Phylloides Tumor Research Articles

P002. Single-institution experience with an under age 40 symptomatic breast clinic

P002. Single-institution experience with an under age 40 symptomatic breast clinic

P001. Rural-urban differences in screening mammography uptake in Australia and Scotland

P001. Rural-urban differences in screening mammography uptake in Australia and Scotland

69P - Diagnostic and prognostic role of stromal CD 10 and Ki 67 in benign and malignant phylloides tumor of breast: A pilot study

Background: Phylloides tumors (PT) are rare fibroepithelial tumor of breast, closely resemble to breast fibroadenoma, ranging from benign to malignant tumor. PT has potential to recur and metastasize due to its stromal characteristics. Differentiation between benign and malignant tumor is not possible with histopathology alone, additional study of stromal CD 10 and Ki 67 antigen expression in PT may be useful to differentiate benign from malignant tumor.

Role of CD10 Immunohistochemical Expression in Predicting Aggressive Behavior of Phylloides Tumors

Phylloides tumors are rare breast neoplasms with a variable clinical course depending on the tumor category. Along with histologic features, the role of immunohistochemical staining has been studied in predicting their behavior. Our aim was to evaluate the role of CD 10 immunohistochemical staining in predicting survival, recurrence and metastasis in phylloides tumor. We also evaluated correlations of other clinicopathological features with overall and disease-free survival. CD10 expression was studied in 82 phylloides tumors divided into recurrent/metastatic and non-recurrent/non-metastatic cohorts. The Chi-square test was applied to determine the significance of differences in CD10 expression between outcome cohorts. Uni and multivariate survival analyses were also performed using log-rank test and Cox regression hazard models. All 3 metastatic cases, 5 out of 6 (83.3%) recurrent cases and 37out of 73 (50.7%) non-recurrent and non-metastatic cases expressed significant (2+ or 3+) staining for CD10. This expression significantly varied between outcome cohorts (p<0.03). Tumor category and histological features including mitotic count and necrosis correlated significantly with recurrence and metastasis. A significant decrease in overall and disease free survival was seen with CD10 positivity, malignant category, increased mitoses and necrosis. Neither CD10 expression nor any other clinicopathologic feature proved to be an independent prognostic indicator in multivariate analysis. CD10 immunohistochemical staining can be used as a predictive tool for phylloides tumor but this expression should be interpreted in conjunction with tumor category.

Role of triple test score in the evaluation of palpable breast lump.

Introduction:Fine-needle aspiration cytology (FNAC) method is safe, reliable and time saving outdoor procedure with little discomfort to the patient for detecting Carcinoma breast. The efficacy can further be enhanced when physical breast examination, mammography and FNAC (the triple test [TT]) are jointly taken into consideration.Aims and Objectives:The aim was to evaluate the role of TT score (TTS) in palpable breast masses.Materials and Methods:This prospective study was carried out from May 2010 to April 2012. In the subjects referred to the Department of Pathology for FNAC of the breast mass, the TTS was calculated, and histopathological findings were noted.Results:In the study period TTS score was calculated in 200 cases out of 225 FNAC's of breast. Of 124 benign cases on cytology, only three showed discordant TTS. Out of 62 malignant cases, 61 showed concordant TTS and one case of mastitis on histopathology showed TTS of five. Out of all the benign lesions, two cases of fibrocystic disease and a single case of phylloides tumor gave a TTS ≥6. These cases were diagnosed as infiltrating ductal carcinoma and angiosarcoma respectively on histopathology. Histopathological correlation was possible in only 70 patients. Of these 70, 28 were from the benign category and 42 were from the malignant category. TTS of ≥6 has a sensitivity of 97.44%, specificity of 100%. FNAC has a sensitivity of 88.37%, specificity of 96.42%.Conclusions:TT reliably guides evaluation of palpable breast masses. Histological correlation indicated TTS to be better diagnostic tool than FNAC alone.

