Phyllodes Tumor Research Articles

Diagnosis of Infarcted Breast Lesions on FNAC, a Blustering Fool: Short Case Series.

Fine-needle aspiration cytology (FNAC) is often used as a screening tool. Cytopathologist should be aware of various mimickers of the malignancy. One of these is infarction of benign breast lesions. Careful examination of cytomorphological features will avoid the misdiagnosis of malignancy in such cases. Six cases were diagnosed as benign breast lesion for 4 years and 5 months in our newly established tertiary referral center. Histopathology follow-up was available in one case. Of six cases, three cases (50%) were reported as fibroadenoma with infarction, two cases (33%) as benign breast lesion with infarction favor fibroadenoma, and one as breast lesion with infarction favor phyllodes tumor in view of recurrence. Most were in the second or third decade of their life. All cases showed dyscohesive cells with pyknotic nuclei. Monolayered sheets of necrotic cells were seen in the four cases (66%). Viable cells were seen in four cases. FNAC provides a rapid and accurate diagnosis of benign breast lesions with infarction in the hands of experienced pathologists who can help in better patient care. Small-sized uniform pyknotic nuclei of dyscohesive cells and regular nuclear membranes help to differentiate them from inflammatory and malignant lesions.

Co expression of EGFR and CD10 in patients with phyllodes tumors of the breast: a single center experience in North Western Algeria.

Breast phyllodes tumors (BPT) have variable malignant potential, their histological classification remains insufficient for an accurate diagnosis. We attempted to investigate CD10 (Cluster of differentiation 10) and EGFR (Epidermal growth factor receptor) expression in BPT in order to highlight their diagnostic and prognostic values. Eight patients with BPT are recruited from January 2014 to December 2020 and immunohistochemical assessment of CD10 and EGFR is realized. Median age was 27±15.2, the mean tumor size was 9.63±10.21. Only malignant tumours showed expression for EGFR. Borderline and malignant tumors were CD10 positive. Patients overexpressing CD10 were postmenopausal with great tumor size, 25% of these were sarcomatous. Coexistence of CD10 and EGFR overexpression was found in 25% of cases and was associated with age (P=0.008), tumor size (P=0.030) and hitologic types (P=0.014). PC1 and PC2, were extracted, they accounted cumulatively for 94.7% of the variance of the data analysed, it suggests that patient's age and histological type of tumor have significant association with CD10 and EGFR expression in BPT. EGFR and CD10 overexpressed combined proteins in phyllode tumors constitute, with histopathological parameters, an important prognostic factor as well as a promising potential targets.

Breast cancer in men: a case of study

This work describes the case of a male patient with breast cancer, with histopathological report of malignant phyllodes tumor. Clinical case: 65-year-old man with clinical data in the right pectoral region, with pain in the right mammary gland, presence of a palpable, painful mass, with gradual increase in volume, movable, with a stony sensation, sudden weight loss in six months, approximately 15 kg, intolerance to oral intake, excretions unchanged. Evaluation by second level of care with report of mammography bi-rads 5 (Breast Imaging Reporting and Data System), suggestive of malignancy. Consulted by general surgery, oncologic surgery and medical oncology, fine needle biopsy was taken, histopathological report of high-grade sarcoma with necrosis, malignant phyllodes tumor, candidate for neoadjuvant therapy.

Intragenic EGFR::EGFR.E1E8 Fusion (EGFRvIII) in 4331 Solid Tumors.

