A rare case of metastatic malignant phyllodes tumor with osteosarcomatous differentiation presenting with intestinal obstruction

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.

Malignant Phyllodes Tumor in the male: A case report

@#Phyllodes tumors are breast tumors accounting for about 1% of all breast neoplasms in women and are rare in males. Reported here is a case of a 45-year-old male presenting with a rapidly enlarging right breast mass with invasion of the anterior chest wall. Core Needle Biopsy revealed Malignant Phyllodes Tumor. He underwent wide excision and chest wall resection. Reconstruction was performed using polyropelene mesh, a latissimus dorsi flap and split thickness skin grafting. Patient was discharged on the 33rd post-operative day due to delayed expansion of the right lung from splinting and subsequent near-complete loss of the split thickness skin graft over the latissimus muscle flap. On the recommendation of the plastic surgeon, the wound was allowed to heal by secondary intention. This report draws attention to the rarity of malignant phyllodes tumor in males, and the difficulty of recognizing a malignant pathology in males presenting with breast mass. It also highlights a cost-effective treatment option in the management of these tumors.

Clinical efficacy of ultrasound-guided vacuum-assisted excision in the treatment of breast benign phyllode tumor and the risk factors of local recurrence after operation / 国际外科学杂志

Objective:To investigate the clinical efficacy of ultrasound-guided vacuum-assisted excision (VAE) in the treatment of breast benign phyllode tumor and the risk factors of local recurrence after operation.Methods:A total of 256 cases of patients with breast benign phyllode tumor admitted to Yuncheng Central Hospital from January 2012 to January 2020 were included in the retrospective study, they were all female, of which 160 cases received ultrasound-guided VAE surgical treatment and 96 cases received open surgical treatment. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups. The Chi-square test or Fisher exact probability method was used to compare the data groups. Univariate analysis was performed on the factors related to the local recurrence of benign phyllode tumor after surgery, and then the factors with statistically significant differences in the univariate analysis were further incorporated into multivariate Logistic regression analysis. Results:Univariate analysis results showed that the maximum diameter of tumor ≥25 mm and the history of ipsilateral breast fibroadenoma were associated with postoperative local recurrence of breast benign phyllodes tumor ( P<0.05). Multivariate Logistic regression analysis results showed that tumor diameter ≥25 mm was an independent risk factor for postoperative local recurrence of breast benign phyllodes tumor ( P<0.05). Conclusion:Ultrasound-guided VAE in the treatment of breast benign phyllodes tumor patients with maximum diameter less than 25 mm can reduce the postoperative local recurrence rate, and patients with tumor maximum diameter greater than 25 mm should have the higher local recurrence risk.

Tumor filoide gigante. Presentación de un caso

Los tumores filoides son una de las tumoraciones raras de la mama. Su forma habitual de presentación es en forma de masa firme, sin dolor, generalmente de un solo lado y móvil. Se presentó el caso de paciente de 17 años, del sexo femenino, con seropositividad para VIH, que se consultó por aumento de volumen de mama izquierda con crecimiento acelerado en los últimos seis meses. Al examen físico se palpó tumoración gigante ulcerada de mama izquierda, indolora y de consistencia firme multilobulada, con red venosa superficial. La tumoración, de unos 33 cm, ocupaba prácticamente toda la mama izquierda. No se palparon adenopatías. Luego de los estudios imaginológicos realizados fue intervenida quirúrgicamente. El estudio anatomopatológico informó tumor filoide de alto grado. La paciente evolucionó favorablemente durante el posoperatorio y se le dio alta médica con buen estado general y sin fiebre. Se revisó el estudio y manejo de esta patología, así como la importancia de un correcto diagnóstico diferencial.

Giant phyllodes tumors are one of the rarest breast tumors. This tumor typically presents itself as a firm and painless mass, mobile and generally located in one of the breasts. An HIV-positive 17 years old female patient presented a left breast swelling with a history of fast growing pace in the previous 6 months. Physical examination showed an ulcerated painless giant phyllodes tumor on the left breast, with multilobed firm characteristics and considerable blood vessel network. The tumor, with a 33cm circumference, took most of the left breast volume. No lymphadenopathies were detected. After radiographic tests, surgical procedure was performed. The anatomopathological report confirmed the presence of a high grade phyllodes tumor. The patient evolved favorably after surgery and was discharged in good general condition, with no fever. The study and management of this pathology was reviewed, as well as the importance of a correct differential diagnosis.

