Phyllodes Sarcomas Research Articles

Case Report : Giant phyllodes sarcoma: Case Report of total mastectomy with immediate latissimus dorsi flap reconstruction – A surgical and aesthetic challenge

Phyllodes tumor of the breast is a rare fibroepithelial tumor, constituting less than 1% of all breast neoplasms. These tumors are characterized by rapid stromal growth and can reach significant sizes, particularly in malignant cases, necessitating aggressive surgical management due to their high recurrence risk. In this case report, we present a 40-year-old Tunisian woman diagnosed with a giant phyllodes sarcoma. The patient experienced considerable physical and psychological impacts, including impaired mobility, body image disruption, and professional limitations. Clinical examination and imaging confirmed the presence of a large lobulated mass in the left breast, with no signs of distant metastasis. A multidisciplinary team recommended a total mastectomy with immediate reconstruction using a latissimus dorsi myocutaneous flap. This approach aimed to restore breast contour while addressing both oncologic and aesthetic needs. The procedure was successful, with the excised tumor weighing 7 kg. Postoperatively, the patient received close monitoring and psychological support, emphasizing the importance of a holistic approach to recovery. This case underscores the complexities of managing giant phyllodes sarcoma, highlighting the value of a timely surgical intervention combined with effective reconstructive techniques. It also emphasizes the need for individualized treatment plans that consider both functional and aesthetic outcomes to optimize patient recovery and quality of life

Giant Phyllodes Sarcoma of the Breast: A Case Report

Breast sarcomas are rare, constituting less than 1% of malignant breast tumors, with phyllodes tumors being the most common. This report details a case of a 50-year-old woman who presented with a rapidly growing right breast mass, initially diagnosed as a low-grade phyllodes tumor two years prior. Upon re-evaluation, the mass had significantly enlarged, exhibiting characteristics of a phyllodes sarcoma.

Primary breast sarcomas: A 13 case-series study treated in university hospital in central Tunisia over a 25-year period.

To retrospectively study the therapeutic modalities of primary breast sarcomas in view of the data of a local Tunisian experience. It is a monocentric, descriptive, retrospective study including 13 cases of primary breast sarcoma treated over a period of 25 years (1995-2020) in the oncological radiotherapy department of a university hospital in Sousse, Tunisia. In our study, 13 cases of non-metastatic breast sarcomas that has been identified, divided into ten cases of phyllodes sarcomas and three cases of non-phyllodes sarcomas.Surgically, all our patients had a mastectomy. Among them, seven underwent a lymph node procedure: five underwent axillary lymph node dissection, and two others had primary axillary lymph node biopsy. For the adjuvant treatment, all the patients included in our study received radiotherapy and seven received chemotherapy. Local recurrence occurred on the operative scar in one patient after completion of radiation therapy. Metastatic relapse was described in five patients. The time to onset of metastases varied between two months and five years. Nevertheless, a complete remission was noted in 6 patients with a follow-up varying from four years to 20 years. Two patients were lost to follow-up. Breast sarcomas remain a very rare entity of aggressive tumors.The therapeutic approach is poorly codified. For this reason, the therapeutic decision should always be discussed in a multidisciplinary assessment.

Phyllodes tumors: A retrospective study of 22 cases in the department of gyneco obstetrics 2 of the Hassan II university hospital

Introduction: Phyllodes tumors (PTs) of the breast are rare fibro-epithelial tumors, which represent 1% of all primary breast tumors with an incidence of 0.3% to 0.9%, and they represent 2% to 3% of fibroepithelial neoplasms. Their diagnosis is based on histology. Our work aims to determine the epidemiological, clinical, histological and therapeutic aspects of PTs. Materials and methods: This is a retrospective study conducted in the gyneco-obstetric II department at the hospital center Hassan II, between January 1st 2015, and December 31st 2020 of, on 22 patients histologically proved cases of phyllodes tumors. Results: The study was conducted on 22 women, for whom the average diagnosis age was 35.6years old from 19 to 63years. 63.6% of the patients were nulliparous. The main clinical manifestation was a unilateral breast nodule measuring between 1 and 15.5cm (5cm on average). Mammographic exploration in the majority of cases revealed hyperdense opacity, roughly oval, well limited, often with regular outlines. The histological type was benign in 68.18% of cases, borderline in 18.18% and phyllodes sarcoma in 13.63%. The treatment was conservative in 86.37% of cases (lumpectomy), and radical in 13.63% of cases (mastectomy). After surgical treatment, 2 patients had insufficient resection limits and subsequently benefited from tumor bed revision. After follow-up, two tumors locally recurred with a huge mass that took up the entire breast. The two patients who had undergone a mastectomy and whose development was marked by the appearance of a second recurrence on the mastectomy scar, one of which was operable and the second had pulmonary metastases hence the indication of chemotherapy. Conclusion: Out of this study, we noticed that Phyllodes tumors of the breast mainly affect young women. The diagnostic confirmation necessarily requires histological proof which is not often easy by only biopsy. The best management of this tumor remains adequate surgical resection with healthy margins, while emphasizing the need for monitoring because the risk of recurrence is always present. The prognosis is based on the histological characteristics of the tumor and the quality of tumor excision.

