Malignant Phyllodes Tumor Research Articles

Spontaneous recurrent non-insulin dependent hypoglycaemia associated with malignant phyllodes tumour of the breast: a rare case report

Spontaneous recurrent non-insulin dependent hypoglycaemia associated with malignant phyllodes tumour of the breast: a rare case report

Osteoid containing breast masses: A rad-path correlation

Objectives: Breast cancer is very common, of which the most common subtype is invasive ductal cancer (IDC). However, there are some rare types that also occur and manifest radiologically in a different manner. Our article aims to emphasize a rare type of breast neoplasm, which shows osteoid matrix on pathology, and to correlate their imaging findings, thus enabling differentiation from usual carcinoma and aiding in further pathology typing. Material and Methods: A retrospective audit of breast masses with osteoid matrix was done from 2008 to 2021. The cases were retrieved from pathology archives. Twenty-five such cases were found with histopathology reports mentioning the osteoid matrix. Eight patients from these 25 had pre-operative mammograms as well as histopathology available for review. We evaluated these with mammograms with multiple parameters. The project was approved by the Institutional Ethics Committee. Waiver of consent was obtained since there was no direct contact between the researcher and the participants. Results: Most cases of eccentric coarse calcification seen on mammography showed type IV matrix, in turn meaning that these cases had mature bone formation with tumor cell rimming type on histopathology. Three tumors produced an osteoid matrix in our study, namely, Metaplastic carcinoma, primary osteosarcoma, and malignant phyllodes tumor. Coarse calcification mostly indicates metaplastic carcinoma with osteosarcoma element. The preoperative diagnosis can guide pathology sampling. Conclusion: When eccentric, large, and coarse calcifications are visible within a mass on a mammogram, it raises suspicion of mature bone formation with tumor cell rimming within the tumor matrix.

Rare breast cancers with seemingly benign features on conventional imaging: Radio-pathological correlation and review of literature

Oval or rounded breast masses with circumscribed margins, absence of microcalcifications, and architectural distortions are usually benign. However, 10-20% of breast cancers may have circumscribed margins, which may be misdiagnosed as benign breast mass or lead to delayed diagnosis in advanced stages of cancer. Most frequently, circumscribed breast cancers are high-grade invasive ductal carcinoma of triple-negative molecular subtype. However, there are many other rare histological subtypes of cancers in the breast with circumscribed margins or less aggressive features on imaging and mimic benign breast lesions. A radiologist needs to be familiar with the imaging features of various atypical malignant breast tumors to avoid delay in diagnosis. These rare malignant breast tumors are mucinous carcinoma, papillary carcinoma, lymphoma, leukemia, myeloma, metastasis from extramammary primaries, adenoid cystic carcinoma, signet-ring carcinoma, malignant phyllodes tumor, mesenchymal sarcoma, Ewing’s sarcoma, and medullary carcinoma. This pictorial review illustrates the clinical, multimodality imaging features of rare malignant breast tumors with less aggressive features on conventional breast imaging with pathological correlation.

Malignant phyllodes tumor with lymphatic metastatic dissemination following surgery and radiotherapy

Phyllodes tumors (PTs) are fibroepithelial neoplasms, and constitute less than 1% of all female breast tumors [1]. Malignancy is observed in 10% of PTs, with metastases usually spreading hematogenously. Although up to 15% of hematogenously metastasized PTs include palpable axillary lymph nodes, less than 1% of these cases have been found to have lymph nodes that are positive for malignancy [1]. We present a patient in her forties with a malignant PT that metastasized distantly to the axillary, mediastenal, and retroperitoneal lymph nodes, with liver metastasis, despite surgical excision and radiotherapy. Unfortunately, the patient succumbed to the disseminated PT. Despite the rarity of this condition, we recommend that breast surgeons and other members of the treating team for PTs should be highly aware of lymphatic dissemination so that the health outcomes of patients are optimized.

CD146 promotes malignant progression of breast phyllodes tumor through suppressing DCBLD2 degradation and activating the AKT pathway.

