Study of clinicopathological factors and their impact on survival in phyllodes tumour of breast at tertiary care cancer centre in India.

BACKGROUND: Phyllodes tumour is a rare breast neoplasm having three histological types i. e benign, borderline and malignant. Surgical excision is the mainstay of treatment, but quantification of adequate margin required during excision is still a matter of debate. Role of adjuvant radiotherapy also remains controversial. AIMS: Study of prognostic factors in patients with phyllodes tumour of breast and their effect on survival. SETTING AND DESIGN: A retrospective analysis. MATERIAL AND METHODS: From the year 2016 to 2019 we included 54 patients in this study and assessment of clinical and histopathological features, requirement of adjuvant radiotherapy and their effect on DFS (disease free survival) and OS (overall survival) was done. Log-rank test was used for univariate analysis and multivariate analysis was done by using Cox propotion hazard ratio method. STATISTICAL ANALYSIS: Descriptive statistics was used for calculating proportion and median value. Survival analysis was done by using Kaplan Meier method. P value of <0.05 was considered statistically significant. RESULTS: Mitotic count and presence of heterologous component had significant effect on overall survival (OS) and disease free survival (DFS) on multivariate analysis. No effect of adjuvant radiotherapy and the type of surgery (breast conservation surgery v/s mastectomy) was found on survival (OS, DFS). CONCLUSION: Surgery with adequate margins should be the treatment of choice for tumours with borderline and malignant histological type Histological features like high mitotic count and stromal overgrowth are known prognostic factors, however, heterologous component is also an important prognostic factor and should be studied in large randomized trials. Role of adjuvant radiotherapy remains controversial.

Malignant phyllodes tumors of the breast associating malignancy of both mesenchymal and epithelial components (invasive or in situ ductal carcinoma).

Phyllodes tumors of the breast are biphasic tumors consisting from an epithelial component and a mesenchymal component. Usually, the mesenchymal component of the tumor is the one who dictates the malignancy of the biphasic proliferation. Presence of the malignancy of the both, epithelial [under the form of invasive carcinoma or ductal carcinoma in situ (DCIS)] and mesenchymal components is very rare. Most of the data available from the literature refers to single case presentations. This paper presents the experience of Prof. Dr. Ion Chiricuta Oncological Institute (IOCN), Cluj-Napoca, Romania, with the malignant phyllodes tumors with both epithelial and mesenchymal components showing malignancy. Over two decades (1999-2018), four cases of malignant phyllodes tumors with concomitant epithelial and mesenchymal malignancy were found and presented as a case series. Two out of four cases were malignant phyllodes tumors harboring invasive breast carcinomas (one case with associated DCIS and one case of pure invasive carcinoma) and two cases were malignant phyllodes tumors with the epithelial component showing DCIS. Average follow-up period was 67 months (from 39 to 132 months) with a disease-free survival of 58 months.

Inflamed Phylloides Tumour in a Girl: A Challenging Diagnosis in Paediatric Breast Lesions.

Introduction: Phylloides tumours (PTs) are rare fibroepithelial neoplasms that account for 0.3⁻0.9% of all breast tumours. These tumours typically occur in women aged 30⁻70 years. The occurrence of these tumours in older children and adolescents poses particular diagnostic and therapeutic problems. However, early diagnosis is mandatory because although most of the cases of PTs in children are benign, the borderline and malignant cases with potential negative outcomes cannot be excluded. Case presentation: A 12-year-old girl presented at the Paediatric Emergency Department for hyperaemia and warmth of the left breast that occurred a few days prior without fever. The girl experienced menarche 8 months previously. She experienced no previous trauma and she had no family history of breast cancer. On physical examination, the left breast was painful, enlarged and tender. The overlying skin was erythematous and warm. A breast ultrasonography (US) revealed a large mass with features of an abscess, including a hyperechoic wall, scattered internal echoes and hypoechoic peripheral lacunae of apparent colliquative nature. After 4 days of unsuccessful antibiotic therapy, surgical drainage was performed due to the suspicion of a mammary abscess. At the surgical incision site, the lesion was not-well circumscribed and lacked a capsule. In addition, purulent material was not detected. Histological examination revealed that the tissue alterations were compatible with benign PT. With this diagnosis, the girl underwent definitive surgical removal of the lesion. The postoperative period passed without negative events. An US performed 6 months later revealed that no new mass was present at this time, suggesting no recurrence of the tumour. Conclusion: This case shows that in the presence of a clinical picture suggesting the inflammation of the breast in adolescent females, PT should be considered as a possible diagnosis and US-guided core biopsy should be considered to confirm this suspicion. Thereafter, when surgical excision is performed, particular attention must be paid to both the preservation of all the normal breast parenchyma and future aesthetic problems.

