Borderline Phyllodes Tumors Research Articles

A Giant, Complex Fibroepithelial Tumor of the Breast: Borderline Phyllodes Tumor Combined with Tubular Adenoma - a Rare Clinical Presentation of a Fibroepithelial Tumor of the Breast.

No abstract available.

Quantitative proteome profiling stratifies fibroepithelial lesions of the breast.

Breast fibroepithelial lesions (FELs) include heterogeneous pathological tumors, involving indolent fibroadenoma (FAD) to potentially aggressive phyllodes tumors (PTs). The current grading system remains unreliable in differentiating these tumors due to histological heterogeneity and lack of appropriate markers to monitor the sudden and unpredictable malignant transformation of PTs. Thus, there exists an imminent need for a marker-based diagnostic approach to augment the conventional histological platform that could lead to accurate diagnosis and distinction of FELs. The high- throughput quantitative proteomic analysis suggested that FAD and PTs form distinct clusters away from borderline and malignant though there exist marked differences between them. Interestingly, over-expression of extracellular matrices (ECM) related proteins and epithelial-mesenchymal transition (EMT) markers in borderline PTs led us to hypothesize a model of deposition and degradation leading to ECM remodeling and EMT acquisition triggering its malignant transformation. We also identified three candidate biomarkers such as MUCL1, HTRA1, and VEGDF uniquely expressed in FAD, borderline, and malignant PTs, respectively, which were further validated using immunohistochemistry. The present work shed light on a brief mechanistic framework of PTs aggressive nature and present potential biomarkers to differentiate overlapping FELs that would be of practical utility in augmenting existing diagnosis and disease management for this rare tumor.

Incidental Pathologic Findings in Young Adult Reduction Mammaplasty.

This study aims to characterize incidental microscopic findings in this population to determine whether there is a benefit to routine histopathologic examination of breast tissue in young women. A retrospective review of young women who underwent reduction mammaplasty between June of 2010 and May of 2018 was performed at a single institution to identify demographics, age at the time of surgery, breast cancer risk factors, and pathologic data. Histologic reevaluation was performed when diagnostic clarification was needed. Descriptive, univariate, and multivariable statistical analyses were performed. A total of 798 young women were included. At the time of surgery, the mean patient age was 17.5 ± 2.0 years, the mean body mass index was 28.7 ± 5.7 kg/m2, and the mean resection weight was 685 ± 339 g/breast. The majority of patients were reported to have pathologically normal tissue [n = 704 (88.2 percent)]. Of the 94 patients (11.8 percent) with abnormal findings, 21 (2.6 percent) had benign nonproliferative changes, 64 (8.0 percent) had proliferative lesions without atypia, nine (1.1 percent) had proliferative lesions with atypia, and a single patient (0.1 percent) had a borderline phyllodes tumor. Univariate and multivariate analyses revealed that age at menarche younger than 12 years was significantly associated with increased incidence of proliferative lesions. Over 10 percent of young women with reduction mammaplasty have histopathologic findings. Although this study demonstrated an overall low incidence of atypical lesions, because early identification offers potential for improved surveillance, the authors continue to advocate for routine pathologic evaluation, particularly for women with early menarche. Risk, III.

Prognosis analysis of local recurrence after excision of breast phyllodes tumors

Objective: To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence. Methods: This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People's Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm (M(QR)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results: According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% (P=0.300). Conclusion: Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.

Skin-Reducing Mastectomy and Immediate Reconstruction for a Large Recurrent Borderline Phyllodes Tumor

Background: Large recurrent phyllodes breast tumors are often malignant. Therefore, when taking the surgical decision, a simple mastectomy and immediate reconstruction must be considered. Case presentation: The patient, aged 40 years, with a benign phyllodes tumor in the left breast, having a recurrence 2 years after, with 4–7 cm conglomerate tumor masses, was subjected to skin-reducing mastectomy, breast reconstruction with a silicone mammary implant in the left breast, and symmetrization of the right breast. Discussion and conclusions: In the case of patients with breast hypertrophy and gigantomastia (cup size D–F), skin-reducing mastectomy and immediate reconstruction with an implant can be the option. It is important for the resection specimen to include the skin tissue above the tumor. After 14 months of follow-up, there was no recurrence of the lesions on a clinical examination, ultrasonography, or MRI.

