A clinical review of 33 cases of breast phyllodes tumor over the last 20 years

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10629-10629
Author(s):  
M. S. Lenhard ◽  
S. Kahlert ◽  
I. Himsl ◽  
N. Ditsch ◽  
M. Untch ◽  
...  
Keyword(s):  
Lymph Node ◽  
Local Recurrence ◽  
Tumor Size ◽  
Phyllodes Tumor ◽  
Distant Metastases ◽  
Primary Diagnosis ◽  
Axillary Lymph ◽  
Malignant Phyllodes Tumor ◽  
Cystosarcoma Phyllodes

10629 Background: The “Cystosarcoma phyllodes” of the breast is a rare entity which accounts for 0.5 % of all breast neoplasms. The diagnosis should be considered in all rapidly growing breast nodules. We reviewed all cases of this rare disease that presented at our hospital in the last 20 years. Methods: The data of 5270 patients with primary breast neoplasms treated in our department between 1984 and 2005 were retrospectively analyzed for the histopathologic diagnosis of a cystosarcoma phyllodes. Results: 33 patients with cystosarcoma phyllodes of the breast could be identified. The median age at diagnosis was 47 years. Median follow up was 86 months. The tumors were classified histologically into benign (40%), borderline (27%) and malignant tumors (33%) based on standardized criteria; 3 tumors were unclassified. Surgery was conducted as a breast conserving (58%) or radical operation (mastectomy) (42%). Median tumor size was 7.1 cm, and no lymph node infiltration was found in the 8 patients who received axillary lymph node dissection. Local recurrence occured in 8 patients (26%). 75% (6/8) of the patients with a local recurrence had been treated with a breast conserving surgery. In patients with the diagnosis of a malignant phyllodes tumor we observed a recurrence rate of 40% (4/10), in those with borderline tumors of 25% (2/8) whereas those with benign phylloides tumor had a local relapse rate of 8% (1/12). Distant metastases were seen in 4 patients (12%) with a malignant phyllodes tumor. All patients with distant metastases in the follow up had been treated radically at primary diagnosis. Neither regarding age at primary diagnosis nor in tumor size there was a significant difference between patients with local recurrence or metastasic spread and those without (p = 0.284 tumor size, p = 0.739 for age, Wilcoxon-W). Conclusions: We recommend local excision with appropiate surgical margins in all patients if the tumor-to-breast ratio is sufficient for good cosmesis. Based on our data, routine axillary lymph node dissection is not recommended. Patients with a malignant tumor are at higher risk for local recurrence and metastasic spread. Therefore, the histopathologic classification seems to be the strongest prognostic factor in this disease. No significant financial relationships to disclose.

Pathological prognostic factors in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma: a study of 644 patients with median follow-up of 18 years.

1989 ◽  
Vol 7 (9) ◽  
pp. 1239-1251 ◽  
Author(s):  
P P Rosen ◽  
S Groshen ◽  
P E Saigo ◽  
D W Kinne ◽  
S Hellman
Keyword(s):  
Prognostic Factors ◽  
Breast Carcinoma ◽  
Local Recurrence ◽  
Median Survival ◽  
Tumor Size ◽  
Stage I ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Systemic Recurrence