Focal Anomalous Expression of Cytokeratin and p63 in Malignant Phyllodes Tumor: A Comparison With Spindle Cell Metaplastic Carcinoma.

Differentiating between malignant phyllodes tumors and metaplastic spindle cell carcinomas could be problematic, especially on core biopsies. Immunohistochemical staining for cytokeratin cocktail and p63 has been utilized to differentiate between these tumor types. Forty-three phyllodes tumors (27 benign, 6 borderline, and 10 malignant) and 22 metaplastic carcinomas, consisting at least 80% of spindle cells, were identified. At least 4 tissue blocks from each phyllodes tumor were subjected to immunohistochemical staining for cytokeratin cocktail and p63. The immunohistochemical profiles for the spindle cells in metaplastic carcinoma were reviewed. Phyllodes tumor was diagnosed in the younger age group (mean age 41 y) with a larger tumor size (mean size 6.6 cm), compared with metaplastic spindle cell carcinoma (mean age 62.7 y, mean size 3.4 cm). Focal expression (5% of the tumor cells) of cytokeratin cocktail and p63 was identified in the stroma of 2 of 10 malignant phyllodes tumors in a scattered/patchy pattern. The stroma of benign and borderline phyllodes tumors was negative for these markers. In metaplastic spindle cell carcinomas, cytokeratin cocktail was negative in 2 of 15 cases and very focally positive in another 3 cases, whereas p63 was negative in one case and focally positive in another case. There can be anomalous, focal expression of cytokeratin and p63 in the stroma of malignant phyllodes tumors, whereas metaplastic spindle cell carcinoma can occasionally have cytokeratin and/or p63-negative staining or have very focal positivity. Caution should be exercised when relying on these markers for confirming a diagnosis, especially on core biopsies.

A Rare Case of Breast Malignant Phyllodes Tumor With Metastases to the Kidney: Case Report.

Phyllodes tumors are rare breast neoplasms. Surgery is the treatment of choice. The role of postoperative radiotherapy and chemotherapy is still under dispute, as there are no equivocal prognostic factors. Treatment failure results in the occurrence of distant metastasis-mainly to the lungs, bones, liver, and brain. We have described the case of a woman with a malignant phyllodes tumor of the breast that was surgically treated. She did not receive adjuvant therapy because there is no consensus on the role of postoperative chemotherapy and radiotherapy. One year following the surgery, the patient had left-sided nephrectomy performed because of a rapidly growing tumor of the kidney. Renal cancer was suspected; however, a histopathological examination revealed that it was a metastatic phyllodes tumor. At the same time, the patient was diagnosed as having metastases in the other kidney, the lungs, liver, and bones.Our case report describes not only an unusual localization of the metastases (in the kidneys), but also failure of the chemotherapy and the aggressive course of malignant phyllodes tumor. Identification of patients with high risk for distant metastasis and the introduction of uniform rules for the management of adjuvant chemotherapy and radiotherapy would make planning treatment as efficacious as possible.

Tumor phyllodes de mama gigante sobreinfectado con Salmonella enteritidis / Giant phyllodes tumor of the breast superinfected by Salmonella enteritidis

Se presenta el caso clínico de una mujer de 51 años, con un absceso de mama izquierda secundario a Salmonella enteritidis, que resultó ser la forma de presentación de un tumor phyllodes de 22 × 12 × 23 cm (AU)

We report the case of a 51-year-old woman with an abscess on her left breast due to Salmonella enteritidis, which was the form of presentation of a giant phyllodes tumor (22 × 12 × 23 cm) (AU)

Comparison of Predictive Factors For the Diagnosis and Clinical Course of Phyllodes Tumours of the Breast.

