Fibroepithelial Lesions Research Articles

MALIGNANT PHYLLODES TUMORS – A SINGLE HOSPITAL ANALYSIS

Abstract Introduction/Objective Phyllodes tumor (PT), a rare fibroepithelial breast lesion, affects around 1% of breast tumors, primarily in women aged 40–50 years old. The interpretive subjectivity, histological overlap, and limited molecular predictors, necessitate further investigation into their pathogenesis. Prognosis relies on WHO grading based on stromal proliferation. Malignant-PTs are rare and challenging to diagnose, posing a diagnostic challenge with breast sarcomas and metaplastic carcinomas. The study aims to highlight morphological features of malignant-PTs and their correlation on patients’ survival and prognosis. Methods/Case Report Retrospective single-institute study of 33 women who were diagnosed with malignant-PT according to WHO criteria and underwent excision were identified from database spanning 2005-2024. Clinical and pathologic characteristics including biopsy results, histological features, imaging findings, and survival outcomes were analyzed statistically using Kaplan-Meier method. Results (if a Case Study enter NA) Patients aged 28-72 years underwent excision, with a mean of 50 years and tumor sizes ranging 1.1-34 cm with a mean of 11.5 cm. The majority (19 cases) were classified as pT stage I or II, with 14 cases at more advanced stages. Malignant heterologous elements were found in 10 cases (30%). Positive margins were noted in 12 excisions (36%). Besides tumor recurrence in 3 cases (9%) within 33 months post-excision, metastasis was observed in 8 cases, occurring between 4-60 months post-excision. Six patients died from metastasis within 11-62 months post-diagnosis. Conclusion The presence of negative margins and appropriate treatment was associated with a lower risk of recurrence and metastasis. However, they were not linked to enhance survival rates. Survival was primarily correlated to the absence of heterologous components and PT’s staging.

Retrospective analysis of core-needle and vacuum-assisted breast biopsies of B3 fibroepithelial lesions and correlation with results in subsequent surgical specimens

BackgroundFibroepithelial lesions (FEL) are a heterogeneous group of biphasic tumours that include fibroadenomas (FA) and the rare entity of benign phyllodes tumors (PT) as well as cases where distinction between these two entities is not possible. The histologic distinction between benign PT and cellular FA is still a diagnostic challenge, especially in core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB). Guidelines are not clearly established regarding the management of FEL in CNB or VAB. In this study, we addressed the frequency of B3 FEL diagnosed in CNB or VAB and compared the final histopathological findings in the excision specimens to evaluate up- or downgrading.MethodsWe identified 117 female patients with the preoperative diagnosis of FEL (B3), PT, or FEL in combination of pure epithelial B3 lesions in CNB or VAB. Clinico-pathological information as well as data on subsequent surgical excision were available for all patients.ResultsPT was diagnosed in 9 (14.8%) and FEL (B3) in 52 (85.2%) cases. Additionally, 56 patients with FA in combination with an additional B3 lesion were identified. Most FEL (B3)/PT initial diagnoses were made in CNB (55.6% of PT; 84.6% of FEL). After the initial biopsy, 7 of 9 (77.8%) patients with initial diagnosis of benign or borderline PT in CNB/VAB and 40 of 52 (77.0%) patients with initial diagnosis of FEL (B3) in CNB/VAB underwent open excision (OE). 4 of 9 cases (44.4%) initially diagnosed as PT were verified, whereas 2 of 9 (22.2%) were downgraded to FA. 20 of 52 cases (38.5%) initially diagnosed as FEL (B3) were downgraded to FA, whereas 11 of 52 cases (21.2%) were diagnosed as benign or borderline PT. One FEL (B3) case was upgraded to malignant PT.ConclusionMost PT and FEL (B3) diagnoses on CNB/VAB underwent surgical removal. In the final pathological findings of cases classified primarily as FEL (B3), the majority were downgraded to FA, one quarter were upgraded to PT, and a small subset remained as combined FA/PT. In clinical daily practice, we recommend individualized decision-making considering different options (clinical follow-up or removal of the lesion depending on the whole context) in a multidisciplinary preoperative conference.

