Malignant Phyllodes Tumor Research Articles

Rethinking on the management strategy of malignant phyllodes tumor of the breast: An analysis based on the SEER database.

Malignant phyllodes tumor of the breast (MPTB) is a rare breast neoplasm that has a high recurrence rate and its optimal treatment strategies remain controversial. Our study used the most up-to-date database to determine prognostic factors that predict cancer-specific survival (CSS) and to evaluate the effects of different treatment strategies for MPTB. We performed a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Women who were diagnosed with MPTB from 2000 to 2019 were included. Kaplan-Meier method and Cox proportional hazards regressions were used to evaluate the prognostic power of variables on CSS. A total of 1902 women with MPTB were included in the study, with a median follow-up duration of 87.5 months. Age was found not to independently predict CSS in patients with tumors larger than 10 cm (P = .235). Mastectomy was performed on a total of 898 (47.2%) patients including 210 women (23.4%) undergoing radiotherapy after surgery. Mastectomy showed worse CSS when compared with breast-conserving surgery in patients with tumors smaller than 10 cm. Patients undergoing radiotherapy were not inferior to non-radiotherapy patients on CSS when patients were stratified by tumor size. Breast-conserving surgery showed survival benefits for patients with small tumors (T1 and T2). Patients with radiotherapy were not inferior to non-radiotherapy patients on CSS. Treatment of patients with MPTB should be carefully selected based on different tumor sizes.

CT-based radiomics with various classifiers for histological differentiation of parotid gland tumors.

This study assessed whether radiomics features could stratify parotid gland tumours accurately based on only noncontrast CT images and validated the best classifier of different radiomics models. In this single-centre study, we retrospectively recruited 249 patients with a diagnosis of pleomorphic adenoma (PA), Warthin tumour (WT), basal cell adenoma (BCA) or malignant parotid gland tumours (MPGTs) from June 2020 to August 2022. Each patient was randomly classified into training and testing cohorts at a ratio of 7:3, and then, pairwise comparisons in different parotid tumour groups were performed. CT images were transferred to 3D-Slicer software and the region of interest was manually drawn for feature extraction. Feature selection methods were performed using the intraclass correlation coefficient, t test and least absolute shrinkage and selection operator. Five common classifiers, namely, random forest (RF), support vector machine (SVM), logistic regression (LR), K-nearest neighbours (KNN) and general Bayesian network (Gnb), were selected to build different radiomics models. The receiver operating characteristic curve, area under the curve (AUC), accuracy, sensitivity, specificity and F-1 score were used to assess the prediction performances of these models. The calibration of the model was calculated by the Hosmer-Lemeshow test. DeLong's test was utilized for comparing the AUCs. The radiomics model based on the RF, SVM, Gnb, LR, LR and RF classifiers obtained the highest AUC in differentiating PA from MPGTs, WT from MPGTs, BCA from MPGTs, PA from WT, PA from BCA, and WT from BCA, respectively. Accordingly, the AUC and the accuracy of the model for each classifier were 0.834 and 0.71, 0.893 and 0.79, 0.844 and 0.79, 0.902 and 0.88, 0.602 and 0.68, and 0.861 and 0.94, respectively. Our study demonstrated that noncontrast CT-based radiomics could stratify refined pathological types of parotid tumours well but could not sufficiently differentiate PA from BCA. Different classifiers had the best diagnostic performance for different parotid tumours. Our study findings add to the current knowledge on the differential diagnosis of parotid tumours.

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.

DIAGNOSTIC PERPLEXITY: METAPLASTIC CARCINOMA OF BREAST VERSUS MALIGNANT PHYLLODES TUMOR OF BREAST

Metaplastic breast carcinoma is an uncommon breast neoplasm constituting less than 1% of all breast cancers. It is more aggressive and has poorer prognosis than other breast carcinomas. It has variable and similar presentation to others. With this case report of a 76-year-old female who presented with a large tender rapidly progressive erythematous lump, we aim to reveal the rarity in pathologic and clinical features of the metaplastic breast carcinoma and its similarities to malignant phyllodes tumor of breast. It has been later diagnosed post operatively as Metaplastic carcinoma of breast. Immunohistochemistry plays an important role in its diagnosis.