Prognostic factors have been examined in 644 patients with tumor-node-metastasis (TNM) stage T1 breast carcinoma treated by mastectomy and followed for a median of 18.2 years. Overall, 148 patients (23%) died of recurrent breast carcinoma. Eighteen (3%) were alive with recurrent disease and 478 (74%) were alive or died of other causes without recurrence. Unfavorable clinicopathologic features were larger tumor size (1.1 to 2.0 cm v less than or equal to 1 cm), perimenopausal menstrual status, the number of axillary lymph node metastases, poorly differentiated grade, presence of lymphatic tumor emboli (LI) in breast tissue near the primary tumor, blood vessel invasion (BVI), and an intense lymphoplasmacytic reaction around the tumor. Median survival after recurrence for the entire series was 2 years. This was not significantly influenced by tumor size, the number of axillary nodal metastases, the type of treatment for recurrence, or the interval to recurrence. The proportions surviving 5 and 10 years after recurrence were 17% and 5%, respectively. Among T1N0M0 cases, the chance of a local recurrence was 2.8% within 20 years. Median survival of T1N0M0 cases after local recurrence (4.5 years) was significantly longer than after systemic recurrence (1.5 years). A similar trend (3.7 v 2.0 years), not statistically significant, was seen in T1N1M0 patients, who had a 6.5% chance of local recurrence within 20 years. Median survival following systemic recurrence detected 10 or more years after diagnosis in T1N0M0 and in T1N1M0 patients was significantly longer than the median survival for systemic recurrences found in the first decade of follow-up. This difference did not apply following local recurrence in either T1N0M0 or T1N1M0 cases. It is evident that patients with T1 breast carcinoma can be subdivided into differing prognostic groups and this must be taken into account when considering the role of adjuvant chemotherapy for stage I disease. Systemic adjuvant treatment may prove to be beneficial for patients with unfavorable prognostic factors, while women with an especially low risk for recurrence (eg, T1N0M0 tumor 1.0 cm or less) might be spared such treatment.

scholarly journals Neopterin Is an Independent Prognostic Variable in Females with Breast Cancer

1999 ◽  
Vol 45 (11) ◽  
pp. 1998-2004 ◽  
Author(s):  
Christian Murr ◽  
Anton Bergant ◽  
Martin Widschwendter ◽  
Kurt Heim ◽  
Hans Schröcksnadel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Distant Metastases ◽  
Cell Immune Response ◽  
Lymph Node Status ◽  
Risk Of Death ◽  
Node Status ◽  
Urinary Neopterin

Abstract Background: Neopterin, produced by human monocytes/macrophages upon stimulation by interferon-γ, is a sensitive marker for monitoring Th1-cell immune response in humans. In malignant diseases, the frequency of increases in neopterin in the serum and urine of patients depends on tumor stage and type. Methods: In a retrospective study comprising 129 females with breast cancer, urinary neopterin/creatinine ratios were measured at the time of diagnosis. Tumor characteristics were determined concomitantly. Results: Urinary neopterin was increased in 18% of the patients. It did not correlate with tumor size or lymph node status, but it was influenced by the presence of distant metastases (P <0.05) and by tumor differentiation (P = 0.01). When product-limit estimates were calculated after follow-up for up to 13 years (median follow-up, 56 months), the presence of distant metastases (P <0.001), neopterin (P <0.001), tumor size (P = 0.001), and lymph node status (P <0.01) were significant predictors of survival. By multivariate analysis, a combination of the variables presence of distant metastases (P <0.001), neopterin (P <0.01), and lymph node status (P <0.05) was found to jointly predict survival. In lymph node-negative patients without distant metastases, the relative risk of death associated with increased neopterin concentrations was 2.5 compared with patients with neopterin concentrations within the reference interval. Conclusion: Urinary neopterin provides additional prognostic information in patients with breast cancer.

Clinical and pathological comparison of patients with breast cancer under age 35 with those over age 70.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11045-e11045
Author(s):  
Pinar Dal ◽  
Samed Rahatli ◽  
Nadire Kucukoztas ◽  
Selim Yalcin ◽  
Omer Dizdar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Tumor Size ◽  
Metastatic Lymph Node ◽  
Lymph Node Involvement ◽  
Axillary Lymph ◽  
Age Group ◽  
Node Involvement ◽  
Young Breast Cancer

