Malignant phyllodes tumor of the breast in ayoung patient ­ case report

Phyllodes tumor (PT) is an uncommon form of breast tumor. It occurs most commonly in women aged 35 to 65 years. The benign form represents about 85­90% of cases and only 10­15% of PTs are malignant. Clinically and radiologically, malignant phyllodes tumor (MPT) presents as regular, well-delimited, mobile nodules that are difficult to distinguish from fibroadenomas of the breast. The most important differential diagnoses of MPT include fibroadenoma, metaplastic carcinoma, and sarcoma. The prognosis of MPT exhibits a higher frequency of local recurrence and metastatic rate with larger tumors and inadequate surgical margins. The case presented here refers to a 24-year-old female patient, with a vast tumor in the right breast, with rapid and progressive growth, associated to local pain, and histological diagnosis of MPT. Surgery was the initial treatment, followed by adjuvant chemotherapy and radiotherapy. The purpose of this article was to report an atypical case of MPT of the breast in a very young woman as well as to make a brief literature review on this infrequent and dangerous disease. (AU)

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.

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.

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.

Risk Factors for Recurrence After Surgical Treatment of a Malignant Phyllodes Tumor of the Breast / 한국유방암학회지

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.

Invasive Ductal Carcinoma Arising in a Recurrent Malignant Phyllodes Tumor: A Case Report

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.

Malignant phyllodes tumor of the prostate (a case report and literature review) / 中华泌尿外科杂志

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.

Clinical Characteristics and Recurrence Patterns of Malignant Phyllodes Tumors

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.