Case Of Malignant Phyllodes Tumor Research Articles

Malignant phylloides with heterologous elements: A case report

Phyllodes tumor of the breast is an uncommon biphasic tumor, occurring mainly in females belonging to the age group of 42 to 45 years. Malignant phyllodes tumor is a rare neoplasm that accounts for 10 to 20% of total phyllodes tumors. Histologically, phyllodes tumors are featured by leaf like projections of hypercellular stroma into the cystic or cleft-like spaces being lined by epithelium. Presence of stromal elements like fibrosarcomatous and heterologous sarcomatous characters are associated with an increased risk of malignant change. Here, we report a rare case of a 50yrs old female patient, who presented with swiftly growing left breast mass that was diagnosed as a case of malignant phyllodes tumor showing heterologous elements in form of chondroid, liposarcomatous, rhabdoid and fibrosarcoma, with marked proliferation of stromal component. The patient was subjected to modified radical mastectomy.

Abstract P2-23-03: Genomic Evaluation of Malignant Phyllodes Tumors Reveals Multiple Targetable Opportunities

Abstract Background: Malignant phyllodes tumors (MPT) are rare fibroepithelial breast tumors that disproportionately affect young women. Despite high local and distant recurrence rates, treatment is almost exclusively surgical. With no known effective chemotherapy or targeted systemic therapy options, metastatic progression portends dismal prognosis. Current national guidelines do not recommend biomarker testing in the non-metastatic setting. Management of metastatic disease follows principles of soft tissue sarcoma recommending Next-Generation Sequencing on an individual basis for patients who may qualify for clinical trials or are refractory to standard therapies. In the largest genomic profiling effort of MPT to date, we sought to describe the genomic landscape of MPTs through comprehensive genomic profiling (CGP) and immunotherapeutic biomarker analysis. Methods: Cases of sequenced MPT were identified from a CLIA-certified, CAP-accredited laboratory database (Foundation Medicine, Cambridge, MA). Cases were categorized as localized/locally recurrent or metastatic. All cases underwent CGP by DNA extraction from FFPE samples using a hybrid capture, adaptor ligation-based next generation sequencing assay, and all classes of genomic alterations, microsatellite instability (MSI), and tumor mutational burden (TMB) were evaluated. PD-L1 expression by IHC was measured by the DAKO 22C3 assay (scored CPS) or the Ventana SP142 assay (scored as IC). Patient characteristics and results of CGP of MPT were summarized by either N (%) or median (range). Factors from MPT were compared to all cases of breast carcinoma in the lab database. Fisher’s Exact Tests were used to test for differences between groups and analysis of variance was used to test for differences for continuous variables. Results: Of 135 MPT cases identified; 94 (69.6%) were localized/locally recurrent (breast, chest wall, soft tissue, skin, or lymph node) and 41 (30.4%) were metastatic (73% lung, followed by bone, liver, other intraabdominal). All patients were female with a median age of 54 years (range 14-86). The median TMB across samples was 2.5 mut/Mb and only 3 were TMB-high tumors (>10mut/Mb). Over 1/3 (36.8%) of samples were PD-L1+ via Ventana SP142 assay (≥1) and 21.4% were PD-L1+ via Dako 22C3 assay (CPS ≥10). All evaluable cases (N=132) were microsatellite stable. The ten most commonly altered genes included TERT-promoter (69.7%), CDKN2A (45.9%), TP53 (37.8%), NF1 (35.6%), CDKN2B (33.3%), MED12 (28.9%), MTAP (27.7%), KMT2D (22.2%), PIK3CA (20.0%), PTEN (18.5%), and RB1 (18.5%); notably distinct in frequency from the breast carcinoma cohort (Table 1). Alterations in genes affecting cell cycle regulation (i.e. CDKN2A/B and TP53) were mutually exclusive from one another (p< 0.001). Several tumors harbored genomic alterations with FDA-approved indications in other tumor types were found including: NF1, PIK3CA, EGFR Exon 19/20 insertions, and BRAF V600E mutations. There were no statistically significant differences between alterations in localized/locally recurrent versus metastatic specimens. Conclusions: In the largest genomic evaluation of localized/locally recurrent or metastatic MPTs to date, multiple clinically actionable mutations for further exploration were found. TERT-promoter was altered in the majority of cases. PDL-1 was expressed in over 1/3 of cases suggesting that clinical investigation of immunotherapeutic strategies is warranted. Routine sequencing of metastatic MPT may provide additional information to guide treatment decisions and clinical trial enrollment. Table 1. Frequency of Genomic Alterations identified in 135 cases of Malignant Phyllodes Tumors. Citation Format: Laura H. Rosenberger, Richard F. Riedel, Natalie A. Danziger, Ethan Sokol, Jeffrey S. Ross, Sarah L. Sammons. Genomic Evaluation of Malignant Phyllodes Tumors Reveals Multiple Targetable Opportunities [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-23-03.

