Pathological features and clinicopathological significance of TERT promoter mutation in breast fibroepithelial tumors without definite diagnosis / 中华病理学杂志

Objective: To investigate the pathological features and the clinicopathological significance of TERT detection in those tumors that were difficult to diagnosis. Methods: A total of 93 cases of fibroepithelial tumors without definite diagnosis were collected from the Affiliated Hospital of Qigndao University between 2013 and 2021. The clinical details such as patients' age and tumor size were collected. All slides were re-reviewed and the pathologic parameters, including stromal cellularity, stromal cell atypia, stromal cell mitoses, and stromal overgrowth were re-interpreted. Sanger sequencing was used to detect TERT promoter status, and immunohistochemistry was performed to detect TERT protein expression. The relationship between TERT promoter mutation as well as protein expression levels and the clinicopathological parameters were also analyzed. Results: The patients' ages ranged from 30 to 71 years (mean of 46 years); the tumor size ranged from 1.2 to 8.0 cm (mean 3.8 cm). These tumors showed the following morphologic features: leafy structures in the background of fibroadenoma, or moderately to severely abundant stromal cells. The interpretations of tumor border status were ambiguous in some cases. The incidence of TERT promoter mutation was high in patients of age≥50 years, tumor size≥4 cm, and stromal overgrowth at ×4 or ×10 objective, and these clinicopathologic features were in favor of diagnosis of phyllodes tumors. TERT protein expression levels was not associated with the above clinicopathologic parameters and its promoter mutation status. Conclusions: The diagnostic difficulty for the breast fibroepithelial tumors is due to the difficulty in recognition of the leafy structures or in those cases with abundant stromal cells. A comprehensive evaluation combined with morphologic characteristics and molecular parameters such as TERT promoter may be helpful for the correct diagnosis and better evaluating recurrence risk.

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.

Malignant Phyllodes Tumor of the Breast: Case Report / Tumor Filoide Maligno de Mama: Relato de Caso / Tumor Phyllodes Maligno de Mama: Reporte de Caso

Introduction: Phyllodes tumors (PT) are rare and account for 0.3% to 0.5% of all breast tumors. PT may be classified as benign, borderline or malignant. The aim of this study was to report a case of malignant PT of the breast. Case report: A 27-year-old woman presented with a mass in the left breast with histopathological features of malignancy (results of US of the breast: an oval, lobulated hypoechogenic lesion, measuring 7.7 cm ­ BI-RADS® 4C). A segmental resection (SR) of the breast was performed and histopathology study of the surgical specimen confirmed a malignant PT. Adjuvant radiotherapy was used for supplemental treatment. One year later, the patient had a local recurrence of the primary tumor and underwent a new SR of the left breast. There was no indication of breast reirradiation. At about 31 months after diagnosis (September 2019 ­ April 2022), the patient is well and adherent to periodical clinical follow-up. Conclusion: This study presents a case of malignant PT that occurred in a young patient and had a more aggressive course

Introdução: Os tumores filoides (TF) são raros e representam entre 0,3% e 0,5% dos tumores de mama, podendo ser classificados como benignos, borderline ou malignos. O objetivo deste estudo foi relatar um caso de TF maligno de mama. Relato do caso: Mulher, 27 anos de idade, apresentando nódulo em mama esquerda com características histopatológicas de malignidade (resultados da ultrassonografia de mamas: lesão hipoecogênica, oval e lobulada, com 7,7 cm ­ BI-RADS® 4C). Foi realizada ressecção segmentar (RS) da mama e o histopatológico da peça cirúrgica mostrou tratar-se de um TF maligno. Como tratamento complementar, foi realizado radioterapia adjuvante. A paciente apresentou recidiva local do tumor primário em cerca de apenas um ano, sendo realizada nova RS da mama esquerda. Não houve indicação de reirradiação da mama. Em 31 meses após o diagnóstico (setembro de 2019 ­ abril de 2022), a paciente encontra-se em bom estado geral e realizando seguimento clínico periódico. Conclusão: Este estudo apresenta um caso de TF maligno que ocorreu em uma paciente jovem e teve um curso mais agressivo

