Malignant Phyllodes Tumor: Imaging Features With Histopathologic Correlation

2021 ◽  
Author(s):  
Jane S Lee ◽  
Jodie Chang ◽  
Ian S Hagemann ◽  
Debbie L Bennett
Keyword(s):  
Clinical Presentation ◽  
Spindle Cell ◽  
Tumor Imaging ◽  
Phyllodes Tumor ◽  
Excisional Biopsy ◽  
Adjuvant Radiation ◽  
Imaging Features ◽  
Phyllodes Tumors ◽  
Histopathologic Analysis ◽  
Metaplastic Breast Carcinoma

Abstract Phyllodes tumors (PT) are rare fibroepithelial lesions of the breast that commonly present as rapidly enlarging, palpable masses. Phyllodes tumors may be classified as benign, borderline, or malignant on the basis of histopathologic analysis. Although malignant PT cannot be distinguished from benign PT on the basis of imaging findings alone, studies suggest that malignant PT tend to be larger and irregular in shape, and they are less likely to have circumscribed margins. If biopsy results are indeterminate, excisional biopsy should be performed. Malignant PT can be difficult to distinguish histologically from sarcomas and spindle cell metaplastic breast carcinoma; the distinction is important for prognosis and treatment. Malignant PT are treated surgically with wide local excision, without a clear role for adjuvant radiation or chemotherapy in most cases. Nearly one-third of malignant PT recur locally, usually within a few years after initial diagnosis. Distant metastatic disease is rare, and the five-year overall survival rate of malignant PT is close to 80%. The purpose of this article is to review the clinical presentation, imaging appearance, histopathology, and management of malignant PT.

scholarly journals Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature

2021 ◽  
pp. 123-133
Author(s):  
Ricardo Fernández-Ferreira ◽  
Andrés Arroyave-Ramírez ◽  
Daniel Motola-Kuba ◽  
Gabriela Alvarado-Luna ◽  
Ileana Mackinney-Novelo ◽  
...  
Keyword(s):  
Case Reports ◽  
Standard Of Care ◽  
Phyllodes Tumor ◽  
Surgical Excision ◽  
Axillary Lymph Node Metastasis ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Phyllodes Tumors ◽  
Complete Surgical Excision ◽  
Mexican Woman

Phyllodes tumor of the breast is an infrequently encountered fibroepithelial neoplasm, which accounts for 0.3–1% of all tumors. Few case reports have described the occurrence of giant phyllodes tumor. To our knowledge, about 20% of phyllodes tumors would be considered giant benign. Complete surgical excision is the standard of care for giant benign phyllodes tumors; axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes. We report the case of a 40-year-old Mexican woman with giant mammary tumor who underwent a right total mastectomy. The pathology results showed a benign phyllodes tumor 4,857 g in weight and 40.2 × 36.3 × 15 cm in size. We do not suggest adjuvant radiation therapy for patients with benign phyllodes tumors that are widely excised. A review of the pertinent literature was performed.

Phyllodes Tumors

2017 ◽  
Author(s):  
Tina J Hieken ◽  
Rafael E Jimenez
Keyword(s):  
High Risk ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Phyllodes Tumor ◽  
Oncologic Outcomes ◽  
Breast Adenocarcinoma ◽  
Adjuvant Radiation ◽  
Core Needle ◽  
Phyllodes Tumors ◽  
Stromal Component

Phyllodes tumors are rare primary breast neoplasms graded as benign, borderline, or malignant based on pathology characterization of the stromal component. Core-needle biopsy is recommended as the first diagnostic step for breast lesions suspicious for phyllodes. Surgical excisional biopsy is recommended for a core-needle biopsy showing cellular fibroepithelial lesion or a mass suspicious for phyllodes tumor as pathology diagnosis is challenging, especially on limited tissue specimens. Surgical treatment parallels that for soft tissue sarcoma rather than breast adenocarcinoma. Wide local excision and mastectomy, with 1 cm tumor-free margins, provide equivalent oncologic outcomes. Tumor enucleation, subtotal resection, and positive final margins should be avoided. Axillary surgery is not recommended as lymph node metastases are rare. Adjuvant radiation is not recommended as routine, nor is adjuvant chemotherapy, although either or both may be considered for primary or recurrent high-risk malignant phyllodes tumors on a case-by-case basis. Local recurrence rates are influenced by margin status and tumor grade. Distant metastases occur in up to 25% of patients with borderline/malignant tumors and bestow a poor prognosis. Recent molecular genetic analyses of phyllodes tumors have identified potentially targetable mutations that may guide future therapy for high-risk, recurrent, or metastatic phyllodes tumors. This review contains 5 figures, 5 tables, and 53 references. Key words: biomarkers, breast sarcoma, diagnosis, outcomes, pathology, phyllodes tumor, surgery, treatment

