Malignant Phyllodes Tumor Research Articles

A rare case of giant malignant phyllodes tumour and long term survival.

Background: Phyllodes tumours are rare breast neoplasm. Its clinical spectrum ranges from a benign and locally recurrent form of behaviour to malignant and metastatic forms. The age at risk is between 35 and 45 years. Giant phyllodes tumours are larger than 10cm in diameter. Case Report: Herewith, we present a rare case of giant malignant phyllodes tumour (40x30x20cm) in a young lady who survived 10 years post-treatment in which most literature reported 10-year survival of 23% to 42%. The patient had mastectomy and radiotherapy to the anterior chest wall. Conclusion: A young lady with a giant malignant phyllodes tumour survived 10 years following treatment.

Phyllodes Tumor as a Secondary Neoplasm in Survivors of Childhood Cancer: A Tertiary Care Cancer Centre Experience.

Secondary neoplasms (SNs) are being increasingly identified in long-term survivors of childhood cancer. Phyllodes tumor (PT) form a distinctly uncommon SN. We report a series of 6 female childhood cancer survivors who developed PT as SN. The median age at primary diagnosis was 13 years. Their primary tumors were bone sarcoma (4) and acute leukemia (2), and all were treated with chemotherapy, predominantly with alkylating agents and/or anthracyclines. None had received direct radiotherapy to the chest wall. Subsequently, PT were detected after a median interval of 7.5 years, with 2 patients developing bilateral and malignant PT. The series highlights a rare SN in childhood cancer survivors, underscoring the importance of regular long-term follow-up.

An Integrated Epigenomic and Genomic View on Phyllodes and Phyllodes-like Breast Tumors.

Simple SummaryFibroepithelial tumors of the breast represent a spectrum of mostly benign diseases. However, some of these tumors tend to recur and may even spread distantly to other body sites. Prediction of their biological behavior is currently morphology-centered. In this study, we set out to answer the question of whether their biologic behavior might be reflected by specific DNA methylation and copy number profiles, both of which can be determined alongside each other in a diagnostic routine workflow through microarrays. We discovered that the fibroepithelial tumors seem to fall into two distinct copy number variant patterns and that they are epigenetically related. Our study underlines the diagnostic usefulness of combined methylation/copy number profiling in fibroepithelial breast tumors to predict clinical outcomes.Fibroepithelial lesions (FL) of the breast, in particular, phyllodes tumors (PT) and fibroadenomas, pose a significant diagnostic challenge. There are no generally accepted criteria that distinguish benign, borderline, malignant PT and fibroadenomas. Combined genome-wide DNA methylation and copy number variant (CNV) profiling is an emerging strategy to classify tumors. We compiled a series of patient-derived archival biopsy specimens reflecting the FL spectrum and histological mimickers including clinical follow-up data. DNA methylation and CNVs were determined by well-established microarrays. Comparison of the patterns with a pan-cancer dataset assembled from public resources including “The Cancer Genome Atlas” (TCGA) and “Gene Expression Omnibus” (GEO) suggests that FLs form a methylation class distinct from both control breast tissue as well as common breast cancers. Complex CNVs were enriched in clinically aggressive FLs. Subsequent fluorescence in situ hybridization (FISH) analysis detected respective aberrations in the neoplastic mesenchymal component of FLs only, confirming that the epithelial component is non-neoplastic. Of note, our approach could lead to the elimination of the diagnostically problematic category of borderline PT and allow for optimized prognostic patient stratification. Furthermore, the identified recurrent genomic aberrations such as 1q gains (including MDM4), CDKN2a/b deletions, and EGFR amplifications may inform therapeutic decision-making.