Survival in Patients with Primary Parotid Gland Carcinoma after Surgery—Results of a Single-Centre Study

This study aims to analyse a single-centre cohort series of patients who underwent parotidectomy for primary malignant parotid tumours. A retrospective chart review of 64 consecutive patients treated from November 2010 to March 2022 was performed. Outcomes were analysed by Kaplan-Meier curves. Sixty-four patients with a primary parotid malignancy were included in the study, with one bilateral case in this cohort. Patients were classified as stage I-II in 39 cases and stage III-IV in 26 cases. The five-year overall survival (OS), disease-specific survival (DSS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 78.4%, 89%, 92.5%, and 87.1%, respectively. Univariate analysis showed that high-risk histology, stage IV disease, lymphovascular invasion, perineural invasion, node metastasis, skin involvement, facial nerve involvement, and positive or close margins were risk factors associated with poorer outcomes. At present, the best evidence suggests that radical surgery should be the standard approach, and adjuvant therapy, in terms of radiotherapy/chemoradiotherapy, is recommended in patients with risk factors.

Parotid gland masses: outcomes in the pediatric age group

BackgroundChildhood parotid neoplasms appear to have different characteristics from adults. This point, in addition to the rarity of these tumors, reflects the challenges faced in diagnosing and treating parotid neoplasms in children.Patients and methodsThis retrospective study included all children who presented to the Children’s Cancer Hospital Egypt (CCHE, 57357) with parotid masses from January 2008 to December 2020.ResultsTwenty-one patients were included. Malignant neoplasms were found in 12 (57.1%) of which mucoepidermoid carcinoma was the most common. Benign neoplasms were found in 6 (28.6%) all of them were pleomorphic adenoma, and non-neoplastic lesions were found in 3 (14.3%). Superficial, deep, or total parotidectomy was performed according to the involved lobes. The facial nerve was sacrificed in three cases because of frank invasion by the tumor. Neck dissection was considered in clinically positive lymph nodes and/or T3/4 masses. Complications occurred in 7 (33.3%) all were of the malignant cases. Adjuvant radiotherapy was restricted to high-risk cases (7 cases). Recurrence occurred in two cases, and one patient died of distant metastasis. Fine needle aspiration cytology (FNAC) showed 88.9% sensitivity and 100% specificity for diagnosing malignant neoplasms. The correlation of radiological and pathological staging was fair (66.74% for overall staging).ConclusionsParotidectomy is the backbone treatment for benign and malignant pediatric parotid tumors. Neck nodal dissection should be considered after preoperative FNAC of suspicious nodes. Adjuvant radiotherapy is considered only in high-risk tumors. Preoperative FNAC of parotid masses and clinically suspicious lymph nodes is highly recommended.

Contrast-Enhanced Ultrasound and Strain Elastography for Differentiating Benign and Malignant Parotid Tumors.

Preoperative differentiation between benign parotid tumors (BPT) and malignant parotid tumors (MPT) is crucial for treatment decisions. The purpose of this study was to investigate the benefits of combining contrast-enhanced ultrasound (CEUS) and strain elastography (SE) for preoperative differentiation between BPT and MPT. A total of 115 patients with BPT (n=72) or MPT (n=43) who underwent ultrasound (US), SE, and CEUS were enrolled. US and CEUS features and the elasticity score were evaluated. Receiver operating characteristic curve (ROC) analysis was used to assess the diagnostic performance of SE, CEUS, and SE + CEUS with respect to identifying MPT from BPT. Solitary presentation, larger diameter, irregular shape, ill-defined margin, heterogeneous echogenicity, and calcification on US and higher elasticity score on SE had a significant association with malignancy. MPT also presented an unclear margin, larger size after enhancement, and "fast-in and fast-out" pattern on CEUS. The combination of SE and CEUS was effective for differentiating MPT from BPT (AUC: 0.88, 0.80-0.95), with a sensitivity of 86.0%, specificity of 88.9%, and accuracy of 87.8%, which were significantly higher than the values for SE (AUC: 0.75, 0.66-0.85) and CEUS (AUC: 0.82, 0.73-0.91) alone. The combination of CEUS and SE is valuable for distinguishing MPT from BPT.