Epidermal growth factor receptor variant III (EGFRvIII, the deletion of exons 2-7) is a recurrent intragenic EGFR::EGFR.E1E8 fusion that occurs in high-grade gliomas. The presence of EGFRvIII in other solid tumors has not been well characterized. We retrospectively reviewed advanced malignant solid tumor cases tested by a custom hybrid capture 610-gene next-generation sequencing platform from 2021 to 2022. EGFRvIII was identified in 17 of 4331 (0.4%) cases, including 16 of 238 (7%) brain tumors and 1/301 (0.3%) breast tumors. EGFRvIII-positive brain tumors were all glioblastoma IDH-wildtype, most with concurrent TERT promoter mutation (14 of 16), EGFR amplification (13 of 16), and EGFR mutation (8 of 16). The only EGFRvIII-positive breast lesion was a sarcomatoid neoplasm in a young female patient. A separate breast case tested outside our institution with reported EGFRvIII was noted in a young female patient with a malignant phyllodes tumor with stromal overgrowth. Microscopically, both EGFRvIII-positive breast tumors showed high-grade sarcomatoid morphology with brisk mitotic activity. In summary, EGFRvIII is rare, occurring primarily in glioblastoma and rarely in breast sarcomatoid neoplasm, with no instances identified in other tumor types in our series. This select group of patients may benefit from chemotherapy and/or targeted anti-EGFR therapy.

Sociodemographic and Histological Trends of Breast Lumps in A Sub-Saharan African Population: A Cross-Sectional Study in A Surgical Oncology Department

Objective: The purpose of the study was to present histological profile of both benign breast tumors (BBT) and breast cancer (BC) in our setting and highlight age trends in the occurrence of BBT. Methods: A retrospective cross-sectional study was conducted in the surgical oncology unit of the Dalal Jamm University Hospital from January to July 2023. Dalal Jamm University Hospital is a teaching hospital based in Dakar, Senegal. Results: The median age was 45 years for BC and 31.5 years for BBT. The main histological types of BC were invasive ductal carcinoma (93.2%) and invasive lobular carcinoma (4.5%) whereas it was fibroadenoma (66.6%) for BBT. Fibroadenoma and benign phyllodes tumor was more common in adolescents and under 40 years (p = 0.046) old while fibrocystic changes were more prevalent during perimenopause (p < 0.001). Conclusion: Invasive ductal carcinoma and fibroadenoma are the most common breast tumors in sub-Saharan African setting. Fibroadenoma and benign phyllodes tumor are more prevalent in adolescents and under 40 years while fibrocystic changes occur most within the fourth and fifth decades of life.

Epithelial to mesenchymal transition (EMT) in metaplastic breast cancer and phyllodes breast tumors.

Epithelial-mesenchymal transition (EMT), a transdifferentiation program whereby epithelial cells acquire mesenchymal phenotype, is essential during embryonic development. EMT has also been implicated in cancer progression by conferring migratory and metastatic potential, as well as cell plasticity and stem cell like traits, to cancer cells. Metaplastic breast carcinoma (MBC) is a rare aggressive type of breast cancer characterized by the presence of heterologous elements, typically by the existence of epithelial and mesenchymal components. Phyllodes tumors (PTs) are uncommon fibroepithelial neoplasms consisting of epithelial and mesenchymal elements. Although various hypotheses have been proposed on the pathogenesis of these biphasic tumors, there is growing evidence supporting the theory that PTs and MBC could both correlate with cancer related EMT. This review summarizes the existing literature on the emerging role of EMT in the pathogenesis of MBC and PTs. Both malignant PTs and MBC are characterized by poor prognosis. Therefore, several anti-EMT targeting strategies such as blocking upstream signaling pathways, targeting the molecular drivers of EMT and targeting mesenchymal cells and the extracellular matrix, could potentially represent a promising therapeutic approach for patients suffering from these aggressive neoplasms.