Diabetic mastopathy in an adult female patient with type 2 diabetes in Indonesia: a case report and literature review

Background: Diabetic mastopathy (DMP) is a rare pathological condition characterized by the formation of tumor-like fibroepithelial lesions in the breast region, typically observed in individuals afflicted with type 1 diabetes mellitus. This study presents an atypical occurrence of diabetic mastopathy found in a 29-year-old female with type 2 diabetes mellitus of the non-insulin-dependent subtype. Case Presentation: The physical examination revealed the presence of a firm and palpable lump near the nipple of the right breast. An ultrasound (US) examination was conducted, illustrating the presence of tissue distortion and nipple retraction of the breast. Lymphadenopathy in the right axilla and infraclavicular regions was also found. Histological findings demonstrated typical DMP with fibrosis without evidence of malignancy. Conclusion: Diabetic mastopathy is a rare disorder that may pose a challenge. However, meticulous monitoring and assertive management, along with timely identification and effective administration of medical care, can ultimately result in a positive prognosis.

Clinicopathological Study of Fibroepithelial Lesions of the Breast in a Tertiary Care Hospital in South India.

Introduction Fibroepithelial lesions of the breast mainly include fibroadenoma and phyllodes tumors with overlapping morphological features and varied clinical behavior. This study aims to determine the histopathological spectrum of fibroepithelial lesions of the breast in a tertiary care hospital. Methods This is a cross-sectional study that was carried out in the pathology department from 1stJanuary 2015 to 31stDecember 2023. Relevant data of all fibroepithelial lesions reported during the study period were retrieved from the medical records, tabulated, and analyzed. The Pearson chi-square test was used to determine the significant association between the various clinicopathological parameters of fibroepithelial lesions. A p-value of less than 0.05 was taken as statistically significant. Results Out of a total of 195 fibroepithelial lesions, 185 (95%) were fibroadenoma, 07 (3.5%) were phyllodes tumors, and three (1.5%) were fibroadenoma with tubular adenoma. The most common age group was 21 to 40 years, with the majority of phyllodes tumors being more than 5 cm in size compared to fibroadenomas. The association between the clinicopathological characteristics such as age of patients, tumor size, and histological grade was statistically insignificant in this study. Conclusions The implementation and usage of morphological diagnostic criteria will help in diagnosing and categorizing this broad group of fibroepithelial lesions, thereby facilitating appropriate treatment forpatients.

Accuracy and Comparison of Core Needle Biopsy Diagnoses With Excision Specimen for Diagnosing Fibroepithelial Lesions of the Breast.

Background Core needle biopsy (CNB) for fibroepithelial lesions (FELs) of the breast is commonly encountered by histopathologists. The distinction between fibroadenoma (FA) and phyllodes tumor (PT) can be challenging due to overlapping histological features and the limited nature of CNB material. Objective This study aimed to assess the accuracy of CNB diagnosis of FA and PT by comparing it with a diagnosis on subsequent surgical excision specimen. Materials and methods A total of 166 cases of FELs of the breast who underwent CNB and subsequent surgical excision between January 2001 and December 2020 were included in our study. All microscopy glass slides were reviewed, and diagnosis confirmed. Results While 125 (75%) cases based on CNB received a definitive diagnosis of either fibroadenoma or PT, the remaining 41 (25%) cases were better classified on excision specimens and were descriptively diagnosed as fibroepithelial lesions on CNB. Diagnoses on CNB and on subsequent excision specimens were concordant in 113 (90.4%) cases. Among 12 cases that were discordant, three cases diagnosed as FA on CNB were upgraded toPT on excision specimens. Nine cases diagnosed as PT on CNB were diagnosed as FA on excision specimens. These included conventional, cellular, juvenile, and complex FA types. Three PTs, which were reported as FA on CNB, measured 6, 12.5, and 17.5 cm in the greatest dimension. Among 23 cases of PT which were further categorized on CNB, tumor categories changed on excision specimens in three cases. The diagnostic accuracy of CNB diagnosis was 90.4%. Conclusion CNB diagnosis showed good accuracy. PT diagnosis should be strongly considered in all tumors measuring >5 cm, especially those exceeding 10 cm. Cellular, juvenile, and complex FAs can be misdiagnosed as PT on CNB. Correlation with clinical and radiological findings can be helpful in establishing correct diagnosis.