Histomorphological analysis of phyllodes tumors at a tertiary care center

Background: Phyllodes tumors (PT) are rare biphasic neoplastic breast lesions. They account for 0.3–0.5% of female breast tumours1 and have an incidence of about 2.1 per million, the peak of which occurs in women aged 45–49 years. There is sometimes difficulty in dividing tumors into the three recognized grades based on histomorphological features. It is because of the subjective variation and absence of a definitive grading system. More importantly, they do not always correlate with clinical outcome in terms of predicting recurrence, malignant transformation, metastasis, and overall survival. Aims and Objectives: (1) The aim of the study was to study the clinicopathological and histomorphological features of the PT and classify the tumors based on 2019 WHO classification. Materials and Methods: This study was done in the Department of Pathology at Government General Hospital Nizamabad. Total 68 cases are included in this study over a period of 5 years (3 1⁄2 years retrospective and 11/2 year prospective) from 2017 March to 2022 March. PT cases were analyzed based on 2019 WHO classification criteria. The age of the patients, tumor locations, and the relevant details were obtained from the pathology records. Results: Of the 68 PT cases, 53 (78%) were classified as benign, 8 (12%) borderline and 7 (10%) malignant PT based on histomorphological features based on 2019 WHO classification. Conclusion: Our study showed that tumors occurring in older age group with a large tumor size and the presence of malignant heterologous elements, infiltrating borders, and surgical margins <1 cm were usually malignant phyllodes.

Unusual presentation of malignant phyllodes tumor in a young female: (Case report and review of literatures)

SUMMARY:
 Phyllodes tumor (PT) of the breast is rare in adolescent females, particularly malignant ones. It usually occurs in middle aged and older women. Malignant phyllodes (MP) do have a recurrence and a metastatic potential, unlike benign or borderline PT. We present the case of a 16-years old female presenting with a 6- month history of a progressive enlarged left breast mass. Tumor was excised as a mass of 7 cm in maximum diameter and sent for histopathological examination. The Histopathology revealed features of malignant phyllodes tumor that were confirmed by immunohistochemistry.

Characteristics, Surgical Management, and Outcomes of Parotid Gland Masses in the Pediatric Age Group: A Single Tertiary Institute Experience.

Parotid gland lesions in children requiring surgical management are not common. Neoplastic lesions of the parotid glands are also less common. Parotid tumors in children have different characteristics from those that occur in adults. When they occur in the pediatric age group, malignancy has to be ruled out. This is a retrospective study of children who presented to our institute, a tertiary care referral hospital for children <12 years, with parotid swellings during the 5-year period between April 2018 and March 2023. The children who underwent surgical management for parotid lesions, in the form of parotidectomy, were included in the study. Children who were treated by nonoperative management were excluded from the study. Twelve children were included. Of the 12 children, three (25.0%) children had malignancy, four (33.33%) children had benign tumors, three (25.0%) children had vascular malformations, and the remaining two (16.67%) children had inflammatory etiology. All children underwent superficial/total parotidectomy, depending on the involvement of superficial and/or deep lobe. Of the three malignant parotid tumors, two were of mucoepidermoid carcinoma and one was myoepithelial carcinoma. One of the children with mucoepidermoid carcinoma had recurrence. Facial nerve-sparing parotidectomy is the treatment for neoplastic and inflammatory lesions. Initially, lymphovascular tumors were treated aggressively with parotidectomy. Neck node dissection should be performed only in children with fine-needle aspiration cytology-confirmed nodal metastases during primary surgery. Adjuvant treatment may be required in selected cases.

Surgery for phyllodes tumour of the breast. What should be surgical margins?

Optimal and tailored surgical treatment of phyllodes tumour(PT) of the breast is controversial. This study aims to determine the appropriate surgical margin in the treatment of PT. The data of 132 patients who underwent breast surgery with the diagnosis of PT at the Breast Unit of Istanbul Faculty of Medicine from 2000 to 2022 were retrospectively reviewed. Median age was 38 and patients with benign PT were younger than others(median age was 34, 44, and 43 for benign, borderline, and malignant, respectively) (P= 0.001). Local recurrence was observed in 7 (5.3%) patients, systemic recurrence was observed in 3 (2.3%) patients, and disease-related death was observed in 2 (1.5%) patients. Local recurrence occurred in 1.4% (n= 1) of benign tumours, 8.3% (n= 2) of borderline tumours, and 10.3% (n= 4) of malignant tumours. All of the systemic recurrences and deaths were seen in the malignant group. The local recurrence rate was found to be higher in borderline and malignant tumours with surgical margins less than 10 mm (44.4% versus 3.7%, P= 0.003), and tumours larger than 5 cm (11.8% versus 1.3%, P= 0.015). In comparison, there was no correlation between the surgical margin proximity, tumour diameter, and local recurrence rates in benign PT (P> 0.05). According to our findings, negative surgical margins seem to be sufficient in the treatment of benign phyllodes tumours. Furthermore at least 1 cm negative surgical margins must be achieved for malignant and borderline phyllodes tumours to avoid local recurrence.