Categorization of fibroepithelial breast tumors according to ultrasound BI-RADS classification

Among breast masses, the most common are fibroadenomas (FA), which belongs to the group of a fibroepithelial tumors. Simple pericanalicular FA ordinarily shows the ultrasound signs of a benign mass. Long-standing pericanalicular FA and intracanalicular FA as they grow acquire some ultrasound features uncommon for benign lesions, which requires differential diagnosis with malignant breast masses. The group of fibroepithelial breast tumors also includes phyllodes tumors with frequency of malignant variants of 20–30%. Differential diagnosis of phyllodes tumor and fibroadenomas is difficult, due to the lack of the clear radiologic diagnostic criteria (incl. ultrasound). All breast masses that shows suspicious or atypical features should be selected for biopsy, with the use of BI-RADS classification for the biopsy need indication.Objective: to reveal the rules for fibroepithelial breast tumors categorization according to BI-RADS depending on the ultrasound features.Material and methods. A total of 86 breast masses in 79 women were assessed by ultrasound in B-mode and Color Doppler (CDI). Of these, 22 masses in 15 women showed the typical ultrasound pattern of FA up to 2.0 cm in size with no necessary of morphological evaluation (the average age of the patients was 24.2 ± 5.1 years). Surgery performed for 64 lesions ≥2.0 cm in size, postsurgery morphological examination revealed pericanalicular FA – 38, intracanalicular FA –19 and phyllodes tumors (benign) – 7.Results. The majority of atypical pericanalicular FA (84.2%) were categorized as BI-RADS 4а (a low risk of cancer), 94.7% of intracanalicular fibroadenomas and all phyllodes tumors – as BI-RADS 4b and BI-RADS 4c (а high risk of cancer). The identification of suspicious ultrasound signs led to an increase in the BI-RADS category with indications to the morphological evaluation of the mass.Conclusion. As the suspicious ultrasound signs in B-mode should be considered the irregular shape and borders, vertical orientation and inhomogeneous acoustic shadowing in the absence of macrocalcifications, in Color Doppler – diffuse or focal mass hypervascularity or abnormal vascular pattern. The atypical ultrasound pattern commonly presents in large breast fibroadenomas (>3.0 cm in size), requires differential diagnosis with phyllodes tumors and breast cancer and indicates the need of morphological evaluation and categorizing them as not lower than BI-RADS4.

A Rare Presentation of Cutaneous Scalp Metastasis From a Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

A Rare Presentation of Cutaneous Scalp Metastasis From a Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

Epithelial Carcinomas Arising within Phyllodes Tumours of the Breast: A Review of Their Pathological Characteristics.

Epithelial proliferation is a common feature of phyllodes tumours (PTs), but epithelial malignancy is rare. This review seeks to further our understanding of epithelial malignancy within PTs by analysing their histopathological characteristics in previously reported cases and providing an overview of studies on their pathological features. PubMed and DeepDyve were searched for case reports, case series, and literature reviews of in situ and invasive carcinoma within PTs. Only cases where the carcinoma was within the PT were included. Cases of synchronous carcinoma in the ipsilateral or contralateral breast were excluded. Ninety-eight cases of in situ or invasive carcinoma within a PT were identified. Across the grades of PTs, there was a similar proportion of invasive carcinomas compared to in situ lesions. Malignant PT correlates with a higher likelihood of epithelial malignancy, and molecular studies support a possible causal pathophysiological relationship. This higher likelihood may suggest interactions between malignant stroma and the transforming epithelium that could potentially play a significant role in the phenomenon, which remains to be elucidated. Encasement within a PT likely improves the prognosis of breast carcinoma due to earlier detection. The presence of carcinoma within a malignant PT has uncertain prognostic implications. Thorough sampling of all PTs is recommended for appropriate prognostication and management.

Primary malignant phyllodes tumors of the breast: A retrospective analysis from a referral center

