍNICO: Paciente de 50 años, con antecedentes obstétricos de dos embarazos y dos cesáreas. Acudió a consulta debido a la aparición de una masa palpable en ambas mamas. Carecía de antecedentes relevantes para cáncer de mama. Con base en la mastografía se determinó que se trataba de un tumor categoría BI-RADS 4A. La biopsia excisional, con estudio transoperatorio, determinó que era un tumor filodes de bajo grado (benigno). Se procedió a la extirpación de ambos tumores, con márgenes libres suficientes, a fin de disminuir el riesgo de recidivas. Se determinó un plan de seguimiento con mastografía anual en las que se ha obtenido la categoría BI-RADS 2. Hasta el momento, la paciente permanece libre de enfermedad. CONCLUSIONES: Los tumores filodes son sumamente raros y más aún su aparición bilateral. Es importante integrar un diagnóstico temprano y efectuar un correcto procedimiento quirúrgico que evite las recidivas porque éstas tienden a ser cada vez más agresivas. Sigue siendo motivo de controversia la indicación de radioterapia y quimioterapia en estos tumores, que solo se reservan como tratamiento alternativo ante tumores sumamente agresivos.

Abstract BACKGROUND: The incidence of phyllodes tumors is 0.3% to 1% of all primary breast tumors. Their bilateral presentation may be synchronous or asynchronous and is exceptional. These tumors are classified (WHO) as fibroepithelial, benign, borderline or malignant. They appear in women with very wide age limits, although the most frequent is between 35 and 55 years of age. The definitive diagnosis is established based on the histopathological report. Treatment is surgical. CLINICAL CASE: 50-year-old patient with obstetric history of two pregnancies and two cesarean sections. She came for consultation due to the appearance of a palpable mass in both breasts. She had no relevant history of breast cancer. Based on the mastography it was determined to be a BI-RADS 4A category tumor. The excisional biopsy, with trans-operative study, determined that it was a low-grade (benign) phyllodes tumor. Both tumors were excised, with sufficient free margins, in order to reduce the risk of recurrence. A follow-up plan was determined with annual mastography in which BI-RADS category 2 has been obtained. So far, the patient remains free of disease. CONCLUSIONS: Phyllodes tumors are extremely rare and even more so their bilateral occurrence. It is important to integrate an early diagnosis and to perform a correct surgical procedure to avoid recurrences because they tend to be more and more aggressive. The indication of radiotherapy and chemotherapy in these tumors remains controversial and is only reserved as an alternative treatment for highly aggressive tumors.

Bilateral phyllodes tumor of the breast in a young nulliparous woman.

Cystosarcoma phyllodes is a rare breast tumor with incidence of 1% of all the mammary tumors. Bilateral occurrence is very rare. Median age of presentation is 40-50 years. We present a case of 24 years old nulliparous female with phyllodes tumour developing in both the breasts one after another with a gap of five years. Patient underwent simple mastectomy on both sides. Histopathology report confirmed benign variety of cystosarcoma phyllodes on both sides.

Case of Benign Phyllodes Tumour Associated with Hypoglycemia

Benign phyllodes tumour is a rare non-cancerous growth of the breast characterized by a solitary unilateral tumour in one breast, or rarely multifocal in one or both breasts. It is diagnosed on the basis of physical examination, imaging studies, and fine-needle aspiration cytology. In this report, we present a case of benign phyllodes tumour with an unusual presentation of recurrent attacks of hypoglycemia, which can be attributed to secretion of insulin-like growth factor II from the tumour.

Tumor filodes de mama con metástasis en pulmón / Phyllodes tumor of the breast with lung metastasis

Se describe el caso clínico de una paciente de 63 años de edad, quien ingresó en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar tos seca persistente, expectoración escasa (en ocasiones amarillenta), astenia y pérdida de peso. En el examen físico se palpó un tumor en la mama derecha, confirmado a través de ecografía y mamografía. Los resultados de la biopsia por aspiración con aguja fina fueron positivos de células neoplásicas, compatibles con carcinoma. La radiografía de tórax y la tomografía axial computarizada revelaron la presencia de imágenes metastásicas pulmonares, por lo cual se realizó la exéresis del tumor con un margen de seguridad de 2 cm. Mediante el estudio histopatológico se confirmó la existencia de un tumor filodes, de manera que fue preciso indicar 3 ciclos de quimioterapia (esquema CISCYVADACT), del que solo se cumplieron 2, pues la anciana evolucionó desfavorablemente y falleció 3 meses después.