Introducción: Los tumores phyllodes (TP) son poco frecuentes y representan del 0,3% al 0,5% de todos los tumores de mama. Los TP pueden clasificarse como benigno, limítrofe o maligno. El objetivo de este estudio fue reportar un caso de TP maligno de mama. Reporte del caso: Una mujer de 27 años se presentó con una masa en la mama izquierda con características histopatológicas de malignidad (resultados de la ecografía de mama: lesión hipoecogénica ovalada y lobulada, de 7,7 cm ­ BI-RADS® 4C). Se realizó una resección segmentaria (RS) de la mama y el estudio histopatológico de la pieza quirúrgica confirmó un TP maligno. Se utilizó radioterapia adyuvante como tratamiento complementario. Un año después, la paciente presentó una recidiva local del tumor primario y fue sometida a una nueva RS de mama izquierda. No hubo indicación de reirradiación mamaria. Aproximadamente 31 meses después del diagnóstico (septiembre de 2019 ­ abril de 2022), la paciente se encuentra bien y se adhiere al seguimiento clínico periódico. Conclusión: Este estudio presenta un caso de TP maligno que ocurrió en una paciente joven y tuvo un curso más agresivo. Palabras clave: neoplasias de la mama; tumor filoide; mastectomía

Metaplastic breast carcinoma with extensive osseous differentiation

Metaplastic breast carcinoma is a rare subtype of invasive breast carcinoma. Metaplastic carcinoma with osseous differentiation is exceptionally uncommon. Because of the heterogenous microscopy of the lesion, various clinical and radiological features are observed, leading to diagnostic difficulty. Herein, we present a case of a 43-year-old female with a recurrent breast lump, who was clinically diagnosed as a phyllodes tumor. However, histopathological examination revealed metaplastic carcinoma with extensive osseous differentiation.

Recurrent Severe Hypoglycemia Secondary to Benign Phyllodes Tumor of the Breast: A rare case of Non-Islet Cell Tumor-induced Hypoglycemia (NICTH) / Journal of the ASEAN Federation of Endocrine Societies

@#Non-islet cell tumor-induced hypoglycemia (NICTH) secondary to phyllodes tumor is extremely rare but potentially life threatening if not treated promptly. We report a case of a 46-year-old Indian female without underlying diabetes mellitus who presented with a large breast tumor and recurrent severe symptomatic hypoglycemia. Investigations supported the diagnosis of NICTH. The hypoglycemia only resolved after corticosteroids and mastectomy. This case highlights the importance of considering NICTH in the evaluation of patients with voluminous tumor and hypoglycemia.

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.

Lacrimal Sac Metastasis from Phyllodes Tumor of the Breast

No abstract available.

Recidiva de tumor Phyllodes sarcomatoide en una mujer joven: a propósito de un caso / Recurrence of sarcomatoide phyllodes tumor in a young

Resumen Introducción: El tumor Phyllodes mamario es una entidad muy poco frecuente, con tendencia a la recidiva local y una tasa de malignización de 5-10%. La base de su tratamiento es la resección quirúrgica. Material y Métodos: Mujer de 32 años diagnosticada de un tumor Phyllodes maligno en mama derecha sometida en otro centro a cirugía conservadora con colocación de expansor y a dos tumorectomías posteriores por recidiva local. Fue referida a nuestro Hospital al presentar una nueva recidiva de gran tamaño (9,2 cm) para valoración de intervención quirúrgica. Resultados: Se realizó exéresis del tumor (remanente de tejido mamario y músculo pectoral mayor) y retirada del expansor con reconstrucción mamaria con colgajo de dorsal ancho en el mismo tiempo quirúrgico. En el momento actual la paciente se encuentra pendiente de iniciar tratamiento radioterápico. Conclusiones: El tumor Phyllodes maligno es una entidad poco frecuente y cuyo manejo terapéutico se basa en la resección quirúrgica con márgenes. De forma adyuvante se puede administrar quimiorradioterapia. Es de gran importancia realizar un manejo multidisciplinar e individualizado de cada caso para ofrecer el mejor pronóstico.