De-escalating indications for excision when breast core needle biopsy returns fibroepithelial lesion—not further characterized

De-escalating indications for excision when breast core needle biopsy returns fibroepithelial lesion—not further characterized

Fibroepithelial Neoplasm with Hybrid Features of Benign Phyllodes Tumor, Juvenile Papillomatosis, and Juvenile Fibroadenoma: A Case Report.

Phyllodes tumor is an uncommon breast fibroepithelial neoplasm mainly found in middle-aged patients, presenting a morphologic continuum from benign to malignant. Juvenile papillomatosis represents a rare benign proliferative breast tumor primarily affecting young individuals and carries a potential elevated risk of subsequent breast cancer development. Juvenile fibroadenoma is a well-circumscribed biphasic neoplasm that often occurs in adolescent girls, characterized by a pericanalicular growth pattern with usual-type epithelial hyperplasia and gynaecomastia-like micropapillary proliferation. Herein, we present an unusual example of a 26-year-old woman with a left breast outer lower quadrant palpable mass. Ultrasonography identified a 5.9 cm lobulated hypoechoic solid mass with scattered small cysts. The preoperative biopsy initially diagnosed a fibroepithelial lesion, considering giant cellular fibroadenoma and phyllodes tumor in the differential. Subsequent complete excision revealed areas of benign phyllodes tumor features closely admixed with distinctive elements such as prominent multiple cysts exhibiting apocrine and papillary apocrine metaplasia, duct papillomatosis, and duct stasis characteristic of juvenile papillomatosis, and hyperplastic ductal epithelium with micropapillary projections demonstrating a pericanalicular growth pattern indicative of juvenile fibroadenoma. The diagnosis was conclusively established as a fibroepithelial lesion with combined features of benign phyllodes tumor, juvenile papillomatosis, and juvenile fibroadenoma. Further investigation uncovered a family history of breast cancer. Molecular analysis revealed a pattern of unique and overlapping mutations within these distinct histopathological areas. This unusual presentation with hybrid features within a single tumor is described for the first time in the literature along with the molecular signature of the individual components.

LOCALLY RECURRENT BREAST PHYLLODES TUMORS: ABOUT TWO CASES AND LITERATURE REVIEW

Phyllodes tumors of the breast, rare fibroepithelial lesions, present unique challenges due to their potential for local recurrence and metastasis. While surgical excision is the primary treatment modality, achieving clear margins does not always guarantee prevention of recurrence. Factors such as tumor histology and pathologic features influence recurrence rates, with borderline and malignant tumors being at higher risk. Adjuvant therapies, particularly radiotherapy, show promise in improving local control, but their efficacy remains under investigation. Continued research is essential to identify predictive factors for recurrence and to refine treatment strategies for recurrent phyllodes, ultimately minimizing their impact on patients and healthcare professionals. This article presents two cases of recurrent phyllodes tumors and underscores the need for further exploration into the management of recurrent phyllodes tumors and highlights the ongoing challenges in mitigating their recurrence and improving patient outcomes.

