ABSTRACT
Phyllodes tumors (PTs) are uncommon biphasic breast neoplasms constituting 0.5 to 1.0% of all breast tumors. Malignant PTs form a very small proportion of these and may metastasize, especially to the lungs and bones. Aggression and metastatic potential are accentuated in tumors exhibiting heterologous differentiation. Metastases to the gastrointestinal tract (GIT) have seldom been reported and are often confined to a segment of the digestive tract. In the absence of relevant clinical history, such patients presenting with gastrointestinal symptoms can lead to diagnostic perplexities. We report a unique case of a malignant PT with extensive osteosarcomatous differentiation and widespread metastases to the GIT.
ABSTRACT
Malignant phyllodes tumor of the prostate is a very rare entity. Here, we describe a 51-year-old patient with a malignant phyllodes tumor of the prostate with a poor prognosis and normal prostate-specific antigen levels. Digital rectal examination revealed a hard, nodular mass in the prostate, and magnetic resonance imaging exhibited a cystic mass measuring 8.7 cm × 7.0 cm × 6.7 cm. Immunohistochemical staining showed that the epithelial components were positive for CK8/18 and cytokeratin AE1/AE3; the atypical stromal cells were positive for CD34 and vimentin. Histological analysis resulted in a diagnosis of malignant phyllodes tumor of the prostate. Radical surgery was the treatment of choice. However, tumor recurrence was identified 6 months after the surgery, and the patient died 10 months after the surgery.
ABSTRACT
Cystosarcoma phyllodes was described first in 1838 and originally was considered to be a benign tumor. It was not until 1931 that metastasis from a cystosarcoma phyllodes was reported. The incidence of cystosarcoma phyllodes is estimated to be 0.3% to 0.9% of all breast tumors. Sites most commonly affected by metastases are the lungs and bones. We present a case report 29-year old female patient presented with a voluminous breast mass at both of them which was completely resected. The right side presented of malignant phyllodes and the left side is borderline phyllodes. Six months later, both of her legs became paralyzed and accompanied by swelling over her right upper arm. Biopsy was performed, and the diagnosis was metastatic malignant phyllodes tumor. Histologic review of the breast tumor revealed stromal overgrowth.
ABSTRACT
Background: Phyllodes tumor is a rare fibroepithelial tumor of the breast comprising less than 1% of all primary breast tumor. Phyllodes tumors are classified into benign, borderline and malignant based on histological criteria. Grading of phyllodes tumor is important as it determines the biological behaviour of the tumor. The aim of the present study was to identify the incidence, pathological features of benign, borderline and malignant phyllodes tumors and to compare the CD10 expression in benign, borderline and malignant phyllodes, in order to highlight its diagnostic significance.Methods: This is a retrospective study conducted in Department of Pathology, Madras Medical College, Chennai for a period of 3 years. The clinical and pathological findings of phyllodes tumors were retrieved from the surgical pathology records. Totally 50 case were selected randomly (38 benign, 6 borderline and 6 malignant) and their representative formalin fixed paraffin embedded tissue samples were subjected to immunohistochemistry for CD10 expression.Results: In the 38 cases of benign phyllodes tumors, only three cases (7.9%) were CD10 positive. Three out of six cases (50%) of borderline phyllodes tumors showed CD10 positivity, whereas five out of six cases (83.3%) of malignant phyllodes tumor showed CD10 positivity.Conclusions: CD10 expression correlated well with grade of phyllodes tumors, which is of statistical significance and therefore it can be used in the determination of tumor grade and this may pave way for development of targeted therapies.
ABSTRACT
Breast sarcomas are rare neoplasms accounting for less than 1% of breast malignancy. Phyllodes tumors have biphasic histological features with both epithelial and stromal component. Careful characterization of the stromal component is critical since it is the pathologic features of the stromal cells that determine its malignant potential. We reported a case of 57 years old female with right breast mass who underwent wide excision and on histological examination a diagnosis of malignant phyllodes tumour with heterogonous osseous differentiation was made. The rarity of the lesion was considered for reporting and on follow up the patient was free of metastasis.
ABSTRACT
Introduction: Phyllodes tumors (PT) of the breast seem to get pre-operatively misdiagnosed as fibroadenomas resulting in inadequate resections and high local recurrence rates. Materials and Methods: Data of 150 patients with PT of the breast managed from January, 2003 to February, 2013 were retrospectively analyzed. Statistical analysis performed using SPSS version 17 (Pearson Chi-square test and analysis of variance test for analysis). Aim: The aim of this study is to compare clinico-pathological profile and recurrence rates in patients with benign (B), borderline malignant (BL) and malignant (M) PT. Results: In a total of 150 patients with PT (n = 77 B, n = 24 BL, n = 49 M), mean age was 36.92, 44.04 and 40.46 years respectively (P 0.015) and mean tumor size being 8.15 cm, 14.7 cm and 12.9 cm respectively (P 0.000). Pre-operatively cytology suggestive of PT in 24% patients with B PT and 63% in M PT; core tissue biopsy suggestive of PT in 85.4% patients with B PT and 100% in M PT. Recurrence seen in 34.7% out of which 32.7% were post-lumpectomy performed elsewhere. Majority of B PT had lumpectomy (49.3%)/wide local excision (WLE, 31.2%) compared with M PT where 55.1% had simple mastectomy (SM) due to large tumor size. Local recurrence was more in M PT (53%) compared with B PT (20%). We found recurrence rates in L (39.3%) compared with WLE (27.3%) and SM (33.9%) (P 0.049). Conclusions: Larger tumor size, incomplete resection and M/BL histology predicted higher recurrence in PT. Core biopsy is much more accurate than fine needle cytology in the diagnosis.