As a rapid-progressing tumor, breast malignant phyllodes tumors (PTs) are challenged by the lack of effective therapeutic strategies and suitable prognostic markers. This study aimed to clarify the role and mechanism of CD146 on promoting PTs malignant progression, and to identify a novel prognosis marker and treatment target of breast malignant PTs. The expression and prognostic significance of CD146 in PTs was detected through single-cell RNA-sequencing (scRNA-seq), immunostaining, real-time PCR and other methodologies. Functional experiments including proliferation assay, colony formation assay, transwell assay, and collagen contraction assay were conducted to validate the role of CD146 in malignant progression of PTs. The efficacy of anti-CD146 monoclonal antibody AA98 against malignant PTs was corroborated by a malignant PT organoid model and a PT patient-derived xenograft (PDX) model. Transcriptome sequencing, proteomic analysis, co-immunoprecipitation, and pull-down assay was employed to identify the modulating pathway and additional molecular mechanism. In this study, the scRNA-seq analysis of PTs disclosed a CD146-positive characteristic in the α-SMA+ fibroblast subset. Furthermore, a progressive elevation in the level of CD146 was observed with the malignant progression of PTs. More importantly, CD146 was found to serve as an independent predictor for recurrence in PT patients. Furthermore, CD146 was found to augment the viability and invasion of PTs. Mechanistically, CD146 acted as a protective "shield" to prevent the degradation of Discoidin, CUB, and LCCL domain-containing protein 2 (DCBLD2), thereby activating the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway and enhancing malignant behaviors of PT cells. In the malignant PT organoid and PDX model, a significant suppression of malignant PT growth was observed after the application of AA98. These findings suggested that CD146 served as an efficacious marker for predicting PT malignant progression and showed promise as a prognosis marker and treatment target of breast malignant PTs. The study further unveiled the essential role of the CD146-DCBLD2/PI3K/AKT axis in the malignant progression of PTs.

Comparative study of benign and malignant parotid gland tumors by infrared thermal imaging

Objective: To analyze the temperature difference of benign and malignant parotid gland tumors in preoperative infrared thermography (IRT), and to provide the basis for predicting tumor properties. Methods: The clinical data of 98 patients with parotid gland tumor admitted to the Department of Oral and maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College, from May 2021 to April 2023 were retrospectively analyzed. There were 61 males and 37 females, aged (51.1±16.0) years (10-86 years). In addition to routine examination, the temperature difference between the lesion site of parotid gland and the contralateral mirror area was measured by infrared thermal imager in all patients one day before surgery. The maximum diameter (dmax) and location of the tumor (deep or superficial lobe) were recorded according to preoperative clinical examination and imaging examinations such as CT and ultrasound. The patients were divided into three groups by tumor size: dmax≤2 cm, 2 cm<dmax≤4 cm, dmax>4 cm. The patients were also divided into different groups: deep lobe group and superficial lobe group (according to the tumor location), benign group and malignant group (according to postoperative pathological results). The relationship between temperature difference, pathology, size and location was analyzed. Results: There were 79 cases in the benign group and 19 cases in the malignant group. The temperature difference of the healthy and affected side in the malignant group [(1.73±0.21) ℃] was significantly higher than that in the benign group [(0.73±0.32) ℃] (t=16.70, P<0.001). There was no significant difference in temperature difference between the healthy and affected sides of tumors with different diameters (P>0.05). The temperature difference of healthy and affected side of tumor in superficial lobe [(0.97±0.50) ℃] was significantly higher than that in deep lobe [(0.67±0.44) ℃] (t=2.24, P=0.028). Conclusions: The difference of temperature difference between benign and malignant parotid gland tumors detected by IRT is statistically significant, which can be used to predict tumor properties, and has certain clinical application value.

1942P Non-metastatic malignant phyllodes tumors of the breast (B-MPT): A retrospective analysis from a referral center

1942P Non-metastatic malignant phyllodes tumors of the breast (B-MPT): A retrospective analysis from a referral center

Extremely Rare Type of Breast Cancer-Dedifferentiated Breast Liposarcoma-Diagnosis and Treatment.

Primary liposarcoma of the breast is an uncommon soft tissue malignant tumor, comprising only 0.003% of all malignant breast tumors. The main differential diagnosis of this mass consists of malignant phyllodes tumor and metaplastic breast carcinoma. The objective of this paper is to report a case of dedifferentiated breast liposarcoma, therapeutic approach and outcome. We present a case of a 79-year-old woman complaining of a large mass in her left breast which had increased in size over the last 6 months. Physical examination revealed an enlarged left breast, and a total body CT scan showed a large tumor in contact with the musculature of the anterior thoracic wall, with no metastatic lesions. The histopathology report of a fine needle biopsy described a high-grade sarcoma. The Oncological Tumor Board recommended neoadjuvant radiotherapy sessions and reevaluation by MRI and CT scans. The patient underwent radical mastectomy with latissimus dorsi myo-cutaneous flap reconstruction. The final histopathology diagnosis was a grade 3 dedifferentiated liposarcoma (FNCLCC), with certain response to radiotherapy and positive MDM2, CDK4 markers. The postoperative period was uneventful; 12 months after surgery, the follow-up CT scan showed multiple pulmonary lesions with metastatic characteristics. Liposarcoma is a very rare type of breast cancer, and the most important treatment for breast sarcoma is surgery, the role of axillary lymph node removal, chemotherapy and radiotherapy still being controversial. Considering such cases are scarce and the development of surgical guidelines is difficult, reporting any new case is crucial.