Abstract PO5-11-01: Audit of multidisciplinary team meetings for improving breast cancer care

Abstract Introduction: Multidisciplinary team (MDT) meeting is a well-established method of optimising care for breast cancer patients. However, its effectiveness has not been proven yet. The present study aims to audit the functioning of MDT at a tertiary care hospital in a low-middle income country. Methods: This study examines the prospectively maintained database of patients being discussed in MDT meetings occurring from August 2018 till June 2023. The MDT was suspended for few months in between owing to the COVID pandemic. The analysis was done in terms of indications of discussion, referring department, modification in the pre-MDT plan, new investigation advised, radiological and pathological concordance, significant change in management strategy and interesting cases. The analysis is both qualitative and quantitative. Quantitative analysis involves percentages, mean and median. Results: MDT at our institute was conducted every Saturday at 12 noon as an in-person meeting. The MDT was suspended from May 2020 till June 2021 in view of the pandemic. It was restarted in July 2021, on an online platform and is continued as such. A total of 473 cases were discussed with 181 (38.2%) benign causes and rest were malignant. The most common indication of discussion for malignant cases was feasibility of breast conservation (59.9%) followed by ruling out recurrence/residual disease (17.4%). The indication for benign cases was rad-path concordance and ruling out phyllodes in a case of fibroepithelial lesion. In 31.4% of the cases the plan was modified from the pre-MDT plan and there was improved care. 34.7% cases were advised to get a new investigation done in form of contrast enhanced mammogram or MRI. Seventy nine percent cases were feasible for BCS, and it was done involving few complex surgeries as well. The most common indication for deferring BCS was extensive DCIS. The total number of man hours spent in preparation as well as MDT were analysed with improved clinical care and revealed the MDT to be a time intensive exercise with poor efficacy in terms of hours spent per patient. The time to decision making was increased at an average of 7.5 days for these patients. Conclusion: MDT helps to achieve goals of superior clinical care for both benign and malignant breast disorders at the cost of increased time to decision. It is labour intensive with capability of changing decision in one third of the cases. However, MDT needs regular audit to ensure optimum care with available resources. Citation Format: Kanika Sharma, Gopal Puri. Audit of multidisciplinary team meetings for improving breast cancer care [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-01.

Using the DNA Integrity Number to Analyze DNA Quality in Specimens Collected from Liquid-Based Cytology after Fine-Needle Aspiration of Breast Tumors and Lesions

Introduction: Cancer genome analysis using next-generation sequencing requires adequate and high-quality DNA samples. Genomic analyses were conventionally performed using formalin-fixed paraffin-embedded sections rather than cytology samples such as cell block or smear specimens. Specimens collected from liquid-based cytology (LBC) have the potential to be sources of high-quality DNA suitable for genetic analysis even after long-term storage. Methods: We collected breast tumor/lesion fractions from 92 residual LBC specimens using fine-needle aspiration (FNA) biopsy, including breast carcinoma (1 invasive carcinoma and 4 ductal carcinomas in situ), papillomatous lesion (5 intraductal papillomas), and fibroepithelial lesion (19 phyllodes tumors and 53 fibroadenomas) samples, and others (1 ductal adenoma, 1 hamartoma, 1 fibrocystic disease, and 7 unknown). DNA was extracted from all samples and subjected to DNA integrity number (DIN) score analysis. Results: Average DIN score collected from 92 LBC specimens was significantly higher score. In addition, high-quality DNA with high DIN values (7.39 ± 0.80) was successfully extracted more than 12 months after storage of residual LBC specimens. Conclusion: Residual LBC specimens collected from FNA of the breast were verified to carry high-quality DNA and could serve as an alternate source for genetic analysis.

Detailed DNA methylation characterisation of phyllodes tumours identifies a signature of malignancy and distinguishes phyllodes from metaplastic breast carcinoma.