BackgroundThe treatment for primary malignant phyllodes tumors of the breast (B-MPT) consists of wide local excision with negative margins (≥1 cm). However, because of their rarity, prognostic factors, type of surgery and adjuvant treatments are still a matter of debate. MethodsWe conducted a single-center retrospective study to describe outcomes and prognostic factors of patients with primary B-MPT, who underwent breast surgery from January 2000 to December 2021. The primary endpoint was the cumulative incidence of any recurrence. Secondary endpoints were the cumulative incidences of distant and local recurrences. Results131 patients were included, of whom all received surgery, 5 adjuvant anthracycline-based chemotherapy and 15 radiation therapy. After a median follow-up of 6.4 years, the cumulative incidences at 5-years of any, local and distant recurrences were of 26% (95% Confidence Interval [CI], 4–34%), 16% (95%CI, 10–24%) and 10% (95%CI, 5.3–16%), respectively. Tumor size ≥ 5 cm was associated with higher distant recurrences (p = 0.05); instead, among small tumors (<5 cm), distant recurrences were higher in those with heterologous differentiation and/or multifocal disease (p = 0.06). Type of breast surgery (mastectomy vs. lumpectomy/excision) was not found to be significantly associated with distant (p = 0.32) or local (p = 0.17) recurrence, even after controlling local recurrence incidence for negative pathologic prognostic factors (p = 0.17). ConclusionsThe natural history of B-MPT is burdened by local and distant recurrences. Pathologic prognostic factors (i.e., tumor size, heterologous differentiation and multifocal disease) more than the type of wide breast surgery (mastectomy vs. lumpectomy) seem to represent the most significant prognostic factor for recurrences.

Infarction of breast and infarction of phyllodes tumor during pregnancy - A case report and review of literature.

The breast can be affected by a variety of specific and unique disorders during pregnancy and lactation. One of these disorders is spontaneous infarction of the breast which is a rare condition seen in physiologically hyperplastic mammary tissue associated with pregnancy and lactation. The causes and mechanism of the development of breast infarct remain largely unknown. Only 25 cases of breast infarct have been reported in the English literature. Phyllodes tumor is uncommon in pregnant women, and to date, only one report of spontaneous infarction of the phyllodes tumor has been reported in a postpartum woman. In this report, we describe the first case of coexistent infarction of the hyperplastic breast parenchyma with infarction of phyllodes tumor in a 25-year-old female.

Abstract 14737: A Case of an Intracardiac Sarcoma Arising From Metastatic Spread of a Primary Phyllodes Tumor of the Breast

Background: Malignant phyllodes tumors with cardiac involvement are rare, presenting diagnostic and management challenges. The benefits of medical and surgical therapies remain unclear. Large-bore aspiration devices are currently only approved for retrieval of venous thromboemboli but may present a valid option for diagnosis and treatment of intracardiac masses in high risk patients. Case Summary: We present the case of a 57-year-old female with a malignant phyllodes tumor of the breast and bilateral pulmonary emboli who presented with an incidental complex intracardiac mass on transthoracic echocardiography (1). A follow-up transesophageal echocardiogram demonstrated masses within the superior vena cava, right atrium, and right ventricle (2a-2b). Aspiration thrombectomy was performed given clinical stability and concern for thrombi with high risk of worsening clot burden. A large-bore aspiration device was used to retrieve the masses in multiple passes (3), which were pathologically consistent with spindle cell sarcoma. A cardiac MRI was completed following aspiration, and multiple mobile masses persisted in the right ventricle (4). The patient was discharged on day nine of hospitalization with therapeutic chemotherapy planned. She had one session of chemotherapy before a fatal cardiac arrest from unknown cause three months after discharge. Discussion: Phyllodes tumors rarely metastasize to the heart, and effective modalities for their diagnosis and management are unclear. Treatment strategies include wide surgical resection of the primary tumor, however mortality remains high in the setting of metastatic spread. Current guidelines recommend following principles of soft tissue sarcomas with chemotherapy. Large-bore aspiration devices may be an effective way to resect intracardiac tumors for both diagnostic and therapeutic purposes as an alternative to invasive surgical intervention for high-risk patients.

Association between CD10 expression and phyllodes tumor: A retrospective case control study.