BACKGROUND: To compare predicting factors for the diagnosis and clinical course of benign and malign/borderline phyllodes tumours (PT) of the breast, and to discuss treatment modalities. METHODS: Clinical and demographic characteristics of the patients with histopathological diagnosis of phyllodes tumour were examined. Patients were divided into group 1 (benign PT) and group 2 (borderline/malignant PT). Groups were compared in terms of demographic and clinical characteristics. RESULTS: Of the patients studied, 37 (68.5%) had benign, 7 (12.9%) had borderline and 10 (18.5) had malignant histopa-thology. A statistically significant relationship was detected between the incidence of malignancy and mass diameter (p = 0.001) and age (p = 0.030) when the two groups were compared. Wide surgical excision was performed on 46 (82.5%) patients, simple mastectomy on 7 (13%) patients and modified radical mastectomy on one (1.9%) patient. Ten (18.5%) patients were re-operated for surgical margin positivity. Local recurrence was determined only in one (1.9%) patient. Distant metastasis due to malignant PT developed in two (3.7%) patients. CONCLUSION: Among the patients who were considered to have PT, malignancy was likely to be present, especially if the patient's age was over 40 and the diameter of the mass was above 33.5 mm. Therefore, in patients with similar characteristics, surgical margins should be kept slightly wider or wider excisions should be preferred with or without simultaneous reconstructive surgery in appropriate cases.

Manejo clínico, tratamiento y control local del tumor phyllodes mamario / Clinical management, treatment and local control of phyllodes tumors

Objetivo. Describir nuestra casuística de los últimos 13 años de acuerdo con un manejo clínico-quirúrgico y control local del tumor phyllodes según el grado tumoral. Material y método. Estudio descriptivo retrospectivo de todos los casos diagnosticados de tumor phyllodes mamario (N = 34) procedentes del Servicio de Anatomía Patológica del Hospital Clínico San Carlos de Madrid entre 1997-2010. Se realizó un análisis de los factores clínico-patológicos que pueden influir en la recidiva y en el intervalo libre de enfermedad. Resultados. La media de edad de las pacientes al diagnóstico fue de 41 años (± 13,3). Se realizó una primera cirugía conservadora en todas las pacientes (N = 34), y en 17 casos, segundas cirugías (50,0%). En 7 casos fueron mastectomías: 5 mastectomías simples y 2 mastectomías con linfadenectomía axilar. Tres casos de mastectomía se realizaron en tumor phyllodes benigno y tamaño tumoral voluminoso (12%) para lograr un buen resultado estético y en 2 pacientes con tumores phyllodes maligno (33,3%). En los otros 2 casos, además de la mastectomía se realizó una linfadenectomía axilar, en un caso por tumor phyllodes maligno con histología agresiva y en otro por recidiva voluminosa de tumor phyllodes benigno, sin evidencia de enfermedad en ambos vaciamientos axilares. En el análisis univariante hubo diferencias significativas en la necrosis histológica encontrada en los tumores phyllodes malignos. Las recidivas locales aparecieron en 8 pacientes (23,5%), principalmente durante los 2 primeros años de seguimiento. Conclusión. El principal objetivo fue conseguir mediante la cirugía (conservadora o mastectomía) márgenes de seguridad mayores de 1 cm, motivo por el que se sometió a algunas pacientes a reintervenciones posteriores. La histología agresiva en los tumores phyllodes malignos determinó en algunos casos la necesidad de realizar una mastectomía y la aplicación de radioterapia adyuvante posterior con el fin de lograr un mejor control local de la enfermedad(AU)

