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PubMed1999

Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors.

BACKGROUND: Pathologists can distinguish benign phyllodes tumors, which very rarely metastasize, from malignant phyllodes tumors, which metastasize in approximately one fourth of patients. However, whether these same histologic criteria can be used to predict the likelihood that a phyllodes tumor will locally recur after breast conserving therapy remains controversial. STUDY DESIGN: Since few patients with malignant phyllodes tumors have been treated with breast conserving surgery in any individual series, the literature was reviewed using a Medline search. RESULTS: After local excision, 21% (111/540), 46% (18/39), and 65% (26/40) of patients with benign, borderline, and malignant phyllodes tumors, respectively, recurred in the breast. Following wide local excision, 8% (17/212), 29% (20/68), and 36% (16/45) of patients with benign, borderline, and malignant phyllodes tumors recurred in the breast. CONCLUSIONS: Malignant phyllodes tumors are much more likely than benign phyllodes tumors to recur in the breast after breast conserving surgery. This high rate of local recurrence of borderline and malignant phyllodes tumors suggests that wide local excision is less than optimal therapy, and challenges us to look for methods to improve local tumor control.

Breast Neoplasms↗
PubMed2004

Stromal expression of vascular endothelial growth factor correlates with tumor grade and microvessel density in mammary phyllodes tumors: a multicenter study of 185 cases.

A retrospective review of 185 mammary phyllodes tumors (105 benign, 51 borderline, 29 malignant) from 4 centers was performed by immunohistochemistry to investigate the expression of vascular endothelial growth factor in the epithelial and stromal cells of mammary phyllodes tumors. The correlation of vascular endothelial growth factor with tumor grade, stromal cell nuclear pleomorphism, cellularity, mitotic rate, margin histomorphology, and the stromal microvessel density was evaluated. Vascular endothelial growth factor expression was found in the epithelium in 29% and in the stromal cells in 31% of cases. There was significant increase of vascular endothelial growth factor expression in the stromal cells with increasing degree of malignancy, but not the epithelium. Microvessel density in the stroma also showed significant correlation with tumor malignancy, and a correlation was shown with the stromal vascular endothelial growth factor expression. Statistical overlap of stromal vascular endothelial growth factor and microvessel density in predicting malignancy suggests that angiogenesis may be an effector mechanism for vascular endothelial growth factor. Assessment of stromal VEGF may be useful as an adjunctive diagnostic criterion in the histologic assessment of malignancy in phyllodes tumors.

Adult↗
PubMed1998

[Phyllodes tumors of the breast].

Phyllodes tumors are mixed tumors of the mammary gland. They account for 0.3 to 0.5 per cent of all breast tumors. This is a report on nineteen cases presenting phyllodes tumors. Depending on the number of mitoses, growth pattern and atypism degree, the neoplasms are classified as benign (12 cases), borderline (2) and malignant (5). Fourteen of them (9 with benign and 5 with malignant phyllodes tumors) undergo clinical follow-up study. A case with bilateral location of the neoplasm exhibiting strongly expressed susceptibility to relapse is described. The basic methods of preoperative diagnosis and the operative treatment procedures used are outlined.

Adolescent↗
PubMed2004

In-situ and invasive carcinoma within a phyllodes tumor associated with lymph node metastases.

BACKGROUND: Phyllodes tumors (cystosarcoma phyllodes) are uncommon lesions in the female breast. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in the literature, but has never been associated with lymph node metastases. CASE PRESENTATION: A 26-year-old woman presented with a firm, mobile, non-tender mass in the left breast and palpable lymph nodes in the left axilla. The excised lesion appeared well circumscribed and lobulated, with variable fleshy and firm areas. Microscopic examination showed a circumscribed fibroepithelial lesion with a well developed leaf-like architecture, in keeping with a benign phyllodes tumor. The epithelial component showed extensive high grade ductal carcinoma in-situ (DCIS) and invasive carcinoma of no special type, located entirely within the phyllodes tumor. Subsequent axillary lymph node dissection revealed metastatic carcinoma in four lymph nodes. CONCLUSIONS: Although rare, phyllodes tumors may harbor DCIS and invasive carcinoma, with potential for lymph node metastasis.