e11045 Background: Despite intensive treatment given to young breast cancer women, prognosis is stil poor in this group of population. However, older patients seem to have better prognosis. Methods: We performed the retrospective study for 50 women ≤35 yo compared with 50 women ≥70 yo, diagnosed and treated from 1991-2009 at Baskent University Hospitals. Results: Older women were more likely to have lower tumor grades and higher HR positivity, ≤35 years old women were more likely to have Her2 positivity, larger tumor size and metastatic lymph node involvement. Median follow up duration was 21.7 (2-91) months for ≤35 group, whereas it was 36.2 (4-195) months for ≥70 years group. Recurrence was observed in 34% of the young age group and 24% of the older age group. Three patients from the young group and 4 patients for ≥70 years age group died during the follow-up Young breast cancer patients have poor prognosis. Even after adjustment of the data, Overall survival and relapse free survival showed worse prognosis. Normal prognostic factors like tumor size, axillary lymph node involvement and grading can therefore be not the explanation for the more agressive disease progression alone. Older women were more likely to have lower tumor grades and higher hormone receptor positivity, ≤35 years old women were more likely to have Her2 positivity, larger tumor size and metastatic lymph node involvement. Median follow up duration was 21.7 (2-91) months for ≤35 age group, whereas it was 36.2 (4-195) months for ≥70 years group. Recurrence was observed in 34% of the young age group and 24% of the older age group. Three patients from the young group and 4 patients for ≥70 years age group died during the follow-up Young breast cancer patients have poor prognosis. Even after adjustment of the data, Overall survival and relapse free survival showed worse prognosis. Normal prognostic factors like tumor size, axillary lymph node involvement and grading can therefore be not the explanation for the more agressive disease progression alone. Conclusions: There are various reasons such as difficulty in diagnosing the patients the patients at earlier stage because of the higher density of breast tissue at younger age may be one of the reason.

scholarly journals Malignant Phyllodes Tumor With Metastases to the Femur the Lung and Bilateral Axillas: A Case Report and Review of Literature

2021 ◽  
Author(s):  
Jie-Yu Zhou ◽  
Wei-Da Fu ◽  
Jun-Wei Gu ◽  
Kang-Kang Lu ◽  
Gui-Long Guo
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Genetic Testing ◽  
Adjuvant Chemotherapy ◽  
Phyllodes Tumor ◽  
Primary Treatment ◽  
Axillary Lymph ◽  
Malignant Phyllodes Tumor ◽  
Primary Treatment Modality ◽  
Obvious Benefit

Abstract Background: Phyllodes tumor is rare accounting for <1% of all breast tumors. It is classified as benign, borderline, or malignant.The lymph node is involved rarely, and the most common metastasis path is through hematogenous channels mainly to the lung the pleura and the bone. Case presentation: This case report presents a 34-year-old woman suffered from metastases to the femur the lung and bilateral axillas from a malignant phyllodes tumor in 9 years. The most recent recurrence was discovered on bilateral axillas. The patient accepted adjuvant chemotherapy. However, because no obvious benefit of chemotherapy was found, the patient received bilateral axillary lymph node dissection finally. Genetic testing after surgery showed tumor-specific mutations and mutations about thepolymorphism of drug metabolism-related enzymes. Conclusions: The primary treatment modality for phyllodes tumor is surgery. For metastases, adjuvant chemotherapy may be efficient. However, when the effect of chemotherapy is not obvious, aggressive surgical therapies should be performed. Besides, genetic testing can provide advices on effective treatments.

scholarly journals Use of Contrast-Enhanced Ultrasound with Sonazoid for Evaluating the Radiotherapy Efficacy for Hepatocellular Carcinoma

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 486
Author(s):  
Akihiro Funaoka ◽  
Kazushi Numata ◽  
Atsuya Takeda ◽  
Yusuke Saigusa ◽  
Yuichirou Tsurugai ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Study ◽  
Local Recurrence ◽  
Tumor Size ◽  
Size Reduction ◽  
Contrast Enhanced Ultrasound ◽  
Tumor Vascularity ◽  
Contrast Enhanced

