Recurrence Of Phyllodes Tumor Research Articles

Margin status impact on recurrence of phyllodes tumors in high-risk groups: a retrospective observational study

BackgroundPhyllodes tumor (PT) is an fibroepithelial tumor with potential for local recurrence. The optimal margin for surgical resection of PT is still debated, particularly in cases of positive margins. This study aimed to identify the risk factors for phyllodes tumor recurrence and the effect of a free margin on tumor recurrence by considering these risk factors.Materials and methodsThis is a retrospective observational study of patients diagnosed with PT who had undergone surgical management. The data were collected from medical records from 2001 to 2020 in the breast clinic of Shahid Motahhari Clinic of Shiraz. Patients were followed up for at least 3 years after the operation to be checked for local recurrence or distant metastasis at regular intervals.ResultsThis retrospective study included 319 patients with PT who underwent surgical management. Of these patients, 83.9% (n = 267), 7.6% (n = 24), and 8.5% (n = 27) were classified as benign, borderline, and malignant, respectively. 8.8% of all patients and 7.6% of non-malignant cases experienced local recurrence, and risk factors for recurrence included oral contraceptive use, smoking, size > 4 cm, stromal overgrowth, and stromal cell atypia. A negative surgical margin decreased the prevalence of recurrence in tumors > 4 cm and with stromal overgrowth significantly.ConclusionThe study found that a negative margin in all patients did not reduce the recurrence rate in benign and borderline phyllodes tumors, suggesting close follow up as a reasonable alternative. However, a negative margin may be effective in reducing recurrence in certain high-risk groups.

Clinico-Pathological Factors Determining Recurrence of Phyllodes Tumors of the Breast: The 25-Year Experience at a Tertiary Cancer Centre.

Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence. This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors associated with a recurrence of PTs of the breast. A retrospective cohort and observational study was conducted, which entailed analyzing the clinicopathological data of patients who were previously diagnosed or presented with PTs of the breast between 1996 and 2021. Data included the total number of patients diagnosed with PTs of the breast and their ages, tumor grade on initial biopsy, tumor location (left or right breast), tumor size, therapeutic interventions carried out (including surgery-either mastectomy or lumpectomy-and adjuvant radiotherapy), final tumor grade, recurrence status, type of recurrence, and time to recurrence. We analyzed data on a total of 87 patients who were pathologically proven to have PTs, and 46 patients (52.87%) were found to have recurrences. All patients were female, with a mean age at diagnosis of 39 years (range 15-70). Patients aged <40 years had the highest incidence of recurrence, with a rate of 54.35% (n = 25/46), followed by patients aged >40 years, with a rate of recurrence of 45.65% (n = 21/46). A total of 55.4% of patients presented with primary PTs and 44.6% had recurrent PTs at presentation. The average time to local recurrence (LR) from the completion of treatment was 13.8 months, whereas for systemic recurrence (SR), it was 15.29 months. Surgery (mastectomy/lumpectomy) was the major determinant for local recurrence (p < 0.05). Patients who received adjuvant radiotherapy (RT) had a minimal recurrence of PTs. Patients who were found to have a malignant biopsy on initial diagnosis (triple assessment) had a higher incidence of PTs and were more prone to SR than LR. Surgery was a determining factor in the increased rate of LR, with lumpectomy associated with a higher incidence of LR than mastectomy.

Phyllodes tumors of breast treated in a single tertiary center: A prospective study

Background: Phyllodes tumors (PT) are rare biphasic tumors occurring exclusively in breast tissue. Due to their various biological behavior and clinical presentation, they have potency for recurrence and progression to malignancy. Hence, it has created trouble in preoperative diagnosis. Aims and Objectives: The aim of the study was to study and analyze the clinical, histopathological findings, modalities of treatment, and outcomes of treatment, i.e., recurrence and survival of patients with late complications. Materials and Methods: A prospective case series study was done during the period of January 2020–December 2022 (2 years) in the Department of General Surgery, VIMSAR BURLA, ODISHA. A total of 42 patients were diagnosed with PT clinically, by ultrasonography and mammography and fine-needle aspiration cytology excluding the cases with recurrent PTs. They were undergone various type of surgical procedures and followed up for outcomes such as recurrences and late complications. Results: The average age during diagnosis was 42 years (range: 20–66 years). Out of 42 cases, 33 (78.6%) were benign, 5 (11.9%) were borderline, and 4 (9.5%) were malignant. Tumor size varies from 3 cm to 13 cm with average size of 6.38 cm. A patient with PT of size 28 cm was identified as an exception in our study. Patients with right side tumors were 19 and left side were 21, and 2 patients were having involvement of breast bilaterally. These patients were followed up for 6 to 24-month period. 6 (14.2%) patients reported with recurrence and reoperated again for that. 5 patients lost follow-up (probably cured) and 2 patients died due to malignant metastasis. Conclusion: Phyllodes tumor has specific clinical characteristics and can be considered one of the differential diagnoses of breast lumps. Preoperative diagnosis and proper treatment by checking clear surgical margins play a critical role in preventing recurrence of PT. Grading of PTs pathologically is essential to predict the risk of recurrence, and survival rate as its biological behavior is unpredictable. In this study, our observations provide perception into the clinical, histopathological findings, treatment modalities, and surgical outcomes, i.e., recurrence and prognosis of PT in this geographical region.