The case report of a 63-year-old patient is described, who was admitted to "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital of Santiago de Cuba due to persistent dry cough, little expectoration (sometimes yellowish), asthenia and loss of weight. On physical examination a tumor was palpated in the right breast, which was confirmed through sonography and mammogram. The results of the fine-needle biopsy were positive for neoplastic cells, consistent with carcinoma. Chest radiography and computerized axial tomography revealed the presence of lung metastatic images, reason why tumor excision with a safety margin of 2 cm was performed. The presence of phyllodes tumor was confirmed by means of the histopathologic study, so that it was necessary to indicate 3 cycles of chemotherapy (CISCYVADACT scheme), of which only two were administered as the old woman had an unfavorable course and she died 3 months later.

Cistosarcoma phyllodes bilateral: un raro caso / Bilateral cystosarcoma phyllodes: a rare case

El cistosarcoma phyllodes es un tumor mixto poco frecuente de la mama, que contiene elementos de tejido epitelial y conectivo. Los cistosarcomas phyllodes bilaterales son raros y solo existen 7 casos publicados en la literatura. A continuación se reporta el caso de una paciente de 48 años con cistosarcoma phyllodes bilateral.

The cystosarcoma phyllodes is a less frequent breast mixed tumor, that containing both: the epithelial and the connective tissue elements. The bilateral cystosarcoma phyllodes tumors are rare and only 7 cases are recorded in the literature. We report a case of a 48 years old female patient with bilateral cystosarcoma phyllodes.

Tumor filoides de la mama / Phyllodes tumor of the breast

Introduction: The phyllodes tumor (PT) of the breast is a rare disease of unknown origin. Despite its classification into benign, borderline and malignant, their behavior tends to be uncertain. Because of this, treatment remains controversial. Objective: To describe the management of the FT in breast pathology unit of our hospital and their outcomes. Material and Methods: We retrospectively reviewed the files of the patients with PT, operated in our hospital between 2001 and 2008. We analyzed the clinical characteristics, diagnostic studies, treatment and outcomes. Results: During this period 12 patients were operated. The ave-rage age was 42 +/- 15.2 years (16-64) and usually the form of presentation was painless palpable nodule. Both mammography and ultrasound were unable to suggest the diagnosis. Eight patients had core biopsy, which revealed the diagnosis of PT in 5, while in the other 3 was fibroadenoma. All patients underwent a partial mastectomy. The biopsy showed six benign, two borderline and two malignant PT. The latter two patients received adjuvant radiotherapy. At the end of this study, 2 patients had relapsed at 12 and 30 months (borderline and benign, respectively). There were no cases of lymphatic or distant metastases. Conclusions: The PT has a low frequency of presentation and preoperative diagnosis is difficult, so we recommend a core biopsy, but it can confuse with fibroadenoma. The management with partial mastectomy and negative borders had a recurrence rate of 18 percent in this series.

Introducción: El tumor filoides (TF) de la mama es una patología poco frecuente y origen desconocido. A pesar de su clasificación en benignos, borderline y malignos, su comportamiento tiende a ser incierto. Debido a esto su tratamiento sigue siendo controversial. Objetivo: Describir el manejo del TF en la unidad de patología mamaria del Hospital San José y sus resultados. Material y Método: Se revisaron las fichas de las pacientes con diagnóstico de TF, operadas en nuestro hospital entre los años 2001 y 2009. Se analizaron las características clínicas, estudios diagnósticos, tratamiento y resultados. Resultados: Durante este período se operaron 12 pacientes. El promedio de edad fue 42 +/- 15,2 años (16-64) y habitualmente la forma de presentación fue nodulo palpable indoloro. Tanto la mamografía como la ecografía fueron incapaces de sugerir el diagnóstico. Ocho pacientes tenían biopsia core, la cual evidenció el diagnóstico de TF en 5, mientras que en las otras 3 resultó fibroadenoma. Todas las pacientes fueron sometidas a mastectomía parcial. En seis pacientes resultó ser TF benigno, en dos borderline y en dos maligno. Estas últimas dos pacientes recibieron radioterapia adyuvante. Al término de este estudio 2 pacientes habían recidivado a los 12 y 30 meses (borderline y benigno respectivamente). No hubo casos de metástasis linfáticas ni a distancia. Conclusiones: El TF tiene una baja frecuencia de presentación, su diagnóstico preoperatorio es difícil recomendándose la biopsia core, sin embargo, suele confundirse con el fibroadenoma. El manejo con mastectomía parcial y bordes negativos tuvo una recidiva del 18 por ciento en esta serie.