Study of CD117 Expression on Phyllodes Tumor of Breast and Its Correlation with Histopathological Grade

Background: Accurately predicting the nature and differentiating of various grades of Phyllodes tumor, the diagnosis may vary by different pathologists1, as there is no standard interpretation of the histologic cut-point criteria and therefore. In this study, we evaluated the impact of CD117 expression on Phyllodes tumor of breast and usefulness of this marker to differentiating benign from malignant phyllodes tumors. Methods: This cross-sectional observational study was conducted in the Department of Pathology, Dhaka Medical College. The study includes mastectomy/lumpectomy specimens received from surgery and surgical oncology departments and diagnosed as phyllodes tumor histopathological. Tissue processing and staining were performed using standard protocol. Histopathological typing and grading were done according to WHO recommended criteria 2012. Immunostaining for CD117 done on all 50 cases. Toluidine blue staining was performed on CD117 immunostaining positive cases, to see presence of mast cells. Result: This study consists of 50 cases of phyllodes tumor of breast. In all the cases immunohistochemistry was done with markers CD117. Histological Grading of phyllodes tumor was done using stromal cellularity, nuclear pleomorphic, stromal overgrowth, mitotic rate, margin of tumor. Statistical analysis was done and results were compared with various available previous studies. This study showed that most of benign/low grade phyllodes tumors belonged to the age group of 35-46 years and most of malignant phyllodes tumors belonged to the age group of 30.50-47.50 malignant phyllodes tumor in this study was 40 years. Overall 44% (22 out of 50) of the cases showed positivity for CD117 in the stroma. Among them 85% cases of malignant Phyllodes tumors of breast shows stromal expression of CD117. This study shows association of CD117 expression with malignant phyllodes tumor. Epithelial CD117 positivity was found in 69.5% cases of benign/low grade Phyllodes tumors of breast. Current study also shows association of CD117 epithelial expression with benign phyllodes tumor the result of our study show strong correlation between CD117 expression and histopathological grade. Conclusion: In conclusion, we can report an association of CD117 protein expression in borderline/malignant tumors and which may be associated with worse prognosis. So we can suggest for targeted therapy for these patient group having Phyllodes Tumor with positive CD117 expression.

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

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

Malignant Mesenchymal and Fibroepithelial Breast Tumors - Presentation of Three Cases

Introduction: Malignant mesenchymal breast tumors, as is the case also with malignant phyllodes tumors, are rare malignancies that share several clinical and pathological characteristics. They are often locally aggressive and have a high potential for distant metastasis. This paper reports two cases of malignant phyllodes tumors and one case of breast sarcoma managed by our breast surgery team. One of the malignant phyllodes tumors showed rapid progression with early multiple visceral involvement and death. Discussion: Presentation of an updated review of the literature covering clinical, pathological, radiological and therapeutic considerations related to breast sarcomas and malignant phyllodes tumors. Conclusion: Breast sarcomas and malignant phyllodes tumors are rare breast malignancies that share more similarities than differences and require a multidisciplinary approach to management.

