Benign Phyllodes Tumor Research Articles

A Huge Benign Phyllodes Tumor in 37 Year Old / Middle Aged Woman: A Case Report

Phyllodes tumor is uncommon benign tumor of breast with a risk of malignant transformassion. Malignant phylloies tumors originates from the connective tissue of the breast therefore these tomors are sarcomas on histology. A 37 years old married woman presented with painless slowly progressive enlargement of right breast for two years duration. On physical examination confirmed the presence of a large size lobulated well defined mass lesion in occupying in UIQ, UOQ & LOQ of right breast. Ultrasonography of breast and Mammography revealed mass lesion. FNAC from the lesion & subsequently histopathology confirmed the diagnosis of benign phyllodes tumor of breast. Overlying skin was normal. There was no discharge from the nipple. No lymph nodes were palpable in right axilla. Left breast and left axilla were unremarkable. Her systemic examination was normal. The present case report describes a case of begin phyllodes tumor of breast in a 37-year-old female and its clinical, ultrasonographic, cytological and histopathological correlation.

Preoperative embolization of a giant benign phyllodes tumor: A case report and review of literature.

Introduction and importancePhyllodes tumors (PT) account for less than 1% of all breast tumors. Giant PTs can lead to breast disfigurement, tumoral ulceration, and bleeding. Outright surgical excision can be challenging or unsafe. Preoperative transarterial embolization (TAE) has a role but data on its use in the management of PT is limited.Case presentationA 43-year-old female presented with a 28 cm fungating, necrotic, benign PT on her left breast that eventually developed tumoral bleeding leading to hemodynamic instability. Preoperative TAE controlled the bleeding and allowed the safe performance of mastectomy. A literature review of preoperative TAE of PTs is also presented including the addition of a chemotherapeutic agent in malignant types.Clinical discussionPTs are rare and comprise only 2.5% of all fibroepithelial breast lesions. Tumoral bleeding causing severe anemia is one of the most common presentations of massive (≥20 cm) PTs, especially when neglected. Indications for preoperative TAE include (1) to halt rapid tumor growth, (2) to control active/persistent tumoral bleeding, and (3) to shrink the tumor size and allow successful resection with negative margins, and avoidance of skin grafting. Post-TAE side effects include fever, chest pain, gradual/expanding tumor necrosis, decrease in tumor weight, and diminished tumoral abscess/discharge, and loss of tumoral vessel elasticity.ConclusionNeglected PTs can reach an alarming size. Preoperative TAE is a safe and effective method of controlling life-threatening tumoral hemorrhage and decreasing the size of PTs thereby allowing definitive resection while avoiding skin grafting and/or flap reconstruction.

Native T1 mapping of the breast in MRI to differentiate fibroadenomas from benign phyllodes tumors: a preliminary study.

Both fibroadenomas (FAs) and phyllodes tumors (PTs) are classified as fibroepithelial lesions. PTs are rare fibroepithelial neoplasms that have a morphologic spectrum ranging from benign to malignant. The differentiation of these entities is important as PTs are to be enucleated surgically. The purpose of this study was to calculate the T1 relaxation times of fibroadenomas and phyllodes tumors and assess the potency of native T1 mapping for the differentiation of these tumors. This prospective study included 11 patients with a proven diagnosis of benign PT and 14 patients with a proven diagnosis of FA. All the patients underwent T1 mapping prior to conventional dynamic contrast-enhanced MRI (DCE-MRI). Two radiologists, in consensus, selected lesion locations using freehand regions of interest from the DCE images and copied them onto T1 maps to acquire T1 relaxation times. The T1 relaxation times of the FA and PT groups were compared statistically. The mean T1 relaxation times were higher in the PT group compared to the FA group (p ≤ 0.001). The receiver operating characteristic analysis showed that the T1 relaxation time being longer than 1,478ms differentiated PTs from FAs with a sensitivity of 0.89, specificity of 1, and area under the curve value of 0.93. We found that benign PTs had longer relaxation times in T1 mapping compared to FAs. Native T1 mapping can be used to differentiate PTs from FAs and adding T1 mapping in breast MRI in cases with fast-growing fibroepithelial lesions or multiple fibroepithelial lesions can facilitate the decision-making process.