Phyllodes Tumors

2017 ◽  
Author(s):  
Tina J Hieken ◽  
Rafael E Jimenez
Keyword(s):  
High Risk ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Phyllodes Tumor ◽  
Oncologic Outcomes ◽  
Breast Adenocarcinoma ◽  
Adjuvant Radiation ◽  
Core Needle ◽  
Phyllodes Tumors ◽  
Stromal Component

Phyllodes tumors are rare primary breast neoplasms graded as benign, borderline, or malignant based on pathology characterization of the stromal component. Core-needle biopsy is recommended as the first diagnostic step for breast lesions suspicious for phyllodes. Surgical excisional biopsy is recommended for a core-needle biopsy showing cellular fibroepithelial lesion or a mass suspicious for phyllodes tumor as pathology diagnosis is challenging, especially on limited tissue specimens. Surgical treatment parallels that for soft tissue sarcoma rather than breast adenocarcinoma. Wide local excision and mastectomy, with 1 cm tumor-free margins, provide equivalent oncologic outcomes. Tumor enucleation, subtotal resection, and positive final margins should be avoided. Axillary surgery is not recommended as lymph node metastases are rare. Adjuvant radiation is not recommended as routine, nor is adjuvant chemotherapy, although either or both may be considered for primary or recurrent high-risk malignant phyllodes tumors on a case-by-case basis. Local recurrence rates are influenced by margin status and tumor grade. Distant metastases occur in up to 25% of patients with borderline/malignant tumors and bestow a poor prognosis. Recent molecular genetic analyses of phyllodes tumors have identified potentially targetable mutations that may guide future therapy for high-risk, recurrent, or metastatic phyllodes tumors. This review contains 5 figures, 5 tables, and 53 references. Key words: biomarkers, breast sarcoma, diagnosis, outcomes, pathology, phyllodes tumor, surgery, treatment

Large Circumscribed Mass in Young Female

2018 ◽  
Author(s):  
Mark D. Kettler
Keyword(s):  
Young Women ◽  
Phyllodes Tumor ◽  
Young Female ◽  
Female Adolescents ◽  
Imaging Features ◽  
Breast Masses ◽  
Histological Assessment ◽  
Histological Features ◽  
Phyllodes Tumors ◽  
Management Recommendations

Fibroepithelial lesions account for the overwhelming majority of solid breast masses affecting women younger than age 20. Nearly all present as self-detected or provider-detected palpable masses. All fibroepithelial lesions are composed of stromal (fibrous) and glandular (epithelial) elements and variable histology. Rapidly growing mobile breast masses in girls or female adolescents may represent juvenile fibroadenomas, which have different but benign histological features when compared to typical fibroadenomas. Benign phyllodes tumors closely resemble usual fibroadenomas and juvenile fibroadenomas on imaging. Decisions whether to biopsy these tumors are made clinically; the diagnosis of phyllodes tumor depends on histological assessment.This chapter, appearing in the section on circumscribed mass, reviews the key clinical and imaging features, differential diagnosis, and management recommendations of large solid breast masses affecting young women, including typical fibroadenomas, giant fibroadenomas, juvenile fibroadenomas, and phyllodes tumors.

Malignant Phyllodes Tumor with Lipomatous Differentiation: A Unique Presentation

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S36-S36
Author(s):  
P Johal ◽  
C Sebastiano
Keyword(s):  
Phyllodes Tumor ◽  
Excisional Biopsy ◽  
Surrounding Tissue ◽  
Beta Catenin ◽  
Significant Past Medical History ◽  
Ki 67 ◽  
Complete Excision ◽  
Malignant Phyllodes Tumor ◽  
Phyllodes Tumors ◽  
Wide Range