Introduction: Phyllodes tumor is a rare entity, with a high tendency to local recurrence and a malignancy rate of 5-10%. The basis of its treatment is the surgical resection. Materials and Method: We report a 32-year-old woman who was diagnosed of a malignant Phyllodes tumor who had previously underwent conservative breast surgery and expander placement in another center. Two subsequent lumpectomies due to local recurrences were necessary. She was referred to our Hospital for she presented a new large-sized recurrence (9.2 cm) at the retroarelor area for assessment of new surgical treatment. Results: Surgical resection of the tumor (remnant of mammary tissue and pectoralis major muscle) and removal of the expander with immediate breast reconstruction with latissimus dorsi flap was performed. At the present time, the patient is pending radiotherapeutic treatment. Conclusions: Malignant Phyllodes tumor is a rare entity whose therapeutic management is based on margin-free surgical excision. Adjuvant chemoradiotherapy might be administered. It is very important to carry out a multidisciplinary and individualized management of each case to offer the best possible forecast.

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.

Identificação dos perfis lipidômicos in situ dos tumores bifásicos da mama por DESI-MS (Desorption Electrospray Ionization/ Mass Spectrometry) / Identification of lipidomic profiles in situ of breast biphasic tumors by DESI-MS (Desorption Electrospray Ionization/ Mass Spectrometry)]

Os tumores bifásicos da mama formam um grupo heterogêneo de tumores que apresentam na histologia dois componentes, o epitelial e o estromal. Esses tumores podem ser benignos ou malignos, alguns podem recidivar ou dar metástase. O seu prognóstico varia conforme a sua classificação histológica, a presença de metástase e a adequabilidade do seu tratamento. Porém, por vezes, há ainda dificuldade em diferenciá-los quando há sobreposição das características histológicas que são utilizadas para realizar o diagnóstico no exame anatomopatológico. Visando um novo método para diferenciar esses tumores entre si, além do exame anatomopatológico habitual, buscou-se analisar esses tumores através de uma técnica da química analítica de ionização ambiente, utilizando espectrometria de massas, o DESI-MSI (Desorption Electrospray Ionization Mass Spectrometry Imaging). Foram utilizados cortes de amostras congeladas em lâminas para analisar no DESI-MSI e, através dessa análise, obteve-se os espectros de massas e as imagens químicas. A análise estatística foi realizada através do teste de Wilcoxon-Mann-Whitney. Nesse estudo encontramos maior intensidade dos ácidos graxos poli-insaturados (PUFAs); de fosfolipídios como as fosfatidilserina e fosfatidiletanolaminas; do ácido ascórbico e de peptídeos no sarcoma do estroma da mama e tumor Phyllodes maligno, comparados ao tumor Phyllodes borderline e, por sua vez, comparado ao tumor Phyllodes benigno, fibroadenomas e tecido normal. Alguns PUFAs, como o ácido araquidônico (m/z 303,2330) e o ácido adrênico (m/z 331,2643), são precursores dos eicosanóides e participam de vias pró-inflamatórias. Os PUFAs podem estar ligados a um fosfolipídio da membrana celular e, quanto mais estiver presente, menor a rigidez da membrana, o que diminui o gasto energético para a realização dos movimentos celulares, como a endocitose. O aumento da intensidade do ácido ascórbico nas células tumorais se deve provavelmente ao aumento da demanda metabólica de glicose pelas células tumorais; ocorrendo, portanto, aumento dos transportadores de glicose (GLUTS) e, como a molécula do ácido ascórbico e sua forma oxidada tem estrutura molecular semelhante à molécula da glicose, o ácido ascórbico seria carreado por esses transportadores para dentro da célula tumoral. A maior intensidade dos peptídeos no tecido maligno pode ser explicada pela maior demanda proteica da célula maligna; porém, além da importância dos peptídeos para construção das proteínas, sabe-se que alguns aminoácidos podem ser convertidos em metabólitos intermediários da glicólise aeróbia. Isso ocorre devido ao aumento da demanda de átomos de carbono para biossíntese de metabólitos. Essas diferenças lipidômicas e metabolômicas ocorrem pelo metabolismo diferenciado da célula maligna, a qual desenvolve mecanismos de adaptação para sobrevivência e proliferação. A análise das imagens químicas dos tumores bifásicos da mama obtidas por DESI-MSI mostrou que é possível diferenciar esses tumores. O uso futuro dessa técnica na rotina diagnóstica pode ser promissor devido a ser de execução rápida e de alta acurácia (AU)