Clinicopathological Parameters Predicting Malignancy in Phyllodes Tumor of the Breast.

Introduction Phyllodes tumor (PT) is an uncommon fibroepithelial neoplasm of the breast. It is a biphasic tumor with stromal and epithelial components, with a tendency to recur. Because of its wide range of disease manifestations, it has been subclassified into three categories, i.e., benign, borderline, and malignant, based on several histological parameters. This study was conducted to evaluate the clinicopathological features associated with malignancy in breast PTs. Methods We conducted a retrospective study at the Department of Histopathology at Liaquat National Hospital, Karachi, Pakistan. A total of 146 biopsy-proven cases of PTs were enrolled in the study. Clinical data were obtained from the clinical referral forms. Specimens were obtained from either lumpectomy or simple mastectomy. The specimens obtained were received at the laboratory where after gross examination, paraffin-embedded tissue blocks were prepared, which were sectioned, stained, and studied by a senior histopathologist. Pathological features, such as mitotic count, necrosis, stromal atypia, stromal overgrowth, and heterologous elements, were observed. Based on these features, the PTs were classified into benign, borderline, and malignant tumors. Results The mean age of the PTs in our setup was 40.65 ± 12.17 years with a mean size of 9.40 ± 6.49 cm. Malignant PT was found to be the most prevalent in our population, accounting for 63 (43.2%) cases, followed by borderline (51, 34.9%) and benign (32, 21.9%). A significant association was found between the tumor subtype and patient age, i.e., patients diagnosed with malignant and borderline PTs were found to be of older age (mean 42.82 ± 12.94 and 42.05 ± 11.31 years, respectively) than those diagnosed with benign PTs (mean age 34.12 ± 9.75 years). Moreover, malignant PTs were associated with larger tumor size (mean 11.46 ± 6.08) compared with the other two subtypes. Conclusion We found a significant association among patient age, tumor size, and PT subtype. Therefore, apart from the usual histological parameters, patient age and tumor sizeare important parameters for predicting the behavior of breast PT and should be considered for management.

Research trends and perspectives on immediate facial reanimation in radical parotidectomy (Review).

For patients diagnosed with advanced malignant parotid tumour, radical parotidectomy with facial nerve sacrifice is part of the treatment. Multiple surgical techniques have been developed to cure facial paralysis in order to restore the function and aesthetics of the face. Despite the large number of publications over time on facial nerve reanimation, a consensus on the timing of the procedure or the donor graft selection has remained to be established. Therefore, the aim of the present study was to conduct a bibliometric analysis to identify and analyse scientific publications on the reconstruction of the facial nerve of patients who underwent radical parotidectomy with facial nerve sacrifice. The analysis on the topic was conducted using the built-in tool of the Scopus database and VOSviewer software. The first 100 most cited articles were separately reviewed to address the aim of the study. No consensus was found regarding the recommended surgical techniques for facial nerve reanimation. The most used donor cranial nerves for transfer included the following: Masseteric branch of the V nerve, contralateral VII nerve with cross-face graft, the XI nerve and the XII nerve. The best timing of surgery is also controversial depending on pre-exiting pathology and degree of nerve degeneration. However, most of the clinical experience suggests facial nerve restoration immediately after the ablative procedure to reduce complications and improve patients' quality of life.

Small Bowel Metastases From Malignant Phyllodes Breast Tumor Detected by 18 F-FDG PET/CT.

The most common sites of distant metastases are lung, bone, pleura, and mediastinum in malignant phyllodes breast tumors. However, small bowel metastasis from malignant phyllodes breast tumors is rare. We reported that using CT and FDG PET/CT imaging we identified a case with small bowel metastasis from breast cancer. PET/CT scan showed that high 18 F-FDG uptake occurred in the duodenum and jejunum. Histopathology and immunohistochemistry analyses further confirmed that malignant phyllodes tumors are derived from the breast.