Malignant Phyllodes Tumor of the Breast with Metastasis to the Pancreas: A Case Report and Review of Literature

Phyllodes tumor (PT) is a rare tumor of the breast accounting for approximately 1% of all breast neoplasms. In 1838, J. Muller coined the term “cystosarcoma phyllodes” based on the leaf-like projections of the tumor extending into the cystic spaces and sarcomatous stromal growth. However, seeing as up to 70% of phyllodes tumors are benign, “cystosarcoma” was removed, and the tumor is now recognized simply as phyllodes tumor. It is mainly seen in females between the ages of 35 and 55. Although most phyllodes tumors are benign, malignant cases do uncommonly occur, 22% of which have distant metastasis typically to the lungs and bones. Rarely, this tumor metastasizes to other locations. Herein, we report a case of malignant phyllodes tumor with metastasis to the pancreas. According to our knowledge, only 3 case reports of pancreatic metastasis from malignant phyllodes tumor have been reported in literature thus far. We aim to increase awareness among physicians of this rare metastasic potential of the uncommonly encountered malignant phyllodes tumor.

Progression of Fibroadenoma to Malignant Phyllodes Tumour in a 14-Year Female.

Phyllodes tumours are uncommon breast tumours which account for less than 1% of all breast neoplasms. High-grade malignant phyllodes tumour is a very rare but aggressive breast malignancy and forms approximately 15-30% of all phyllodes tumours. The transformation of a benign fibroadenoma into a malignant phyllodes tumour in a teenaged female is even rarer. We report here an interesting case of malignant phyllodes tumour in a 14-year female patient who was operated twice previously with the diagnosis of complex fibroadenoma in the same breast. There was a large tumour involving whole of the breast and infiltrating the skin. The patient was operated and total mastectomy was done. Diagnosis was confirmed after histopathological examination and immunohistochemistry of the resected specimen. Patient received adjuvant radiotherapy and there was no recurrence on 6-month follow-up. Owing to the rare occurrence of malignant phyllodes tumour in this age group along with previous operations for complex fibroadenoma, this case is being reported here.

A case of malignant phyllodes tumor of the breast with intramuscular metastasis

A case of malignant phyllodes tumor of the breast with intramuscular metastasis

Fibroadenoma in an operated case of malignant phyllodes tumour: a rare case report

Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of breast neoplasms. Displaying a broad range of clinical and pathological behaviour, phyllodes tumours should be regarded as a spectrum of fibroepithelial neoplasms rather than a single disease entity. We would like to present a rare presentation of fibroadenoma over site of a previously operated case of malignant phyllodes tumour. A 36 year old female came to OPD with complaints of lump in both breasts since 4 months. She gave history of previous surgery, i.e., left breast lumpectomy for which HPE report was suggestive of malignant phyllodes tumour. On examination, 3x2 cm, solitary, firm to hard, non-tender lump was felt in the junction of the upper outer and inner quadrant just below the scar of previous surgery and was not freely mobile and appeared fixed to the scar. Patient underwent excision of the lump with frozen section and final HPE report turning out to be fibroadenoma. Though diagnosis of malignant phyllodes tumour is not difficult, diagnosis of low grade phyllodes tumour and distinction from fibroadenoma on FNA is difficult due to overlapping features between the two lesions. Surgery remains the mainstay of treatment for patients with cystosarcoma phyllodes, extent of surgery been controversial, and continues to evolve. Incidence of fibroadenoma occurring at the previous operated site of malignant phyllodes tumour is very rare with no known previous documentation of such a case.

集学的治療が奏効した乳房悪性葉状腫瘍異時性リンパ節転移の1例

59歳，女性．6カ月前より左乳房腫瘤を自覚していたが放置していた．腫瘤からの出血にて当科初診．20cm大の腫瘍が自壊し出血しており，針生検で葉状腫瘍と診断した．その後1カ月で30cmまで急速に増大，低栄養と貧血にて入院．中心静脈栄養と輸血を行った後，初診より2カ月で単純乳房全摘術を施行，腫瘍重量は3,400gだった．術後は創感染以外は良好であり，術後31日に退院．切除標本では，線維性間質と上皮の増生からなる葉状部分，間質の充実性増生からなる部分があり，間質の充実性増生部分で高度な異型細胞が認められ，骨肉腫と横紋筋肉腫の像も伴っていた．多彩な組織像を示す悪性葉状腫瘍と診断した．術後1年のPET-CT検査でFDG集積を伴う縦隔・右鎖骨上リンパ節腫大あり，転移と診断した．ドキソルビシン投与を行った後に放射線照射を施行，転移巣は縮小した．5年6カ月経過したが無再発である．

Omental Metastasis of Malignant Phyllodes Tumor: A Case Report

Malignant Phyllodes tumor behaves like sarcomas and has a tendency for local spread and for local recurrence. The metastasis commonly known is blood borne and is usually to the lungs, mediastinum and skeleton rather than to the axillary lymph nodes. In present case of malignant phyllodes tumor there was metastasis to omentum, probably the only reported case in English literature.