Radiotherapy is one of the available curative therapies for hepatocellular carcinoma (HCC). We investigate the use of contrast-enhanced ultrasound using Sonazoid (SCEUS) in evaluating the efficacy of radiotherapy for HCC. We enrolled 59 patients with 59 HCCs in this retrospective study. Tumor size and tumor vascularity were evaluated using SCEUS before and 1, 3, 7, 10, and 13 months after radiotherapy. The median follow-up period was 44.5 months (range: 16–82 months). Of the HCCs, 95% (56/59) had no local recurrence, while 5% (3/59) did. At 13 months after radiotherapy, in cases with no local recurrence, SCEUS showed a reduction in tumor vascularity in all cases, while tumor size reduction (>30% reduction, compared with pre-radiotherapy) was observed in 82.1% (46/56). In all three cases of local recurrence, vascularity and tumor size reduction were not observed during the follow-up period and residual HCCs were demonstrated pathologically. Compared with cases with local recurrence, tumor size reduction and reduction in tumor vascularity (p < 0.001) were significantly greater in cases with no local recurrence at 13 months after radiotherapy. SCEUS may be useful in evaluating radiotherapy efficacy for HCC.

Isolated same-basin lymph node recurrence after precision lymph node excision for clinically evident melanoma metastasis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9576-9576
Author(s):  
Kevin Lynch ◽  
Yinin Hu ◽  
Norma Farrow ◽  
Yun Song ◽  
Max Meneveau ◽  
...  
Keyword(s):  
Lymph Node ◽  
Disease Control ◽  
Lymph Node Dissection ◽  
Patient Preference ◽  
Distant Metastases ◽  
Node Dissection ◽  
Melanoma Patients ◽  
Regional Disease ◽  
In Transit

9576 Background: While management of the nodal basin for melanoma has largely moved to observation for microscopic sentinel lymph node (SLN) metastasis, complete lymph node dissection (CLND) remains the current standard of care for melanoma patients with macroscopic, clinically detectable lymph node metastases (cLN). As CLND is associated with high surgical morbidity, we sought to study whether cLN may be safely managed by excision of only clinically abnormal nodes (precision lymph node dissection, PLND). Currently, a small subset of patients with cLN do not undergo CLND because of frailty or patient preference. We hypothesized that in these selected patients, PLND would provide acceptable regional control rates. Methods: Retrospective chart review was conducted at four academic tertiary care hospitals to identify melanoma patients who underwent PLND for cLN. cLN were defined as palpable or radiographically abnormal nodes. Recurrences were categorized as local/in-transit, same-basin lymph node, or distal lymph node/visceral. The primary outcome was isolated same-basin recurrence after PLND. Results: Twenty-one patients underwent PLND for cLN without synchronous distant metastases (characteristics of primary lesions summarized in Table). Reasons for forgoing CLND included patient preference (n=8), imaging indeterminate for distant metastases (n=2), comorbidities (n=4), loss to follow up (n=1), partial response to checkpoint blockade (n=1), or not reported (n=5). The inguinal node basin was the most common site (n=10), followed by the axillary (n=8) and cervical basins (n=3). A median of 2 nodes were resected at PLND, and 68% of resected nodes were positive for melanoma (median: 1, range: 1-3 nodes). Median follow-up was 23 months from PLND, and recurrence was observed in 28.6% of patients overall. Only 1 patient (4.8%) developed an isolated same-basin recurrence. The 3-year cumulative incidence of isolated same-basin recurrence was 5.3%, while risk of isolated local/in-transit recurrence or distant basin/visceral metastasis were 19.8% and 33.3%, respectively. Complications from PLND were reported in 1 patient (4.8%) and were limited to post-operative seroma and lymphedema. Conclusions: These pilot data suggest that PLND may offer acceptable regional disease control for cLN. Post-operative morbidity from PLND was also low, raising the possibility that PLND may provide adequate regional disease control without the morbidity associated with CLND. These data justify additional, prospective evaluation of PLND in selected patients.[Table: see text]

scholarly journals A Case of Malignant Phyllodes Tumor of the Breast with Metachronous Lymph Node Metastasis Treated by Maltimodal Therapy