Expression of TRPS1 in phyllodes tumor and sarcoma of the breast

When a sarcomatous neoplasm is identified in the breast, distinguishing metaplastic carcinoma, malignant phyllodes tumor (MPT), and primary sarcoma is a diagnostic challenge, especially on small biopsies, as all these tumors may have overlapping morphological features, thoroughly grossing with histological examination and immunohistochemical staining being the standard approach to aid in classifying these lesions. Recently, we identified a highly sensitive and specific breast carcinoma marker TRPS1 with high expression in metaplastic breast carcinoma. In the current study, we tested TRPS1 in MPTs and primary sarcoma of the breast. We found TRPS1 was highly expressed (95%) within spindle cell, chondro-osseous, and/or liposarcomatous components of MPTs, in all breast primary chondrosarcomas and extraskeletal osteosarcomas, but not in other sarcomas of the breast. In extramammary sarcomas, TRPS1 was expressed in 28% of conventional chondrosarcomas and 56% of osteosarcomas of bone, but rarely in undifferentiated pleomorphic sarcomas (UPSs), liposarcomas, and angiosarcomas. In summary, MPTs may share similar genetic background with metaplastic carcinoma exhibiting TRPS1 expression, and TRPS1 may play a role in chondro-osseous differentiation because of its expression in chondro-osseous sarcomas from both breast and extramammary sites. Our findings suggest TRPS1 may be clinically useful in distinguishing MPT and metaplastic carcinoma from primary breast sarcoma except for tumors with chondro-osseous differentiation.

Establishment of Breast Phyllodes Tumor Cell Lines Preserving the Features of Phyllodes Tumors

Abstract Breast phyllodes tumors (PTs) are biphasic, with epithelial and stromal components. Although the PT incidence is low (approximately 1% of all breast tumors), its clinical outcomes are unpredictable, and malignant PTs often progress rapidly. No effective treatment is currently available, thus resulting a high mortality rate from malignant PTs. PT cell lines must be established to facilitate the study of PTs. Herein, we established six PT cell lines through continuous passage or cell immortalization. We characterized these PT cell lines through in vitro functional assays, malignant PT marker detection and short tandem repeat identification. Benign PT cell lines (SYSH-BPT-01 and SYSH-BPT-02) were transfected with human papillomavirus 16 E6/E7, and two malignant PT cell lines (SYSH-MPT-01 and SYSH-MPT-02) were transfected with Simian virus 40 large T antigen. Two malignant PT cell lines (SYSH-MPT-03 and SYSH-MPT-04) were established through continuous passage. All malignant PT cell lines showed greater proliferation, colony formation, migration, invasion and collagen contraction ability than the benign PT cell lines. Moreover, the expression levels of malignant PT markers (α-smooth muscle actin and fibroblast activation protein) and short tandem repeat identification indicated that each PT cell line was identical to the parental primary cells. We successfully established PT cell lines that preserved the features of primary cells. These cell lines may serve as ideal experimental models for studying the function of breast PTs, thus opening new possibilities for PT drug screening and therapeutic target validation.

Clinicopathological Study of Breast Lesions with Special Reference to the Role of CD34 Immunostaining in DiagnosisA Cross-sectional Study from a Tertiary Care Hospital of West Bengal, India

Introduction: Breast carcinoma is the most common cancer among women and leading cause of mortality. Prognosis of breast carcinoma primarily depends on early detection. The changes in molecular and antigenic expression in stromal microenvironment surrounding the tumour cells was noted earlier in tumours of skin and gastrointestinal tract which showed loss of Cluster of Differentiation 34 (CD34) expression in stromal cell of malignant tumours. Aim: To evaluate the intensity of CD34 staining in benign, borderline and malignant lesions of breast and to find out whether it can help to differentiate benign and malignant lesions from borderline and in situ carcinomas. Materials and Methods: This was a cross-sectional prospective study done over a period of 18 months in a tertiary care hospital of Bankura, West Bengal, India. Total 78 specimens of breast lesions obtained by lumpectomy and Modified Radical Mastectomy (MRM) were first evaluated on routine histology and classified as benign, borderline or malignant accordingly. Subsequent immunohistochemical staining was performed for CD34 and intensity of expression in stromal cells was graded from 0 to 3+. Then comparison of CD34 expression in different lesions was done and level of significance was assessed by using Student’s t-test. Results: Out of total 78 cases evaluated, 50 (64.1%) were categorised as benign and rest 28 (35.9%) were either premalignant or malignant lesions. Intensity of CD34 expression was found to be significantly higher in benign and in situ lesions compared to malignant epithelial lesions of breast (p<0.05) whereas those between borderline and malignant phyllodes found to be statistically non significant (p-value 0.342). Conclusion: CD34 immunostaining can help to differentiate benign and in situ carcinomas from invasive carcinomas, however its role in differentiating borderline from malignant phyllodes tumour is limited.