Journal Article↗
PubMed2006

Prognostic factors of phyllodes tumor of the breast.

The phyllodes tumor is characterized by its tendency to recur locally and occasionally to metastasize. The purpose of the present paper was to assess the prognostic value of clinical-morphological characteristics in patients with phyllodes tumor. Forty-seven cases of phyllodes tumors was studied; the World Health Organization classification was used and follow up was obtained. A total of 51%, 28% and 21% of the tumors were classified as benign, borderline and malignant, respectively. The adherence (P = 0.01), size >10 cm (P = 0.001), high mitotic activity (P = 0.03), infiltrative tumor margin (P = 0.0002) and type of surgery in malignant tumors (P = 0.02) proved to be good predictors of relapse. The presence of pain (P = 0.03), postmenopausal status (P < 0.04), heavy cellular pleomorphism (P = 0.007), high mitotic activity (P = 0.002), tumoral grade (P = 0.006) and metastasis (P < 0.00001) were prognostic factors of poor survival. Tumoral grade and some clinical-morphological characteristics of patients with phyllodes tumors have a significant impact on the prediction of its biological behavior.

Adult↗
PubMed2004

Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors.

BACKGROUND: Malignant phyllodes tumor (MPT) is a rare but aggressive breast malignancy. The aim of this study was to evaluate parameters that influence outcome in patients with MPT. METHODS: Fifty women were diagnosed with MPT of the breast and treated between August 1971 and July 2000. All medical records were reviewed retrospectively. The Cox regression model was used for multivariate analysis. RESULTS: Tumors were classified as borderline (6%), low grade (32%), or high grade (62%). The median patient age was 46 years (range, 14-77 years). The median tumor diameter was 3.5 cm (range, 1.5-18 cm). Twenty-two patients had wide local excision (WLE), and 28 patients had mastectomy. The median follow-up was 91 months (range, 12-360 months). Local recurrence (LR) occurred in 16 patients (32%) an average of 26 months after surgery (median, 17 months; range, 3-72 months). Distant metastasis occurred in 13 patients (26%) at an average of 53.4 months (median, 36 months; range, 4-177 months). Sixteen (32%) patients have died of their disease. LR was significantly increased with stromal overgrowth (P < .0001), large tumor size (P = .0177), and surgical margins <1 cm (P = .0120), but not with WLE (P = .5099). Stromal overgrowth was the only independent variable predictive of systemic metastasis (P < .0001) and patient survival (P < .0001). CONCLUSIONS: Stromal overgrowth in MPT carries a grave prognosis. Close surgical margins and large tumor size, but not type of operation, significantly increased LR. Either WLE with adequate margins or mastectomy is an appropriate treatment for patients with MPT.

Adolescent↗
PubMed2005

p53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study.

Breast phyllodes tumors are fibroepithelial neoplasms whose clinical behavior is difficult to predict on histology. There is relatively scant data on the role of biological markers. In this study, we determined if p53 and CD117 (c-kit) protein expression was predictive of behavior in a series of 335 phyllodes tumors diagnosed at the Singapore General Hospital, using immunohistochemistry on tissue microarrays. Representative areas from 250 (75%) benign, 54 (16%) borderline and 31 (9%) malignant phyllodes tumors were selected for construction of tissue microarrays using the 2 mm punch. Immunohistochemistry for p53 and CD117 was carried out using the streptavidin-biotin method. Staining proportion and intensity of both epithelial and stromal elements were analyzed. p53 immunostaining was observed in the epithelium of 28 (10%) of 278 microarrays; myoepithelium of 53 (21%) of 251 microarrays; and stromal cells in 105 (36%) of 289 microarrays. CD117 immunohistochemical reactivity was noted in epithelial and stromal components of 175 (of 267, 66%) and 17 (of 273, 6%) microarrays, respectively. Stromal p53 and CD117 protein expression was associated with tumor grade (P < 0.05). Of 43 (13%) women who suffered recurrences during the follow-up period, CD117 stromal staining predicted recurrent disease (P<0.05), but p53 was not correlative. We conclude that tissue microarrays are a convenient method for evaluating immunostaining results of large numbers of phyllodes tumors. Although positive p53 stromal immunohistochemical detection may corroborate histologic malignancy, it is CD117 protein expression in phyllodes tumor stromal cells that may be of potential utility in predicting recurrent disease.