Tumores filoides são um dos tumores raros da mama. Sua forma usual de apresentação é como uma massa firme, indolor, geralmente unilateral e móvel. Foi apresentado o caso de uma paciente de 17 anos com soropositividade para HIV, que foi consultada devido ao aumento do volume da mama esquerda com crescimento acelerado nos últimos seis meses. Ao exame físico, palpava-se tumoração gigante ulcerada em mama esquerda, indolor e firme, multilobulada, com rede venosa superficial. O tumor, de cerca de 33 cm, ocupava praticamente toda a mama esquerda. Não havia adenopatias palpáveis. Após a realização dos exames de imagem, foi submetida a cirurgia. O estudo anatomopatológico relatou um tumor phyllodes de alto grau. A paciente evoluiu bem no pós-operatório, recebendo alta em bom estado geral e sem febre. Foi revisto o estudo e tratamento desta patologia, bem como a importância de um correto diagnóstico diferencial.

Are both distinct epithelial and stromal cells molecular analysis from phyllodes tumors versus fibroadenoma components affected in breast fibroepithelial progression?

Purpose: To determine molecular events involved in the tumorigenesis of phyllodes tumors (PT) and the role of each stromal (SC) and epithelial (EC) cell. Methods: Frozen breast samples enriched with epithelial and stromal cells from three fibroadenomas and 14 PT were retrieved and laser microdissected. Sanger and polymerase chain reaction-based sequencing of exon 2 MED12 and TERT promoter hotspot mutations were performed; 44K microarray platform was used to analyze gene expression. Results: All three fibroadenomas (FAs) presented mutations in MED12, but not in TERT, whose mutation was observed in five of the 14 PTs. EC and SC of each affected tumor displayed identical alterations. Of the total differentially expressed genes (DEG) (EC = 1,543 and SC = 850), 984 were EC-eDEGs and 291 were SC-eDEGs. We found a high similarity of diseases and functions enriched by both cell types, but dissimilarity in the number of enriched canonical pathways. Three signaling canonical pathways overlapping with EC and SC were predicted to be activated in one cell type and inactivated in the other, while no overlap in eDEGs was assigned to them. We also identified 13 EC-eDEGs and five SC-eDEGs enriched networks, in which the SC-eDEGs were able to segregate FA from PT samples. Conclusions: Identical TERT mutations from both SC and ES origins might affect the PTs tumorigenesis. Gene expression differences suggest coordinated molecular processes between these components with determinant differences acquired by SC, able to fully distinguish PTs from FAs lesions.

Tumor filoides maligno con diferenciación angiosarcomatosa / Malignant phyllodes tumor with angiosarcomatous

Resumen Los tumores filoides (TF) malignos son infrecuentes. Poco se ha descrito en la literatura sobre la diferenciación angiosarcomatosa de un TF maligno (1). Presentamos el caso de una mujer de 25 años con TF maligno de alto grado con diferenciación angiosarcomatosa y compromiso axilar. Manejada con mastectomía radical modificada y adyuvancia con radioterapia (RT). Se hace una discusión del caso y revisión de la literatura.

Abstract Malignant phyllodes tumors (TF) are rare. Little has been described in the literature on angiosarcomatous differentiation of a malignant TF. We report the case of a 25 years old woman with a malignant phyllodes tumor of high grade with angiosarcomatous differentiation and axillary involvement. She was managed with modified radical mastectomy and adjuvant radiotherapy. A discussion of the case and review of the literature was made.

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.

Tumor filodes: experiencia de 12 años en la Unidad de Oncología del Hospital General de Puebla / Phyllodes tumor: A 12-year experience at Oncology Unit of the Hospital General de Puebla