骨・軟骨成分と癌成分を伴う悪性葉状腫瘍の1例

骨・軟骨成分と癌成分を伴う悪性葉状腫瘍の1例

術後早期に局所再発と肺・骨転移し予後不良であった悪性葉状腫瘍の1例

葉状腫瘍は乳房腫瘍中の0.5％以下と稀で，25％が悪性である．われわれは急速増大し，術後短期間に再発・転移した悪性葉状腫瘍の1例を経験した．症例は38歳女性．1カ月前から急速増大する左乳房腫瘤を自覚，皮膚自壊部から出血し当院受診，緊急入院となった．針生検で葉状腫瘍が疑われ，左乳房切除・植皮術を施行．病理診断は悪性葉状腫瘍であった．術後1カ月で局所再発，多発肺転移出現．症状緩和目的に再発腫瘍切除術・植皮術を施行し術後経過良好であったが，術後10日目のCTで肺転移増大・胸壁再発・骨転移指摘された．初回手術3カ月後，下肢麻痺を主訴に受診，骨転移による脊髄圧迫を認めた．放射線照射およびステロイドパルスも効果なく，再発巣・転移巣ともに増大．初回手術から5カ月後に永眠された．根治手術後短期間に再発をきたした悪性葉状腫瘍の1例を経験したので報告する．

MFH Mimic in Breast: A High-Grade Malignant Phyllodes Tumor

Malignant phyllodes tumor is usually diagnosed by the presence of benign duct-like epithelium and malignant mesenchymal tissue. In addition to the usual fibrosarcomatous features, the mesenchymal component may show areas resembling osteogenic sarcoma, chondrosarcoma, liposarcoma, leiomyosarcoma, rhabdomyosarcoma, malignant mesenchymoma, and, very rarely, malignant fibrous histiocytoma. We present one such rare case of malignant phyllodes tumor with malignant fibrous histiocytoma-like stromal differentiation.

Comparison of stromal CD10 expression in benign, borderline, and malignant phyllodes tumors among Egyptian female patients

Phyllodes tumors are group of biphasic fibroepithelial tumors of the breast of varying malignant potential, ranging from benign tumors to fully malignant sarcomas. According to the Egyptian National Cancer Institute, female malignant cases showed appreciable increase in the recent time period for breast cancer with the malignant phyllodes tumors representing 0.41% of cases in the year 2003-2004. This is an immunohistochemical study to compare CD10 expression in benign, borderline, and malignant phyllodes tumors, in order to highlight its diagnostic and prognostic values. This study conducted 34 Egyptian female cases of phyllodes tumors of different grades to be studied histologically and immunohistochemically using antibodies against CD10. The Chi-square test was used to determine differences in CD10 expression between benign, borderline, and malignant tumors. One-way ANOVA test was used to determine whether the difference was significant. Significance was established at P<0.05. In the 24 cases of benign phyllodes tumors, only four cases (16.7%) showed positive CD10 reactivity. Three cases (60%) out of five borderline phyllodes tumors showed positive CD10 reactivity, while four (80%) out of five cases of malignant phyllodes tumors showed positive CD10 staining. From these highly significant results, we believe that there is a strong correlation between CD10 expression and tumor grade, which could be an important observation that may have both diagnostic and prognostic implications as well as promising potential target for development of novel therapies.

Malignant phyllodes tumor in an 11-year-old premenarchal girl

Phyllodes tumor is uncommon in children, and the malignant form is rare. There have only been a few cases of benign phyllodes tumor reported in peripubertal children and only one malignant case. We report the second case of malignant phyllodes tumor in a premenarchal 11-year-old girl.