Biphasic breast tumors form a heterogeneous group of tumors that present in histology two components, epithelial and stromal. These tumors may be benign or malignant, some may recur or metastasize. Its prognosis varies according to its histological classification, the presence of metastasis and the adequacy of its treatment. However, sometimes there is still difficulty in differentiating them when there is overlap of the histological features that are used to make the diagnosis in the pathological examination. Aiming at a new method to differentiate these tumors from each other, in addition to the usual pathological examination, we sought to analyze these tumors using an analytical chemistry technique of ambient ionization using mass spectrometry, the Desorption Electrospray Ionization Mass Spectrometry Imaging (DESI-MSI). Frozen specimen sections were used to analyze the DESI-MSI and, through this analysis, mass spectra and chemical images were obtained. Statistical analysis was performed using the Wilcoxon-Mann-Whitney test. In this study we found higher intensity of polyunsaturated fatty acids (PUFAs); phospholipids such as phosphatidylserine and phosphatidylethanolamines; ascorbic acid and peptides in breast sarcoma and malignant phyllodes tumor, compared to borderline phyllodes tumor and, in turn, compared to benign phyllodes tumor, fibroadenomas and breast normal tissue. Some PUFAs, such as arachidonic acid (m/z 303,2330) and adrenic acid (m/z 331,2643), are precursors of eicosanoids and participate in proinflammatory pathways. PUFAs may be linked to a cell membrane phospholipid and, the more it is present, the lower the membrane stiffness, which decreases the energy expenditure to perform cell movements, such as endocytosis. The increase in ascorbic acid intensity in tumor cells is probably due to the increased metabolic demand for glucose by tumor cells; there is therefore an increase in glucose transporters (GLUTS) and, since the ascorbic acid molecule and its oxidized form have a similar molecular structure to the glucose molecule, the ascorbic acid would be carried by these transporters into the tumor cell. The higher intensity of peptides in malignant tissue may be explained by the higher protein demand of the malignant cell; However, in addition to the importance of peptides for protein construction, it is known that some amino acids can be converted into intermediate metabolites of aerobic glycolysis. This is due to the increased demand for carbon atoms for metabolite biosynthesis. These lipidomic and metabolomic differences occur due to the differentiated metabolism of the malignant cell, which develops adaptation mechanisms for survival and proliferation. Analysis of chemical images of biphasic breast tumors obtained by DESI-MSI showed that it is possible to differentiate these tumors. The future use of this technique in the diagnostic routine may be promising due to its fast execution and high accuracy (AU)

A cavernous hemangioma located in the axillary area: Challenges in preoperative diagnosis and operation

Cavernous hemangiomas are benign neoplasms of endothelial cells. Although this neoplasm has the potential to develop in all parts of the body, it rarely develops in the axilla; in fact, there are only two case reports of axillary cavernous hemangiomas in the literature. Here, we describe a third case, which occurred in a 30-year-old Korean woman. The patient presented with a palpable mass in the left axilla that was initially thought to be either a phyllodes tumor or a lymphoma based on imaging studies. However, the results of an excisional biopsy led to a diagnosis of cavernous hemangioma. Although uncommon, a cavernous hemangioma can be encountered unexpectedly, presenting as a mass in axilla. Although usually curative, surgery may be challenging not only because of the rarity of the condition, but also because of inconsistent preoperative findings and the involvement of large vessels.

