Tumor Phyllodes con transformación a osteosarcoma / Breast osteosarcoma originating in a phyllodes tumor: report of one case

Phyllodes tumors account for less than 1% of tumors of the mammary gland, have both epithelial and stromal components and are classified as benign, borderline and malignant. The malignant tumors are highly heterogeneous: they can differentiate to liposarcomas, fibrosarcomas, rhabdomyosarcomas, chondrosarcomas or osteosarcomas. The differentiation to osteosarcoma is extremely rare, constitutes 1.3% of cases and is very aggressive. The standard treatment of these tumors is surgical. The role of radiotherapy and chemotherapy is not clear. However, in patients in whom wide surgical margins are not achieved, adjuvant radiotherapy can be of help. We report a 63 years old female with a right breast osteosarcoma with an osteoclastic component, originating in a phyllodes tumor. The tumor was excised surgically and afterwards she was treated with 10 sessions of 50 Gy of radiotherapy in 25 fractions. She has remained free of disease for the last 10 months.

Tumor phyllodes maligno gigante de mama; neoplasia infrecuente de mal pronóstico: a propósito de un caso clínico / Giant phyllodes tumor of the breast; uncommon neoplasm of poor prognosis: clinical case

Los tumores Phyllodes agrupan un conjunto de patologías caracterizadas por presentar una arquitectura histológica estromal y epitelial; dividiéndose en benignos, borderline o malignos, en función de múltiples características. Se desarrollan más frecuentemente en pacientes entre los 35-55 años de edad, representando el 0.3%-1% de los tumores primarios de la mama. Clínicamente se caracterizan por la aparición de una masa indolora, firme, dura, multilobulada y de crecimiento rápido que puede llegar a alcanzar un gran tamaño, denominándose gigantes cuando superan los 10 cm de longitud. El diagnóstico de los tumores Phyllodes, se basa en el estudio anatomopatológico mediante biopsia radioguiada y las pruebas de imagen mamarias. La cirugía conservadora o radical, con márgenes de resección quirúrgica libres de enfermedad mayores de 1 cm, y la radioterapia adyuvante sobre el lecho tumoral, son el tratamiento de elección de este tipo de tumores. El tamaño de la masa, el tipo histológico y la afectación tumoral de los bordes quirúrgicos son los principales factores de riesgo de recurrencia, que puede alcanzar un 40%, siendo casi siempre a nivel local. Por otro lado, la probabilidad de desarrollar metástasis a distancia presenta una mayor variabilidad, siendo más frecuente a nivel pulmonar y óseo. A continuación, presentamos el caso de una paciente diagnósticada de un tumor Phyllodes maligno gigante de mama derecha (mayor de 20 cm) que, tras tratamiento mediante cirugía radical y radioterapia adyuvante, desarrolló múltiples metástasis a distancia, recibiendo actualmente cuidados paliativos, a pesar de los esfuerzos terapéuticos multidisciplinares realizados.

Those Phyllodes tumors grouped a set of pathologies characterized by presenting an architecture histological stromal and epithelial; divided into benign, borderline or malignant, based on multiple characteristics. Occur most frequently in patients between 35-55 years of age, representing 0.3% - 1% of primary tumors of the breast. Clinically is characterized by the appearance of a mass painless, firm, hard, multilobulated and of growth fast that can get to reach a great size, calling is giant when exceed the 10 cm of length. Phyllodes tumors diagnosis, based on the study pathological radioguided biopsy and breast imaging tests. It surgery conservative or radical, with margins of resection surgical free of disease greater of 1 cm, and the radiation therapy adjuvant on the bedding tumor, are the treatment of choice of this type of tumors. He size of the mass, the type histologically and it involvement tumor of them edges surgical are the main factors of risk of recurrence, that can reach a 40%, being almost always to level local. On the other hand, the probability of developing metastasis to distance presents a greater variability, being more frequent to level lung and bone. Then, present the case of a patient diagnosed of a tumor Phyllodes malignant giant of mama right (greater of 20 cm) that, after treatment by surgery radical and radiotherapy adjuvant, developed multiple metastasis to distance, receiving currently care palliative, despite those efforts therapeutic multidisciplinary made.

Challenges in management of phyllodes tumors of the breast: A retrospective analysis of 150 patients.

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.