Aim. To describe the clinical and surgical management of phyllodes tumors in our center in the last 13 years, as well as local tumor control, according to tumoral grade. Material and method. We performed a retrospective study of all patients with a diagnosis of phyllodes tumor (N = 34) in the Pathology Department of Hospital Clínico San Carlos in Madrid between 1997 and 2010. The clinical and pathological factors that could influence recurrence and disease-free survival were analyzed. Results. The mean age of the patients at diagnosis was 41 years (± 13.3). Conservative surgery was initially performed in all patients (N = 34) and reoperation in 17 (50.0%). Mastectomies were performed in 7 patients: 5 simple mastectomies and 2 mastectomies with axillary lymphadenectomy. Three mastectomies were performed for benign phyllodes tumor and large tumor size (12%), with good cosmetic outcome, and 2 mastectomies were performed for malignant phyllodes tumors (33.3%). In the remaining 2 patients, mastectomy plus axillary lymphadenectomy was performed for a malignant phyllodes tumor with aggressive histology in one patient and for a recurrent, bulky, benign phyllodes tumor in the other. There was no evidence of disease in either of the 2 axillary dissections. In the univariate analysis, significant differences in histological necrosis were found in malignant phyllodes tumors. Local recurrences occurred in 8 patients (23.5%) mainly during the first 2 years of follow up. Conclusion. Our main objective was to achieve larger safety margins (of at least 1 cm) through surgery (mastectomy or conservative surgery), leading to reoperation in some patients. In histologically-aggressive malignant phyllodes tumors, mastectomy and adjuvant radiotherapy were required to achieve better disease control(AU)

Solución del caso 40. Tumor Phyllodes maligno de mama con diferenciación liposarcomatosa / Malignant phyllodes tumor of the breast with liposarcomatous differentiation. Solution to case 40

No disponible

Tumor phyllodes de mama. Revisión de 35 casos / No disponible

Introducción y objetivo: el tumor phyllodes es una tumoraciónpoco frecuente de la mama, de comportamiento clínicoimprevisible y cuyo tratamiento es aún objeto de controversia.Presentamos una revisión de 35 casos diagnosticados y tratadosen nuestro centro a lo largo de 10 años, así como una revisiónde los datos publicados en la literatura.Pacientes y métodos: estudio retrospectivo, descriptivo, de35 pacientes portadoras de esta neoplasia estudiadas en la“Unidad de Oncología y Patología Mamaria” (HH.UU. Virgendel Rocío. Sevilla) entre enero de 1998 y enero de 2007.Resultados: la edad al momento del diagnóstico fue de45,02 ± 15 años. El tiempo medio de duración de la sintomatologíafue de 7,8 meses. La forma de presentación en todoslos casos fue la aparición de una tumoración, que en el 11%casos tuvo un crecimiento rápido. La mayoría se localizó enlos cuadrantes supero-externos y el tamaño osciló entre los 2y 20 cm. Las pruebas de imagen orientaron el diagnóstico enel 20% casos; la PAAF/Tru-cut fue positiva en 7 pacientes.De los 35 casos, 54,5% fueron benignos, 27,3% malignos y18,2% borderline. En el 68,6% de las pacientes se realizó tumorectomíaamplia; en cinco pacientes se realizó mastectomíay en un caso se indicó radioterapia adyuvante. Sólo 3 pacientespresentaron recidivas loco-regionales. 2 pacientes evolucionaroncon metástasis a distancia.Conclusiones: la resección con amplios márgenes de seguridades el tratamiento de elección y principal factor que condicionala probabilidad de recidiva local y a distancia de los tumoresphyllodes(AU)

Introduction and objective: the phyllodes tumour is anuncommon breast lesion, with an unpredictable clinical behaviour,which treatment is exposed to controversy. We analyzethe results of 35 patients diagnosed and treatment in ourcenter during 10 years, and also review the dates report onthe literature.Patients and methods: we retrospectively reviewed 35 patientshaving phyllodes tumour, seen at “Unidad de Oncologíay Patología Mamaria” (HH.UU. Virgen del Rocío.Sevilla) between January 1998 and January 2007.Results: the mean age at diagnosis was 45.02 ± 15 years.The mean follow-up was 7.8 months. The appearance of amass was the way of presentation in all cases; in 11% patientsthe tumour’s growth was fast. Tumours predominated on theupper-outer quadrant and the range size was 2-20 cm. Imagingfinding were helpful for diagnosis in 20% cases.PAAF/Tru-cut were positive in 7 patients. Tumours were classifiedas benign in 54.5% cases, malignant (27.3%) and borderline(18.2%). Wide tumorectomy was performed in 68.6%of cases. 5 patients underwent mastectomy, and another onereceived adjuvant external radiation therapy. Only 3 patientshad a recurrence and two had metastases.Conclusions: wide excision with a clear margin may be thepreferable initial therapy. Loco-regional and general spreaddepends on margin surgery(AU)

Prognostic factors on 45 cases of phyllodes tumors.

