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

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.

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A CASE OF A RAPIDLY WORSENING MALIGNANT PHYLLODES TUMOR WITH AXILLARY LYMPH NODE METASTASIS

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.70.39 ◽

2009 ◽

Vol 70 (1) ◽

pp. 39-43

Author(s):

Hiroki TAKAHASHI ◽

Goro YOKOYAMA ◽

Yuka INOUE ◽

Masakazu KATSURA ◽

Eiji KUSUMOTO ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Axillary Lymph Node ◽

Phyllodes Tumor ◽

Axillary Lymph Node Metastasis ◽

Axillary Lymph ◽

Malignant Phyllodes Tumor ◽

Node Metastasis

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

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10629 ◽

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.

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CDX2-positive breast cancer presented with axillary lymph node metastases: a case report

Cancer Treatment and Research Communications ◽

10.1016/j.ctarc.2020.100300 ◽

2020 ◽

pp. 100300

Author(s):

Hideko Hoshina ◽

Hiroyuki Takei ◽

Takashi Sakatani ◽

Zenya Naito

Keyword(s):

Breast Cancer ◽

Case Report ◽

Lymph Node ◽

Lymph Node Metastases ◽

Axillary Lymph Node ◽

Axillary Lymph ◽

Axillary Lymph Node Metastases ◽

Node Metastases ◽

Positive Breast Cancer

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Heterotopic ossification in lymph node metastasis after rectal cancer resection: a case report and literature review

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02098-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Hideki Nagano ◽

Tamotsu Togawa ◽

Takeshi Watanabe ◽

Kenji Ohnishi ◽

Toshihisa Kimura ◽

...

Keyword(s):

Rectal Cancer ◽

Case Report ◽

Lymph Node ◽

Heterotopic Ossification ◽

Tumor Cells ◽

Digestive Tract ◽

Histological Examination ◽

Metastatic Lesion ◽

Axillary Lymph ◽

The Brain

Abstract Background Heterotopic ossification (HO) is the formation of osseous tissue outside the skeleton. HO in malignant tumors of the digestive tract is extremely rare, as is ossification in metastatic lesions from HO-negative digestive tract tumors. Regarding the pathogenesis of HO, two theories have been proposed. The first is that the osteoblastic metaplasia of tumor cells (driven by the epithelial-mesenchymal transition, EMT) results in HO, and the second is that factors secreted by cancer cells lead to the metaplasia of stromal pluripotent cells into osteoblasts. However, the osteogenic mechanisms remain unclear. Case presentation An 83-year-old Japanese woman underwent low anterior rectal resection for rectal cancer before presentation at our institution, in June 2018. The final diagnosis was stage IIB rectal adenocarcinoma (T4aN0M0). Histological examination did not reveal HO in the primary tumor. Thirteen months after the operation, a solitary metastatic lesion in the brain 20 mm in size and a solitary metastatic lesion in a right axillary lymph node 20 mm in size were diagnosed. The patient was treated with gamma-knife therapy for the brain metastasis. One month later, she was referred to our institution. She underwent lymph node resection. Histological examination revealed that most portions of the affected lymph node were occupied by metastatic tumor cells and that central necrosis and four small ossified lesions without an osteoblast-like cell rim were present in the peripheral region. Immunohistochemical analysis showed tumor cells positive for BMP-2, osteonectin, osteocalcin, AE1/AE3, TGF-β1, Gli2, Smad2/3, and CDX2 and negative for nestin, CD56, and CK7. Conclusion This is the first English case report of HO in a metachronous metastatic lymph node after the curative resection of HO-negative rectal cancer. Unlike HO lesions in past reports, the HO lesion did not show peripheral osteoblast-like cells, and the immunohistochemical findings indicated that the present case resulted from the EMT.

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Malignant Phyllodes Tumor Including Aneurysmal Bone Cyst-Like Areas in Pregnancy - a Case Report and Review of the Literature

Breast Care ◽

10.1159/000448236 ◽

2016 ◽

Vol 11 (4) ◽

pp. 291-294 ◽

Cited By ~ 1

Author(s):

Canan Kelten ◽

Ceren Boyaci ◽

Cem Leblebici ◽

Kemal Behzatoglu ◽

Didem C. Trabulus ◽

...

Keyword(s):

Case Report ◽

Bone Cyst ◽

Clinical Breast Examination ◽

Phyllodes Tumor ◽

Breast Cancer Diagnosis ◽

Left Breast ◽

Malignant Phyllodes Tumor ◽

Her Family ◽

Simple Mastectomy ◽

Clinical Breast

Background: Malignant phyllodes tumors of the breast are rare biphasic neoplasms. Only few cases related to pregnancy have been reported. Case Report: A 37-year-old woman presented with swelling and pain in her left breast as well as hyperemia on the breast skin, 4 weeks after labor. In her family history, her aunt and maternal cousin had had a breast cancer diagnosis. Clinical evaluation of the patient was consistent with a breast abscess. Therefore, abscess drainage and biopsy from the cavity wall were performed. However, the biopsy was diagnosed as malignant phyllodes tumor. An evaluation by ultrasonography showed a well-defined hypoechoic mass with many cystic spaces covering the entire breast tissue. Therefore, a simple mastectomy was performed. Microscopic examination revealed a high-grade malignant phyllodes tumor. Additionally, bone cyst-like areas in the form of sponge-like blood-filled non-endothelialized spaces were observed. Conclusions: Since the breasts become larger due to the physiological changes during pregnancy, any underlying breast lesions may be obscured. Therefore, clinical breast examination in the first visit of pregnancy is important.

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Right axillary lymph node metastasis of carcinoma of the cecum with histologically proven cutaneous lymphatic invasion by carcinoma cells: a case report

Surgical Case Reports ◽

10.1186/s40792-015-0054-0 ◽

2015 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Yutaka J Kawamura ◽

Michitaka Kohno ◽

Junji Shiga ◽

Naoki Asakage ◽

Minoru Hatano ◽

...

Keyword(s):

Case Report ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Axillary Lymph Node ◽

Lymphatic Invasion ◽

Axillary Lymph Node Metastasis ◽

Carcinoma Cells ◽

Axillary Lymph ◽

Node Metastasis

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An AN OBSERVATIONAL STUDY OF SLN MAPPING IN PATIENTS OF LOCALLY ADVANCED BREAST CANCER FOLLOWING NCT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.899 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Ankur Garg ◽

Udbhav Kathpalia ◽

Shweta Bansal ◽

Manoj Andley ◽

Sudipta Saha

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Nodes ◽

Locally Advanced ◽

Lymph Node Biopsy ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Biopsy ◽

Neo Adjuvant Chemotherapy

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3) Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5) Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed. Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy. Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.

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