Single-institution Experience of Outcomes after Excision of Benign Phyllodes Tumors: Low Recurrence Risk Despite Positive Margins

Single-institution Experience of Outcomes after Excision of Benign Phyllodes Tumors: Low Recurrence Risk Despite Positive Margins

Machine Learning-Based Ultrasound Texture Analysis in Differentiation of Benign Phyllodes Tumors from Borderline-Malignant Phyllodes Tumors.

Phyllodes tumors (PTs) are uncommon fibroepithelial breast lesions that are classified as three different forms as benign phyllodes tumor (BPT), borderline phyllodes tumor (BoPT), and malignant phyllodes tumor (MPT). Conventional radiologic methods make only a limited contribution to exact diagnosis, and texture analysis data increase the diagnostic performance. In this study, we aimed to evaluate the contribution of texture analysis of US images (TAUI) of PTs in order to discriminate between BPTs and BoPTs-MPTs. The number of patients was 63 (41 BPTs, 12 BoPTs, and 10 MPTs). Patients were divided into two groups (Group 1-BPT, Group 2-BoPT/MPT). TAUI with LIFEx software was performed retrospectively. An independent machine learning approach, MATLAB R2020a (Math- Works, Natick, Massachusetts) was used with the dataset with p < 0.004. Two machine learning approaches were used to build prediction models for differentiating between Group 1 and Group 2. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance of statistically significant texture data between phyllodes subgroups. In TAUI, 10 statistically significant second order texture values were identified as significant factors capable of differentiating among the two groups (p < 0.05). Both of the models of our dataset make a diagnostic contribution to the discrimination between BopTs-MPTs and BPTs. In PTs, US is the main diagnostic method. Adding machine learning-based TAUI to conventional US findings can provide optimal diagnosis, thereby helping to choose the correct surgical method. Consequently, decreased local recurrence rates can be achieved.

Nipple sparing mastectomy for a giant phyllodes tumor; a case report.

IntroductionOncoplastic surgery has come into the limelight in the surgical treatment of breast cancer. In this report, we will introduce our challenge to apply oncoplastic surgery to a benign neoplasm like phyllodes tumor (PT).Presentation of caseA 45-year-old female visited our hospital complaining of a rapidly growing lump on her left breast. She already had experienced lumpectomy twice on the same breast. Her left breast was occupied by a 14 × 10 cm mass with another small 1.7 × 1.6 cm nodule considered as a daughter lesion. Core needle biopsy suggested that it was a benign PT. We conducted nipple sparing mastectomy (NSM) and immediate reconstruction of the breast by latissimus dorsi muscle flap. During 7-years follow up, she has no recurrence and is satisfied with the reconstructed breast.DiscussionThere are some reports that performed conventional or radical mastectomy with immediate breast or chest wall reconstruction for giant PT. Reports about NSM with breast reconstruction for PT are rare, there are 5 including ours. All the cases accomplished long term recurrent free survival. All except ours were reconstructed by implants. Implant reconstruction is technically easier, but recently, malignant lymphoma after putting breast implant is concerned. Another merit of autologous tissue reconstruction is that they change naturally as age like contralateral breast so that it can achieve better long-term cosmetic result.ConclusionNSM with autologous tissue reconstruction is a good option for PT treatment even though it is not malignant.

Diagnostic Role of Collagen Type III Alpha in Fibroepithelial Lesions of the Breast: An Immunohistochemical Study