Benign and borderline phyllodes tumors of the breast: Clinicopathologic analysis of 205 cases with emphasis on the surgical margin status and local recurrence rate

BackgroundThe management of benign and borderline phyllodes tumors of the breast with a positive surgical margin is still controversial. Our aim in this study was to evaluate the impact of surgical margin status on the local recurrence rate of benign and borderline phyllodes tumors. MethodsWe reviewed 205 phyllodes tumors (191 benign, 14 borderline) that were surgically excised at our hospital between 2005 and 2019. Follow-up information extending to at least 6 months after surgery was retrieved from the clinical, radiology, and pathology records. ResultsThe initial surgical margin was negative in 54 (26%) cases, close (≤ 1 mm) in 29 (14%) cases, and positive in 122 (60%) cases. Approximately half of the cases with a close margin and two-third of the cases with a positive margin underwent re-excision to obtain negative margins. Three (2.3%) local recurrences were observed among 131 cases with follow-up information, all three with benign phyllodes tumor. Of these three patients, one had a positive final margin, and two had negative final margins. There was no significant difference in the rate of local recurrence between PT with a positive surgical margin versus a close and negative margin. ConclusionThe study results suggest that close clinical and radiologic follow-up may provide a better course of management rather than re-excision when managing positive margins in benign and borderline phyllodes tumors.

Management of phyllodes tumour of breast: 5 year experience at Madina Teaching Hospital, Faisalabad.

Objectives: To determine the oncological outcome of different types of phyllodes tumour (PT) and to analyze the impact of radiotherapy on outcome. Study Design: Experimental study. Setting: Madina Teaching Hospital, Faisalabad, Pakistan. Period: April 2015 to April 2020. Material &amp; Methods: Female patients diagnosed as phyllodes tumour of breast were included and classified into benign, borderline and malignant PT according to WHO criteria. Borderline and malignant PT were further divided into 2 groups; Group A (Surgery alone) and Group B (Surgery + Radiotherapy). Oncological outcome based on local recurrence, distant metastasis and overall survival rate among different types of phyllodes tumour and those patients who received or not received radiotherapy was assessed. Results: In 5 years, 29 patients of phyllodes tumour were studied. 15 (51.7%) patients had benign, 8 (27.6%) malignant and 6 (20.7%) borderline tumour. Mean age of our patients was 39.5 years (range: 25-55 years).The disease free survival rate was 82.8% (100% for benign, 83.4% for borderline and 50% for malignant PT). Malignant histotype and tumour size &gt;6cm were significantly associated with recurrence (p&lt;0.05). In Group A, 4 patients developed local recurrence and 2 of them developed distant metastasis; while in group B only 1 patients developed local recurrence (p=0.2, OR=0.147). Overall survival rate was 93.1%. It was 100% for radiotherapy group compared to 88% for non irradiated patients. Conclusion: Malignant phyllodes tumour and large tumour size is associated with worse prognosis. Post operative radiotherapy is associated with improved local recurrence, distant metastasis and overall survival.

Phyllodes Tumors of the Breast: A Single-Center Experience

We aimed to analyze the clinicopathological findings, treatment approach, and treatmen outcomes in patients diagnosed with phyllodes tumor (PT). The clinicopathological data of 26 patients with PT, who were treated between 2008 and 2019, were retrospectively analyzed. Mean age was 35.07±13.95 years (range: 14-71), while mean tumor size was 54.76±29.24 mm (range: 25-135). Benign, borderline, and malignant PT were detected in 18 (69.2%), 3 (11.5%), and 5 (19.2%) patients, respectively. Marginless excision was performed in 20 patients (76.9%), while six (23.1%) patients underwent mastectomy. A statistically significant correlation of tumor type with mean tumor size and mean age was observed (p=0.041 and p=0.013, respectively). Margin positivity on first excision was more frequent in the malignant tumors (p=0.02). No statistically significant correlation of PT type with presence of breast cancer in the family history, and tumor localization was observed (p=0.79 and p=0.13, respectively). Mean postoperative follow-up duration was 56 months (range: 6-147). Local recurrence was not observed in any of the patients. Lung and left vastus lateralis muscle metastases were encountered. The patient with lung metastasis became exitus because of the same reason 6 months after detection of the metastasis. PT is a rare fibroepithelial tumor of the breast that is characterized by a mixed histology seen in younger ages when compared to the classical breast tumors. The probability of PT should be considered in the presence of a rapid-growing mass in the breast. In addition, it should also be considered that the contribution of imaging techniques may be limited.