Role of CD10 Immunoshistochemical Expression in Discriminating the Categories of Phylloides Tumor

Background and objectives: Phylloides tumors are categorized as benign, borderline and malignant on the basis of histological features which are subjected to significant inter-observer variability. Our aim was to study the role of immunohistochemical expression of CD10 in discriminating benign, borderline and malignant categories of phylloides tumor. Methods: The expression of CD10 was studied in 85 phylloides tumors (27 benign, 25 borderline, and 33 malignant) using immunohistochemistry to see whether the expression differed between these histologic categories. Chi-square test was applied to determine the significance of difference in CD10 expression among tumor categories. Significance was established at p<0.05. Results: 5/27 (18.5%) benign, 16/25 (64%) borderline and 26/33 (78.8%) malignant cases expressed significant (2+ or 3+) staining. This expression of CD10 significantly varied among histological categories (p<0.001). Histological features such as stromal atypia, stromal cellularity, tumor margins, mitotic activity and tumor size correlated significantly with tumor categories as well as with CD10 expression. Conclusion: From these highly significant results, we believe that there is a strong correlation between CD10 expression and tumor grade and it can be used as an adjunct diagnostic tool for categorizing Phylloides tumors along with other histological features.

Recurrent Malignant Phylloides Tumor: A Rare Entity

Phylloides tumor of breast is a rare tumor of fibroepithelial origin forming only about 0.3-0.5% of all breast malignancies. Malignant phylloids tumor is even more rarely encountered lesion of very unpredictable clinical outcome with high chances of recurrence and distant metastasis. Accurate preoperative pathological diagnosis is mandatory to allow correct planning of the surgical treatment which can be either wide excision or mastectomy with an intent to have a negative surgical margin of at least 1 cms. This rare and enigmatic tumor should be kept in mind while dealing with breast lumps. Here, we present a case of recurrent malignant phylloides tumor in a young female alongwith review of literature of this rare entity. Aim and Objective: To present a case of recurrent malignant phylloides tumor in a young female alongwith its cytology images and to have a review of literature of this enigmatic entity.

Phylloides Tumors of the Breast: A Case Series with Review of the Literature

Phylloides Tumors of the Breast: A Case Series with Review of the Literature

Analysis of patients with phyllodes tumor of the breast.

The diagnosis and management of phyllodes tumors is challenging due to its low incidence. The treatment of these tumors is surgery, however the extent of surgery, the application of adjuvant chemotherapy and radiotherapy are still controversial. Therefore, we aimed to evaluate patients who were treated with a diagnosis of phyllodes tumor of the breast in our clinic. Patients who were treated with a diagnosis of phyllodes tumor of the breast between June 2011 and June 2013 were reviewed retrospectively. Patient demographic characteristics (age, gender), menopausal status, symptoms, radiologic and surgical methods used for diagnosis and treatment, histopathologic features of the tumor and type of adjuvant therapy were evaluated. Patients were grouped as benign or borderline/malignant according to histopathological diagnosis. Patients in these groups were compared in terms of age, menopausal status, tumor size and the number of mitosis within the tumor. The median age was 26 years (17-59), and 30 patients were female. The surgical treatment of choice was wide local excision with tumor-free surgical margins in 29 patients and mastectomy in one patient. Histopathological diagnosis after surgery was benign in 21 patients (70%), borderline in 6 patients (20%) and malignant phyllodes tumor in 3 patients (10%). Patients with borderline and malignant phyllodes tumors were significantly older (p=0.002) and had higher mitotic counts (p<0.0001). There was no significant relationship between histopathologic subtypes of phyllodes tumors and menopausal status (p=0.06) or tumor size (p=0.1). Surgery is the treatment of choice for phyllodes tumors, and obtaining tumor-free margins is important. Since phyllodes tumors might recur as borderline/malignant tumors, local control with surgery and adjuvant radiotherapy should be provided when required. In this way, distant metastases and death that may arise due to possible malignant recurrences might be avoided.