Evaluating Online Patient Health Information on Parotidectomy - Is it Readable and of Good Quality?

Parotidectomy is considered the definitive management for benign and malignant parotid gland tumours. Complications and long-term outcomes of parotidectomy can pose a massive impact on patients’ quality of life. Although there are potential benefits of obtaining health information from the internet, it has its limitations on quality and accuracy of information. This research evaluates the readability and quality of online patient health information(PHI) on parotidectomy.

Role of Cross-sectional Imaging in Evaluation of Parotid Gland Tumours: A Pictorial Review

Radiological evaluation of the parotid gland neoplasms is a major challenge for radiologists, due to the wide variety of imaging features and differential diagnosis. Though Ultrasonography (USG) combined with guided Fine Needle Aspiration Cytology (FNAC) is the primary diagnostic modality, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in the evaluation of patients presenting with suspected neoplastic lesions of the parotid gland. Cross-sectional imaging data of seven patients were selected and reviewed in detail. CT and MRI imaging had been done on patients referred to Radiology Department for clinically suspected parotid tumours. All of them underwent surgical excision and histopathological examination postimaging. Benign tumours usually arise from superficial lobe and exhibit strong signal intensity on T2 weighted images with well-defined margins. Lobulated margins with T2 dark rim are characteristic of pleomorphic adenoma. Hyperdense lesion with cystic changes with occasional bilateralism favour Warthin’s tumour. Most of the malignant parotid tumours involve deep lobe and appear as low signal lesion on T2 weighted imaging with ill-defined margins. Locally aggressive features like subcutaneous/deep infiltration strongly suggests malignancy. Cross-sectional imaging feature of carcinoma ex pleomorphic adenoma is variable from focally aggressive to totally aggressive tumourigenesis. Few malignant tumours like high-grade Mucoepidermoid Carcinoma (MEC) and Adenoid Cystic Carcinoma (AdCC) can show tendency towards perineural spread. Although histopathological examination is required for definitive diagnosis, few pathology-specific imaging findings on cross-sectional imaging can help in localising and characterising the parotid lesions and categorising innocuous benign from sinister malignant lesions and thus narrow down the differential diagnosis.

Histopathological Spectrum of Phyllodes Tumor of Breast in a Tertiary Health Care Center: A 5-Year Retrospective Study

Objectives: This study was done to evaluate the histopathological spectrum of phyllodes tumor of breast in women of various age groups. Study design: Cross-sectional descriptive study Place and Duration: This cross-sectional study was done at the Department of histopathology, Liaquat University of Medical and Health sciences, Jamshoro, Pakistan. 2017-2021. Methods: Total 178 cases of phyllodes tumors were retrospectively identified. The clinical history of patients was taken from computer storage data followed by review of microscopic slides by two histopathologists. Excel 2021 and SPSS 22 were used for statistical analysis. Results: The mean age was 35.37±11.74 (range 12-70 years). Most of the cases were of benign phyllodes tumors 55.1%(n=98). Maximum number of cases were of the age groups 30-39 years (36.5%(n=65). Two cases of malignant phyllodes tumor were noted in age groups 11-20 years. Conclusion: Phyllodes tumor of breast is more common in 3rd decade. A multidisciplinary approach including complete and thorough clinical examination, careful histopathologic evaluation should be done to ensure prompt treatment to patients. Keywords: Phyllodes tumor, Fibroepithelial lesion, Histopathologic examination

Histological Risk Factors for Local Recurrence of Phyllodes Tumors of the Breast.