Radiological Aspect of Unusual Case of Rapidly Growing Giant Phyllodes Tumour of Breast

Phyllodes tumour or cystosarcoma phyllodes are a rare fibroepithelial tumour of breast, predominantly affecting the adult woman of age group 40-60 years. This is a case report of unusual, rapidly growing giant phyllodes in a 58-year-old women who came with history of enlarging lump in right breast without any significant pain or nipple discharge and was referred to the Radiology Department for mammographic and sonomammographic evaluation by the referring breast surgeon. This case is unique, since it describes how a rapidly growing breast lump is not always a sinister breast carcinoma but can be a benign, borderline or malignant phyllodes all of which can mimic a carcinoma in signs and symptoms, but hold a better prognosis. The final diagnosis of borderline phyllodes tumour was made on core biopsy followed by mastectomy of the involved breast. The main take away of this case report is how by having high level of suspicion, knowledge of specific imaging characteristics, correct biopsy technique combined with histopathology can help in reaching to a correct diagnosis leading to proper patient care and management.

A cellular fibroepithelial tumor of the breast: A case report

Introduction: Fibroepithelial breast lesions are biphasic neoplasms characterized by proliferation of both stromal and epithelial cells. They encompass a spectrum of tumors ranging from benign fibroadenoma to potentially fatal malignant phyllodes tumor, with tumors of borderline clinical significance in-between. It is important to correctly characterize each lesion, as this defines management and thus risk of local recurrence and potential distant metastasis in case of malignancy. Case Report: A 48-year-old woman presented with a palpable retro-areolar lump in the left breast. After core biopsy, the initial pathology report initiated tumorectomy. When the final report stated a borderline phyllodes tumor with incomplete resection, reintervention was needed with wide surgical margins to avoid local recurrence. The local re-excision showed scarring and steatonecrosis as a result of the previous procedure, but no residual lesion. Consequently, there was no need for further surgical intervention. Conclusion: Fibroepithelial lesions (FEL) of the breast are a wide variety of lesions with distinct management based on the exact pathologic character. Core needle biopsy poses a risk of sampling error due to intratumoral heterogeneity that sometimes may be found in cellular FEL. As a consequence, upgrading at the time of the excision specimen can frequently occur with need of reintervention.

Malignant phyllodes tumor of the breast with rapid progression: a case report

BackgroundMalignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period.Case presentationA 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin–ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy.ConclusionsA standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.

A case of recurrent malignant phyllodes tumor undergoing nipple-sparing mastectomy with immediate breast reconstruction

BackgroundAlthough the primary treatment for malignant phyllodes tumor (PT) is complete surgical excision with either breast-conserving surgery or total mastectomy, recent technical advances have led to the adoption of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR).Case presentationA 28-year-old woman noticed a mass in her left breast that was rapidly increasing in size. She underwent tumor excision and a histological diagnosis of marked degenerative and necrotic induration suggested benign PT. One year later, however, she was found to have recurrent masses in the left breast on follow-up mammography and sonography. Needle biopsy was performed and the tumor was diagnosed as borderline or malignant PT. She underwent NSM and sentinel lymph-node biopsy with IBR using a tissue expander. Histological examination of the mastectomy specimen showed multiple fibroepithelial tumors with marked stromal overgrowth, focal necrosis, and hemorrhage. Stromal cells showed pleomorphism and a maximal mitotic rate of approximately 25 per 10 high-power fields. The tumor was diagnosed as malignant PT. She did not receive adjuvant chemotherapy or radiation treatment. At 3-year follow-up, the patient remains free of disease and highly satisfied with the cosmetic results.ConclusionsNSM with IBR is not a contraindication for malignant PT. It is both curative and can offer an appealing cosmetic option for localized malignant PT.