Invasive lobular carcinoma co-existing with benign phylloides tumor

Phylloides tumor constitutes less than 1% of all breast tumors and 2 - 3% of fibroepithelial breast tumors. Several histological parameters should be evaluated, including stromal cellularity, atypia, mitoses, stromal overgrowth, infiltrative borders, and presence or absence of necrosis. Here we report a case of a 60 years- old female who presented with left breast lump. Fine needle aspiration cytology was done which suggested epithelial hyperplasia with fibrocystic changes. Biopsy was performed which showed predominance of stromal hypercellularity with proliferation of spindle cells (no atypia, mitosis and stromal overgrowth were noticed). However, a focus showed proliferation of discohesive tumor cells arranged singly and in single file. A diagnosis of benign phylloides tumor with foci of invasive lobular carcinoma was made. The diagnosis was confirmed with IHC which showed intense 80%positivity for estrogen and progesterone receptor and spindle cells showing positivity for bcl-2. In situ lobular carcinoma component was not observed. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10321 Journal of Pathology of Nepal (2014) Vol. 4, 597-599

Quantitative breast tissue characterization using grating-based x-ray phase-contrast imaging

X-ray phase-contrast imaging has received growing interest in recent years due to its high capability in visualizing soft tissue. Breast imaging became the focus of particular attention as it is considered the most promising candidate for a first clinical application of this contrast modality. In this study, we investigate quantitative breast tissue characterization using grating-based phase-contrast computed tomography (CT) at conventional polychromatic x-ray sources. Different breast specimens have been scanned at a laboratory phase-contrast imaging setup and were correlated to histopathology. Ascertained tumor types include phylloides tumor, fibroadenoma and infiltrating lobular carcinoma. Identified tissue types comprising adipose, fibroglandular and tumor tissue have been analyzed in terms of phase-contrast Hounsfield units and are compared to high-quality, high-resolution data obtained with monochromatic synchrotron radiation, as well as calculated values based on tabulated tissue properties. The results give a good impression of the method’s prospects and limitations for potential tumor detection and the associated demands on such a phase-contrast breast CT system. Furthermore, the evaluated quantitative tissue values serve as a reference for simulations and the design of dedicated phantoms for phase-contrast mammography.

Hyaline Globules in Mammary Myofibroblastoma

A 52-year-old otherwise healthy woman presented with a solitary firm mass in the right breast. Histopathological evaluation of the 1.5-cm mass showed a mammary myofibroblastoma of the conventional spindle-cell type. High-power examination of hematoxylin-eosin-stained sections showed round, eosinophilic, intracytoplasmic, as well as extracellular, hyaline globules. These 5- to 20-µm globules appeared gray with a pinkish rim on Masson's trichrome stain. Immunohistochemically, the hyaline globules were strongly reactive with smooth muscle myosin heavy chain, desmin, and caldesmon. Histologically similar inclusion bodies have been reported in phylloides tumors--including those with myoid differentiation. To our knowledge, this is the first description of hyaline globules, a peculiar histological curiosity with no known clinical significance, in mammary myofibroblastoma.

Costomammary Hydatid Disease: Imaging Findings

A suspicious non-calcified mass found during mammography that appears to be solid on sonography may represent a malignant lesion, such as an invasive ductal, mucinous or medullary carcinoma, or an uncommon benign lesion, such as a phylloides tumour, tubular adenoma, fat necrosis, adenosis or haemangioma. We report a case of hydatid disease with rib and breast involvement. Breast MRI findings are discussed. To our knowledge there have been no previous reported cases of primary breast and rib hydatid disease in the English literature.