Subject(s)
Adult , Breast Neoplasms/radiotherapy , Breast Neoplasms/therapy , Female , Humans , Middle Aged , Phyllodes Tumor/radiotherapy , Phyllodes Tumor/therapy , Radiotherapy/therapeutic use , RecurrenceABSTRACT
PURPOSE: Malignant phyllodes tumors are rare breast tumors. Information on the prognosis and optimal treatment of these lesions is not yet sufficient. The aim of this study was to determine parameters that predict the recurrence of malignant phyllodes tumors of the breast. METHODS: Retrospectively, we reviewed the medical records and pathological slides of 23 patients with malignant phyllodes tumors that had undergone surgical treatment from 1988 to 2006. The age of the patients, tumor size, type of surgery, resection margin, adjuvant therapy and pathological characteristics of the tumors such as stromal hypercellularity, cellular phleomorphism, mitosis, margins, and stromal pattern were examined. RESULTS: The mean age of the patients was 41 yr. The tumor size ranged from 1 cm to 25 cm, with a median of 7.42 cm. The median follow-up time was 29.0 months. Recurrence was observed in 6 patients (26.1%) and the 5-yr disease free survival was 48.9%. Risk factors for recurrence of a malignant phyllodes tumor were a mitotic index greater than 10 per high-powered field (p=0.0242) and an invasive margin (p=0.0437). CONCLUSION: Frequent mitosis and an invasive margin were the principal determinants of recurrence. Patients with poor prognostic components should be treated more aggressively and the patients need more close follow-up.
Subject(s)
Humans , Breast Neoplasms , Breast , Disease-Free Survival , Follow-Up Studies , Medical Records , Mitosis , Mitotic Index , Phyllodes Tumor , Prognosis , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
We report here on a case of invasive ductal carcinoma arising in a recurrent malignant phyllodes tumor. The patient was a 33-year-old woman who presented with a left breast mass, and an excision was then performed. The mass, measuring 7.0 x 4.0 cm in size, was relatively well demarcated with a nodular contour and showed pale gray and solid cut surface with clefts on it. Histologically, the mass mainly consisted of stromal components that were characterized by high cellularity, marked nuclear atypism and brisk mitosis. The sparse glandular components were leaf-like in shape and lined by bland ductal epithelium without any nuclear atypism. Sixteen months later, the patient revisited our hospital with a recurrent mass, and underwent total mastectomy. The recurrent mass contained foci of definite invasive ductal carcinoma in the background of malignant phyllodes tumor, which was identical to the primary mass. This case demonstrates that it is possible that an invasive ductal carcinoma might arise within, at least with, a recurrent malignant phyllodes tumor.
Subject(s)
Adult , Female , Humans , Breast , Carcinoma, Ductal , Epithelium , Mastectomy, Simple , Mitosis , Phyllodes TumorABSTRACT
Objective To evaluate the clinical and pathological characteristics and treatment of malignant phyllodes tumor of the prostate. Methods A 60 year old male patient with malignant phyllodes tumor of the prostate was reported.The complaints consisted of dysuria,intermittent gross hematuria for 1 year,and recurrent symptoms after TURP for 2 months.The enlarged prostate was 5 cm?6 cm and palpated softly and smoothly by DRE,and heterogeneous by CT.His serum PSA level was 1.25 ng/ml.Sarcoma of the prostate was suspected and radical prostatectomy was performed on him. Results The pathology showed a special type of epithelial stromal tumor like cystosarcoma phyllodes of the mammary gland. Microscopically, the tumor was composed of cystically dilated ducts with leaf like stroma projections in the lumen.The stroma cell proliferated obviously with atypia and high mitotic rate,and the epithelial cell also proliferated but with no atypia and no mitosis.The seminal vesicle and bladder neck had tumor infiltration and the diagnosis of malignant phyllodes tumor of the prostate was confirmed.The tumor margin was negative.With immunohistochemical staining,the stromal cells were positive for vimentin,but negative for actin,with the epithelial cells positive for CK,PSA and AE1/AE3,and the basal cells positive for CK34BE12.The patient had tumor recurrence after 6 months,but refused to further treatment and was followed up till now. Conclusions Malignant phyllodes tumor of the prostate is rare but can be diagnosed properly based on clinical and pathological features.Radical prostatectomy is considered to be the most reliable treatment.
ABSTRACT
PURPOSE: Malignant phyllodes tumors are rare lesions of the breast. The purpose of this study was to evaluate the clinical charateristics and the recurrence patterns of malignant phyllodes tumors. METHODS: Twelve patients with malignant phyllodes tumors who had undergone surgery at the Breast Clinic, Asan Medical Center, from February 1991 to October 1997 were analyzed retrospectively. Histologic criteria of malignant phyllodes tumor was more than 10 mitoses/10 high-power fields in this study. RESULTS: The mean age of the patients was 40.7 years. As regards to preoperative histological confirmation, malignant phyllodes tumors were proven in all 6 cases with an excision biopsy, but in only one of the 4 cases with fine needle aspiration. All the patients received surgical treatment: a modified radical mas tectomy in 4 cases, a simple mastectomy in 5 cases, a simple mastectomy with reconstruction in 2 cases, and a subcutaneous mastectomy in one case. During 34 months of mean follow-up, 3 patients had a recurrence. One patient had a chest wall recurrence at 29 months and lung metastasis at 48 months; the others had lung metastasis at 14 and 16 months, respectively. CONCLUSION: Malignant phyllodes tumors were difficult to confirm with fine needle aspiration preoperatively. The lung was the main site of metastasis, and if metastasis occurred, the prognosis was very poor.