The authors, in order to obtain a diagnostic index for phyllodes tumors and identified histological parameters that will predict the clinical course of this neoplasm, developed a histological degree of aggressiveness based on specific histological parameters, including: stromal:gland ratio, tumor margins, mitotic index and degree of stromal pleomorphism. Three categories were established: benign, intermediate and malignant. The probability of recurrence was estimated by the relative risk and by a multivariate Cox analysis. A strong and significant association was observed between this histological index and recurrence. The relative risk was 6.0 for intermediate lesions and 11.4 for malignant lesions when compared with the benign category. The microscopic examination of all axillary lymph nodes was negative for metastatic disease. In the multivariate analysis, the stroma:gland ratio was the strongest predictor for recurrence. These results indicate that by assigning a numerical value to certain histopathologic variables a better correlation with the clinical outcome of the patient can be obtained.

Tumor phylloides / Phylloides tumor

El tumor phylloides fue descrito por primera vez en 1838 por Johannes Müller quien originalmente lo denominó cistosarcoma phylloides. Fue considerado como un tumor inocente hasta 1931 cuando Lee y Park encontraron signos de malignidad histológica en 1 de 111 casos. Es un tumor fibroepitelial similar al fibroadenoma, pero que se diferencia de éste por la mayor celularidad y pleomorfismo del estroma. Desde el punto de vista histológico los tumores phylloides se clasifican en benignos y malignos. Es un tumor raro que representa el 0,3 al 0,9 por ciento de los tumores mamarios. Se puede presentar a cualquier edad, pero es más frecuente entre los 40 y 50 años. Clínicamente se caracteriza por ser de gran tamaño, superficie abollonada, bien delimitado y ocasionalmente con ulceración cutánea por distensión excesiva de la piel. Su tratamiento es quirúrgico y consiste en resecar el tumor con un margen de seguridad. En algunos casos es necesario llegar a la mastectomía cuando el tumor compromete gran parte de la mama. Tiene tendencia a la recidiva local, especialmente cuando no se extirpa con un margen de seguridad. La diseminación cuando se produce, se hace fundamentalmente por vía hematógena y su frecuencia oscila entre un 3 por ciento y 12 por ciento, según las diferentes series

Estudio clínico patológico de los casos de tumor phyllodes en el Hospital General de México / Clinico-pathologycal study of the phyllodes tumors in the Hospital General de Mexico

El objetivo del presente trabajo fue conocer la frecuencia y características clínico-patológicas del tumor phyllodes en el Hospital General de México. La información fue obtenida de los archivos de patología quirúrgica de la Unidad de Patología, y consideró un periodo de 15 años. Fueron seleccionados todos los casos con patología en la glándula mamaria y, de este grupo, se separaron los diagnosticados como tumores phyllodes según los criterios histológicos aceptados. De un total de 157,355 casos se encontraron 7,628 con lesiones mamarias, lo cual representan un 4.85 porciento. De éstos, se registraron 108 tumores phyllodes que corresponden al 1.42 porciento de las lesiones mamarias, La edad media fue de 42.5 años y no hubo predominio en cuanto al lado afectado. El tamaño promedio fue de 12.3 x 9.3 x 6.25 cm. El número total de recurrencias conocidad fue de 20 (18.5 porciento). En 55 (52.4 porciento) casos se realizó mastectomía simple, en 14 (13.3 porciento) mastectomía radical y en 36 escisión local. En el 45.4 porciento se hizo acertadamente el diagnóstico clínico. concluimos que la frecuencia del tumor phyllodes en el Hospital General de México es similar a la informacda en otras series; la edad promedio de las pacientes no varió; pero el tamaño promedio observado en este estudio fue comparativamente mayor que el de otros informes.