Phyllodes tumours (PTs) are rare fibroepithelial lesions of the breast that are classified as benign, borderline, or malignant. As little is known about the molecular underpinnings of PTs, current diagnosis relies on histological examination. However, accurate classification is often difficult, particularly for distinguishing borderline from malignant PTs. Furthermore, PTs can be misdiagnosed as other tumour types with shared histological features, such as fibroadenoma and metaplastic breast cancers. As DNA methylation is a recognised hallmark of many cancers, we hypothesised that DNA methylation could provide novel biomarkers for diagnosis and tumour stratification in PTs, whilst also allowing insight into the molecular aetiology of this otherwise understudied tumour. We generated whole-genome methylation data using the Illumina EPIC microarray in a novel PT cohort (n = 33) and curated methylation microarray data from published datasets including PTs and other potentially histopathologically similar tumours (total n = 817 samples). Analyses revealed that PTs have a unique methylome compared to normal breast tissue and to potentially histopathologically similar tumours (metaplastic breast cancer, fibroadenoma and sarcomas), with PT-specific methylation changes enriched in gene sets involved in KRAS signalling and epithelial-mesenchymal transition. Next, we identified 53 differentially methylated regions (DMRs) (false discovery rate < 0.05) that specifically delineated malignant from non-malignant PTs. The top DMR in both discovery and validation cohorts was hypermethylation at the HSD17B8 CpG island promoter. Matched PT single-cell expression data showed that HSD17B8 had minimal expression in fibroblast (putative tumour) cells. Finally, we created a methylation classifier to distinguish PTs from metaplastic breast cancer samples, where we revealed a likely misdiagnosis for two TCGA metaplastic breast cancer samples. In conclusion, DNA methylation alterations are associated with PT histopathology and hold the potential to improve our understanding of PT molecular aetiology, diagnostics, and risk stratification. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Benign Phyllodes Tumor with Extensive Cystic Squamous Metaplasia, Clinically Presenting as Malignant Phyllodes

Abstract Phyllodes tumor are very rare fibroepithelial lesions which comprises 0.3%–1% of all primary breast tumors with peak age around 40–50 years. Phyllodes tumor are classified ino three types: Benign, borderline and malignant tumors. Metaplastic change is very rare in these tumors and can involve both epithelial or stromal components. Stromal metaplastic changes include cartilage, bony or fatty change. Epithelial metaplastic changes include apocrine or squamous change. About 10% of phyllodes tumor show squamous metaplasia. We report a case of 47-year-old patient presenting with large lump in right breast measuring 16 cm × 15 cm × 11 cm, occupying all four quadrants. Clinically, it appeared as malignant phyllodes. But, microscopically, it was benign phyllodes tumor having extensive cystic squamous metaplasia.

Comparative analysis of mammary lump histology and elasto-graphy results at a tertiary hospital

In the majority of India's metropolitan populations, mammary carcinoma has become the commonest type of carcinoma. A non-invasive imaging method called mammary sono-elasto-graphy can reveal information about mammary lesions. Aims &amp; objectives: In the current research, we examined the diagnostic efficacy of elasto-graphy and histopathological findings of mammary lumps. Material and Methods: The current investigation involved Female patients had solid mammary lesions less than 3 cm in size that were visible on sonography. Classified as BI RADS 3 and 4 lesions, these lesions. Results: 252 female patients had U.S.G. elastography, followed by biopsy or surgery, and histopathology reports were available during the research period. Histopathologically, 104 (41.72%) samples were benign, and the remaining 148 (58.73%) were malignant. Age, B.I.R.A.D.S., Elastography Score, and Strain Ratio were all statistically higher in malignant cases than in benign patients (p 0.001). According to Histo-pathological analysis, fibroadenoma (77.03%) accounted for the majority of benign lesions, followed by Abscess (5.41%), sclerosing adenosis (1.35%), benign fibroepithelial lesion (6.76%), and fibrocystic disease (9.46%). Conversely, poorly differentiated invasive carcinoma (5.77%), invasive ductal carcinoma (67.31%), and invasive mucinous carcinoma (13.46%), IL.C. (5.77%), medullary carcinoma (1.92%), papillary carcinoma (1.92%), and phylloid (1.92%) made up the bulk of malignant cases, Excellent results were noticed with the combination of Ultrasound Score + Elastography Score + Strain Ratio, with scores of 96.00%, 96.05%, 96.03%, 94.12%, and 97.33%, respectively, for susceptibility, accuracy, diagnostic accuracy, and N.P.V. and PPV. Conclusion: The ability to distinguish between benign and malignant mammary masses using ultra-sound elasto-graphy, strain elasto-graphy, and ultra-sound score has good susceptibility, accuracy, and diagnostic accuracy.