Resumen OBJETIVO: Exponer la experiencia de 12 años de la Unidad de Oncología del Hospital General de Puebla Eduardo Vázquez N en el tratamiento de pacientes con tumor filodes. MATERIALES Y MÉTODOS: Estudio longitudinal, retrospectivo, observacional y clínico efectuado en pacientes con diagnóstico histopatológico de tumor filodes atendidas entre los meses de enero de 2009 a diciembre de 2021 en la Unidad de Oncología del Hospital General de Puebla. Variables de estudio: incidencia, edad al momento del diagnóstico, localización y técnica quirúrgica aplicada. Para determinar las variables entre grupos independientes se aplicaron medidas paramétricas. RESULTADOS: Se revisaron 37 expedientes de pacientes con diagnóstico de tumor filodes. Se obtuvo una incidencia institucional de 1.4%, de la que 18.9% correspondió a tumor maligno. La edad promedio de las pacientes fue de 39.4 (límites 13 a 61 años). En dos casos se encontró asociación con el embarazo. En términos generales el tratamiento fue quirúrgico, con mastectomía simple y tumorectomía, con recurrencia en seis casos. CONCLUSIONES: Si bien la incidencia del tumor filodes es baja, siempre es importante considerar su existencia como alternativa para el diagnóstico de tumores de mama. El tratamiento quirúrgico con mastectomía simple ha reportado buena respuesta, con bajas tasas de recurrencia.

Abstract OBJECTIVE: To present the 12-year experience of the Oncology Unit of the General Hospital of Puebla Eduardo Vázquez N in the treatment of patients with phyllodes tumor. MATERIALS AND METHODS: Longitudinal, restrospective, observational and clinical study carried out in patients with histopathological diagnosis of phyllodes tumor attended from January 2009 to December 2021 in the Oncology Unit of the General Hospital of Puebla. Study variables: incidence, age at diagnosis, location and surgical technique applied. Parametric measures were applied to determine the variables between independent groups. RESULTS: Thirty-seven files of patients with a diagnosis of phyllodes tumor were reviewed. An institutional incidence of 1.4% was obtained, of which 18.9% corresponded to malignant tumor. The mean age of the patients was 39.4 (limits 13 to 61 years). In two cases an association with pregnancy was found. In general terms, treatment was surgical, with simple mastectomy and lumpectomy, with recurrence in six cases. CONCLUSIONS: Although the incidence of phyllodes tumor is low, it is always important to consider its existence as an alternative for the diagnosis of breast tumors. Surgical treatment with simple mastectomy has seemed to have a good response, with low recurrence rates.

Características clínico patológicas, tratamiento y pronóstico de tumor filodes en centros de referencia en Medellín, Colombia / Clinicopathological characteristics, treatment and prognosis of phyllodes tumor in reference centers in Medellín, Colombia / Clinicopathological characteristics, treatment and prognosis of phyllodes tumor in reference centers in Medellín, Colombia

RESUMEN Objetivo . Describir los datos sociodemográficos, manifestaciones clínicas, paraclínicos, tratamiento y recurrencia, entre la serie de pacientes diagnosticados con tumor filodes. Métodos . Estudio descriptivo, retrospectivo de una base de datos institucional, entre el periodo 1 enero de 2016 y 31 diciembre de 2019. Se recopilaron de los registros médicos los datos demográficos, clínicos, paraclínicos, que fueron analizados utilizando estadística descriptiva. Resultados . La prevalencia de tumor filodes en la muestra fue 1,3%. Todos los casos fueron mujeres, edad media 42 años, con motivo de consulta más frecuente masa mamaria (n= 42, 97,6%), tamaño medio del tumor 8,6 cm (rango 2,1 a 20 cm). La biopsia cortante hizo el diagnostico de tumor filodes en 8 pacientes (18,6%) y fibroadenoma en 30,2% (n=12). Según la clasificación histológica, el más frecuente fue el tipo benigno y limítrofe, con 34,9% (n=15) cada uno, seguido por maligno en 30,2% (n=13). El tipo de cirugía más efectuada fue la cuadrantectomía en 55,8% (n=24). La media de seguimiento fue de 60,3 meses y se encontró recaída en 9,3% (n=4), con un tiempo hasta la recaída promedio de 23,2 meses. Conclusiones . En la muestra estudiada, el tumor filodes afectó a las mujeres en la cuarta década de la vida, se presentó como una masa, grande, unilateral, sin predominio de lateralidad, de rápido crecimiento. El tratamiento óptimo fue la cirugía con márgenes negativos amplios, y la radioterapia en casos seleccionados. Es importante su riesgo de recurrencia.