Abstract Casestudy Phyllodes tumors (PT) are uncommon biphasic fibroepithelial neoplasms that account for <1% of all breast tumors. The distinction between benign and malignant PTs is made based on a number of histologic characteristics, including an infiltrative margin, stromal overgrowth, mitotic count, hypercellularity and atypia. 30% of cases show heterologous differentiation, which mostly occurs in stromal elements. This can result in a wide range of tumor histopathology including lipomatous areas. Results We present the case of a 46-year-old female with a 3.1 cm left breast palpated mass and no significant past medical history. Ultrasound guided needle biopsy revealed multiple foci of hypercellular spindle cells with marked atypia and mitoses (ki-67: 40–60%) surrounded by focal fat necrosis. Immunohistochemical staining was negative for CK 5/6, p63, CAM 5.2, SMA, desmin, AE1/3, CD163, nuclear beta-catenin and CD34. The patient subsequently underwent a wire localization excisional biopsy. Microscopic examination revealed a biphasic hypercellular lesion with both stromal and distorted glandular elements and extensive lipomatous differentiation. Although mostly well- circumscribed, some infiltration into the surrounding tissue was identified as well as nuclear atypia and an increased mitotic rate (10 mitoses/HPF). The diagnosis of malignant phyllodes tumor with lipomatous differentiation was made based on these findings. FISH was performed and was negative for MDM2, suggesting that the lipomatous component itself was not malignant (i.e. liposarcoma) Conclusion Malignant phyllodes tumors rarely show heterologous differentiation. A literature review revealed that most lipomatous differentiation was liposarcomatous with rare cases of pure lipomatous metaplasia. Although malignant phyllodes tumor have the highest rate of metastasis relative to their benign counterparts, complete excision has resulted in a mortality rate of approximately 12%. The clinical implications of lipomatous differentiation are currently unknown. However, in these cases ensuring the lack of malignant liposarcomatous tumor growth is imperative.

scholarly journals Progressive Metastatic Breast Phyllodes Tumor Turns into Spindle Cell Sarcoma: Report of Two Cases and Review of the Literature

2020 ◽  
pp. 40-44
Author(s):  
Nahid Nafissi ◽  
Seyed-Mohamad-Sadegh Mirahmadi ◽  
Majid Samsami ◽  
Nafiseh Ansarinejad
Keyword(s):  
Ct Scan ◽  
Lung Metastasis ◽  
Spindle Cell ◽  
Young Patients ◽  
Phyllodes Tumor ◽  
Chemotherapeutic Agents ◽  
Thoracic Wall ◽  
Ct Guided ◽  
Phyllodes Tumors ◽  
Short Period

Background: Breast fibroepithelial lesions encompass a wide variety of tumors from benign fibroadenomas to malignant phyllodes tumors (PTs). Local recurrence was reported in 20% of all subgroups and 20-25% risk of distant metastasis though superaggressive tumors are rare. Two young patients with nonresponsive, frequent recurrences of phyllodes tumors turned into the aggressive metastatic sarcoma are presented.Case Presentation: Case 1: A 34-year-old married woman referred with the chief complaint of a mass and pain in her right breast. There was a 3cm well defined mass in right breast. An intermediate grade benign phyllodes tumor was confirmed in biopsy. Patient underwent surgical wide excision, radiotherapy. Three weeks later the mass recurred in her right breast with severe pain and nonproductive cough without hemoptysis. A single lung metastasis is conformed in the CT scan. Total mastectomy and thoracoscopic metastasectomy was performed and spindle cell sarcomas in both specimens is confirmed. Chemotherapy was done. Two weeks after chemotherapy she presented with multiple bilateral lung metastasises and thoracic wall involvement. No regression in metastasis was seen receiving the second line chemotherapeutic agents. Case 2: A 17-year-old young girl was referred to the breast clinic with a 2 cm firm mobile mass in left breast. The histopathology of the mass was benign phyllodes tumor. (1.5 cm margins) The tumor recurred 3 months later treated. During radiotherapy, the patient referred to the emergency department with the complaint of dyspnea and sever pleural effusion. The cytology reported malignant cells. CT-guided biopsy showed a high grade sarcoma. During chemotherapy, large ulcer in the site of the breast was appeared and mastectomy with Latissmus dorsi flap was performed and angiosarcoma was confirmed. Despite the second and third line chemotherapy the disease was progressed and multiple lung metastasis were confirmed in chest CT scan. Conclusion: It seems that some subtypes of breast sarcomas could have an extremely an aggressive behavior which threatens the life of the patients in a short period of time. Further studies is suggested to discriminate the aggressive subtypes at the first step.

Radiologic Findings of a Rare Subtype of Invasive Breast Cancer with Poor Prognosis: Metaplastic Carcinoma of the Breast

2019 ◽  
Vol 15 (3) ◽  
pp. 338-348
Author(s):  
Hale Aydin ◽  
Bahar Guner ◽  
Isil Esen Bostanci ◽  
Nazan Ciledag ◽  
Melda Boyacioglu Bulut ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Multimodality Imaging ◽  
Metaplastic Carcinoma ◽  
Imaging Features ◽  
Mri Findings ◽  
Radiologic Findings ◽  
Round Shape ◽  
Malignant Feature ◽  
Imaging Results ◽  
Metaplastic Breast Carcinoma