Retrospective Analysis of 136 Patients Operated for a Parotid Gland Tumor

Background: We examined the patients who were operated for parotid gland tumor. In our study, we aimed to evaluate retrospectively the histopathological results, incidence, surgical treatment modalities and complications of parotid tumors operated in our clinic. Methods: The files of 136 patients who were admitted to the Otorhinolaryngology department of Dicle University Medical Faculty Hospital between January 2010 and April 2020 due to a parotid mass and underwent parotidectomy and whose pathology results were reported as benign or malignant parotid tumors were retrospectively scanned and included in the study. Patients' age, gender, FNAB cytology result, type of surgery, histopathological results after surgery and complications after surgical treatment were recorded. Results: A total of 136 patients, 73 (53.7%) male and 63 (46.3%) female, were included in the study. The mean age of the patients was 48.26±17.37 (min=14, max=83) years. Superficial parotidectomy was performed in 108 (79.4%) patients and total parotidectomy was performed in 28 (20.6%) patients. According to the histopathological results after surgery, 108 (79.4%) benign tumors and 28 (20.6%) malignant tumors were diagnosed. Accordingly, pleomorphic adenoma (47.8%) was the second most common with 65 patients, followed by Whartin tumor (25.7%) with 35 patients. The sensitivity (sensitivity) of FNAB was 85.2%, and the specificity (specificity) was 96.2%. The accuracy of FNAB was found to be 94.0%. Conclusion: Good identification of the parotid mass preoperatively, together with both FNAB and radiological imaging methods, gains much more value in differentiating malignant and benign pathologies. While superficial parotidectomy is mostly sufficient in benign tumors, total parotidectomy-radical parotidectomy in malignant tumors and neck dissection should be considered in high-grade tumors even if there is no neck metastasis. Patients should be evaluated for RT and CT according to the tumor type after surgery.

Retrospective Analysis of 136 Patients Operated for a Parotid Global Tumor

Background: While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed in the US each year, about 1300 to 1600 cases. The salivary gland cancer rate is 0.9 per 10000. The frequency of salivary gland tumors varies according to localization. Objective: In our study, we aimed to evaluate retrospectively the histopathological results, incidence, surgical treatment modalities and complications of parotid tumors operated in our clinic. Methods: We examined the patients who were operated for parotid gland tumor. The files of 136 patients who were admitted to the Otorhinolaryngology department of Dicle University Medical Faculty Hospital between January 2010 and April 2020 due to a parotid mass and underwent parotidectomy and whose pathology results were reported as benign or malignant parotid tumors were retrospectively scanned and included in the study. Patients’ age, gender, FNAB cytology result, type of surgery, histopathological results after surgery and complications after surgical treatment were recorded. Results: A total of 136 patients, 73 (53.7%) male and 63 (46.3%) female, were included in the study. The mean age of the patients was 48.26±17.37 (min=14, max=83) years. Superficial parotidectomy was performed in 108 (79.4%) patients and total parotidectomy was performed in 28 (20.6%) patients. According to the histopathological results after surgery, 108 (79.4%) benign tumors and 28 (20.6%) malignant tumors were diagnosed. Accordingly, pleomorphic adenoma (47.8%) was the second most common with 65 patients, followed by Whartin tumor (25.7%) with 35 patients. The sensitivity (sensitivity) of FNAB was 85.2%, and the specificity (specificity) was 96.2%. The accuracy of FNAB was found to be 94.0%. Conclusion: Good identification of the parotid mass preoperatively, together with both FNAB and radiological imaging methods, gains much more value in differentiating malignant and benign pathologies. While superficial parotidectomy is mostly sufficient in benign tumors, total parotidectomy-radical parotidectomy in malignant tumors and neck dissection should be considered in high-grade tumors even if there is no neck metastasis. Patients should be evaluated for RT and CT according to the tumor type after surgery.