Abstract Background The fibroepithelial lesions (FELs) are heterogeneous biphasic tumors composed of epithelial and stromal components, they include fibroadenoma (FA) and phyllodes tumor (PT). The most FAs are benign, while the PTs have unpredictable biologic behavior, where they can recur if incompletely excised, and can even metastasize. According to the WHO Classification of Tumors of The Breast, PT is classified by the histological features into benign, borderline, and malignant. There is difference in management of the FELs, where a FA is treated conservatively or by simple enucleation. While PT must be excised with wide surgical margin to avoid the recurrence of this tumor, where it can recur as high grade. For this reason the preoperative distinction between FA and PT is critical for management. On another hand, still this differentiation is difficult and challenging in some cases especially on limited sample of core needle biopsy (CNB) and also on excision due to the heterogeneity of PT and overlapping features between the FELs. Recently, the use of immunohistochemical markers may have helpful role in differentiation between FA and PT, and grading of the last one. Collagen III α (Col A ) has been emerged as a potential new diagnostic maker useful in differentiation between fibroepithelial lesions. Methodology In this retrospective study we evaluated the histopathological features of Cases of FELs including FA and PT with its subgrades. We also evaluated an immunohistochemical diagnostic potential of collagen III α (Col A) in differentiating FA from PT, and categorizing the last one. Furthermore, correlations between Col A expression and clinicopathological parameters were performed. Results The staining expression of Col A was increased significantly in PTs when compared with FAs (P&amp;lt;) . Col A expression increased with increased grade of PT but without significant difference between benign PT and borderline PT, and between borderline PT and malignant PT. By pairwise comparison, there was a significant difference between CFA and benign PT according to Col A expression (P&amp;lt;) , and also between the typical FA and FA with PT like features (P&amp;lt;) . There was a trend of increased expression but did not reach the significance between FA with PT like features and benign PT (P=) . Distinct periductal cuffing pattern of Col A staining was present in all PTs and absent in most FAs (P&amp;lt;) , and only cases of FA with PT features exhibited this pattern. Conclusion Col A is a diagnostic marker can differentiate between FA and PT, especially between CFA and benign PT, and the Col A expression increased with increased grade of PT but without significant difference. FA with PT like features might be a distinct category that should be distinguished from typical FΑ as it may an initial event of tumor progression to PT.

Clinicopathologic Characteristics and Patient Outcomes of Phyllodes Tumors: A Single Institution Experience.

Phyllodes tumors (PT) are rare fibroepithelial neoplasms that are classified as benign, borderline, or malignant. Patients with PT diagnosed between 2009 and 2019 were identified from a prospectively maintained single institutional database. 76 patients with PT were included; 47 (61.8%) were benign, 9 (11.8%) were borderline, and 20 (26.3%) were malignant. The mean age at diagnosis was 52. Surgical treatment of benign PT included excisional biopsy in 31 (66.0%) patients, segmental mastectomy in 15 (31.9%), and mastectomy in 1 (2.1%). Among patients with borderline PT, operative management was excisional biopsy in 4 (44.4%) and segmental mastectomy in 5 (55.6%). Of those with malignant PT, 7 (35.0%) were treated with excisional biopsy alone, 9 (45.0%) had lumpectomy (segmental mastectomy), and 4 (20.0%) underwent mastectomy. Malignant PT had a higher rate of necrosis compared to borderline or benign PT (25.0% vs 0% vs 4.3%, P = .016). Four patients had recurrent PT. Final positive margins were associated with recurrence (P = .044). The median overall follow-up time was 86.3months (range 1.5-1414.1months), and no deaths occurred among patients with malignant PT. Overall, recurrence rates of PT are low but may be increased by presence of positive margins.

Fibroepithelial tumours of the breast-a review.

Fibroepithelial tumours of the breast are biphasic neoplasms composed of both epithelial and stromal elements, including the common fibroadenoma and the infrequent phyllodes tumour. The admixture of epithelium and stroma in the fibroadenoma shows intra- and pericanalicular patterns, and may display a variety of histological changes. Fibroadenoma variants include the cellular, juvenile, myxoid and complex forms. The cellular fibroadenoma may be difficult to distinguish from the benign phyllodes tumour. Stromal mitotic activity can be increased in fibroadenomas in the young and pregnant patients. Phyllodes tumours, neoplasms with the potential for recurrence, show an exaggerated intracanalicular growth pattern with broad stromal fronded architecture and stromal hypercellularity. They are graded into benign, borderline and malignant forms based on histological assessment of stromal features of hypercellularity, atypia, mitotic activity, overgrowth and the nature of the tumour borders. Classification of phyllodes tumours is imperfect, compounded by tumour heterogeneity with overlapping microscopic features among the different grades, especially in the borderline category. Malignant phyllodes tumours can metastasise and cause death. Determining which phyllodes tumours may behave aggressively has been difficult. The discovery of MED12 mutations in the pathogenesis of fibroepithelial tumours, together with other gene abnormalities in the progression pathway, has allowed refinements in diagnosis and prognosis.