The rate of local recurrence (LR) of phyllodes tumor (PT) varies from 4 to 18%. Several histological risk factors of LR of PT are known. The aim of this study was to estimate the LR rate of PT according to PT grade and to evaluate histological risk factors of PT LR in our retrospective cohort. This was a two-center study, conducted from 1995 to 2019. All patients with PT diagnosed on surgical specimen were included. PT was diagnosed histologically according to the grade category defined by the 2012 World Health Organization classification as benign, borderline or malignant PT. Univariate analysis and then multivariate logistic regression analysis were performed to determine histological risk factors of LR of PT. A total of 224 patients with PT were included: 152 with benign, 49 with borderline and 23 with malignant PT. The median and standard deviation for the duration of follow-up was 136.60 ± 167.43 months, and 18 patients (8.04%) developed LR: 7 (4.61%), 7 and (14.29%) and 4 (17.39%) with benign, borderline and malignant PT, respectively. In univariate analysis, LR was statistically increased for histological size ≥45 mm (p=0.003), borderline/malignant TP (p=0.006) and dense stromal cellularity (p<0.001). In multivariate analysis, only histological size ≥45 mm and cellularity were statistically associated with LR (odds ratio=1.83, 95% confidence interval=1.06-9.83, p=0.04; and odds ratio=3.69, 95% confidence interval=1.11-12.28, p=0.03, respectively). Histological size ≥45 mm and dense stromal cellularity were demonstrated as histological risk factors of LR of PT. In our cohort, no association was found between LR and PT grade nor LR and surgical margins ≥10 mm.

The MR mammography of phyllodes tumors of different histological grades

Purpose: to evaluate retrospectively the MR data of the breast phyllodes tumors and to perform comparative analysis of the MR signs and the histological grade of the phyllodes tumors.Materials and methods. The analyses enrolled 27 pathologically confirmed phyllodes tumors (mean age of patient 37.8 y.o.). Following features were evaluated: tumor shape and structure, margins, size, type of contrast enhancement, foci of high signal intensity on the T1-WI, foci of hypo- or isointense signal on the T2-WI comparing with intact breast tissue, presence of cystic inclusions and the type of their margins.Results. The study included 18 benign, 4 borderline and 5 malignant phyllodes tumors. The following features showed significant correlation with the tumor grade: irregular margins of the cystic foci (p = 0.003), foci of hypoor isointense signal on the T2-WI compared with intact breast tissue (p = 0.005). Foci of high signal intensity on the T1-WI were often revealed in the malignant (3/5) and borderline tumors (2/4), but this dependence was not significant (p = 0.021). According to pathomorphological correlation the foci of the high signal intensity on the T1-WI corresponded to hemorrhages, while cystic foci with irregular margins were revealed to be foci of necrosis. The foci of hypo- or isointense signal on the T2-WI compared with intact breast tissue corresponded to the hypercellular stroma.Conclusion. Specific features of phyllodes tumors are useful in differentiation of their histological types; furthermore the MR mammography provides accurate data for planning the point of biopsy.

A Case Report of Double Primer Cancer: Malignant Phyllodes Tumor and Invasive Ductal Carcinoma

Introduction: Multiple primaries have been reported in patients with breast cancer in the range of 4.1% to 16.4%. This report followed the standard Surgical Case Report (SCARE) and discussed two histologically distinct breast cancer malignancies. This paper also explored the risk factor, pathogenesis, treatment, and prognosis of multiple primary malignancies in the same organs, especially in the breasts.Case Presentation: The patient was a 45-year-old woman with a lump in the left and right breasts for five years. The patient claimed that the lump was enlarged and painless. The tumor size of the left breast was 3 x 2 x 3 cm, the right breast was 4 x 2 x 4 cm, and the patient had no enlargement of lymph nodes. The patient underwent a biopsy examination of the left breast showing invasive ductal carcinoma NST (No Special Type) 3rd grade with LV1 (+). The biopsy examination of the right breast showed malignant phyllodes tumor. Thus, the patient must undergo chemotherapy and mastectomy as definitive therapy. The patient has already completed the treatment and is currently under evaluation.Conclusion: This report looked for the rare case of double primary malignancies in the breasts. It highlighted double primary cancers starting to increase these days but in a particular way because it happens in the same organ, the breasts. However, medical literature rarely presented a synchronous malignancy case, prompting the publishing of this case. With improved cancer treatment and more prolonged survival, the number of patients with double cancers is increasing.