The present study aimed to explore the association between immunohistochemical markers and phyllodes tumor (PT). The retrospective case control study included biopsies from patients with PT who underwent surgical treatment, and patients with fibronenoma (FA), diagnosed in our hospital from October 2014 to May 2021. Differences in microscopic histopathological characteristics and expressions of common immunohistochemical markers (CD10, cluster of differentiation 117 marker, cluster of differentiation 34 marker, tumor protein P53, cell proliferation antigen) for different grades of PT and FA were analyzed. A total of 69 patients were enrolled, of them 34 with PT (12 with benign PT, 13 with borderline PT, and 9 with malignant PT) and 35 with FA. With the increase of tumor malignancy, significant enlargement trend was noted; for FA, most tumor boundaries were well-defined, the stromal distribution was homogeneous, the stromal cellularity was small. In contrast for PT, as the degree of malignancy increased, tumor boundary gradually became ill-defined and the stromal distribution was heterogeneous; stromal cellularity and stromal overgrowth had increased significantly (All P < .05). Multivariate analysis showed that among other markers only CD10 expression (OR = 0.67, 95%CI: -0.88, 2.22, P < .05) was independently associated with PT. The study showed that in addition to histological features, CD10 expression was independently associated with PT and has a potential to be used as a differentiation marker.

Metabolic coupling in phyllodes tumor of the breast and its association with tumor progression.

There are markers of metabolic coupling in breast cancer. Loss of caveolin-1 (Cav-1) and upregulation of monocarboxylate transporters (MCTs), especially MCT1 and MCT4, serve an important role in metabolic coupling necessary for release and uptake of metabolites. However, the occurrence of these phenomena in phyllodes tumors (PTs) of the breast is unclear. A total of 101 PTs (60 benign, 26 borderline and 15 malignant) and nine breast tissue samples with no pathological lesions were analyzed. Immunohistochemical staining for Cav-1, MCT1 and MCT4 was performed using tissue microarray and their expression in both stromal and epithelial components was assessed. Cav-1 expression in PTs demonstrated a significant decrease in the stromal component compared with that in the normal breast tissues (P<0.001). MCT1 expression in both epithelial and stromal components was significantly increased in PTs, compared with that in normal breast tissues (both P<0.001). Stromal MCT1 and MCT4 expression were different depending on tumor grade of PTs, and stromal MCT1 expression significantly increased with increasing tumor grade (P<0.001). Although not statistically significant, stromal Cav-1 expression notably decreased with increases in PT grade. High stromal MCT1 expression was significantly associated with lower disease-free survival rate in comparison with low stromal MCT1 expression (P<0.05). These results suggested that changes in protein expression of Cav-1, MCT1 and MCT4 may be associated with tumorigenesis and progression of PTs of the breast.

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

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

MO21-6 Efficacy and safety of chemotherapy in metastatic malignant phyllodes tumors

MO21-6 Efficacy and safety of chemotherapy in metastatic malignant phyllodes tumors

SPINAL TUMORS-03 MALIGNANT PHYLLODES TUMOR OF THE BREAST WITH METASTASIS TO THE THORACIC SPINE: A CASE REPORT

Abstract Malignant phyllodes tumors (MPT) of the breast are rare, and spinal metastasis from these tumors is even rarer. We present a case report of a 37-year-old female with a breast mass, who was diagnosed with malignant MPT after incisional biopsy. The patient underwent a right partial mastectomy, and negative margins were reported. However, two weeks later, the patient presented to the emergency department with severe back pain, paresthesia, and lower limb weakness. Neurosurgery consultation led to a diagnosis of T4 pathological fracture, spinal tumor and spinal cord compression, likely due to metastasis from the breast mass. Chest abdomen and pelvis CT revealed no other lesion except the T4 compression fracture. The patient underwent cord decompression tumor resection, and transpedicular fixation of T3-T5 with T4 vertebroplasty. Histopathological analysis confirmed that it was a metastasis from phyllodes tumor. Our case report highlights the importance of early detection and management of MPT, as well as the need for close follow-up and monitoring of patients with a history of breast masses it also highlights the importance of considering malignant phyllodes tumors as a differential diagnosis for breast masses and the potential for metastasis to the spine.

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.