Excision of breast fibroepithelial lesions: when is it still necessary?-A 10-year review of a regional centre.

Fibroepithelial lesions (FEL) range from benign fibroadenoma (FA) to malignant phyllodes tumor (PT), but can be difficult to diagnose on core needle biopsy (CNB). This study assesses risk factors for phyllodes tumor (PT) and recurrence and whether a policy to excise FELs over 3cm in size is justified. Patients having surgery for FELs from 2009 to 2018 were identified. The association of clinical, radiology and pathological features with PT and recurrence were evaluated. Trend analysis was used to assess risk of PT based on imaging size. Of the 616 patients with FELs, 400 were identified as having FA on CNB and 216 were identified as having FEL with a comment of concern for phyllodes tumor (query PT, QPT). PT was identified in 107 cases; 28 had CNB of FA (7.0%), while 79 had QPT (36.6%). Follow-up was available for 86 with a mean of 56months; six patients had recurrence of PT, all of whom had QPT on CNB. The finding of PT was associated with CNB of QPT, increasing age and size on multivariate logistic regression. All patients diagnosed with PT following CNB of FA had enlarging lesions with a mean size of 38.3mm. Our data does not support routine excision of FELs based on size alone. All patients with QPT on CNB, regardless of size should consider excision due to high risk of PT and recurrence, and the decision to excise FAs to rule out PT should also consider whether the lesion is enlarging.

Under- and Normal-Weight Patients Are More Susceptible to Recurrence of Phyllodes Tumor.

Purpose Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, and factors associated with the recurrence of PTs are poorly understood. This study sought to identify clinicopathological factors associated with the recurrence of PTs. Method From January 2009 to December 2019, we identified 100 patients who underwent definitive surgery for PT. Clinicopathological risk factors associated with the recurrence of PT were assessed. Results The median age of the patients was 44 y (range, 19–62 y), and the median tumor size was 4 cm (0.8–30 cm). At a median follow-up of 26.7 mo (0–103 mo), 22 of the 100 patients experienced local recurrence. In the univariate and multivariate analyses, body mass index ≥ 23 kg/m2 (P = 0.042 in the univariate analysis; P = 0.039 in the multivariate analysis), tumor size ≥ 5 cm (P = 0.006 in the univariate analysis; P = 0.036 in the multivariate analysis), and the presence of stromal overgrowth (P = 0.032 in the univariate analysis; P = 0.040 in the multivariate analysis) were associated with an increased risk of local recurrence. Resection margins and grade were not associated with local recurrence. Conclusion Normal- or underweight patients and those with larger tumor sizes were more prone to local recurrence. Further larger, multicenter studies with a long-term follow-up are required.

Skin Recurrence of a Phyllodes Tumor and Impact of Radiotherapy: A Case Report and Review of the Literature

Introduction:Phyllodes tumors (PTs) are rare and are usually associated with local recurrences. Determining appropriate clear margins at surgery, adjuvant chemotherapy, and adjuvant radiotherapy is an ongoing dilemma for oncology professionals. The skin recurrence of a PT is not a commonly described situation in the published literature. Herein, we presented a patient with a skin recurrence of a PT. Case:A 48 year old Turkish woman presented with a lump on her left nipple-areolar complex. She had an anamnesis of a lumpectomy for PT 6 years ago and a nipple-areolar complex sparing mastectomy with immediate silicon reconstruction due to the recurrence of PT 3 years ago. No adjuvant treatment was administered after either of these surgical procedures. A magnetic resonance examination of her breast and a histopathological evaluation revealed the skin recurrence of PT. A nipple-areolar complex excision with 2 cm clear margins and adjuvant radiotherapy was then administered to her as the treatment regimen. Discussion:Surgery is defined as the effective treatment for PT but patients with high risk factors as large tumor size, positive margins and recurrent disease adjuvant treatments must be added.