ABSTRACT Objective : To describe the sociodemographic data, clinical and paraclinical manifestations, treatment and recurrence, among a series of patients diagnosed with phyllodes tumor. Methods : Descriptive, retrospective study of an institutional database, between January 1, 2016 and December 31, 2019. Demographic, clinical and paraclinical data were collected from medical records, which were analyzed using descriptive statistics. Results : The prevalence of phyllodes tumor in the sample was 1.3%. All cases were women, mean age 42 years, with breast mass as the most frequent reason for consultation (n = 42, 97.6%), mean tumor size 8.6 cm (range 2.1-20 cm). The sharp biopsy made the diagnosis of phyllodes tumor in 8 patients (18.6%) and fibroadenoma in 30.2% (n = 12). According to the histological classification, the most frequent were the benign and borderline type with 34.9% (n = 15) each, and malignant in 30.2% (n = 13). The type of surgery most performed was quadrantectomy in 55.8% (n = 24). The mean follow-up was 60.3 months and relapse occurred in 9.3% (N = 4) in about 23.2 months. Conclusions : In the sample studied, the phyllodes tumor affected women in the fourth decade of life, it appeared as a large, unilateral mass, without predominance of laterality, of rapid growth. The optimal treatment was surgery with wide negative margins, and radiotherapy in selected cases. The risk of recurrence is important.

Core needle biopsy in fibroepithelial tumors: predicting factors for phyllodes tumors

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.

Diseminación tumoral de un filoide en una paciente gestante de 19 años / Dissemination of Phyllodes Tumor in a 19-Year-Old Pregnant woman / Disseminação tumoral de filoide em uma paciente gestante de 19 anos

Resumen Introducción: el tumor filoide es uno del tipo estromal fibroepitelial raro de la mama, que corresponde a menos del 1 % de todos los tumores primarios del seno. Las presentaciones malignas de esta neoplasia se caracterizan por metástasis hasta en el 10 % de los casos. Presentación del caso: se describe el caso de una mujer de 19 años de edad, con edad gestacional de 11 semanas, quien consultó por ictericia en la piel y en las escleras, dolor abdominal y hepatomegalia en el examen físico. Como antecedente de importancia, había requerido mastectomía izquierda por una masa caracterizada histológicamente como tumor filoide 16 meses atrás en otra institución médica. El desenlace es fatal a pesar de los esfuerzos médicos previos y durante el embarazo. Conclusión: el pilar fundamental del tratamiento de tumor filoide continúa siendo la resección quirúrgica. La edad se comporta como un factor predictor de pronóstico; de ahí que el seguimiento de las posibles recurrencias hace parte del manejo.

Abstract Introduction: Phyllodes tumor is a rare fibroepithelial stromal tumor of the breast, accounting for <1% of all primary breast tumors. Malignant presentations of this neoplasm are characterized by metastases in up to 10% of all cases. Case presentation: The case reported is of a 19-year-old female patient who was 11 weeks pregnant and presented with jaundice at the skin and scleral levels, abdominal pain, and hepatomegaly, as determined on physical examination. The patient required left mastectomy for a phyllodes tumor that was histologically characterized 16 months ago at another medical institution. The outcome was fatal despite medical efforts before and during pregnancy. Conclusion: The fundamental pillar of the treatment of phyllodes tumor remains to be surgical resection. While age can act as a prognostic predictor, the follow-up of possible recurrences is part of the management process.

Resumo Introdução: o tumor filoide é um tumor estromal fibroepitelial raro da mama, correspondem a menos do 1% de todos os tumores primários da mama. As apresentações malignas desta neoplasia se caracterizam por apresentar metástase até no 10% dos casos. Apresentação do caso: se descreve o caso de paciente feminina de 19 anos, com idade gestacional de 11 semanas quem consulta por icterícia a nível de pele e escleras, dor abdominal e hepatomegalia ao exame físico. Como antecedente de importância; requereu mastectomia esquerda por massa caracterizada histologicamente como tumor filoide 16 meses atrás em outra instituição médica. O desenlace é fatal apesar dos esforços médicos prévios e durante a gravidez Conclusão: o pilar fundamental do tratamento de tumor filoide continua sendo a ressecção cirúrgica. A idade se comporta como fator preditor de prognóstico, o seguimento das possíveis recorrências faz parte do manejo.

