[Tumor phyllodes of the mammary gland].
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Breast Neoplasms↗
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Fine-needle sampling in malignant phyllodes tumors: clinicopathologic study of 22 cases seen at the Institut Curie.
The preoperative cytological diagnosis of malignant phyllodes tumor (MPT) is challenging due to the heterogeneity of its clinical, radiological, and morphological presentation. To better define the cytopathological characteristics of MPT, we reviewed 22 examples seen at the Institut Curie. The original cytologic diagnosis was benign breast tumor in four cases (18.2%), suspicious in seven cases (31.8%) (low-grade phyllodes tumor in six cases needing histological evaluation, suspicious of sarcoma in one case), and malignant in 11 cases (50%). Smears were composed of different proportions of clusters of epithelial cells (68.2%), phyllodes fragments (31.8%), spindle cells within stromal tissue (31.8%), isolated spindle-shaped or round cells (45.5%), and bipolar naked nuclei (22.7%). Giant cells and mitotic figures were also occasionally seen. The cytological findings on smears were correlated with histopathological observations. One of the difficulties to reach an accurate cytological diagnosis for MPT is the frequent overwhelming of clearly malignant sarcomatous cell by the presence of largely predominant clusters of epithelial cell.
Adult↗
A case of noninvasive ductal carcinoma arising in malignant phyllodes tumor.
We report on an exceedingly rare case of noninvasive ductal carcinoma arising in malignant phyllodes tumor of the breast. The patient was a 75-year-old woman who presented with a chief complaint of an indolent tumor mass of the left breast. Papillotubular carcinoma was diagnosed by aspiration cytology, and mastectomy with preservation of the pectoral muscle was subsequently performed (Bt+Ax+Ic, R2). Histopathological examination showed proliferation of monotonous, uniform tumor cells in a cribriform pattern amid atypical and spindle-shaped cells. Neither stromal invasion of the epithelial tumor cells nor clear transition between epithelial tumor cells and non-epithelial tumor cells was seen. Immunohistochemical staining revealed that the epithelial component was positive for antibodies such as CEA, EMA and keratin, while the non-epithelial component was negative for the same antibodies. Malignant phyllodes tumor with a noninvasive ductal carcinoma was diagnosed rather than true carcinosarcoma of the breast. No metastasis was detected in the axillary lymph nodes, and the patient was classified as stage II A (T2N0M0). Although neither chemoendocrine therapy nor irradiation was employed postoperatively, no recurrence was observed two years and two months after the surgery. There is little consensus on the treatment or prognosis of the disease. Careful observation of the present case is therefore important.
Aged↗
Phyllodes tumors of the breast: correlation of nucleolar organizer regions with histopathological malignancy grading, flow cytometric DNA analysis and clinical outcome.
To examine whether nucleolar organizer regions detected by argyrophilia (Ag-NOR counts) can be used as a prognostic indicator in phyllodes tumors of the breast, and to compare its usefulness with that of DNA flow cytometric analysis, 28 cases of breast phyllodes tumors (including 15 benign, two borderline and 11 malignant tumors) were subjected to Ag-NOR staining and counting as well as DNA flow cytometric analysis. S-phase fraction and DNA ploidy analysis showed useful trends for improving outcome predictions in malignant phyllodes tumors. However, high Ag-NOR counts were significant in predicting survival status (P = 0.013) and reached near statistical significance in predicting survival times (P = 0.07). In predicting survival status, results for Ag-NOR counts were significantly better than those for ploidy analysis (P = 0.02) and S-phase fraction (P < 0.01). Only S-phase fraction was significantly predictive of survival times (P = 0.025). It is concluded that Ag-NOR counts and DNA flow cytometric analysis, easily performed using paraffin sections, give information that can improve predictions made by histopathological classification. Ag-NOR counts are significant in predicting survival in the presence of histopathological features of malignancy.
Adolescent↗
Phyllodes tumor with lobular carcinoma in situ and liposarcomatous stroma.