Patient access to immediate breast reconstruction following cancer surgery. Learning from the National Mastectomy and Breast Reconstruction Audit (NMBRA)

s / International Journal of Surgery 11 (2013) 589e685 605 ABSTRACTS 0329: PATIENT ACCESS TO IMMEDIATE BREAST RECONSTRUCTION FOLLOWING CANCER SURGERY. LEARNING FROM THE NATIONAL MASTECTOMY AND BREAST RECONSTRUCTION AUDIT (NMBRA) Senthurun Mylvaganam, Niraj Vethirajan, Khalid Boussouara, George Metaxas, Hemant Ingle. Good Hope Hospital, Heart of England NHS Trust, Sutton Coldfield, Birmingham, UK. Introduction: NICE guidance requires breast reconstruction discussionwith all patients requiring mastectomy. The national mastectomy and reconstruction audit showed significant variation in accessibility and practice in NHS Trusts offering breast reconstruction. Our trust service has evolved since the audit combining breast and dedicated plastic surgeons on site. Aims: Assess current local accessibility and practice for offering immediate breast reconstruction following mastectomy. Methods: Retrospective analysis of patients undergoing mastectomy for cancer at Heart of England NHS trust (HEFT) between September 2011 to July 2012. Data collected on tumour biology, whether reconstruction options offered and if not performed why. Results: N1⁄476. Mean Nottingham Prognostic Index(NPI)1⁄44.03. Mean age1⁄461(31-90) Immediate reconstruction offered 1⁄446%. Immediate reconstruction performed 1⁄425%. Reconstruction techniques; immediate with expander(2), immediate delayed with expander(5), Transverse Rectus Abdominis Myocutaneous(TRAM) free flap(7), Lattissimus Dorsi(LD) pedicled flap(2), LD with implant(2), Deep Inferior Epigastric Perforator(DIEP) free flap(1). Reasons reconstruction not performed; patient choice(8), patient choosing delayed(6). Conclusion: Our trust breast cancer service is a partnership between breast and plastic surgeons with joint MDT and clinic services. The trust rate of discussion of immediate reconstruction is greater than the published NMBRA local cancer network rate(36%). An integrated oncoplastic service is a key measure towards fulfilling NICE guidance. 0331: THE IMPORTANCE OF NEEDLE CORE BIOPSY IN THE DIAGNOSIS OF PHYLLOIDES TUMOURS Senthurun Mylvaganam, Lucinda Frank , Clare Toro , Sarah Vestey , Steven Thrush . Worcester Royal Hospital, Worcestershire Acute NHS Trust, Worcester, Worcestershire, UK; Gloucestershire Hospitals NHS Trust, Gloucester, Gloucestershire, UK. Introduction: Phylloides tumours are rare fibroepithelial breast tumours and are usually clinically and radiological indistinguishable from fibroadenomas. This makes core biopsy the main method of diagnosis. Only small studies have looked at the diagnostic histological accuracy of needle core biopsy(NCB) and none have addressedwhether there is any variability of NCB accuracy between institutions. Aims: To assess the diagnostic accuracy of NCB compared to the gold standard excision biopsy report in 2 separate hospitals trusts. Methods: Multicentre retrospective analysis of all cases of phylloides tumours on core and/or excision biopsy from March 2006 to July 2012 at Worcestershire Acute NHS Trust (WAHNST) and Gloucestershire hospitals NHS Trust (GHNHST). Results: N1⁄494. Mean age1⁄448. Mean clinical size1⁄431.7mm, mean radiological size1⁄435.4mm. WAHNST n1⁄442. NCB Sensitivity1⁄487% and Positive Predictive Value(PPV)1⁄490%. GHNHST n1⁄452 NCB Sensitivity1⁄474% and PPV1⁄4100%. Conclusion: The high sensitivity of NCB shown demonstrates its importance in the diagnosis of Phylloides tumours (comparative study in literature 63%). There does appear to be variation between pathologists in interpretation of NCB, which may be caused by the interpretation of the criteria for diagnosing Phylloides. NCB is not 100% sensitive at diagnosing these tumours so there must be local protocols to ensure tumours are not missed. 0434: BREAST CANCER SURGERY IS SAFE IN THE ELDERLY PATIENT Ramesh Yap Kannan, Nadi Khaldoun, Khawaja Saira, Sumrien Haytham, Holt Simon, Sharaiha Yousef. Prince Philip Hospital, Llanelli, Carmarthenshire, UK. Aims: To assess the safety of surgical resection of breast cancer in patients over 70 years Methodology: A retrospective study of 188 consecutive patients diagnosed with breast cancer at the age of 70 or older (2004 to 2008). Notes were examined for demographics, treatment, complications and final outcome. Patients received surgery with an intent to cure (SC) or conservative treatment (C). Results: 68 patients received C and 120 patients underwent SC. SC was performed in 63.8%(120 of 188), of whom 93.3% had a general anaesthetic. Mastectomy (M) was performed in 51.6%, M following a wide local excision (WLE) in 4.2% and WLE in 44.2%. Axillary surgery (n1⁄493) was either an axillary sampling (AS) in 5%, AS and clearance (AC) in 1%, primaryAC in87.1%, sentinel node biopsy (SNB) in 3.2% and SNB followed by AC in 3.2% (3 of 93). 30 day mortality was 0.008% (1 of 120) following a myocardial infarction. 10 patients had minor complications. Median follow up (SC) was 24 months versus 20 months (C). Overall survival was 89%(SC) versus 50% (C). Conclusion: Elderly patients with breast cancer, can be treated surgically with an intent to cure, safely and this has an impact on survival. 0470: A RETROSPECTIVE ANALYSIS OF PHYLLODES TUMOURS AND B3 LESIONS ON CORE BIOPSY Lucinda Frank, Sarah Vestey, Richard Bryan. Gloucester Royal Hospital,