Comparison of Snail-1 and Estrogen Receptor Immunoexpression between Fibroadenomas and Phyllodes Tumors

Fibroadenomas (FA) and phyllodes tumors (PT) are fibroepithelial lesions in the breast, which until now the relationship between the pathogenesis of both have not been ascertained yet. Epithelial cells are thought to be involved in the regulation of changes in the stromal cells in the PT, so it can be estimated that this process is involved in epithelial-mesenchymal transition (EMT). This study aims to compare of snail family transcriptional repressor 1 (Snail-1) and estrogen receptor (ER) impression as EMT factors among tumor type (FA, benign PT, boderline PT and malignant PT). This study was an observational analysis with the cross-sectional method. After the histologic grade of the samples was reviewed, immunohistochemistry examination for ER and Snail-1 was performed. Statistical analysis for categorical data was tested by chi-square test. There were 66 samples, consists of 20 FA, 17 benign PT, 16 borderlines PT, and 13 malignant PT. A significant difference in the loss of ER expression in borderline and malignant PT was found compared to FA and benign PT. This is inversely proportional to the snail-1 expression, where the expression was high in borderline PT and malignant PT stromal cells. This could support the consideration of the pathomechanism regulation of epithelial-mesenchymal cell transition changes in FA with PT, where Snail-1 is one of the proteins in the regulation of the EMT and RE processes acting as an inhibiting factor in transcription factors in the mechanism of EMT occurrence.

Width of margins in phyllodes tumors of the breast: the controversy drags on?-a systematic review and meta-analysis.

Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most studies suggested margins of at least 10mm while some recent studies suggested narrower margins without an increased risk of local recurrences (LR) and distant metastases (DM). The objective of this systematic review was to identify and compare studies that assessed these different practices. A systematic review was performed through five databases up to April 2019. Studies exploring the association between the width of margins, subtypes of PT, and the LR and DM rates were considered for inclusion. A statistical model for analyzing sparse data and rare events was used. Thirteen studies met eligibility criteria and were selected. Considering a threshold of 10mm (margins < 10 vs margins ≥ 10mm), the 5-year incidence rate of LR was estimated to be 5.22 vs. 3.63 (diff. -1.59) per 100 person-years for benign PT, 9.60 vs. 7.33 (diff. -2.27) for borderline PT, and 28.58 vs. 21.84 (diff. -6.74) for malignant PT. For DM, it was estimated to be 0.88 vs. 0.86 (diff. -0.02) for benign PT, 1.61 vs. 1.74 (diff. 0.13) for borderline PT, and 4.80 vs 5.18 (diff. 0.38) for malignant PT. The data for a threshold of 1mm were not sufficient to draw any conclusions. Irrespective of tumor grade, we found that DM was a rarer event than LR. Malignant PT had the highest incidence rate of LR and DM. This meta-analysis found a clear association between width of margins and LR rates. Whatever the tumor grade, surgical margins ≥ 10mm guaranteed a lower risk of LR than margins < 10mm. On the other hand, the width of margin did not influence the apparition of DM.

Ki67 and P53 Expression in Relation to Clinicopathological Features in Phyllodes Tumour of the Breast.