Adolescent↗
PubMed2003

Case report: Malignant phyllodes tumor of prostate.

Malignant phyllodes tumor of prostate is described in a 78 year old man. He had symptoms of prostatism since six months before developing acute urinary retention, which was relieved by suprapubic cystostomy. Transabdominal ultrasonography showed a few hypoechoic areas in a 120 gm prostate. Serum prostate specific antigen was 2.7 ng/ml. Transrectal trucut biopsy was inconclusive. With a diagnosis of benign hyperplasia of prostate. Transvesical prostatectomy was performed. Postoperative biopsy showed phyllodes tumor of the prostate with metastastic deposits in the anterior abdominal wall. He received chemotherapy with Vincristine, Mitomycin C, Adriamycin and Cisplatin every 21st day for six cycles in addition to orchiectomy. Routine follow up by transabdominal ultrasound at ten months showed space occupying lesions in the liver. Patient succumbed to his disease a few days later.

Aged↗
PubMed2006

Malignant phyllode tumor metastatic to the duodenum.

Phyllode tumor (PT) is extremely rare tumor of the breast. Distant metastasis occurs in 10%-20% of patients with malignant phyllode tumor. The most common sites of metastases are the lungs and bones. Although theoretically any organ may have metastasis, an isolated duodenum metastasis has not been documented as yet in the English-language literature. We report herein a case with a isolated duodenal metastasis from PT of breast in a 31 year-old-woman who underwent right mastectomy 4 years before because of the recurrent malignant PT. She presented to our hospital with massive upper gastrointestinal bleeding. Clinical evaluation revealed a huge mass originated from duodenum. Urgent laparotomy and pancreaticoduodenectomy were carried out in order to remove the bleeding duodenal mass. The pathologic examination of the resected specimen showed a malignant spindle cell tumor consistent with metastatic malignant PT. Our case of gastrointestinal bleeding due to an isolated duodenal metastasis as a result of hematogenous spread from malignant phyllode tumor of breast is unique in the English literature and pancreaticoduodenectomy is a curative treatment for patients with isolated duodenal involvement.

Adult↗
PubMed1993

99mTc-HMDP accumulation in a phyllodes tumor of the breast, a case report.

In a patient with breast tumor, 99mTc-HMDP accumulation in the tumor was recognized in evaluating bone metastasis. Surgery and histopathology revealed that the tumor was a phyllodes tumor. This scintigraphic finding was thought to be rare and phyllodes tumor should be included in differential diagnosis when 99mTc-HMDP accumulation in the breast was recognized.

Breast Neoplasms↗
PubMed1997

Technetium-99m-sestamibi scintimammography of benign and malignant phyllodes tumors.

We presented two cases of phyllodes tumor of the breast examined by 99mTc-sestamibi (MIBI) two-phase scintimammography. In the case with malignant phyllodes tumor, 99mTc-MIBI accumulation was recognized on both early and delayed images. In the case with benign phyllodes tumor, however, 99mTc-MIBI accumulation was recognized on only the early image. 99mTc-MIBI delayed imaging may have the potential to distinguish between benign and malignant phyllodes tumors.

Breast Neoplasms↗
PubMed2000

Malignant phyllodes tumor of the prostate.

We report a case of malignant phyllodes tumor of the prostate which is the eleventh reported case in the world. Phyllodes tumor of the prostate is extremely rare and histologically resembles mammary phyllodes tumor. Phyllodes tumor of the prostate is classified into benign, borderline and malignant, but health professionals should carefully follow up the borderline cases in case they take a malignant clinical course. This case was the first to be treated by pre- and postoperative radiation therapy. Although the patient had a slight response to radiation therapy, he eventually developed metastasis. Because malignant phyllodes tumor of the prostate is a very aggressive tumor, people with the condition should undergo systemic chemotherapy as adjuvant therapy.