Tumor Phyllodes: revision de la literatura / Phyllodes tumor: literature review

Resumen El tumor phyllodes de mama es un tumor fibroepitelial raro, pero clínicamente importante, que representa menos del 1% de las neoplasias de mama. Histológicamente, los tumores phyllodes se clasifican en tres; como: benignos, limítrofes o malignos, basándose en una combinación de criterios histológicos y patológicos. Esta clasificación del tumor phyllodes de mama es precisamente relevante en su clínica. Si bien la recurrencia local del tumor phyllodes puede ocurrir en todos los grados, la metástasis se limita principalmente a casos malignos y pocos casos limítrofes, por lo general siendo estos dos últimos los que presentan un peor pronóstico de la enfermedad. El tratamiento es principalmente quirúrgico ya que los tumor phyllodes no responden bien a la terapia sistémica. Esta revisión del tumor phyllodes de mama permite orientar a toda la comunidad médica, con base en la evidencia más reciente, a diagnosticar y así poder manejar esta patología, evitando sus complicaciones.

Abstract Phyllodes tumor of the breast is a rare, but clinically important fibroepithelial tumor, accounting for <1% of breast tumors. Histologically, phyllodes tumor is classified into three; as: benign, borderline or malignant, based on a combination of histological and pathological criteria. This classification of the phyllodes breast tumor is precisely relevant in the clinic. While local recurrence of phyllodes tumor may occur in all grades, metastasis is mostly limited to malignant and few borderline cases, usually the latter two types having a worse prognosis of the disease. Treatment is mainly surgical as phyllodes tumor doesn´t respond well to systemic therapy. This review of the phyllodes tumor allows to guide the entire medical community based on the most recent evidence to diagnose and thus be able to manage this pathology, avoiding its complications.

Phyllodes tumor presented as fungating mass on right breast and fibroadenoma on contralateral breast: a case report

This is an article reporting a large phyllodes tumor with fibroadenoma. A 25 years female presented with a fungating mass of size 20×15 cms in right breast since last 1 year and amass of size 3×3 cms in left breast since 6 month. Biopsy from right side and left side breast mass proven to be Cystosarcomaphyllodes and fibroadenoma respectively. Wide local excision with 1cm normal tumor margin on right side and   excision of mass on left side done. Proliferative markers like Ki-67 and P53 were in range of 1-2% and 3-4% respectively. Histopathological diagnosis of tumor was borderline phyllodes tumor (right side) and fibroadenoma (left side). Patient had an uneventful post-operative course and is presently on three monthly follow up since 1 year.

Rapidly progressing malignant phyllodes tumor of the prostate with normal prostate-specific antigen levels: A case report

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.

Tumor filodes de la mama: experiencia en el diagnóstico, tratamiento y seguimiento de 28 casos en Colombia / Phyllodes tumor of the breast: experience in the diagnosis, treatment and follow-up of 28 cases in Colombia

Resumen: OBJETIVO: Describir la experiencia en el diagnóstico, tratamiento y seguimiento de pacientes con tumor filodes que consultaron en dos instituciones de Bogotá, en un periodo de 6 años. MATERIALES Y MÉTODOS: Estudio descriptivo, de serie de casos. Se revisaron las historias clínicas y los reportes de patología quirúrgica de pacientes con diagnóstico de tumor filodes que asistieron a la consulta de Mastología del Hospital de San José y Hospital Infantil Universitario de San José entre los meses de enero de 2013 a junio de 2019. Se analizaron los estudios imagenológicos, biopsias preoperatorias, tratamiento quirúrgico, reporte final de Patología y el seguimiento posterior al tratamiento. Toda la información se guardó en una base de datos con las características sociodemográficas y clínicas de interés. RESULTADOS: Se reportaron 15 de 28 casos benignos, 7 de 28 malignos y 6 de 28 fronterizos; la mediana de edad fue de 49.3 años (rango intercuartil: 43.5 -57), la biopsia trucut identificó a 18 de 28 casos con tumor filodes. Los estudios ecográficos se reportaron como BI-RADS 4 en 18 de 28 pacientes. El tratamiento quirúrgico fue cuadrantectomía y mastectomía, según el tamaño de la lesión. No se reportaron muertes. CONCLUSIONES: El tumor filodes es de crecimiento rápido, baja incidencia, frecuente en mujeres entre la quinta y sexta décadas de la vida, aunque se registran casos en edades extremas (15 y 74 años). El síntoma principal es una masa palpable; en estudios de imágenes se manifiesta como lesión sugerente de malignidad (BI-RADS 4). El tratamiento quirúrgico es la base de la conducta terapéutica.