Assessment of quantitative dynamic contrast-enhanced MRI in distinguishing different histologic grades of breast phyllode tumor

To investigate whether quantitative DCE-MRI (qDCE-MRI) could help distinguish breast phyllodes tumor (PT) grades. This retrospective study included 67 breast PTs (26 benign lesions, 25 borderline lesions, and 16 malignant lesions) from April 2016 to July 2020. MRI was performed with a 1.5-T MR system. Perfusion parameters (Ktrans, kep, ve, iAUC60) derived from qDCE-MRI, tumor size, and the mean ADC value were correlated with histologic grades using Spearman's rank correlation coefficient. Ktrans, kep, ve, and iAUC60 of three histologic grades were also calculated and compared. The Spearman correlation coefficient with histologic grade of the tumor size was 0.578 (p < 0.001); the ADC value was not correlated with histologic grades of breast PT (p = 0.059). The Ktrans, kep, ve, and iAUC60 of benign breast PTs were significantly lower than those of borderline breast PTs (p < 0.001) and lower than those of malignant breast PTs (p < 0.001). In comparison, the Ktrans, ve, and iAUC60 of borderline breast PTs were significantly lower than those of malignant breast PTs (p < 0.001, p < 0.001, p = 0.007, respectively). For ROC analysis, AUCs of Ktrans, ve, and iAUC60 were higher than tumor size and ADC value for differentiating three PT grades. Quantitative and semi-quantitative perfusion parameters (Ktrans, ve, and iAUC60, especially Ktrans) derived from qDCE-MRI showed better diagnosis efficiency than tumor size and ADC for grading breast PTs. Therefore, qDCE-MRI may be helpful for preoperative differentiating breast PT grades. • Quantitative dynamic contrast-enhanced MRI can be used as a complementary noninvasive method to improve the differential diagnosis of breast PT. • Ktrans, ve, and iAUC60 derived from qDCE-MRI showed better diagnosis efficiency than tumor size and ADC for grading breast PTs.

“A Prospective Study Clinicopathological Factors of Benign Breast Diseases”

Background: Benign breast lesions represent a wide spectrum of disorders that come to clinical attention either as palpable lumps or as imaging abnormalities. Some of these are clinically suspected as malignant lesions but diagnosed as benign after histopathological examination. Objective: To study benign breast lesions to correlate their clinicopathological parameters and to study incidence of benign breast lesions in different age groups. Materials and Methods: A descriptive study with cross sectional design was conducted in the Department of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh between Januarys to December-2019. All patients male and female with any benign breast lesions reported were included in the study. The patients reported as malignant tumors were excluded from this study. A total of 90 benign breast specimens received for histopathological study were analyzed during this period. In each case detail history and clinical data was collected. Results: A total of 90 cases were analyzed during this period. Benign breast lesions were studied in detail with relation to available clinical data. Incidence of benign breast lesions reported in our study was 65.21%. Fibroadenoma was the most common benign lesion found with incidence 71.11%, followed by fibrocystic change and benign phyllodes tumors. The most common age group for fibro adenoma was 11 to 20 years. Conclusion: Benign breast lesions are common in females and fibroadenoma being the most common of them all. The most common presenting complaint was painless breast lump.

Malignant Phyllodes Tumor: Imaging Features With Histopathologic Correlation.