Osseous differentiation in cystosarcoma phyllodes - diagnosed by fine needle aspiration cytology

Osseous differentiation within a phyllodes tumor is extremely rare. Cytological and histological findings of a case of malignant phyllodes tumor with osseous differentiation are presented. A 45-year-old female had a malignant phyllodes tumor with osseous stroma diagnosed by fine needle aspiration cytology. The cytological findings were representative of the histological features. The diagnosis of these tumors preoperatively is important in planning the most appropriate treatment. It is also important to follow up these patients postoperatively for long periods for recurrence and metastasis.

Malignant phyllodes tumor composed almost exclusively of a fibrosarcomatous component: a case report and review of malignant phyllodes tumors with metastases

Here we present a case of malignant phyllodes tumor which was composed almost exclusively of a fibrosarcomatous component. A 52-year-old Japanese female noted a rapid increase of her right breast tumor. On admission, multiple lung metastases were detected by imaging. Right simple mastectomy was performed. The tumor, 10 x 10 cm in the largest dimension, had somewhat of a pushing margin, and showed a flesh-like appearance with marked necrosis. Microscopically, the tumor showed proliferation of atypical ovoid- or spindle-shaped cells in a myxoid matrix. Multiple sectioning revealed that the tumor had only focal occurrence of elongated tubular structures, and the occurrence of a small component of benign phyllodes tumor, leading to the aforementioned final diagnosis. Spindle cell carcinoma was excluded on the basis of the HE findings and the lack of immunoreactivity for cytokeratin when using a broad spectrum antibody mixture. Although the patient received adjuvant chemotherapy, no responsiveness was obtained. The patient died 4 months following surgery. We reviewed 15 malignant phyllodes tumors with metastases reported in Japan. The estimated 2.2-year survival rate following detection of metastasis was 11%, thus confirming the aggressiveness of the disease.

Malignant Phyllodes Tumors: A Review of 752 Cases

Malignant phyllodes tumor (MPT) is a rare breast malignancy. Because of the scarcity of the disease, there are no evidence-based treatment or follow-up guidelines established. This study evaluated the survival of MPT patients to create recommendations for management. We identified 752 cases of malignant phyllodes tumors in the California Cancer Registry from the years 1988 to 2003. Relative survival was determined using Berkson-Gage life table analysis which was then compared with the relative survival of nonphyllodes breast cancer patients. For MPT patients, the relative annual survival at 1 year was 94 per cent and at 10 years was 99.6 per cent. Thus, after 10 years, these patients are no more likely to die than the general population. At 10 years, the relative cumulative survival of the MPT patients was 87.4 per cent, whereas the nonphyllodes breast cancer patients had only a 57.2 per cent relative cumulative survival. MPT patients with localized disease had a higher 10-year relative cumulative survival than those with regional disease (90.9% vs. 61.5%, P < 0.001). MPT has a good prognosis, particularly in patients with localized disease. After 10 years, MPT patients have no increased mortality relative to the general population. Clinicians should plan these patients' follow-up accordingly.

CD34, CD117, and actin expression in phyllodes tumor of the breast.

This study investigated the immunophenotypic patterns of CD34, CD117 (a product of the c-kit proto-oncogene), and actin (HHF35) in benign and malignant phyllodes tumors (PTs). We correlated the expression of CD34, CD117, and actin with histopathological grade. We analyzed 19 cases (7 benign and 12 malignant cases) of PTs using immunohistochemical analysis. Six of 7 benign PT stromal lesions stained positively for CD34, while only 3 of 12 cases of malignant PT were focally CD34 positive (P = 0.0106). Only 1 of the 7 benign PTs stromal lesions expressed CD117. Nine of the malignant PTs were composed CD117-positive fibroblasts. This result demonstrated that CD117 expression is associated with the malignant potential of PTs (P = 0. 0106). Actin (HHF-35) expression was found in 8 of 12 cases of malignant PTs (P = 0.027), but in only 1 of 7 cases of benign PTs. Actin expression was significantly (P = 0.04) correlated to frequent mitotic activity (>5 mitoses per 10 high-power fields). The immunophenotypic markers were not related to tumor size. Additionally, we sequenced part of the juxtamembrane region of the c-kit proto-oncogene and found point mutations in two malignant PTs. Our results demonstrated that expression of CD34 was associated with benign PTs, while CD117 and actin were preferentially expressed in malignant PTs. Our results implied that these immunohistological markers might be used for the histopathological grading of PTs.