Benign phyllodes tumor arising from accessory breast tissue of the axilla: An inquisitive rarity

Abstract Accessory breast tissue is the superfluous tissue that persists from normal embryological development. The pathological involvement of this tissue is quite uncommon and can be diagnostically challenging. Phyllodes tumor is a rare mammary fibroepithelial lesion that has been seldom reported to originate from the accessory breast tissue. This article describes an extremely rare case of a benign phyllodes tumor arising from the accessory breast tissue of the left axilla in a 40-year-old female so as to create awareness about rare tumors occurring within rare anomalies.

European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO

IntroductionBreast lesions of uncertain malignant potential (B3) include atypical ductal and lobular hyperplasias, lobular carcinoma in situ, flat epithelial atypia, papillary lesions, radial scars and fibroepithelial lesions as well as other rare miscellaneous lesions. They are challenging to categorise histologically, requiring specialist training and multidisciplinary input. They may coexist with in situ or invasive breast cancer (BC) and increase the risk of subsequent BC development. Management should focus on adequate classification and management whilst avoiding overtreatment. The aim of these guidelines is to provide updated information regarding the diagnosis and management of B3 lesions, according to updated literature review evidence. MethodsThese guidelines provide practical recommendations which can be applied in clinical practice which include recommendation grade and level of evidence. All sections were written according to an updated literature review and discussed at a consensus meeting. Critical appraisal by the expert writing committee adhered to the 23 items in the international Appraisal of Guidelines, Research and Evaluation (AGREE) tool. ResultsRecommendations for further management after core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB) diagnosis of a B3 lesion reported in this guideline, vary depending on the presence of atypia, size of lesion, sampling size, and patient preferences. After CNB or VAB, the option of vacuum-assisted excision or surgical excision should be evaluated by a multidisciplinary team and shared decision-making with the patient is crucial for personalizing further treatment. De-escalation of surgical intervention for B3 breast lesions is ongoing, and the inclusion of vacuum-assisted excision (VAE) will decrease the need for surgical intervention in further approaches. Communication with patients may be different according to histological diagnosis, presence or absence of atypia, or risk of upgrade due to discordant imaging. Written information resources to help patients understand these issues alongside with verbal communication is recommended. Lifestyle interventions have a significant impact on BC incidence so lifestyle interventions need to be suggested to women at increased BC risk as a result of a diagnosis of a B3 lesion. ConclusionsThese guidelines provide a state-of-the-art overview of the diagnosis, management and prognosis of B3 lesions in modern multidisciplinary breast practice.

Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation.

Fibroepithelial lesions (FELs) are among the most common breast masses encountered by breast radiologists and pathologists. They encompass a spectrum of benign and malignant lesions, including fibroadenomas (FAs) and phyllodes tumors (PTs). FAs are typically seen in young premenopausal women, with a peak incidence at 20-30 years of age, and have imaging features of oval circumscribed hypoechoic masses. Although some FA variants are especially sensitive to hormonal influences and can exhibit rapid growth (eg, juvenile FA and lactational adenomas), most simple FAs are slow growing and involute after menopause. PTs can be benign, borderline, or malignant and are more common in older women aged 40-50 years. PTs usually manifest as enlarging palpable masses and are associated with a larger size and sometimes with an irregular shape at imaging compared with FAs. Although FA and FA variants are typically managed conservatively unless large and symptomatic, PTs are surgically excised because of the risk of undersampling at percutaneous biopsy and the malignant potential of borderline and malignant PTs. As a result of the overlap in imaging and histologic appearances, FELs can present a diagnostic challenge for the radiologist and pathologist. Radiologists can facilitate accurate diagnosis by supplying adequate tissue sampling and including critical information for the pathologist at the time of biopsy. Understanding the spectrum of FELs can facilitate and guide appropriate radiologic-pathologic correlation and timely diagnosis and management of PTs. Published under a CC BY 4.0 license. Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Synchronous presentation of borderline phyllodes tumour and tubular adenoma in a background of fibrocystic disease - A case report

Mammary fibroepithelial lesions encompass a wide spectrum of tumours ranging from an indolent fibroadenoma to potentially fatal malignant phyllodes tumour. Here, we report a case of 22 -year -old unmarried girl with bilateral breast lump for one month who underwent wide local excision which on histopathological examination revealed borderline phyllodes tumour and tubular adenoma in a background of fibrocystic disease with adenosis, marked epithelial hyperplasia, fibro adenomatoid change and apocrine metaplasia a rare occurrence which can be confused with benign and malignant lesions of the breast.