A Rare Case of the Malignant Phyllodes Breast Tumor - Case Report

Abstract The phyllodes tumor (cystosarcoma phyllodes) is a rare fibroepithelial neoplasm presenting less than 1% of all breast tumors. Based on histologic features World Health Organization (WHO) classifies into benign, border line and malignant tumors (the rarest). Only around 5-15% of all malignant form cases metastasize hematogeneosly in the lung, bone and brain. Clinically are mostly presented the phyllodes tumor mostly presents as a rapid growth, palpabile, painless, elastic, oval or lobulated masses over 5 cm among women between 40 to 50 years old. On ultrasound and mammography these tumors usually resembles other round or oval benign lesions, mostly like fibroadenomas. These tumors on ultrasound and mammography usually resembles other round or oval benign tumors, mostly like fibroadenomas. Ultrasound guided core needle biopsiy (CNB) performed under ultrasound is a gold standard for palpabile breast masses. Surgical resection remains the gold standard of treatment. To date, there is no consensus regarding the recommendations for radiotherapy, hormonal therapy and systemic chemotherapy. We present the case of 30 years old woman, who noted a painless mass in her left breast, which was gradually increasing in size. Clinical, ultrasound and magnetic resonance examination confirmed the existence of tumor formation without the possibility of making an accurate diagnosis. Malignant phyllodes tumor was initially diagnosed by core biopsy. The patient underwent a radical modified mastectomy and postoperative radiotherapy. During the follow-up for the first 11 months, our patient has been feeling well without signs of local recurrence and metastasis. The aim of our case is to emphasize the importance of early diagnosis and treatment of this rare breast tumor. Treatment is based on the size and the extent of the mass with surgical resection and adequate margins extremely important in successful outcome. We present the case of 30 old woman, who noted a painless mass in her left breast, which was gradually increasing in size. She was diagnosed with ultrasound and magnetic resonance imaging and the diagnosis of the malignant phyllodes tumor was confirmed by patohistological verification.

Low intensity whole-body oxidative stress in patients with parotid gland tumors.

Recently, there has been a significant increase in the number of patients hospitalized and undergoing surgery due to parotid gland tumors. We have observed an increase in the total number of salivary gland tumors, and hence an increased number of malignant tumors. Etiological factors of salivary gland tumors are still unknown. Oxidative stress (OS) has been suggested to be an important indicator of carcinogenesis in some tumors. Therefore, the aim of our study was to assess the state of OS in patients with selected benign and malignant parotid gland tumors. After final postoperative histological diagnosis of the tumor, patients were divided into the following groups i.e. pleomorphic adenoma 35 patients, Warthins tumor (WT) - 17 patients, mucoepidermoid carcinoma - 9 patients and 45 controls. The final study group included 106 patients. We found an increase in plasma lipofuscin levels in patients with all investigated parotid gland tumors. Furthermore, the activity of Cu/Zn-SOD in Warthins tumor patients was statistically lower compared to the controls, pleomorphic adenoma or mucoepidermoid carcinoma.In conclusion, we sustain the hypothesis on the presence of a low intensity whole-body OS in patients with parotid gland tumors. Furthermore, LPS may be a useful marker of OS in patients with benign and malignant tumors. Moreover, pathological mechanisms connected with WT seem to be different compared to malignant neoplasms and other benign tumors. It seems that Cu/Zn-SOD, as an antioxidative enzyme, may play an important role in those mechanisms taking part in WT.

Contrast-Enhanced Ultrasound in the Differentiation between the Most Common Benign Parotid Gland Tumors: A Systematic Review and Meta-Analysis.

Recently, contrast-enhanced ultrasound (CEUS) has become a promising tool in distinguishing benign from malignant parotid gland tumors. However, its usefulness in differentiating various benign parotid tumors has not been determined so far. This study aimed to systematically review the literature to determine the utility of CEUS in the preoperative differentiation between pleomorphic adenomas (PAs) and Warthin's tumors (WTs) of the parotid gland. PubMed, Embase, and Cochrane were searched for English-language articles published until 21 July 2022. Fifteen studies were included. On CEUS examination, a significantly greater percentage of PAs displayed heterogeneous enhancement texture compared to WTs. Contrarily, the enhanced lesion size, the enhancement margin, and the presence of the enhancement rim did not differ significantly between the entities. Significantly longer normalized mean transit time (nMTT) and time to peak (TTP) were observed in PAs. Contrarily, the mean values of area under the curve (AUC) and time from peak to one half (TPH) were significantly higher for WTs. Due to the considerable overlap among the qualitative CEUS characteristics of PAs and WTs, the reproducible, investigator-independent quantitative CEUS measurements have a greater potential to distinguish PAs from WTs, which might influence the selection of an appropriate management strategy.