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.

Phyllodes Tumors of the Breast: Clinicopathological Analysis of 35 Single-Center Cases

Aim: This study was conducted with the aim of to evaluate demographics of patients with phyllodes tumor (PT), clinical and histopathologic characteristics of tumors, and to share treatment approach to PTs from the experience of our center. Method: In the study, the demographic, clinicopathological characteristics and treatment approaches of the patients who were treated between 2006 and 2017 at the Oncology Institute, Istanbul University with the diagnosis of PT were evaluated retrospectively by examining the patient files and pathology records. Results: The median age was 39.7±11.1 years. For diagnosis, 6 patients underwent excisional biopsies, 1 patient incisional biopsy, and 27 patients core biopsies. Twenty seven patients underwent breast-conserving surgery (BCS), whereas 8 patients had mastectomy. Re-excision was added to one lumpectomy, and 2 cases who had BCS were converted to mastectomy due to margin positivity. The mean PT size was 55.3 mm (13 mm - 210 mm). The PT subtypes were as follows: benign (n=15, 42.9%), borderline (n=7, 20.0%), and malignant (n=13, 37.1%). Among those with malignant PTs, 3 patients received chemotherapy (CT) and radiotherapy (RT) following mastectomy, one patient with lumpectomy had CT and RT, and 2 patients received only RT. Patients with PT were followed for an average of 70 months (12 months- 184 months). Seven local recurrences (LR) (2 benign PT, 1 borderline PT, and 4 malignant PT), 1 single distant metastasis (malignant PT), and 1 LR plus distant metastasis (malignant PT) were observed in follow-up. Conclusion: Negative surgical margin of ≥1cm is the most important step in the management of PTs. The survival benefit of adjuvant CT or RT are contraversial and need further investigation.

Comprehensive Clinical-Pathologic Assessment of Malignant Phyllodes Tumors: Proposing Refined Diagnostic Criteria.

The latest World Health Organization classification of breast tumors recommends diagnosing malignant phyllodes tumors (MPTs) when all 5 morphologic features are present: permeative borders, marked stromal cellularity, marked stromal cytologic atypia, ≥10 mitoses per 10 high-power fields (HPF), and stromal overgrowth. We assessed the performance of this recommendation to capture MPTs and features predictive of distant metastasis in a multi-institutional retrospective study. Of 65 MPTs, most cases had at least focally permeative borders (58, 89%), with marked stromal cellularity in 40 (61.5%), marked atypia in 38 (58.5%), ≥10 mitoses per 10 HPF in 50 (77%), and stromal overgrowth in 56 (86%). Distant metastases were observed in 20 (31%) patients (median follow-up 24.5mo, 1 to 204). Only 13 of 65 (20%) cases had all 5 morphologic features, while only 7 of 20 (35%) cases with distant metastases had all 5 features. In univariate analysis, only marked stromal atypia ( P =0.004) and cellularity ( P =0.017) were associated with decreased distant metastasis-free survival. In multivariate Cox regression, the combination of stromal overgrowth, marked stromal cellularity, and atypia (C-index 0.721, 95% CI: 0.578, 0.863) was associated with decreased distant metastasis-free survival. The current World Health Organization recommendation will miss a significant number of MPTs with distant metastases. We propose refined diagnostic criteria for MPTs: (1) stromal overgrowth combined with ≥1 feature(s) (marked cellularity, marked atypia, or ≥10 mitoses per 10 HPF), or (2) in the absence of stromal overgrowth, marked cellularity combined with ≥1 feature(s) (permeative borders, marked atypia, or ≥10 mitoses per 10 HPF).

Classification of benign and malignant parotid tumors based on CT images combined with stack generalization model.

Parotid tumors are among the most prevalent tumors in otolaryngology, and malignant parotid tumors are one of the main causes of facial paralysis in patients. Currently, the main diagnostic modality for parotid tumors is computed tomography, which relies mainly on the subjective judgment of clinicians and leads to practical problems such as high workloads. Therefore, to assist physicians in solving the preoperative classification problem, a stacked generalization model is proposed for the automated classification of parotid tumor images. A ResNet50 pretrained model is used for feature extraction. The first layer of the adopted stacked generalization model consists of multiple weak learners, and the results of the weak learners are integrated as input data in a meta-classifier in the second layer. The output results of the meta-classifier are the final classification results. The classification accuracy of the stacked generalization model reaches 91%. Comparing the classification results under different classifiers, the stacked generalization model used in this study can identify benign and malignant tumors in the parotid gland effectively, thus relieving physicians of tedious work pressure.