Latissimus Dorsi Myocutaneous Flap Reconstruction Post Resection of a Giant Malignant Phyllodes Tumor of the Breast: A Case Report

Phyllodes tumors (PTs) are a rare group of mammary fibroepithelial lesions accounting for up to 1% of breast tumors. They display biologic diversity, ranging from benign to malignant. PTs of the breast are mostly found in females aged 35–55 years and are rare in adolescents and the elderly. They usually present as a fast growing, painless breast mass. The treatment of choice for PTs is complete excision with clear margins. In patients with large PTs, breast reconstruction results in better outcome and increased satisfaction.Our patient, a 39-year-old female presented with an enlarging breast mass over a period of 6 months. Physical examination showed a large, ulcerated mass involving the entire right breast. Histopathology revealed features of a malignant PT. Total mastectomy and immediate reconstruction with a pedicled latissimus dorsi myocutaneous flap and symmetrization reduction mastopexy of the left breast was done. At 6 months, the patient has not shown any gross tumor recurrence with acceptable cosmesis.

The Genetic Landscape of Fibroepithelial Lesions of the Breast.

Fibroepithelial lesions of the breast encompass a broad spectrum of lesions from fibroadenomas and their variants to phyllodes tumors, including their clinical range of benign, borderline, and malignant. Classification of this spectrum of neoplasms has historically and currently been based purely on morphology, although the nomenclature has shifted over the years largely due to the significant histologic overlap that exists primarily within the cellular fibroadenomas to borderline malignant phyllodes tumor categories. A review of the current diagnostic challenge, proposed ancillary studied and their value in prognostic significance, is provided. This article highlights the most recent molecular and genetic findings as well as the limitations of the studies, in the context of practical and available applications for the diagnostician and managerial implications for the clinician.

Versican core protein aids in the diagnosis and grading of breast phyllodes tumor

Phyllodes tumors (PTs) are biphasic fibroepithelial lesions that occur in the breast. Diagnosing and grading PTs remains a challenge in a small proportion of cases, due to the lack of reliable specific biomarkers. We screened a potential marker versican core protein (VCAN) through microproteomics analysis, validated its role for the grading of PTs by immunohistochemistry, and analyzed the correlation between VCAN expression and clinicopathological characteristics. Cytoplasmic immunoreactivity for VCAN was identified in all benign PT samples, among which 40 (93.0 %) showed VCAN-positive staining in ≥50 % of tumor cells. Eight (21.6 %) borderline PT samples showed VCAN-positive staining in ≥50 % of the cells with weak to moderate staining intensity, whereas 29 samples (78.4 %) showed VCAN-positive staining in <50 % of the cells. In malignant PTs, 16 (84.2 %) and three (15.8 %) samples showed VCAN-positive staining in <5 % and 5–25 % of stromal cells, respectively. Fibroadenomas showed a similar expression pattern to benign PTs. Fisher's exact test showed that the percentages of positive cells (P < .001) and staining intensities (P < .001) of tumor cells were significantly different between the five groups. VCAN positivity was associated with tumor categories (P < .0001) and CD34 expression (P < .0001). The expression of VCAN gradually decreases as the tumor categories increases, following recurrence. To the best of our knowledge, our results are the first in the literature to reveal that VCAN is useful for diagnosing and grading PTs. The expression level of VCAN appeared to be negatively associated with PT categories, suggesting that dysregulation of VCAN may be involved in the tumor progression of PTs.