We describe a patient with a malignant phyllodes tumor with both lobular carcinoma in situ and liposarcomatous stromal differentiation. Although lobular carcinoma in situ and adipose differentiation have been reported as separate features rarely seen in the phyllodes tumor, we are unaware of any cases in which both of these features have been seen within the same tumor. The prognosis for this patient related not only to the malignant stromal component of the tumor but also to her increased risk of developing carcinoma in the remaining breast tissue.
Biomarkers↗
Phyllodes tumor with osteosarcomatous differentiation: a comparative immunohistochemical study between epithelial and mesenchymal cells.
AIMS AND BACKGROUND: Phyllodes tumor of the breast with osteosarcomatous differentiation is rare and very little is known about its molecular profile. METHODS AND STUDY DESIGN: An immunohistochemical panel with 37 primary antibodies including cytokeratins, mesenchymal markers, key regulators of the cell cycle, oncogenes, apoptosis-related proteins, metalloproteinases and their inhibitors was performed on a formalin-fixed paraffin-embedded sample of phyllodes tumor with osteosarcomatous differentiation in a 49-year-old woman. RESULTS: Antiapoptotic stimuli (survivin) predominated in sarcomatous cells. Antiproteolytic stimuli (TIMP-1, TIMP-2 and PAI) were preponderant in all cells, a surprising fact in view of the aggressiveness of the neoplasm. The immunoprofile of the osteoblastic and stromal cells was quite similar, except for c-erbB-3, c-myc, cyclin D1 and p21. Both exhibited positive cells for actin, MyoD1 and GFAP. CONCLUSIONS: Our results suggest that this osteosarcoma may have originated from metaplasia of stromal cells that underwent a malignant change.
Axilla↗
Phyllodes tumor in ectopic breast tissue of the vulva.
Phyllodes tumor arising from ectopic breast tissue of the vulva is an extremely rare occurrence. A case is reported in a 34-year-old nulligravida woman, presenting as a nodule on the left labium majus. A simple excision was carried out, and no recurrence has been detected after 18 months of follow-up.
Adult↗
[Surgical methods for the treatment of breast phyllodes tumors--a report of 319 cases].
UNLABELLED: Breast phyllodes tumors (FT) belong the fibroapitelial group of breast tumors arising in terminal ductulo-lobular unit (TDLU). Their incidence do not exceed 1% of all breast tumors. Biologicaly they can be divided into benign, borderline and malignant group. Incomplete tumor excision can be the reason for local reccurence. Malignant form of FT metastazise hematogenous most often in the lung. There is no uniform surgical opinion about the treatment FT. METHODS: We analyzed histopathology features of 319 FT of the breast surgicaly removed on Departement of surgery Institut of oncology and radiology of Serbia between 1.1.1985.-31.12.1994. Retrospective study of surgical treatment 84 patients with FT of the breast (69 benign, 4 borderline and 11 malignant) and 5 year follow up after surgery we analysed. RESULTS: local reccurence after surgery was found in 17 (20,2 %) patients(14 benign , 2 borderline and 1 malignant FT), pulmonary metastases in 6 (7,1%) patients with malignant FT. DFI was 21,3 months for local reccurences and 25,1 months for pulmonary metastases. DFS for al forms of FT was 71 % (p =0,7104) in 5-year follow up. CONCLUSION: According to biological behavior we propose wide excision for benign and borderline forms and simple mastectomy for malignant FT, and voluminous benign and borderline forms. Axillary disection is not necessary because lymphatic spread of malignant FT is unfrequent.
Breast Neoplasms↗
Giant cystosarcoma phyllodes tumor of prostate: case report of a rare entity.
Although glandular and stromal proliferations of prostate are very common in adult men, neoplastic proliferations of prostatic stroma are distinctly uncommon. These tumors are now grouped as Prostatic Stromal Proliferations of Uncertain Malignant Potential (PSPUMP). Phyllodes tumor of the prostate is a rare neoplasm in this group with cellular, sarcomatoid stroma and benign hyperplastic glands. It is a locally expansile tumor with clinical course varying from benign to aggressive. We report a case of a 45-year-old man presented with retention of urine and abdominal lump. On laparotomy it was a huge tumor of 4 kg and was histologicaly characterized by cellular pleomorphic stroma and hyperplastic epithelium. Immunohistochemistry demonstrated prostate specific antigen in the glands. It was diagnosed as cystosarcoma phyllodes tumor of prostate. This is extremely uncommon tumor similar in histology to that of breast and it's clinical course varies with the grade. The patient was without recurrence one year after surgery.