Phyllodes tumors (PT) are rare fibroepithelial lesions of the breast that commonly present as rapidly enlarging, palpable masses. Phyllodes tumors may be classified as benign, borderline, or malignant on the basis of histopathologic analysis. Although malignant PT cannot be distinguished from benign PT on the basis of imaging findings alone, studies suggest that malignant PT tend to be larger and irregular in shape, and they are less likely to have circumscribed margins. If biopsy results are indeterminate, excisional biopsy should be performed. Malignant PT can be difficult to distinguish histologically from sarcomas and spindle cell metaplastic breast carcinoma; the distinction is important for prognosis and treatment. Malignant PT are treated surgically with wide local excision, without a clear role for adjuvant radiation or chemotherapy in most cases. Nearly one-third of malignant PT recur locally, usually within a few years after initial diagnosis. Distant metastatic disease is rare, and the five-year overall survival rate of malignant PT is close to 80%. The purpose of this article is to review the clinical presentation, imaging appearance, histopathology, and management of malignant PT.

Correlation of Glucose Transporter-1 (GLUT-1) Immunohistochemical Expression on Benign, Borderline, and Malignant Phyllodes Tumors

Correlation of Glucose Transporter-1 (GLUT-1) Immunohistochemical Expression on Benign, Borderline, and Malignant Phyllodes Tumors

Axillary Mass Turned Out to be A Phyllodes Tumour in An Ectopic Breast Tissue– A Rare Case Report

Background: Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast neoplasm. However, phyllodes tumours arising from ectopic breast tissue are even rarer, with less than 15 cases ever reported involving the axilla, vulva and groin. Case Presentation: A 27-year-old lady presented to the surgical clinic with left axillary swelling, measuring 5cm x 6cm. Ultrasound of the axilla revealed heterogenous mass displacing the left axillary artery and vein medially. Excision was performed, and histopathological examination confirmed the diagnosis of a benign phyllodes tumour. Conclusion: Phyllodes tumour in ectopic breast tissue over the axilla is a rare occurrence, and our case is the fourth case ever reported. Despite its rarity, diagnosis and treatment modalities are similar to phyllodes tumour of the breast. Regular follow-up is recommended owing to the risk of local recurrence.

Predicting the pathological grade of breast phyllodes tumors: a nomogram based on clinical and magnetic resonance imaging features.

To explore the potential factors related to the pathological grade of breast phyllodes tumors (PTs) and to establish a nomogram to improve their differentiation ability. Patients with PTs diagnosed by post-operative pathology who underwent pretreatment magnetic resonance imaging (MRI) from January 2015 to June 2020 were retrospectively reviewed. Traditional clinical features and MRI features evaluated according to the fifth BI-RADS were analyzed by statistical methods and introduced to a stepwise multivariate logistic regression analysis to develop a prediction model. Then, a nomogram was developed to graphically predict the probability of non-benign (borderline/malignant) PTs. Finally, 61 benign, 73 borderline and 48 malignant PTs were identified in 182 patients. Family history of tumor, diameter, lobulation, cystic component, signal on fat saturated T2 weighted imaging (FS T2WI), BI-RADS category and time-signal intensity curve (TIC) patterns were found to be significantly different between benign and non-benign PTs. The nomogram was finally developed based on five risk factors: family history of tumor, lobulation, cystic component, signal on FS T2WI and internal enhancement. The AUC of the nomogram was 0.795 (95% CI: 0.639, 0.835). Family history of tumor, lobulation, cystic components, signals on FS T2WI and internal enhancement are independent predictors of non-benign PTs. The prediction nomogram developed based on these features can be used as a supplemental tool to pre-operatively differentiate PTs grades. More sample size and characteristics were used to explore the factors related to the pathological grade of PTs and establish a predictive nomogram for the first time.

Race-Related Differences in the Clinical Presentation and Histopathologic Features of Phyllodes Tumor.