Clinicopathologic Risk Factors for the Local Recurrence of Phyllodes Tumors of the Breast

Phyllodes tumors (PTs) are rare breast tumors that usually occur in middle-aged women. Here we discuss our recent experiences in the diagnosis, surgical management, and clinical follow-up of this disease. We retrospectively reviewed 164 patients with PTs who underwent surgical treatment at the Department of Surgery, Samsung Medical Center, Seoul, Korea, from January 1995 to July 2009. Clinical and histopathological data were analyzed. The median follow-up period was 33.6 months (range 2-179 months), and the median patient age was 43 years (range of 11-72 years). Tumor size ranged from 1 to 30 cm, with a median of 6.1 cm. A total of 148 patients (90.2 %) received local or wide excisions. Mastectomies were performed in 16 patients (9.8 %). The pathologic diagnoses included 82 benign (50.0 %), 42 borderline (25.6 %), and 40 malignant PTs (24.4 %). The tumor border was infiltrating in 43 patients (26.2 %) and pushing in 116 patients (70.7 %). The resection margin was divided by based on the width. Local recurrence was observed in 31 patients (18.9 %), and distant metastasis developed in four patients with malignant PTs. Risk factors for the local recurrence of a PT were a positive resection margin (P = .029) and tumor size (P = .001). The presence of tumor cells on the resection margin was a strong prognostic factor for local recurrence of PTs. However, a 1 cm negative margin thickness did not confer any local control advantage over a thinner negative margin width.

The Clinical and, Pathologic Risk Factors for Local Recurrence of Phyllodes Tumor

야에서상피세포가없는순수기질의과증식유무, 종양가장자리 Purpose: Phyllodes tumors of the breast are biphasic neoplasms. They are composed of epithelium and a spindle cell stroma. However, there is some controversy over its clinical behavior, pathologic characteristics, and local recurrence rates. Therefore we analyzed the clinicopathological characteristics of phyllodes tumor and the risk factor that influence a local recurrence after surgery were analyzed. Methods: We retrospectively analyzed the medical records of 73 patients with a phyllodes tumor and who had undergone surgery at the Department of Surgery, Kosin University, from 1994 to 2005. The median follow up period was 73 months (range: 5-250 months). The microscopic slides were re-examined and the pathologic criteria we analyzed were cellular atypia, stromal cellularity, pleomorphism, necrosis, differentiation, the tumor margin, and the number of mitosis. The malignancy was reclassifed using the histological criteria reported by Pietruszka et at. (benign was 0-4 mitoses/10 highpower folds, borderline 5-9 mitoses, and malignant was more than 10 mitoses), The clinical features we evaluated included age, the preoperative diagnosis, the tumor size, surgical methods, and local recurrence. Results: The mean age was 38.2 yr (range: 15-60 yr) and the mean tumor size was 4.3 cm (range: 1.6-18 cm), The most commonly performed surgical procedures were local or wide excision (60 cases, 82.2%), mastectomy in 10 cases (13.7%) and MRM in 3 cases (4.1%). Out of the 73 cases we reviewed, 49 (67.1%) were confirmed as being a benign, 3 (4.1%) were borderline, and 21 (28.7%) were malignant phyllodes tumor. Cellular atypia was minimal in 55 cases (75.3%) and it was prominent in 18 cases (24.6%). The stromal cellularity was minimal in 49 cases (67.1%) and it was prominent in 24 cases (32.8%). The tumor margin was infiltrating in 27 cases (36.9%) and pushing in 46 cases (63.0%). A local recurrence developed in 12 cases (16.4%). There were no dependable histopathological features to predict a local recurrence except for stromal cellularity, and an infiltrating margin. Conclusion: From the above results, the strong prognostic factors that can be used to predict a local recurrence appear to be stromal cellularity, and an infiltrating tumor margin. (J Breast Cancer 2007;10:85-9)

Prognostic Value of Proliferating Cell Nuclear Antigen in Phyllodes Tumor of the Breast

The proliferating cell nuclear antigen (PCNA), a nuclear protein essential for cellular DNA synthesis, has been used to assess cellular proliferation in many tumors. To evaluate the potential value of PCNA in predicting the outcome of phyllodes tumor of the breast, we retrospectively studied 17 tumors diagnosed during the period 1985-1991. PC 10, a monoclonal antibody that recognizes PCNA, was applied to for malin-fixed, paraffin-embedded sections. The PCNA index ranged from 0.2% to 66.3%. The tumors were stratified into high (&gt;9.8%, n = 4) or low (≤9.8%, n = 13) PCNA index groups. No significant correlation between high PCNA index and the clinicopath ologic parameters with the exception of infiltrative margin was sound. However, the difference in recurrence-free survival between the two groups was significant (log rank test P &lt; .01). The Cox's regression analysis showed that high PCNA index was an important prognostic factor for tumor recurrence. PCNA staining could be used as an objective prognostic factor for the local recurrence of phyllodes tumor of the breast. Int J Surg Pathol 2(2):125-132, 1994