Humans↗
Cystic degeneration in phyllodes tumor. A source of error in cytologic interpretation.
OBJECTIVE: To examine problems encountered in the cytologic interpretation of phyllodes tumor (PT) with cystic degeneration and solutions thereof. STUDY DESIGN: Cystic degeneration was found in seven PTs (five benign, one low grade and one high grade). Aspirates from these yielded fluid and were usually labelled fibrocystic change on the original cytology. Smears were retrospectively analyzed, with special attention to the background, presence and nature of the epithelial and stromal fragments, foam cells and naked nuclei in the background. RESULTS: PTs with cystic degeneration on cytology showed thick fluid in the background, foamy macrophages (100%), apocrine cells (28%) and epithelial fragments, which showed nuclear atypia in two cases. On reviewing the smears, five of seven PTs had stromal fragments, albeit in small numbers. Most important, even in the absence of stromal fragments, all cases showed 5-50% naked nuclei of the fibroblastic type dispersed within the fluid background. CONCLUSION: In cases of fluid aspirates from well-defined lumps, one must search for fibroblastlike naked nuclei or stromal fragments within the fluid to clinch the diagnosis of phyllodes tumor.
Adult↗
Phyllodes Tumor of the Breast with a Grossly Malignant Appearance: A Case Report.
A huge phyllodes tumor of the breast that appeared grossly malignant in a 43-year-old woman is described. The patient suffered from a large breast tumor thatsuddenly increased in size over 5 months to occupy the entire breast. The tumorwas hard, ulcerated and 20 cm in greatest diameter. Diagnostic imaging(US, CT and MRI)demonstrated a circumscribed mass with a large cystic cavity. She underwent total mastectomy under a diagnosis of malignant breast tumor. Grossly, the cut surface of the tumor showed a large cystic cavity surrounding a fleshy, hemorrhagic and necrotic mass with a lobulared or trabeculared appearance. Unexpectedly, benign phyllodes tumor(PT)without any stromal overgrowth was diagnosed histologically. She has been doing well since total mastectomy. In our case and in many other reported cases, PT does not show any distinctive correlation between pathologic findings and tumor behavior. Thus wide local excision is the preferred initial treatment for PT.
Journal Article↗
The extent of surgery and prognosis of patients with phyllodes tumor of the breast.
In an attempt to clarify the controversial issues related to prognosis and therapeutic aspects of phyllodes tumors (PT), we retrospectively reviewed all cases of PT treated in our hospital during the last fifteen years. Re-examining the pathology material we found 84 cases, while thirteen more cases which had been initially classified as fibroadenomas with areas of phyllodes tumor were rejected from the analysis because they were classified as fibroadenomas. Based on the criteria proposed by Azzopardi and Salvadori and adopted by WHO, we found 55 benign PT (65.14%), 14 borderline PT (16.6%), and 15 malignant PT (17.8%). The median age of the patients with benign PT was 34 years, compared to 46.5 years for those with borderline tumors and 52 years for those with malignant. The median size of benign tumors was 3 cm, 9.5 cm for borderline, and 7.25 cm for malignant. Out of 55 patients with benign PTs, 37 underwent wide local excision and the remaining 18, with small tumors, underwent enucleation. In this group of patients, there was no recurrence after a median interval of 6.65 years. Eleven patients with borderline PT underwent wide local excision and three mastectomy; one immediately after an incomplete PT excision and the remaining two 8 months and 2 years later due to a locally recurrent PT (the last one proven histologically in the permanent biopsy of the recurrence to be malignant). Twelve patients with malignant PT underwent mastectomy, either during the same operation or following the results of the permanent section biopsy. Three more patients with malignant PT underwent wide local excision. The size of the tumor in these patients was relatively small and the pathology report indicated clear margins with normal breast tissue surrounding the tumor. One patient with 8 cm diameter malignant PT, who underwent mastectomy, passed away sixteen months later from widely spread metastases. Applying the criteria of Azzopardi and Salvadori, each case of PT can be managed successfully avoiding unnecessary mastectomies.