Synchronous collision tumor of malignant phyllodes and invasive ductal carcinoma

Phyllodes tumor (PT) constitutes <1% of breast tumors. Malignancy usually arises from the stromal component forming homologous or heterologous elements such as chondrosarcoma, liposarcoma, fibrosarcoma, osteosarcoma, or rhabdomyosarcoma. Rarely, carcinoma can arise from the epithelial cells within the PT. Rarer is the occurrence of collision tumor of malignant phyllodes and carcinoma in the breast which lacks the exact incidence since only few cases are reported in the literature. This is another such rare case of synchronous collision tumor of malignant phyllodes having chondrosarcomatous and osteosarcomatous differentiation associated with invasive and in situ ductal carcinoma having metastatic carcinomatous deposits in axillary lymph nodes in a 43-year-old female. Hence, extensive sampling of the gross specimen is crucial in diagnosing the collision tumors which are not detected either in breast imaging studies or during the surgery. Since malignant PT usually spreads through a hematogenous route, it has to be treated by wide local excision or simple mastectomy without the axillary lymph node dissection. If a PT is associated with carcinoma, the patient management and prognosis depend on the stage of the carcinoma.

Metastatic Phyllodes Tumor in a Patient With Beckwith-Wiedemann Syndrome

Beckwith-Wiedemann syndrome (BWS) is an epigenetic disorder of imprinting on the chromosome 11p15 region that presents with clinical features, such as macroglossia, abdominal wall defects, neonatal hypoglycemia, hemihypertrophy, and embryonal tumors. Phyllodes tumors (PTs) are rare fibroepithelial tumors that account for 0.3% to 1% of breast tumors and present in women aged 35 to 55 years. Here we describe a rare case of metastatic malignant phyllodes tumor in a 27-year-old woman with BWS and uniparental disomy (UPD) of chromosome 11p15.5. To our knowledge, this is the first case report in literature to describe metastatic malignant phyllodes tumor in a woman with BWS.

A retrospective review of phyllodes tumor of breast treated with multimodality approach: Experience of a tertiary care institution in Eastern India

Background: The cornerstone of management of phyllodes tumor is surgery. No standard of care exists regarding adjuvant therapy; however, local recurrence is a predominant pattern of failure. The aims of this study were to evaluate the clinical characteristics and treatment patterns of phyllodes tumor and to compare local recurrence and disease-free survival rates of patients with borderline and malignant phyllodes tumor treated with or without adjuvant radiotherapy. Materials and Methods: We analyzed the demographic data, treatment details, and recurrence patterns of all patients with nonmetastatic phyllodes tumors of the breast (n = 34) treated with a multimodality approach who presented to our institute from January 2015 to December 2020. Results: The median age at presentation was 41.2 years, and the median tumor size was 12.5 cm. All patients underwent definitive surgical procedures in the form of wide local excision or mastectomy. No recurrence was noted in the patients with a benign histology. After a median follow-up period of 38 months, the local recurrence rate was 27% for the patients with borderline and malignant histology treated with adjuvant radiotherapy (n = 11) versus 47% for those (n = 17) who did not receive adjuvant radiotherapy. The 3-year local recurrence-free survival rate was 72% in the adjuvant radiotherapy group, versus 51% in the surgery only group. Conclusion: The results of the current study confirm the excellent prognosis of patients with benign phyllodes tumor undergoing surgery alone. Local recurrence was the predominant mode of failure in the patients with borderline and malignant histology. Locoregional control was improved with the addition of postoperative radiotherapy in the patients with borderline and malignant histology irrespective of margin status.

Long-term Survival After Diverse Therapeutic Modalities in Malignant Phyllodes Tumors of the Breast.