Evolución natural del tumor Phylloides de mama por retraso en el diagnóstico y tratamiento realizado / Natural Evolution of Phylloides Tumor of the Breast Due To Delay in Diagnosis and Treatment

Los tumores Phylloides se originan del estroma de la glándula mamaria. La frecuencia es menor a 1 por ciento predominando en mujeres entre 35 a 55 años. Típicamente se presentan como nódulos móviles, redondeados, usualmente indoloros, y pueden tener crecimiento rápido. El tratamiento de elección es la escisión local de la lesión, tanto para formas benignas y malignas, con márgenes de al menos 1 cm. Presentar el caso de una paciente con Tumor Phylloides de mama y su evolución natural por retraso en el diagnóstico y tratamiento temprano. Paciente de sexo femenino, 42 años, nulípara, sin antecedentes familiares de Cáncer de mama que consulta presentando un tumor de gran tamaño, en cuadrante inferior interno de la mama izquierda, cuyo crecimiento fue progresivo hasta deformar la glándula mamaria. Se le realizó biopsia por Trucut, con diagnostico histopatológico de tumor Phylloides de bajo grado de malignidad y se somete a tratamiento radical mediante mastectomía de limpieza. Resultados: Se realizó mastectomía de limpieza, sin complicaciones postquirúrgicas, siendo la evolución clínica satisfactoria. Toda paciente con tumor de crecimiento progresivo después de los 30 años, debe de ser de estudiada de inmediato para determinar su estirpe histológica y el tratamiento adecuado, sin permitir que continúe con la evolución de la historia natural de enfermedad(AU)

Phylloides tumors originate from the stroma of the mammary gland. The frequency is less than 1percent predominantly in women aging 35 and 55 years. They typically present as mobile, rounded nodules, usually painless, and may grow rapidly. The treatment of choice is local excision of the lesion, both for benign and malignant forms, with margins of at least 1 cm. We present the case of Phylloides tumor of the breast and its natural evolution due to delay in diagnosis and early treatment with a 42-year-old female patient. She was nulliparous, with no family history of breast cancer who came to consultation presenting a large tumor in the inner lower quadrant of her left breast. The tumor grew progressively until the mammary gland was deformed. A trucut biopsy was performed with a histopathological diagnosis of Phylloides tumor of low grade of malignancy. This patient underwent radical treatment by mastectomy. Cleaning mastectomy was performed, without postoperative complications, and the clinical evolution was satisfactory. All patients with progressive growth after the age of 30 should be studied immediately to determine histological characteristics of the tumor, and the appropriate treatment to prevent the evolution of the natural history of the disease(AU)

Manejo diagnóstico-terapéutico de las lesiones mamarias atípicas / Diagnostic-therapeutic Management of Atypical Breast Lesions

Las lesiones mamarias se dividen histológicamente en dos grandes grupos, malignas y benignas. Las lesiones malignas pueden ser de origen ductal o lobulillar, siendo el carcinoma ductal infiltrante la neoplasia invasiva más frecuente. Las lesiones benignas se clasifican en no proliferativas, proliferativas sin atipias y proliferativas con atipias. Dentro de los dos últimos grupos se encuentran entidades que conllevan un alto riesgo de desarrollar carcinoma de mama, como pueden ser la hiperplasia ductal atípica, la cicatriz radial o la neoplasia lobular. Revisamos en qué consisten dichas entidades y cuáles son sus características principales en imagen, fundamentalmente en mamografía y ecografía. Si tras realizar una biopsia se obtiene uno de esos diagnósticos histológicos, es importante analizar las características imagenológicas y el tipo de procedimiento realizado (número de cilindros obtenidos, calibre de aguja...), para realizar un adecuado manejo posterior. En algunos casos la actitud a seguir será la extirpación quirúrgica completa de la lesión, mientras que en otros se podrá realizar una extirpación percutánea (mediante biopsia con aguja de vacio), o incluso seguimiento estricto por imagen. Mediante diferentes casos mostraremos nuestra experiencia y analizaremos la literatura vigente para recordar esas entidades y llegar a un consenso adecuado sobre el manejo de las mismas.