The importance of needle core biopsy in the diagnosis of phylloides tumours

The importance of needle core biopsy in the diagnosis of phylloides tumours

Routine follow-up of benign phylloides tumours is not indicated

Routine follow-up of benign phylloides tumours is not indicated

Phylloides Tumor With Numerous Thanatosomes (“Death Bodies”)

Thanatosomes, a form of degenerative intracellular hyaline globules, have been described in various neoplastic and nonneoplastic disease processes in several organs. These structures are indicative of apoptotic cell death. Herein, we report 2 cases of malignant phylloides tumor, both of which showed numerous thanatosomes-to the point of dominating the histological appearance and masking the stromal element. Our subsequently conducted study showed that thanatosomes were present in 14 of 86 (16.3%) high-grade malignant breast tumors. The structures were identified in 5/25 (20%) malignant phylloides tumors, 4/19 (21.1%) metaplastic spindle cell carcinomas, 3/21 (14.3%) invasive carcinomas s/p neoadjuvant chemotherapy, and 2/21 (9.5%) poorly differentiated invasive ductal carcinomas. When present, thanatosomes were typically a rare and focal finding in most types of cases. In malignant phylloides tumors, the structures were relatively more numerous when present. Our study shows that although thanatosomes can be present in several types of malignant breast tumors, they are more common in malignant phylloides tumor. Only rarely, as evident from our 2 index cases, do thanatosomes cause diagnostic difficulty.

BREAST DISEASES;

Objective: To determine pattern of breast diseases presenting in the surgical OPD of a General hospital. Design: Aprospective observational study. Place &amp; duration of study: The study was conducted at Railway hospital, Rawalpindi from September2008 to Feburary 2010. Patients &amp; Methods: Female patients presenting with complaints regarding breast were recruited in the study. Allof them underwent clinical breast examination followed by necessary radiological and / or histopathological investigations to diagnosethe disease. Data regarding personal information, clinical examination findings and results of investigations done was collected on aproforma. Results mainly as frequencies were analyzed using software SPSS 16.0. Results: A total of 207 female patients presented inthe OPD with breast complaints. 15 patients were lost to follow up before a definitive diagnosis could be made; therefore they wereexcluded from the study. Out of 192 patients 21.9% had mastalgia followed by fibroadenoma (19.3%), breast abscess (15.6%),carcinoma breast (13.5%), fibrocystic disease (6.25%), duct ectasia (5.7%), acute mastitis (4.7%), no disease (4.2%), nipple eczyma(2.1%). Benign phylloides tumour, chronic mastitis, prominent axillary tail, cracked nipple were each 1% and 3 patients presented withmammary fistula (0.5%), accessory nipple (0.5%), and lipoma(0.5%). Conclusion: Breast diseases make a sizeable portion of thegeneral surgical practice. In our set up benign diseases are far more common than the malignant ones. Mastalgia is the commonestbreast problem. Malignancy of breast presents usually in late stages.