Clinical perspectives and outcomes of the giant breast phyllodes tumor and sarcoma: a real-world retrospective study

BackgroundGiant breast malignant phyllodes tumor or sarcoma (GBPS) are rare entities with diameter larger than 10 cm and variously histological pleomorphisms. This disease poses a significant threat to the quality of life of individuals, and its prognosis remains unclear. This study aimed to explore the differential diagnosis, treatment, and prognosis of GBPS in a real-world retrospective cohort.MethodsWe collected GBPS (diameter > 10 cm, n = 10) and BPS (diameter ≤ 10 cm, n = 126) from patients diagnosed with sarcoma or malignant phyllodes tumor between 2008 and 2022. We analyzed clinical characteristics, histological status, treatment, and local recurrence using the Fisher’s exact test between GBPS (diameter > 10 cm) and BPS (diameter ≤ 10 cm) cohort. We described overall survival (OS) and disease-free survival (DFS) using Kaplan–Meier curves and identified risk factors for local recurrence using logistic regression. The tumor size, age at diagnosis, and differential immunohistochemistry markers of breast sarcoma or phyllodes tumor to determine the prognosis of GBPS.ResultsIn our retrospective analysis of breast malignancies, we identified 10 cases of GBPS and 126 cases of BPS, corresponding to a GBPS prevalence of 0.17% (10/6000). The median age was 38.5 years (inter-quartile range, IQR: 28.25–48.5 years). During the follow-up of period (median: 80.5 months, IQR: 36.75–122 months), the local recurrence (LR) rate was 40% and 20.6%, respectively. Clinical characteristics of young age (HR:2.799, 95%CI -00.09276—0.017, p < 0.05) and cytological characteristics of marked stromal atypia (HR:0.88, 95% CI 0.39–1.40, p < 0.05) were risk factors for the poor prognosis of GBPS by COX regression model analysis. The Kaplan–Meier curves of GBPS 5-year disease-free survival (DFS) and overall survival (OS) were 31.5 months and 40 months, respectively, and were not associated with adjuvant radiation or chemotherapy.ConclusionWe recommend mastectomy with a clear surgical margin as the preferred treatment for GBPS. Age and stromal atypia are significantly associated with recurrence. Adjuvant radiation therapy is advised; however, there was no improvement in overall survival. There is no consensus on the effectiveness of adjuvant chemotherapy and genetic methods, highlighting the need for further research into this aggressive tumor. We recommend a multidisciplinary approach involving a dedicated team for the management of GBPS.

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.

Construction and Application of a Nomogram for Predicting Benign and Malignant Parotid Tumors.

A prediction model of benign and malignant differentiation was established by magnetic resonance signs of parotid gland tumors to provide an important basis for the preoperative diagnosis and treatment of parotid gland tumor patients. The data from 138 patients (modeling group) who were diagnosed based on a pathologic evaluation in the Department of Stomatology of Jilin University from June 2019 to August 2021 were retrospectively analyzed. The independent factors influencing benign and malignant differentiation of parotid tumors were selected by logistic regression analysis, and a mathematical prediction model for benign and malignant tumors was established. The data from 35 patients (validation group) who were diagnosed based on pathologic evaluation from September 2021 to February 2022 were collected for verification. Univariate and multivariate logistic regression analysis showed that tumor morphology, tumor boundary, tumor signal, and tumor apparent diffusion coefficient (ADC) were independent risk factors for predicting benign and malignant parotid gland tumors ( P < 0.05). Based on multivariate logistic regression analysis of the modeling group, a mathematical prediction model was established as follows: Y = the ex/(1 + ex) and X = 0.385 + (1.416 × tumor morphology) + (1.473 × tumor border) + (1.306 × tumor signal) + (2.312 × tumor ADC value). The results showed that the area under the receiver operating characteristic curve of the model was 0.832 (95% confidence interval, 0.75-0.91), the sensitivity was 82.6%, and the specificity was 70.65%. The validity of the model was verified using validation group data, for which the sensitivity was 85.71%, the specificity was 96.4%, and the correct rate was 94.3%. The results showed that the area under receiver operating characteristic curve was 0.936 (95% confidence interval, 0.83-0.98). Combined with tumor morphology, tumor ADC, tumor boundary, and tumor signal, the established prediction model provides an important reference for preoperative diagnosis of benign and malignant parotid gland tumors.

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.