Two relatives female patients with primary malignant phyllodes sarcoma and primary stromal sarcoma of breast

Two relatives female patients with primary malignant phyllodes sarcoma and primary stromal sarcoma of breast

Sarcomes mammaires primitifs : à propos de 30 cas traités à l’institut Salah-Azaiez de Tunis

PurposeTo identify retrospectively prognostic factors of primary breast sarcoma and review its treatment modalities. Materials and methodsThis is a descriptive study on 30 cases of primary breast sarcoma. We carried out a univariate and multivariate analysis correlating clinical, pathological and therapeutic parameters with disease-free survival and overall survival. ResultsThe mean age was 46.8 years. The mean tumour size was 10cm. The 30 cases were 18 phyllodes sarcomas, eight angiosarcomas, three liposarcomas and a case of granulocytic sarcoma. Sixteen patients had adjuvant radiotherapy and only seven patients received adjuvant chemotherapy. The median follow-up was 64 months. Overall survival rates at 3 and 5 years were 49.1% and 33.7%. Disease-free survival rates at 3 and 5 years were 22.8% and 15.2% respectively. The analytical study of the following parameters: tumour size and presence or absence of node or distant metastases, showed no correlation with overall survival nor with disease-free survival. Furthermore, adjuvant radiotherapy did not improve overall survival (P=0.298; hazard ratio [HR]=1 [0.982–1.04]) nor disease-free survival (P=0.61; HR=0.942 [0.862–1.029]). By univariate analyses, we identified a correlation between overall survival, surgical margins (>1cm) (P=0005; HR=3.4 [1.217–9.919]) and tumour necrosis (P=0.028; HR=0.099 [0.014–0.682]). We did not find any independent prognostic factor by multivariate analysis. ConclusionThe prognosis of primary breast sarcoma seems to depend essentially on optimal surgical excision (margin over 1cm). The only potential histological parameter correlated with the prognosis is the presence of tumour necrosis. The histological subtype should not be considered as a prognostic marker for overall or disease-free survival in patients with primary breast sarcoma.

Primary osteosarcoma of the breast presented as a large breast abscess

Primary extra osseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none - phyllodes sarcoma of a previously normal breast. Due to its rarity, natural history and optimal treatment methods remain unclear. A 60-year-old patient presented to the surgical casualty with large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent immunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. The patient was referred to the oncologist for further management. Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy help to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the sternum and ribs were excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

Low grade adenosquamous carcinomas of the breast are epithelial and myoepithelial tumors

Breast adenosquamous carcinomas are rare tumors that are categorized as subtypes of metaplastic carcinoma. They are composed of well-developed gland formation intimately admixed with solid nests of squamous cells immersed in a highly cellular spindle cell stroma. A low grade variant has been described to have a relatively indolent clinical course and an uncommon low grade histological pattern. However, some aspects of this tumor remain unclear, due to its rarity. Here, we report 25 cases of adenosquamous carcinoma of the breast: 14 cases of ’pure’ low grade adenosquamous carcinoma, seven cases of metaplastic carcinoma arising within foci of low grade adenosquamous carcinoma, one case of a composite tumor that associated adenosquamous carcinoma and phyllodes sarcoma with liposarcomatous stroma and three cases corresponding to high grade adenosquamous carcinoma. As results, we found that the glandular formations within foci of low grade and high grade adenosquamous carcinoma were surrounded by a certain amount of myoepithelial cells. Furthermore, spindle cells and heterologous elements of the stroma, in all tumor types, arose from the myoepithelial cells and expressed myoepithelial markers, basal keratins and a variable level of epidermal growth factor receptor expression.

Immunolocalization of heparin-binding EGF-like growth factor (HB-EGF) as a possible immunotarget in diagnosis of some soft tissue sarcomas

Heparin-binding EGF-like growth factor (HB-EGF), a member of the family of epidermal growth factors (EGFs), is involved in several biological processes and tumor formation. Several lines of evidence show that HB-EGF plays a key role in the acquisition of malignant phenotype. Studies show that HB-EGF expression is essential in oncogenesis of cancer-derived cell lines. HB-EGF is a promising target for cancer therapy. The aim of this study was to find new insights on the biological features of the soft tissue sarcomas, in order to consider the possibility to use HB-EGF as an immuno-target in histotype characterization and to facilitate therapeutic intervention. In our study we did HB-EGF-immunostaining on tissue samples collected from 43 human soft tissue sarcomas. We analyzed HB-EGF immunoexpression in some types of tumors such as clear cell sarcomas, leiomyosarcomas, phyllodes sarcomas, chondrosarcomas and liposarcomas. In relation to the different histotypes, we detected different immunostaining localization. From our results it was evident that pleomorphic cells, a signal of tumor progression, were HB-EGF immunostained, and this was accompanied by an extracellular matrix immunostaining. Moreover statistical analysis showed a correlation between HB-EGF immunostaining and the different types of analyzed soft tissue sarcomas. In conclusion, in some types of soft tissue sarcoma HB-EGF could be considered a useful diagnostic marker for their characterization.