Objective:Phyllodes tumour (PT) is a rare fibroepithelial neoplasm of the breast that carries a risk of malignancy. Histopathological examination remains a gold standard for diagnosis. The usage of the immunohistochemical markers of Ki67 and p53 acts as a supplement method, particularly for the malignant PT. We aim here to study the expression of these markers in PT and to see their relation to the tumour grading. Methodology:We conducted a retrospective cross-sectional study on 57 archived formalin-fixed paraffin-embedded tissue blocks of PT from the years 2015 to 2018 from two hospitals in East Coast Malaysia. The histopathological examination and immunohistochemical stain for Ki67 and p53 were analysed. Results:There was an association between clinical descriptive data of skin changes, lump size of more than 3 cm, cytological atypia, stromal hypercellularity, mitosis and immunohistochemistry with the clinical diagnosis of PT. Both marked expression of Ki67 and p53 were seen in borderline and malignant PT. Our study showed that in the presence of high mitotic figures, marked expression of Ki67 was only seen in cases of malignant PT. Conclusion:We found a significant association of Ki67 and p53 expressions, high mitosis and other descriptive histopathological features in malignant PT. Further study with larger sample size is recommended to predict tumour grade and prognosis as well as the disease-free survival of the tumour.

Giant benign phyllodes breast tumour with pulmonary nodule mimicking malignancy: A case report

BACKGROUNDPhyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease.CASE SUMMARYA 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment.CONCLUSIONThis case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.

Abstract 5449: Calretinin can be the specific marker for phyllodes tumor

Abstract Background Rare phyllodes tumors (PT) comprise a mixture of stromal and epithelial cells, and they can acquire malignant potential, which results in rapid progression and metastasis. Therefore, PT should be resected with an adequate free margin for curative intent. Fibroadenoma (FA) is a benign type of tumor that rarely becomes malignant, and usually does not require resection. However, PT and FA are morphologically and pathologically similar, which makes them difficult to distinguish in clinical practice. Thus, we aimed to determine a means of distinguishing them using a proteomic approach called Isobaric Tag for Relative and Absolute Quantitation (iTRAQ). We added different isobaric tags to normal and phyllodes tumor tissues, detected proteins using a database search and selected those that were at least three-fold more abundant than in normal tissue. Among them, we found high expression levels of calretinin, a specific marker for mesothelioma, in PT. Methods Tissue specimens were collected from 36 patients with PT (benign, n = 16; borderline, n = 15; malignant, n = 5), from 37 with FA and from three local recurrence sites of PT. All patients were treated by surgical resection at the Department of Breast Surgery, Tokyo Medical and Dental University, Japan, between March 2003 and August 2012. The specimens were analyzed by immunohistochemistry (IHC) using a calretinin antibody, and malignant mesothelioma as a positive control. Immunostaining for calretinin was analyzed by light microscopy in three high-power fields (HPF) and calretinin expression was assessed using Allred scores calculated on a scale from 0 to 8 as proportion (PS) plus intensity (IS) scores. We defined Allred scores of 0 and 2 as low (CLG) and those &amp;gt; 3 as high (CHG) calretin as reported for malignant mesothelioma. Data were analyzed using chi-square tests. Results All samples were stained. Stromal, but not epithelial cells tended to be positively stained for calretin. We found 20 and 17 FA, and 9 and 27 PT in CLG and CHG, respectively. More calretinin was expressed in PT than in FA (p = 0.011). Six and 25 benign or borderline PT were found in CLG and CHG, respectively. More calretinin was expressed in benign and borderline PT than in FA (p = 0.006). Three patients had local recurrence and one had distant metastasis. Recurrence did not significantly correlate with calretinin expression in PT; calretinin expression was low in all instances of local recurrence. Conclusion We found that calretinin could distinguish between PT and FA and could therefore function as an important marker when planning surgery. Malignant PT and sites of local recurrence tended to express low levels of calretinin. Further investigation of calretinin with PT and FA is needed. Citation Format: Tohiyuki Ishiba, Tomoyuki Aruga, Miyako Nara, Sakiko Yabe, Chiaki Saita, Mai Onishi, Naoko Iwamoto, Rika Yonekura, Hiromi Miyamoto, Yayoi Honda, Goshi Oda, Tsuyoshi Nakagawa, Akira Nakanishi, Hiroyuki Uetake, Yoshio Miki. Calretinin can be the specific marker for phyllodes tumor [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5449.