Immune hyperplasia patterns in lymph nodes draining breast cancer: A correlation with histomorphological parameters

Background: Lymph nodes serve as site of immunologic expansion of lymphocyte populations. Enlargement of nodes may be caused by spread and growth of cancer cells or it can be due to reactive hyperplasia of lymph nodes. Aim : To study the pattern of reaction in involved and uninvolved lymph nodes draining breast carcinoma and correlate different patterns of hyperplasia with other morphological parameters in modified radical mastectomy (MRM) specimens. Material and Methods: Histopathological examination of 734 lymph nodes isolated from MRM specimens over a period of 2 years was performed on routine microsections. Results: Mixed pattern of hyperplasia was the most widespread followed by the diffuse pattern, the follicular hyperplasia, sinus histiocytosis, and paracortical hyperplasia in decreasing order. Follicular hyperplasia was seen in 23.44% of the ductal carcinomas and 36.36% of the malignant phylloides tumor. Sinus histiocytosis was seen in 23.53% of the metaplastic carcinomas, 22.22% of the medullary carcinomas with a decline to 12.10% amongst the ductal carcinomas. However, mixed pattern of hyperplasia was seen in 28.57% of the papillary carcinomas, 26.31% of the lobular and 27.41% of the ductal carcinomas. The incidence of sinus histiocytosis increased from 10.96 to 23.68% with the grade of tumor. There was a decline in the incidence of sinus histiocytosis, paracortical hyperplasia with the increase in the size of the tumor. Conclusions: The assessment of the reactive behavior of lymph nodes serves as an indicator to the histologic immunostaging of malignant tumors. This data indicate that the lymph node reaction to cancer and their incidence and prognostic significance may vary depending upon the stage and type of tumor.

Desmoid Tumor of the Breast in Young Women: 2 Case Reports

INTRODUCTION: Aggressive fibromatosis or desmoid tumors consist of infiltrative proliferations of fibroblastic and myofibroblastic cells, accounting for less than 0. 2% of breast tumors. These tumors are characterized by a locally aggressive growth pattern with frequent recurrences but are non-metastasizing. The ethiology is unknown however there is a well documented association with genetic disorders such as Gardner s syndrome. REPORTING: The authors report two cases of desmoid tumor in young women, one of them bilateral. The first case presented in a 23 year old woman, with a 3 month history of painful palpable mass with rapid growth in the upper external quadrant of the right breast associated with skin retraction. The mammogram and ultrasound show in the right breast two images suggesting a carcinoma and in left breast another image BI-RADS 5. Core biopsies were performed, the right breast suggested a desmoid tumor, but the left one was informed as normal tissue. To establish the diagnosis an excisional biopsy in both breasts was performed. The second case consists of a 22 year old woman, who presented with a rapidly growing breast mass with a presumptive diagnosis of phylloides tumor. A lumpectomy was performed with an attempt of free margins however macroscopically it was difficult to distinguish between the tumor and the normal breast tissue. Delayed biopsy informed a desmoid tumor. Both patients were treated with mastectomy followed by immediate breast reconstruction with expansors. The second one completed her reconstruction with implants, contralateral symmetrization and nipple areola complex reconstruction. DISCUSSION: Even though this tumor has no metastatic potential, wide excision is required because of the higher risk of local recurrence when it is incompletely excised. The role of radiotherapy and of medical treatments such as antioestrogens remains unclear. Desmoid tumors should be considered in the differential diagnosis of a rapid growth tumor in young women, in this way local treatment can be achieved with better oncologic and cosmetic results.