Adult↗
Malignant phyllodes tumor of the prostate.
We report the case of a 47-year-old male patient who suffered from a malignant phyllodes tumor of the prostate with invasion to the rectum and urinary bladder. The local recurrence at the left scrotum was identified 6 years after radical cystoprostatectomy. Another 2 years after radical orchiectomy showed no evidence of secondary local recurrence or distant metastasis. Histopathologically, both primary and recurrent tumors showed an admixture of stromal and glandular components. However, while extensive squamous metaplasia was identified in the primary tumor, the recurrent tumor had only focal and mild squamous metaplasia. No dependable prognostic factor has been found to date. Here, we describe the morphological features and immunohistochemical presentations of malignant phyllodes tumor of the prostate and review the literature.
Cystectomy↗
Phyllodes tumors of the breast: a review of 32 cases.
Most general surgeons involved in breast cancer care have limited experience with phyllodes tumors. We analyzed a comprehensive database incorporating 8567 breast cancer cases treated surgically in the Tulsa, Oklahoma, region between 1969 and 1993. This yielded 32 cases of phyllodes tumors (0.37%) in 31 patients. The median age was 57 years (range, 18-91). There were 9 low-grade (28%), 2 intermediate-grade (6%), and 21 high-grade (66%) lesions. Size distribution consisted of 23 (72%) lesions 5 cm or less and 9 (28%) greater than 5 cm (mean, 3; range, 1.2-17.5 cm). Of 137 resected nodes in 13 patients, none were positive for metastatic disease. Surgical management consisted of wide excision or mastectomy. No patients received adjuvant chemoradiation therapy. The disease-free, locoregional disease-free, and overall mean survival rates were 80, 81, and 97 months, respectively. Ten-year disease-free survival (DFS), locoregional disease-free survival (LRDFS), and overall survival (OS) rates were 66, 72, and 55 per cent, respectively. Although there was a tendency toward a higher rate of locoregional recurrences and metastases with high-grade lesions, this was not statistically significant and did not affect DFS, LRDFS, or OS rates. Similarly, size of lesion did not affect DFS, LRDFS, or OS rates. Three patients (9.6%) had metastatic disease at presentation, and a further two (6.4%) developed metastases during follow-up. Overall, nine (28.1%) recurrences developed in eight patients, seven locoregional and two distant. Four patients (12.9%) died with evidence of disease. These findings indicate prolonged survival in this patient population with cystosarcoma phyllodes. Wide local excision of primary and recurrent lesions remains the mainstay of therapy. Neither regional lymph node dissection nor adjuvant chemoradiation adds significant benefit.
Adolescent↗
[Prostatic phyllodes tumor, a rare entity. Anatamo-clinical and immunohistochemical study of 1 case].
We report the case of a prostatic phyllodes tumor in a 47-year-old man. It measured 6 cm and was composed of a glandular component with leaf-like architecture, lined with two cellular layers, and a moderately cellular stromal component, with no atypia and no mitosis. Basal cells were marked with high-molecular-weight cytokeratin antibody (34BE12) and stromal cells were marked with anti-vimentin and for some of them with CD34 antibodies. Prostatic phyllodes tumor is a rare lesion with uncertain prognosis. Total surgical removal is necessary because malignant transformation to high-grade sarcoma has been reported. In our case the development of the tumor at the posterior side of the prostate, the lack of PSA immunoreactivity and the presence of mucinous glands, sometimes "endocervical-like", could suggest an origin from embryonic mullerian remnants in the prostatic utricle rather than urogenital sinus.
Antigens, CD34↗
Dynamic MR appearance of benign phyllodes tumor of the breast in a 20-year-old woman.
We describe a 20-year-old woman with benign phyllodes tumor of the left breast. Dynamic MRI demonstrated a multi-lobulated lesion rapidly and markedly enhanced on dynamic studies of contrast-enhanced T1-weighted imaging without washout. Histological examination of an excisional biopsy specimen obtained under local anesthesia disclosed a well-circumscribed multi-lobulated lesion, confirming the diagnosis of benign phyllodes tumor of the breast.
Adult↗