Breast lesions are divided histologically into two large groups, malignant and benign. Malignant lesions may be of ductal or lobular origin, with infiltrating ductal carcinoma being the most frequent invasive neoplasm. Benign breast lesions are classified as proliferative, proliferative without atypia and proliferative with atypia. Within the last two classifications are entities that carry a high risk of developing breast carcinoma, such as atypical ductal hyperplasia, radial scar or lobular neoplasia. We review what these entities consist of and what are their fundamental characteristics in image, fundamentally in mammography and ultrasound. When we perform one of these histological diagnoses after a biopsy, it is important to analyze the radiological characteristics and the type of procedure performed (number of cylinders, needle gauge ...) to perform an appropriate posterior management. In some cases the attitude to be followed will be the complete surgical removal of the lesion, while in others a percutaneous excision (through vacuum needle biopsy) or even strict image follow-up may be performed. Through different cases we will show our experience and analyze current literature to remember these entities and reach an adequate management consensus.

Caso Clínico: Tumor Phyllodes / Case Report: Tumor Phyllodes

INTRODUCCIÓN: El tumor phyllodes representa menos del 1 % de los tumores mamarios, con una incidencia de 2.1 por millón a nivel mundial, la edad de presentación es entre los 35 a 55 años. Las mujeres latinas tienen mayor riesgo de tumor phyllodes que otros grupos étnicos. En Ecuador las ciudades con mayor incidencia son Quito, Guayaquil y Loja según el Registro Nacional de Tumores; en Cuenca se presenta un caso por año. CASO CLÍNICO: Paciente femenino de 46 años, con antecedente de resección de fibroadenoma en mama derecha 2 años antes, quien hace seis meses atrás, presenta tumor multilobulado de crecimiento rápido, móvil, definido, que ocupa el 80 % de la mama derecha, ecografía BIRADS II; mamografía BIRADS 0. Biopsia con aguja fina presenta resultado histopatológico de tumor phyllodes limítrofe. EVOLUCIÓN: Con el reporte de patología de tumor phyllodes maligno de alto grado con límites negativos, se realizó mastectomía; posteriormente paciente no necesito tratamiento adyuvante, al momento con buen pronóstico. CONCLUSIÓN: El tumor phyllodes maligno es poco frecuente, pero debe considerarse como diagnóstico diferencial en pacientes mayores de 35 años, su tratamiento estandarizado es quirúrgico, sin haberse demostrado que un tratamiento adyuvante pueda disminuir la recurrencia loco regional o a distancia.

BACKGROUND: The phyllodes tumor represents less than 1 % of mammary tumors, with an incidence of 2.1 per million worldwide, the age of presentation is between 35 to 55 years. Latina women are at higher risk of phyllodes tumor than other ethnic groups. In Ecuador, the cities with the highest incidence are Quito, Guayaquil and Loja according to the National Registry of Tumors. In Cuenca, one case is presented per year. CASE REPORT: Female patient of 46-year-old woman with a history of resection of fibroadenoma in the right breast 2 years; who 6 months ago, presented a rapidly growing, mobile, defined multi-lobed tumor that occupies 80 % of the right breast, BIRADS II ultrasound; mammography BIRADS 0. Fine needle biopsy presents histopathological result of phyllodes borderline tumor. EVOLUTION: Mastectomy was performed with high-grade malignant phyllodes tumor pathology report with negative limits, the patient does not need adjuvant treatment, and it remains good prognosis. CONCLUSION: Malignant phyllodes tumor is rare, but it should be considered as a differential diagnosis in patients older than 35 years, it is standardized treatment surgical, without having demonstrated that an adjuvant treatment can reduce loco or regional recurrence.