Phyllodes tumor (PT) is a rare fibroepithelial lesion of the breast with variable malignant potential. Black women have a higher incidence of a related benign tumor, fibroadenoma, but there are limited epidemiological data on PT. The aim of our study was to evaluate race-related differences in the clinicopathologic features and outcomes of PT. Our institutional pathology database was queried for breast specimen reports from 01/2009 to 10/2019 to identify patients with a pathologic diagnosis of PT. Chart review and detailed slide review were performed to obtain clinical and histopathologic variables, respectively. Among twelve patients, two had malignant PT, three had borderline PT, and seven had benign PT. All patients with malignant and borderline PT were black, compared with 29% of those with benign PT. There were no apparent race-related differences in specific histopathologic features among black vs. non-black women with benign PT. Malignant and borderline PT were relatively larger than benign PT, with mean tumor sizes of 9.0cm (standard deviation [SD] 4.7cm), 12.2cm (SD 9.4cm), and 5.4cm (SD 5.8cm), respectively. Two women had a local recurrence, both of whom were black. In this single-institution retrospective study, we observed disproportionate rates of aggressive histopathologic features and disparate outcomes among black women with PT. A multi-institutional PT registry would facilitate improved knowledge about race-related differences in the presentation and outcomes of this rare tumor.

A retrospective review of phyllodes tumors of the breast from a single institution.

Phyllodes tumors (PTs) are rare fibroepithelial breast tumors with diverse biological behavior. This study aimed to analyze the characteristics, management, and outcome of phyllodes tumors. Patients diagnosed with PTs in our institution from January 2013 to December 2017 were identified retrospectively by the ICD-10 code. Data were collected from medical records. The diagnosis of this tumor was based on histopathological results. Variables analyzed included age, tumor site, surgical option, axillary lymph nodes, chemotherapy and radiotherapy, metastases, disease-free survival (DFS), and overall survival (OS) rate. Sixty-nine cases of PTs were diagnosed during the period, of which 31 were benign, 38 were malignant, and 1 was a case of bilateral metachronous tumors. We did not find any borderline pathologic cases. The patient's ages ranged from 20 to 71 years, with the highest number of cases (28) from the 40-49-year-old age group. The majority of patients (42) had PT on the right side. Simple mastectomy was the most performed treatment, with 53 such cases, including both benign and malignant. The axillary staging was carried out in 16 cases, of which none had nodal metastasis. Ten cases received chemotherapy, and 16 cases of malignant phyllodes received postoperative radiotherapy. We found 4 cases with distant metastases and 5 cases that developed local recurrence. The DFS rate reached 92.75%, and the overall 5-year survival rate was 84.21%. The incidence of PTs is highest in women in the 3rd and fourth decades of age. Simple mastectomy and wide excision are the treatments of choice, with a low recurrence rate in both benign and malignant PTs cases.

Diagnostic concordance of phyllodes tumour of the breast.

Phyllodes tumours (PT) are rare and distinct breast tumours, which span a morphological continuum. Classification into benign, borderline and malignant categories reflects their biology and clinical behaviour and is essential to guide management. This study aims to assess the diagnostic agreement of PT using the UK National Health Service Breast Screening Programme (NHSBSP) breast pathology external quality assurance (EQA) scheme data. Twenty-six PTs were identified in the EQA scheme, which were diagnosed by an average of 607 participants/circulation. Data on diagnostic categories were collected and representative slides were reviewed. The level of concordance between reporting pathologists was assessed. There were 14 benign, six borderline and six malignant PT. The overall rate of diagnosis agreement was 86% when analysed as benign lesions, borderline PT and malignant lesions, which decreased to 79% when diagnosed as PT (irrespective of grade) and to 63% when the diagnosis was further refined to PT categories (benign, borderline and malignant PTs). The highest agreement rate was observed in malignant PT (86%) and the lowest in borderline PT (42%). Malignant heterologous elements, stromal overgrowth and leaf-like architecture are features associated with higher concordance rates. Lower-priority features were stromal expansion, clefting and multinodularity. The concordance of PT diagnosis, as an entity, is high, but its classification into benign, borderline and malignant has variable agreement levels, with borderline tumours having the lowest concordance rate. More research to refine the diagnostic criteria for categorisation of PT is warranted to improve concordance between pathologists.

Clinical practice guidelines for ultrasound-guided vacuum-assisted breast biopsy: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021.

Clinical practice guidelines for ultrasound-guided vacuum-assisted breast biopsy: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021.

Benign Phyllodes Tumor During Pregnancy: 2 Cases Report at the University Hospital of Angre, Abidjan

Benign Phyllodes Tumor During Pregnancy: 2 Cases Report at the University Hospital of Angre, Abidjan