Background and Objects: Malignant phyllodes tumor of the breast (MPTB) is a rare tumor for which surgery or surgery combined with radiotherapy (RT) is the primary treatment method. However, recently, the therapeutic effect of RT on MPTB has been controversial. We aimed to explore the role of RT, chemotherapy (CT), and surgical modalities in patients with MPTB. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to select patients with MPTB who met the criteria between 2010 and 2018. Kaplan–Meier curves and Cox proportional risk regression models were used to analyze the effects of RT on MPTB patients. Based on this, we compared the effects of breast-conserving surgery (BSC) and mastectomy on the postoperative survival of MPTB. Results: A total of 298 patients with MPTB were included in this study. RT was received by 22.1% (n = 66) of the patients while 77.9% (n = 232) did not receive RT. CT was received by 4.7% (n = 14) patients while 95.3% (n = 284) did not receive CT. According to Kaplan–Meier curves, RT and CT combined resulted in a decrease in breast cancer-specific survival (BCSS) and overall survival (OS) compared to patients who did not receive RT. Mastectomy improved the OS and BCSS of the patients more than BCS). The findings of univariate and multivariate Cox regression analyses suggested that “distant metastasis”, “tumor grade” and “number of positive lymph node biopsies” affected OS of breast cancer, while “distant metastasis”, “tumor grade”, “surgery combined with radiotherapy/surgery”, and “radiotherapy/chemotherapy or not”, had a significant effect on BCSS. Conclusion: RT and CT did not significantly improve the long-term survival of MPTB patients. Mastectomy improved OS and BCSS of the patient more than BCS. RT in an early stage improved early prognosis moderately in MPTB patients with tumor diameter less than 50 mm.

Advance Malignant Phyllodes Tumor with Active Bleeding in Children: A Rare Case

Introduction: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, there are only a few large pediatric phyllodes tumor series. Current guidelines do not differentiate treatment recommendations between children and adults.Case Presentation: A 12-year-old girl presented with a lump in her right breast which grew rapidly within a month. On physical examination, we found a mass on the right breast sized ± 10 x 10 cm; the lump was fragile and bled easily. The patient’s condition was getting worse and worse. Due to this deterioration, we performed a mastectomy immediately.Conclusions: The incidence of malignant phyllodes tumor in children is very rare and required prompt treatment in emergency cases.

Characteristics and Outcomes of Parotid Gland Tumors in Adolescents.

Parotid tumors are rare neoplasms in adults but are exceedingly infrequent in adolescents. We aimed to determine the clinical characteristics and outcomes of parotid tumors in adolescents under 20years old. Between 1999 and 2020, 979 cases of benign parotid tumors and 236 cases of malignant parotid tumors were treated surgically in our department. Of these, 12 benign cases (1.2%) and 9 malignant cases (3.8%) were in adolescents. There were no benign or malignant cases for those aged under 10years. Regarding the histological type, all benign tumors were pleomorphic adenomas. About half of malignant tumors were mucoepidermoid carcinomas, and excluding one high-grade case, the grade of malignancy was all low/intermediate. The accuracy of fine-needle aspiration cytology among adolescents showed no significant difference with that of adults. In contrast to adults, adolescent benign tumor cases showed a markedly high rate of pleomorphic adenomas and no postoperative facial nerve palsy. Malignant tumors in adolescents had a different trend than adults; low/intermediate-grade malignancies were common and thus few symptoms/signs of malignancy could be observed. As well, the accuracy of fine-needle aspiration cytology was poor. All cases had a good prognosis and are disease-free survival. Parotid tumors in adolescents are rare but have several characteristics that are distinct from adults. As long-term observation is required posttreatment in adolescent patients, recurrence in benign pleomorphic adenomas and poor long-term prognosis in malignant tumors, especially for those with low/intermediate-grade malignancy, are more likely to be observed.