2017 ◽  
Vol 78 (6) ◽  
pp. 1225-1229
Author(s):  
Hiroshi TANAKA ◽  
Yasutomo GOTO ◽  
Takayuki MINAMI ◽  
Takuya NAGAO ◽  
Koichi MOURI ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Phyllodes Tumor ◽  
Malignant Phyllodes Tumor ◽  
Node Metastasis

scholarly journals MON-533 Diffuse Sclerosing Variant Papillary Thyroid Cancer: Clinical and Histopathological Features, Mutational Profile, Management and Outcome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Abeer Abdulhadi Aljomaiah ◽  
Yosra Moria ◽  
Nora Aldaej ◽  
Meshael Alswailem ◽  
Ali Saeed Alzahrani
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Molecular Genetics ◽  
Papillary Thyroid Cancer ◽  
Distant Metastases ◽  
The Other ◽  
Papillary Thyroid ◽  
Histopathological Features ◽  
Diffuse Sclerosing Variant

Abstract Diffuse sclerosing variant (DSV) is a rare subtype of papillary thyroid cancer (PTC). Whether it represents a higher grade subtype than conventional PTC is not quite clear. Furthermore, there are limited data on its long-term outcome and its molecular genetics. In this report, we studied all cases of DSV PTC seen at our center during the last 20 years. Out of more than 6000 patients (pts) with differentiated thyroid cancer, only 37 were DSV. We reviewed the clinical and histopathological features, management and outcome of these cases. In addition, molecular genetics is partially achieved; 17 out of these 37 cases have been genotyped for BRAFV600E, TERT promotor mutations, NRAS, HRAS and KRAS mutations. The molecular profiling of the other 20 cases is being done. A total of 37 pts were studied {(12 Males:25 Females, median age 21 years (8-89)}. One pt had lobectomy and the other 36 pts (97.3%) had a total thyroidectomy. Central only (4 pts) or central/lateral lymph node dissection (29 pts) were performed. The median tumor size was 4.5 cm (1.5-8.1). The tumor was multifocal in 27 cases (73%), with extrathyroidal invasion in 27 (73%) and lymphovascular invasion in 24 pts (64.8%). A background lymphocytic thyroiditis was present in 12 pts (32.4%). Lymph node metastases were present in 34 pts (92%) and distant metastases in 13 pts (35%). The sites of metastasis are lungs in 12 pts (32.4%) and lungs and bone in 1 pt. Twenty pts (54.1%) were in TNM8 stage 1, 10 pts (27%) in stage 2, 1 (2.7%) in stage 4a, 3 (8.1%) in stage 4b and 3 unstageable. The ATA risk classification for these pts was 4 pts (10.8%) in low, 12 (32.4%) in intermediate, 19 (51.4%) in high-risk groups and 2 could not be assessed. I-131 was administered to 33 pts (89.2%). The median administered activity was 136 mCi (46-218). Fifteen pts (40.5%) received additional therapies (3 surgeries, 7 RAI, 5 surgeries, and RAI). In 17 pts (46%) which were genotyped, only 3 tumors (8.1%) had BRAFV600E mutation, 1 (2.7%) had TERT promotor C228T mutation and none had RAS mutations. At the last follow up, 15 pts (40.5%) achieved an excellent response, 9 (24%) an indeterminate response, 6 (16.2%) with a structural disease, and 7 (19%) were lost for follow up. Conclusion: DSV PTC is a rare variant, occurs mostly in adolescent and young pts, characterized by aggressive histopathological features and high rates of lymph node and distant metastases but the commonly reported mutations in PTC are rare in DSV and mortality is absent.

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