Breast Lesions in Children and Adolescents: Diagnosis and Management

Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.

Distant metastasis from benign phyllodes tumor

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> As there is a dearth of information on phyllodes tumors of the breast in the Philippines yet this ultimately impacts on the management and survival of Filipino patients, the authors reviewed their surgical cases of phyllodes tumors, focusing in this report, for the first time in Philippine literature, on the real risk of distant metastasis from the more common benign variety of phyllodes tumors. They therefore aim to identify case/s and do a review of literature on distant metastasis from benign phyllodes tumors.</p><p style="text-align: justify;"><strong>METHODS:</strong> A review of records of all surgical cases of phyllodes tumor managed at PGH from 2005 - 2014 was done. Data from patients who on follow up were found to have distant metastasis were gathered and further reviewed. A literature search on metastatic phyllodes tumor and its implications was likewise done to complete this study.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 200 patients with phyllodes tumor surgically managed within the study period were reviewed and followed up. One hundred sixty one out of 200 (80.5%) patients were histologically classified as benign. Twelve patients out of 200 (6.0%) developed distant metastasis on follow up, 1 (0.62% of 161 benign phyllodes tumors) of whom had benign phyllodes tumor.</p><p style="text-align: justify;"><strong>CONCLUSIONS:</strong> The authors show that distant metastasis from benign phyllodes tumor can occur here in the Philippines. Therefore, the subtype of phyllodes tumor alone, especially in benign lesions, does not absolutely predict biological behavior and risk of recurrence. A better understanding of the true nature of metastasis in these tumors is highly anticipated.</p>

Surgery for giant tumours of the breast: a 15 year review

Background: Giant tumours of the breast tend to occur in the adolescent age group. Racial predilection has been noted in the literature. The mass often occupies most of the breast, leading to its distortion. Many authors have advocated a mastectomy for benign tumours that severely distort the breast. Giant benign tumours when treated by simple excision risk persistence of asymmetry. To avoid this asymmetry, some authors have resorted to excision and immediate reduction mammaplasty. The aim of this retrospective study was a report on giant tumours of the breast presenting to a plastic surgery unit and to analyse demographic factors, clinical presentations, tumour pathology, management, complications, as well as patient and breast outcomes.Methods: Medical records of patients with giant tumours were retrospectively analysed for assessing demographic factors, clinical presentation, tumour pathology, the technique of surgery performed and patient and breast outcomes in a single hospital setting. Breast outcomes were rated by panel of 4 experienced plastic surgeons using the 4 Point Likert scale. Their ratings were statistically analysed for inter-rater agreement.Results: Twenty-three subjects were identified to have giant tumours of the breast. Of these South African patients, 19 were black, 3 were Indian and 1 was of mixed ethnicity. The age range was 12­49 years(y) with an average of 19y. All masses were palpable. The final pathological diagnosis was fibrocystic disease in 3, giant fibroadenoma in 14, phyllodes tumour in 4, and hamartoma in 2. The size range was 10­45 cm with a median size of 18 cm. All but one patient had simple excision followed by immediate reduction mammaplasty. Twenty patients were assessed after operation. A minimum of 1 to a maximum of 4 patients per reviewer showed unsatisfactory outcomes and a minimum of 18 to a maximum of 21patients per reviewer showed satisfactory to excellent outcomes. The overall agreement between assessors for this was 84%. Conclusion: Benign giant tumours (> 10 cm) of the breast are suitably managed by excision of the mass and a reduction mammoplasty technique of reconstruction