Malignant phyllodes tumor in a young woman with multiple recurrences

Malignant phyllodes tumor in a young woman with multiple recurrences

A rare case of giant malignant phyllodes tumour and long term survival

ABSTRACT Background: Phyllodes tumours are rare breast neoplasm. Its clinical spectrum ranges from a benign and locally recurrent form of behaviour to malignant and metastatic forms. The age at risk is between 35 and 45 years. Giant phyllodes tumours are larger than 10cm in diameter. Case Report: Herewith, we present a rare case of giant malignant phyllodes tumour (40x30x20cm) in a young lady who survived 10 years post-treatment in which most literature reported 10-year survival of 23% to 42%. The patient had mastectomy and radiotherapy to the anterior chest wall. Conclusion: A young lady with a giant malignant phyllodes tumour survived 10 years following treatment. Keywords: Long-term survival, Malignant giant phyllodes tumour, Young lady

Differential diagnosis of parotid gland tumours: Application of SWI combined with DWI and DCE-MRI

BackgroundParotid tumours (PTs) have a variety of pathological types, and the surgical procedures differ depending on the tumour type. However, accurate diagnosis of PTs from the current preoperative examinations is unsatisfactory. MethodsThis retrospective study was approved by the Ethics Committee of our hospital, and the requirement for informed consent was waived. A total of 73 patients with PTs, including 55 benign and 18 malignant tumours confirmed by surgical pathology, were enrolled. All patients underwent diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), susceptibility-weighted imaging (SWI), T2-weighted imaging (T2WI), and T1-weighted imaging (T1WI). The signal uniformity and capsule on T2WI, apparent diffusion coefficient (ADC) derived from DWI, semi-quantitative parameter time-intensity curve (TIC) pattern, and quantitative parameters including transfer constant (Ktrans), extravascular extracellular volume fraction (Ve), wash-out constant (Kep) calculated from DCE-MRI, and intratumoural susceptibility signal (ITSS) obtained from SWI were assessed and compared between benign and malignant PTs. Logistic regression analysis was used to select the predictive parameters for the classification of benign and malignant parotid gland tumours, and receiver operating characteristic (ROC) curve analysis was used to evaluate their diagnostic performance. ResultsMalignant PTs tended to exhibit a type C TIC pattern, whereas benign tumours tended to be type A and B (p < 0.001). Benign PTs had less ITSS than malignant tumours (p < 0.001). Multivariate analyses showed that ADC, Ve, and ITSS were predictors of tumour classification. ROC analysis showed that the area under the curve (AUC) of ADC, Ve, ITSS, and ADC combined with Ve were 0.623, 0.615, 0.826, and 0.782, respectively, in differentiating between malignant and benign PTs. When ITSS was added, the AUCs of ADC, Ve, and ADC combined with Ve increased to 0.882, 0.848, and 0.930, respectively. ConclusionSWI offers incremental diagnostic value to DWI and DCE-MRI in the characterisation of parotid gland tumours.

Histogram analysis of dynamic contrast-enhanced magnetic resonance imaging in the differential diagnosis of parotid tumors

ObjectiveDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) histograms were used to investigate whether their parameters can distinguish between benign and malignant parotid gland tumors and further differentiate tumor subgroups.Materials and methodsA total of 117 patients (32 malignant and 85 benign) who had undergone DCE-MRI for pretreatment evaluation were retrospectively included. Histogram parameters including mean, median, entropy, skewness, kurtosis and 10th, 90th percentiles were calculated from time to peak (TTP) (s), wash in rate (WIR) (l/s), wash out rate (WOR) (l/s), and maximum relative enhancement (MRE) (%) mono-exponential models. The Mann–Whitney U test was used to compare the differences between the benign and malignant groups. The diagnostic value of each significant parameter was determined on Receiver operating characteristic (ROC) analysis. Multivariate stepwise logistic regression analysis was used to identify the independent predictors of the different tumor groups.ResultsFor both the benign and malignant groups and the comparisons among the subgroups, the parameters of TTP and MRE showed better performance among the various parameters. WOR can be used as an indicator to distinguish Warthin’s tumors from other tumors. Warthin’s tumors showed significantly lower values on 10th MRE and significantly higher values on skewness TTP and 10th WOR, and the combination of 10th MRE, skewness TTP and 10th WOR showed optimal diagnostic performance (AUC, 0.971) and provided 93.12% sensitivity and 96.70% specificity. After Warthin’s tumors were removed from among the benign tumors, malignant parotid tumors showed significantly lower values on the 10th TTP (AUC, 0.847; sensitivity 90.62%; specificity 69.09%; P < 0.05) and higher values on skewness MRE (AUC, 0.777; sensitivity 71.87%; specificity 76.36%; P < 0.05).ConclusionDCE-MRI histogram parameters, especially TTP and MRE parameters, show promise as effective indicators for identifying and classifying parotid tumors. Entropy TTP and kurtosis MRE were found to be independent differentiating variables for malignant parotid gland tumors. The 10th WOR can be used as an indicator to distinguish Warthin’s tumors from other tumors.