Treatment of phyllodes tumours of the breast: evaluation of 66cases and literature review

Phyllodes tumours (PTs) of the breast are classified as benign, borderline and malignant based on the constellation of defined histological parameters. Surgical excision is the primary therapy, but the need to maintain certain safety margins is still controversially discussed for all three categories.This paper aims to provide a critical opinion on the existing recommendation on safety margins for resection.In our breast centre, all patients with phyllodes tumours were identified retrospectively on the basis of the histopathological documentation from 1999 to 2018. The cases were evaluated, in particular, with a view to recurrences and the occurrence of multicentricity.A total of 66 patients were diagnosed with a PT. In 38 cases, the tumours were benign, in 15 borderline and in 13 malignant. Local recurrences were observed in one benign PT, 7 borderline and 5 malignant PTs. Two PTs that were initially classified as borderline tumours progressed to malignant PTs. Multicentricity occurred in about 20 % of borderline and malignant PTs but only in 5 % of benign PTs.The resection margins for phyllodes tumours should be chosen depending on dignity and recurrence. The key question to be challenged is whether or not there is a need to maintain a certain safety margin in benign PTs. In case of recurrence of borderline or malignant PTs, a mastectomy should be considered early.

Phyllodes Tumors of the Breast (the Egyptian Experience).

Phyllodes tumors (PT) are rare fibroepithelial lesions, about 0.3-0.5% of all breast tumors. This study is an evaluation of patient characteristics, clinicopathologic features, diagnostic tools, therapeutic options, risk factors for recurrence, and distant metastasis and follow-up findings in patients with PTs. One hundred twenty-seven patients with pathologically proved PTs in the National Cancer Institute, Cairo University, Egypt, from January 2011 to January 2016 were reviewed and analyzed. Sixty patients presented with benign PTs (47.2%), 34 had borderline PTs (26.8%), and 33 had malignant PTs (26%). The mean follow-up period was approximately 36months; local recurrence occurred in 34 patients, 9 benign cases (14.5%), 11 borderlines (32.4%), and 14 malignant PTs (42.4%). Mastectomy was the most commonly used surgery in recurrent cases (61.4%). Axillary staging was performed in 31 cases (24.4%); only 2 cases showed positive nodal metastasis (6.5%) and were of the malignant subtype. Distant metastasis occurred in 12 patients, 4 with borderline PTs, and 8 with malignant PTs. The most common site for metastasis was the lungs and bones. Adjuvant radiotherapy was applied in 9 patients, 2 in borderline phyllodes, and 7 in malignant phyllodes; post-radiotherapy recurrence occurred in 5 malignant phyllodes patients. Chemotherapy was employed in 10 metastatic patients (4 with borderline and 6 with malignant phyllodes); excision with clear margins is important to reduce the local recurrence. Routine axillary staging should not be done. The adjuvant radiation therapy is still controversial. Local recurrence can develop even after appropriate surgery. Therefore, close follow-up is mandatory.

Report of Two Cases with Simultaneously Detected Tubular Carcinoma and Phyllodes Tumor of the Breast

Tubular carcinoma (TC) is a subtype of invasive breast carcinoma with better prognosis, and phyllodes tumors (PT) are rare fibroepithelial lesions. Accurate preoperative pathological diagnosis allows for correct surgical planning and avoidance of reoperation for these breast neoplasms. A database was created by analyzing the archives of Department of General Surgery of the İstanbul Faculty of Medicine between September 2006 and November 2017, and a total of 105 PTs and 55 TCs were collected. Two cases with concurrence of TC and PT were identified and examined in detail. The first patient was a 33-year-old woman with a 20×12 mm2 TC and a 65×32 mm2 malignant PT in the left breast. The second patient was a 28-year-old woman with two masses in the right breast. The first mass was 38×16 mm2 on the upper outer quadrant, and the second mass was 10×8 mm2 in size in the lower inner quadrant, accompanied by a 16×10 mm2 TC and a 33×26 mm2 borderline PT. Both cases were treated by mastectomies due to patient's decisions or insufficient margin control. This study extrapolated that if two tumors are detected simultaneously, margin control can become more difficult, and breast-conserving surgery should be thoroughly reviewed.