Background and Objectives: The purpose of this study was to evaluate the mammographic, sonographic and MRI findings of metaplastic breast carcinoma. Methods: In this retrospective review study, we analyzed the medical files of 9600 patients who were treated for invasive breast cancers. Clinical information, histopathologic and radiologic findings of 65 patients were included in this study. All existing radiologic images and medical reports were reviewed retrospectively. Thirty-three patients had MG, 58 patients had US and 7 patients had MRI imaging results. Results: Mammographically, the most frequent presentations of MPBC were round shape, microlobulated margin and high density masses. Calcifications with or without masses were not a frequent finding. The most common sonographic findings were round shape, partially indistinct angular margin, hypoechoic and heterogeneous echo patterns and no posterior feature masses. All lesions were presented as masses rather than non-mass enhancements on magnetic resonance imaging. Features of masses had more malignant feature on MRI than other modalities in all 7 patients. Conclusion: Metaplastic breast carcinoma is one of the rarest poorly differentiated invasive breast carcinomas. Interestingly, these aggressive tumors demonstrate benign or moderately malign features on imaging methods. This appearance of MPBC can cause it to be misdiagnosed as a benign breast lesion especially in young women. MPBC should be kept in mind in the differential diagnosis of large palpable breast masses. Therefore, follow-up at short intervals and/or multimodality imaging studies which include breast MRI are important for the diagnosis of MPBC.

Merkel Cell Carcinoma of the Lower Extremity

2014 ◽  
Vol 104 (4) ◽  
pp. 422-425 ◽  
Author(s):  
Dominic J. Roda ◽  
Brian Albano ◽  
Bharti Rathore ◽  
Linda Zhou
Keyword(s):  
Lower Extremity ◽  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Clinical Presentation ◽  
Treatment Guidelines ◽  
Excisional Biopsy ◽  
Lymph Node Biopsy ◽  
Rapid Progression ◽  
Merkel Cell ◽  
Unusual Lesion

Merkel cell carcinoma is a rare, often fatal, neuroendocrine cutaneous malignancy with a highly variable clinical presentation. Due to the rapid progression of the disease, early detection and treatment is vital to survival. Here, we report the case of a 45-year-old woman whose podiatrist noticed an unusual lesion on her lower left leg and referred her to a dermatologist for work-up. A diagnostic excisional biopsy confirmed the diagnosis and was followed by treatment that included wide local excision of the primary lesion with subsequent chemotherapy and radiation. At the time of diagnosis, sentinel lymph node biopsy was positive. Due to the increasing prevalence of Merkel cell carcinoma in the past decade and its propensity to present on the lower extremity, podiatric physicians need to be aware of the clinical presentation and treatment guidelines for this elusive disease.

scholarly journals Temporal gliosarcoma: case report and review of literature

2015 ◽  
Vol 22 (1) ◽  
pp. 112-116
Author(s):  
Amit Agrawal ◽  
Vissa Shanthi ◽  
Baddukonda Appala Ramakrishna ◽  
Kuppili Venkata Murali Mohan
Keyword(s):  
Case Report ◽  
Median Survival ◽  
Glial Cells ◽  
Primary Tumor ◽  
Clinical Presentation ◽  
Spindle Cell ◽  
Review Of Literature ◽  
Future Studies ◽  
Aggressive Tumor ◽  
The Brain

Abstract First characterized by Stroebe, the gliosarcomas are highly malignant and rare primary tumor of the brain composed of neoplastic glial cells in association with spindle cell sarcomatous elements (biphasic tissue patterns). In spite of being recognized as two different pathologies studies have not shown any significant differences between gliosarcoma and glioblastoma with regard to age, sex, size, clinical presentation, and median survival. In summary, gliosarcoma is an aggressive tumor with a propensity to recur and re-grow with poor outcome. Future studies are needed to understand the true pathology of these biphasic tumors.

scholarly journals Dendritic Myxofibrolipoma: Often Misdiagnosed as Sarcoma

2011 ◽  
Vol 4 (3) ◽  
pp. 171-174 ◽  
Author(s):  
Awatif Y. Al-Maskery ◽  
Salem M. Al-Sidairy ◽  
Aisha S. Al-Hamadani
Keyword(s):  
Soft Tissue Tumor ◽  
Clinical Presentation ◽  
Spindle Cell ◽  
Spindle Cell Lipoma ◽  
Complete Excision ◽  
Lower Lip ◽  
Benign Soft Tissue Tumor ◽  
Proper Diagnosis ◽  
Fibrous Tumor ◽  
Combined Feature

The author describes a benign soft tissue tumor that could be easily mistaken for sarcoma. It represents a combined feature of solitary fibrous tumor and spindle cell lipoma. The clinical presentation, diagnosis, and management of this lesion are discussed. It highlights the importance of proper diagnosis to prevent unnecessary and ineffective treatment by clinicians as the complete excision of this lesion is the treatment of choice and recurrence is very unlikely. It is believed that this case is the first reported case of dendritic myxofibrolipoma occurring in the lower lip mucosa in an Omani patient.

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