Abstract: OBJECTIVE: Describe the experience of diagnosis, treatment and follow-up of patients with phyllodes tumor who consulted in two institutions in Bogotá, in a period of 6 years. MATERIALS AND METHODS: A descriptive case series study was carried out, where clinical histories and reports of surgical pathology of patients with a diagnosis of PT who attended a mastology consultation at the San José Hospital and San José University Children's Hospital in January were reviewed. from 2013 to June 2019. Imaging studies, preoperative biopsies, surgical management, final pathology report and post-treatment follow-up were analyzed. A database with sociodemographic and clinical characteristics of interest was tabulated. RESULTS: 15 of 28 benign cases, 7 of 28 malignant cases and 6 of 28 borderline cases were reported, the median age was 49.3 years (RIC 43.5 -57), Trucut biopsy identified 18/28 of phyllodes tumor. Ultrasound studies were reported as BIRADS 4 in 18/28. The surgical management was quadrantectomy and mastectomy according to the size of the lesion. No deaths were reported. CONCLUSIONS: Phyllodes tumor is a tumor of rapid growth, low incidence, frequent in the fifth and sixth decade of life, however, cases are recorded at extreme ages (15-74 years). Its main symptom is palpable mass and in imaging studies it manifests itself as suggestive lesions of malignancy (BIRADS 4). Surgical management is considered as the treatment pillar.

Tumor filodes benigno de la vulva: reporte de un caso / Benign phyllodes tumor of the vulva: Case Report

Resumen: ANTECEDENTES: El tumor filodes de la vulva es una lesión proliferativa, benigna, poco común, que comparte características similares con los tumores mamarios. Aparece en forma de masa unilateral, no dolorosa, localizada en los labios mayores o menores, y en la horquilla posterior de la vulva. Hasta la fecha se han reportado 30 casos de tumor filodes vulvar en todo el mundo. Debido a su baja incidencia no se han estimado los datos epidemiológicos y fisiopatológicos concretos de la enfermedad. CASO CLÍNICO: Paciente de 20 años, que acudió a consulta debido a la aparición de una masa vulvar de aproximadamente 11 cm en el labio mayor izquierdo, no dolorosa, de crecimiento rápido. El tratamiento consistió en resección quirúrgica. El diagnóstico presuntivo fue fibroma vulvar. El servicio de Anatomopatología reportó: tumoración de 280 g, de 12 x 7 x 6 cm, con bordes y formas irregulares, multinodular, cubierta por piel con epidermis; superficie sólida, con bordes irregulares, de aspecto frondoso y consistencia blanda. Se estableció el diagnóstico de tumor filodes de bajo grado (benigno). CONCLUSIÓN: El tumor filodes de la vulva es una alteración excepcional, por lo que es importante conocer sus manifestaciones clínicas, características macro y microscópicas para establecer el diagnóstico y tratamiento certeros.

Abstract: BACKGROUND: Phyllodes tumor of the vulva is a rare, benign, proliferative lesion that shares similar characteristics with mammary tumors. It appears as a unilateral, non-painful mass located on the labia majora or majora, and on the posterior fork of the vulva. To date, 30 cases of phyllodes tumor have been reported worldwide. Due to its low incidence, the specific epidemiological and pathophysiological data of the disease have not been estimated. CLINICAL CASE: A 20-year-old patient, who came to the clinic for a vulvar mass of approximately 11 cm in the left, non-painful, rapidly growing lip. Treatment consisted of surgical resection. The presumptive diagnosis was vulvar fibroma. The pathology service reported: a 280 g mass, 12 x 7 x 6 cm, with irregular edges and shapes, multinodular, covered by skin with epidermis; Solid cutting surface with uneven edges, leafy appearance and soft consistency. The diagnosis of low-grade phyllodes (benign) tumor was established. CONCLUSION: The phyllodes tumor of the vulva is an exceptional alteration, so it is important to know its clinical manifestations, in addition to the macro and microscopic characteristics to establish the accurate diagnosis and treatment.