Concurrent ductal carcinoma in-situ and malignant phyllodes with tp53 mutation in an 11-year-old

Phyllodes breast tumours are a rare fibroepithelial lesion that rarely occur in the pediatric population. Reports for benign phyllodes tumours have been limited to case series while only two reports have reported borderline or malignant tumours in children. We report the case of an 11-year-old female presenting with a borderline malignant phyllodes tumor and associated ductal carcinoma in situ (DCIS). We present an interesting case outlining the pathological assessment, surgical management, reconstruction, and subsequent genetic diagnosis of Li-Fraumeni Syndrome. We discuss the importance of multidisciplinary collaboration required and challenges undergoing treatment of rare pediatric breast cancer. To our knowledge, this is the youngest case of a phyllodes tumor within a DCIS field defect in an adolescent female reported to date.

Infrahyoid myofascial flap transfer for the prevention of concave deformity and gustatory sweating after parotidectomy

ObjectiveConcave deformities and gustatory sweating are the most common complications that cause substantial patient dissatisfaction after parotidectomy. Various surgical methods to prevent these complications have been described. However, effective techniques have not been established, especially in patients with medium- to large-sized parotidectomy defects. We evaluated the utility of infrahyoid myofascial flap reconstruction of parotidectomy defects for the prevention of these complications. MethodsWe conducted a retrospective case series study in patients with a benign or malignant parotid tumor measuring over 4 cm who underwent immediate pedicle infrahyoid myofascial flap reconstruction after total or subtotal parotidectomy or total resection of either the superficial or deep parotid gland at our hospital. Subjective analyses of facial symmetry, postoperative concave deformities of the anterior neck, gustatory sweating, voice disorders, odynophagia, neck scarring in the parotid and anterior neck areas, sensory disorders, pain, and neck stiffness were performed using patient interview data. Objective evaluations of facial symmetry were made by the first or second author. Both analyses were performed after a follow-up of more than six months. Additionally, patient demographic data, clinicopathological factors, parotidectomy and skin incision types, flap survival, and postoperative complications were evaluated. ResultsWe included eight patients (male, n=5; mean age, 69.3 years [range, 37–93 years]). Procedures included total or subtotal parotidectomy (n=4), superficial lobe parotidectomy (n=2), and deep lobe parotidectomy with partial superficial lobe parotidectomy (n=2). Infrahyoid myofascial flaps reached the cranial tip of the parotid defect without tension, and their volume sufficiently filled the parotidectomy defect in all patients. There were no local signs of insufficient blood flow within the transferred flaps.Objective and subjective assessments were made after a mean duration of 1.2 years (range, 0.6-1.8). Postoperatively, no patient subjectively reported facial asymmetry. Objectively, facial symmetry was “good” in four patients and “fair” in four patients. No distinctly visible concave deformity in the parotid or anterior neck area occurred in any patient. Gustatory sweating occurred in one patient; this individual had the largest parotidectomy defect. Only one patient experienced donor site morbidity (mild anterior neck stiffness) related to infrahyoid myofascial flap elevation. ConclusionAlthough complete prevention of gustatory sweating was unsuccessful, infrahyoid myofascial flap reconstruction of medium- to large-sized parotidectomy defects led to postoperative facial symmetry with minimal donor site morbidity.