Adult↗
PubMedDate not supplied

Malignant phyllodes tumor of the breast metastatic to the parotid gland diagnosed by fine needle aspiration biopsy. A case report.

BACKGROUND: Phyllodes tumor (cystosarcoma phyllodes) is a rare fibroepithelial neoplasm of the breast. Malignant phyllodes tumor is characterized by an infiltrative border and marked degree of hypercellular stromal overgrowth with > 5 mitoses per 10 high-power fields. Distant metastasis occurs in 10-20% of patients with malignant phyllodes tumor. The most common sites of distant metastases are the lungs, bone and abdominal viscera. Although theoretically any organ may have metastasis, the parotid gland has not been documented before in the English-language literature. CASE: A 40-year-old, Caucasian woman with a history of malignant phyllodes tumor of the left breast presented with a mass on the right side of the parotid gland. Fine needle aspiration biopsy of the mass revealed abundant discohesive spindle cells showing moderate nuclear pleomorphism with occasional mitoses. No epithelial elements were seen. A diagnosis of malignant spindle cell tumor consistent with metastatic malignant phyllodes tumor was made. Histology confirmed the cytologic diagnosis. CONCLUSION: Fine needle aspiration biopsy is accurate and efficient in conjunction with clinical information in the diagnosis of malignant phyllodes tumor of the breast metastatic to the parotid gland.

Adult↗
PubMed2006

Genome-wide analysis for loss of heterozygosity in primary and recurrent phyllodes tumor and fibroadenoma of breast using single nucleotide polymorphism arrays.

Phyllodes tumors of the breast are biphasic stromal and epithelial tumors histologically similar to benign fibroadenomas, but with a neoplastic stromal component. In contrast to fibroadenoma, phyllodes tumors can recur and be locally aggressive or be malignant. This study uses SNP array analysis to present a genome-wide map of loss of heterozygosity (LOH) in a cohort of phyllodes tumors and fibroadenomas. LOH is frequent and sometimes extensive in phyllodes tumors, but is rarely seen in fibroadenomas. There is heterogeneity between phyllodes tumors of different patients and no one LOH marker identifies a majority of these lesions. However, a subset of LOH loci occur in multiple cases of phyllodes tumors and are not found in fibroadenomas. Primary phyllodes tumors and paired recurrences from the same patient share common regions of LOH. In contrast, metachronous fibroadenomas from the same patient have different LOH patterns with no indication of a shared origin. Specific LOH loci may be associated with pathologic progression in recurrent phyllodes tumors. In a single case of phyllodes tumor containing a malignant epithelial component the malignant epithelium and stroma partially share an LOH genotype, suggesting a common precursor cell for the biphasic malignant components.

Breast Neoplasms↗
PubMed2005

[Phyllodes tumor and pregnancy. A report of a case].

Phyllodes tumor is a rare breast fibroepithelial neoplasm of the breast, predominant in females (0.3 to 0.5%). Few cases have been described in males. Phyllodes tumor during pregnancy grows fast and its size is relatively big. These tumors can be classified as benign, malignant or neighboring. A 32-year-old patient at 23.4 week of gestation was admitted in the National Institute of Perinatology with a rapidly growing mass in the right breast; diagnosis confirmed by ultrasound study reporting echoic images on right breast, 10 x 10 cm the greatest and 3x3 cm the smallest. A simple mastectomy was performed at the 26.6 week of gestation on the right breast. A possible phyllodes tumour in the right breast was observed during surgery, weight 9.6 pounds, with partial infiltration to major pectoral muscle. Pathology reported a benign phyllodes tumor in the right breast, with surgical borders free of tumor. Phyllodes tumor is rare and can occur during pregnancy. It is unknown if the tumor is hormone-dependent. The growth of a tumor on a subsequent pregnancy is not necessarily associated with recurrency or with a new disorder on the patient, who has had a complete excision.

Adult↗
PubMed1995

Progression of fibroadenoma to phyllodes tumor demonstrated by clonal analysis.