Osteosarcoma de alto grado originado en un tumor filodes maligno / High grade osteosarcoma originated in a malignant phyllodes tumor

Resumen El tumor filodes maligno con componente estromal (sic) de osteosarcoma es un tumor de muy baja incidencia. La identificación de esta enfermedad se ha convertido en un desafío para la medicina actual debido a su difícil diagnóstico histopatológico, imagenológico y clínico. El tratamiento principal se basa en el manejo quirúrgico y las opciones de terapia adyuvante aún no presentan un sustento científico sólido para su utilización como tratamiento estándar. Su pronóstico no es bueno y la variante osteoblástica presenta un comportamiento muy agresivo, con un riesgo del 38% para compromiso metastásico y riesgo de muerte debido a la enfermedad del 33%. Se presenta el caso de una paciente y se describe cómo se diagnosticó y se trató la enfermedad.

Abstract Malignant phyllodes tumor with osteosarcomatous differentiation has a very low incidence. The assessment of this tumor has become a challenge for current medicine due to its difficult histopathological, imaging and clinical diagnosis. The main treatment is based on surgical management, and the options of adjuvant therapy have not yet presented a solid evidence for its use as standard of care. Its prognosis is not good. The osteoblastic subtype, especially, has a very aggressive behavior, with a risk of 38 % for metastatic compromise and risk of death due to pathology of 33 %. We present the case of a patient and describe how the disease was diagnosed and treated.

Role of stromal CD10 expression in classifying phyllodes tumors

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.

Transformation of fibroadenoma to phyllodes tumor and the use of oncoplastic technique for breast conservative treatment / A transformação do fibroadenoma em tumor filóides e o uso de técnicas oncoplásticas no tratamento cirúrgico conservador de mama

Phyllodes tumors (PT) are rare neoplasms accounting for <1% of breast lesions. A transformation of a fibroadenoma (FA) to a PT is even more rare and unpredictable. Many challenges face PT management, since diagnostic through surgical treatment. We describe a case of a 63-year old woman with PT that was previously diagnosed as a FA who underwent an oncoplastic conservative surgery. A review of the literature on the diagnostic and surgical management of PT was performed. The diagnostic of PT can be hard mostly in needle biopsy, and the close follow up of negative lesions is recommended. Oncoplastic techniques might be an important tool on the conservative treatment of these patients.

O tumor filoide (TF) é uma rara neoplasia que corresponde a menos de 1% das lesões mamárias. A tranformação do fibroadenoma (FA) em TF é um evento raro e imprevisível. Existem muitos desafios no manejo dos TF, desde o seu diagnóstico ao tratamento. Nós descrevemos o caso de uma paciente de 63 anos com TF com diagnóstico prévio de FA que foi submetida ao tratamento cirúrgico conservador da mama por técnicas oncoplásticas. Uma revisão da literatura sobre o diagnóstico e tratamento do TF foi realizada. O diagnóstico dessa condição pode ser especialmente difícil quando feito a partir de amostra de biópsias por agulha, e em caso de resultados negativos recomenda-se acompanhamento rigoroso. As técnicas oncoplásticas podem ser uma importante ferramenta no tratamento cirúrgico conservador desses pacientes.

X-ray texture analysis in differential diagnosis of phyllodes tumor and fibroadenoma in breast / 中国医学影像技术

Objective: To investigate the value of X-ray texture analysis in differential diagnosis of breast phyllodes tumors (BPTs) and breast fibroadenoma (BF). Methods Preoperative X-ray data of 32 patients with BPTs and 32 patients with BF were retrospectively analyzed. MaZda 4.6 software was used to manually draw ROIs on the maximum level of mammography images. The optimized texture parameters of texture analysis were selected with Fisher coefficient, probability of classification error and average correction coefficient (POE+ACC), mutual information (MI) as well as combination of the above three methods (MI+PA+F), respectively. The diagnostic results obtained by radiologist or using texture analysis techniques were contrasted with pathology. The misclassification rates of BPTs and BF were compared between texture analysis and subjective diagnosis by radiologist. Results: The misclassification rate of subjective diagnosis, Fishers, POE-ACC, MI and MI+PA+F was 20.31%(13/64), 14.06% (9/64), 23.44% (15/64), 25.00% (16/64) and 3.12% (2/64), respectively. The misclassification rate of MI+PA+F was lower than that of subjective diagnosis, POE-ACC and MI, respectively (all P<0.05). Conclusion: It is feasible to use texture analysis on X-ray films for differentiation of BPTs and BF.