Tumor phyllodes benigno gigante de mama / Benigmant, giant phyllodes tumor of the breast

O tumor phyllodes geralmente é benigno, muito raro, correspondendo a menos de 1% dos tumores fibroepiteliais da mama. O tratamento é cirúrgico e a taxa de recidiva, alta. Relatou-se o caso de uma paciente com tumor phyllodes benigno gigante, com infiltração de músculos peitorais e parede torácica, ulcerado, sangrante, submetida a tratamento cirúrgico emergenciado no Hospital Erasto Gaertner, em Curitiba, por mal estado geral, anemia intensa e infecção local. Evidenciou-se, pela apresentação desse caso, dificuldade em se apresentar terapêutica definitiva devido à manisfestação clínica atípica de tumor phyllodes benigno, caracterizado por lesão de grandes dimensões, de características invasivas, com comprometimento extenso da parede torácica, sem relatos prévios na literatura. O tratamento conservador nesse caso consistiu em mastectomia simples com ressecção em bloco dos músculos peitorais e preservação da parede torácica, contrastando com a literatura, em que a discussão entre cirurgia radical e conservadora inclui apenas relatos de mastectomia simples e ressecção da lesão com margens respectivamente.

The phyllodes tumor is normaly benignant and rare, accounting for less than 1% of the breast tumors. The treatment is surgical and the recurrence is high. We report the case of a patient with benignant, giant phyllodes tumor, with infiltration of the pectorales muscles and thoracic wall, ulcerated, bleeding, treated by emergency surgecal at the Erastus Gaertner Hospital in Curitiba, because of bad general state of the patient, acute anaemia and local infection.We show the difficulty to present the definitive therapeutic because of the atypical clinical manifestation benignant phyllodes tumor, caracterized by a big and invasive lesion, with infiltration of the thoracic wall, without prior report at the literature. The conservative treatment in this case was simple mastectomy with resection of the pectorales muscles and preservation of the thoracic wall, that contrast with the literature, whose discussion between conservative surgery just include reports of simple mastectomy and resection of the lesion with margin respectively.

Cystosarcoma Phyllodes of the Breast

BACKGROUND: Cystosarcoma phyllodes are relativly rare neoplasms of the breast and have an unpredictable clinical behavior. This study is to determine whether histological features correlate with clinical behavior, and which operation method affect recurrence. METHODS: This study reviewed the histological features and clinical outcomes in 12 patients with phyllode tumors of the breast diagnosed at Chungnam University Hospital from 1989 to 1998. RESULTS: The pathological results revealed benign forms were in 8 cases and malignant forms in 4 casese. As to the nature of the growth, the tumors in 10 cases grew rapidly 10 cases were rapid in nature, but two malignant tumors not. One of the 4 malignant tumors was high grade, the others were borderline. Eight (8) patients were had been treated conservatively (7 cases, wide tumor excision; 1 case, excisional biopsy), and 4 cases patients underwent radical operation (2 cases, modified radical mastectomy; other 2 cases, simple mastectomy). Only one patient with borderline malignancy, who underwent modified radical mastectomy, experienced recurrence. CONCLUSIONS: Tumor growth & histological features do not correlate with recurrence, and wide resection should to be primary treatement and axillary dissection is not worthwhile.

Cystosarcoma phyllodes: A Clinical study of 18 cases at Songklanagarind Hospital.

Cystosarcoma phyllodes is an uncommon breast tumor with a wide variety of pathologic and clinical features. The surgical management of cstosarcoma phyllodes is controversial and the tumor may recur after management by excision of the mass. We performed a retrospective study of 18 patients treated for cystosarcoma phyllodes between September 1983 and March 1991 at Songklanagarind Hospital. All patients received surgical treatment (eleven excision of the mass, three wide excision and four mastectomy). The mean follow up was 48.3 months (1 week – 92 months). One patient was found with local recurrence after treatment by excision of the mass. It is suggested that the treatment for cystosarcoma phyllodes should be wide excision for benign cystosarcoma phyllodes. Mastectomy has been indicated for large tumor and for malignant cystosarcoma but axillary dissection is not worthwhile.

Patterns of p53 expression in phyllodes tumors of the breast: an immunohistochemical study

Authors performed an immunohistochemical analysis using monoclonal antibody to p53 protein on 15 cases of benign and malignant phyllodes tumor of the breast along with a review of other conventional clinicopathological parameters to investigate the meaning of p53 expression. The cases were composed of 8 benign and 7 malignant lesions. The pattern of p53 expression showed a statistically significant difference between these benign and malignant lesions (p<0.005). None of the benign cases expressed p53 whereas 6 out of 7 malignant cases did. Among malignant phyllodes tumors, the pattern of expression was diffuse and strong in two cases while granular and relatively weak in the remaining 4 cases. p53 expression seemed to be a unique feature of malignant phyllodes tumors, thereby, one of the most significant parameters for the differentiation of benign and malignant phyllodes tumors of the breast.