BACKGROUND: The histogeneses of fibroadenoma and phyllodes tumor of the breast appear to be closely related, but it is still unclear whether fibroadenoma can progress directly to phyllodes tumor. METHODS: This issue was studied by conducting clonal analysis of fibroadenoma and phyllodes tumors that were obtained sequentially from the same patient. One patient developed local recurrence of phyllodes tumor twice, and the other two patients each developed a phyllodes tumor after excision of a primary fibroadenoma. The method for clonal analysis was based on trinucleotide repeat polymorphism of the X chromosome-linked androgen receptor (AR) gene and on random inactivation of the gene by methylation. RESULTS: Clonal analysis revealed that all the three primary fibroadenomas were monoclonal and all four recurrent phyllodes tumors were also monoclonal in origin. In addition, the same allele of the AR gene was inactivated in fibroadenoma and phyllodes tumor(s) in each patient. The probability that phyllodes tumors of different origin happen to inactivate the same allele of the AR gene as fibroadenomas in every case is quite low. Rather, it is more reasonable to assume that the phyllodes tumor has the same origin as fibroadenoma. CONCLUSIONS: These results identified monoclonal fibroadenomas that can progress to phyllodes tumors.

Adult↗
PubMed2001

Proliferating activity in differential diagnosis of benign phyllodes tumor and cellular fibroadenomas: is it helpful?

Benign phyllodes tumors and fibroadenomas are two types of fibroepithelial tumors of breast that are usually difficult to differentiate. The purpose of this study is to evaluate the proliferative activity of these tumors and to find out if it helps in differential diagnosis. Thirty-one benign phyllodes tumors and twelve cellular fibroadenomas were retrieved from the archives of Pathology Department of Akdeniz University, School of Medicine. Proliferating activity of epithelial and stromal cells were evaluated by using labeling index (LI) of proliferating cell nuclear antigen (PCNA) and Ki-67 antigen by immunohistochemistry. The results were compared with other clinicopathologic findings. There was not any significant difference between the proliferating activity of phyllodes tumor and cellular fibroadenomas. Mean LI of PCNA was 28.01 (+/-22.85) in stromal cells and 56.57 (+/-30.98) in epithelial cells of phyllodes tumor where it was 28.92 (+/-24.02) and 62.53 (+/-32.56) in fibroadenomas. Ki-67 indices were 0.05 (+/-0.19) in stromal cells, 2.65 (+/-12.53) in epithelial cells of phyllodes tumors and 0.0 (+/-0) in stromal cells, 0.43 (+/-0.63) in epithelial cells of fibroadenomas. There was no correlation between the diameter of tumors and proliferating activity in both groups. Proliferating activity, determined by immunohistochemistry with PCNA and Ki-67 antibodies did not reveal significant difference between phyllodes tumor and fibroadenoma.

Adolescent↗
PubMed1993

Clonal analysis of fibroadenoma and phyllodes tumor of the breast.

Clonality of fibroadenoma and phyllodes tumor of the breast was analyzed by means of the polymerase chain reaction using small DNA samples prepared from cryostat sections. The method of clonal analysis was based on restriction fragment length polymorphism of X-chromosome-linked phosphoglycerokinase gene and on differential methylation of the gene. Specimens from 10 fibroadenomas and 5 phyllodes tumors heterozygous for the BstXI polymorphism of PGK gene were subjected to clonal analysis. It was found that fibroadenoma was polyclonal, but phyllodes tumor was made up of both monoclonal and polyclonal cell components. Since these tumors contained both epithelial and stromal components, clonality of each component was analyzed separately. Analysis of clonality of each cell component showed that both the epithelial and stromal cells were polyclonal in fibroadenoma and that the epithelial cells were polyclonal, but the stromal cells were monoclonal in phyllodes tumor. When DNA samples were prepared from widely separated sites of phyllodes tumors, every sample was found to contain a monoclonal stromal cell component. These results demonstrate that fibroadenoma is a hyperplastic lesion rather than a neoplasm, and that phyllodes tumor is a neoplasm of the stromal cells.

Adenofibroma↗