Management and outcomes of phyllodes tumours – 10 year experience

2021 ◽  
pp. 1-6
Author(s):  
P.A. Boland ◽  
A. Ali Beegan ◽  
M. Stokes ◽  
M.R. Kell ◽  
J.M. Barry ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Surgical Management ◽  
Surgical Excision ◽  
Breast Conserving Surgery ◽  
Tertiary Referral Centre ◽  
Benign Pathology ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours ◽  
Tumour Characteristics

INTRODUCTION: Phyllodes tumours represent 0.3–1% of breast tumours, typically presenting in women aged 35–55 years. They are classified into benign, borderline and malignant grades and exhibit a spectrum of features. There is significant debate surrounding the optimal management of phyllodes tumour, particularly regarding appropriate margins. METHODS: This is a retrospective review of a prospectively maintained database of patients who underwent surgical management for phyllodes tumours in a single tertiary referral centre from 2007–2017. Patient demographics, tumour characteristics, surgical treatment and follow-up data were analysed. Tumour margins were classified as positive (0 mm), close (≤2 mm) and clear (>2 mm). RESULTS: A total of 57 patients underwent surgical excision of a phyllodes tumour. The Mean age was 37.7 years (range: ages 14–91) with mean follow-up of 38.5 months (range: 0.5–133 months). There were 44 (77%) benign, 4 (7%) borderline and 9 (16%) malignant phyllodes cases. 54 patients had breast conserving surgery (BCS) and 3 underwent mastectomy. 30 (53%) patients underwent re-excision of margins. The final margin status was clear in 32 (56%), close in 13 (23%) and positive in 12 (21%). During follow-up, 4 patients were diagnosed with local recurrence (2 malignant, 1 borderline and 1 benign pathology on recurrence samples). CONCLUSION: There are no clear guidelines for the surgical management and follow-up of phyllodes tumours. This study suggests that patients with malignant phyllodes and positive margins are more likely to develop local recurrence. There is a need for large prospective studies to guide the development of future guidelines.

scholarly journals Low grade fibromyxoid sarcoma of the perineum: a surgical challenge

2016 ◽  
Vol 4 (1) ◽  
pp. 429
Author(s):  
Afzal Anees ◽  
Kaushal D. Singh ◽  
Shehtaj Khan
Keyword(s):  
Local Recurrence ◽  
Surgical Management ◽  
Surgical Excision ◽  
Low Grade ◽  
Rare Presentation ◽  
Desmoid Fibromatosis ◽  
Fibromyxoid Sarcoma ◽  
Slow Growing ◽  
Late Metastasis

Low-grade fibromyxoid sarcoma is a rare, slow growing and deceptively benign-appearing neoplasm. It is presently diagnosed on the basis of histopathology (typical fibro-myxoid appearance), immunohistochemistry (vimentin staining) and cytogenetics [chimeric FUS/CREB3L2 gene produced by t (7;16), (q33;p11)]. This tumour should be differentiated from other resembling tumours like myxofibrosarcoma, sclerosing epitheloid fibrosarcoma, desmoid fibromatosis and others. It has the potential for local recurrence and late metastasis, if not treated adequately. Although surgical excision is the only hope for treatment, reporting of details of surgical management have often been neglected for this primarily pathological entity. We report a case of a 30-year female who had a perineal mass which was managed by wide surgical excision. It was diagnosed as low-grade fibromyxoid sarcoma on the basis of histopathology and immunohistochemistry. This extremely rare presentation is, thus, discussed in context of challenging nature of its surgical excision. Patient is in follow-up and has no recurrence even after 5 years.

scholarly journals High-grade ductal carcinoma in-situ detected by microcalcification within borderline phyllodes tumour: A report of a case and literature review

2021 ◽  
Author(s):  
Wing Nam Yuen ◽  
Joshua Jing Xi Li ◽  
Man Yi Chan ◽  
Gary M Tse
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Management Plan ◽  
High Grade ◽  
Total Mastectomy ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Abstract BackgroundPhyllodes tumour is a rare biphasic neoplasm of the breast that mostly affects middle aged women. Ductal carcinoma in-situ and microcalcifications occurring within phyllodes tumours are documented but are rare findings. Primary surgical excision with adjuvant therapies remains the mainstay of treatment.Case presentationWe report a case of a 42-year-old woman with high-grade ductal carcinoma in-situ within a borderline phyllodes tumour. Radiologically, clumps of microcalcification were detected within the lesion. Local excision followed by total mastectomy with axillary dissection was then performed. No tumour recurrence was detected up to a period of 8 years.ConclusionPresence of microcalcifications within a phyllodes tumour should alert clinicians and pathologists of possible coexisting carcinoma components. Stromal and epithelial components of these lesions should be evaluated separately when formulating a management plan.

Staged excision of primary periocular basal cell carcinoma: absence of residual tumour in re-excised specimens: a 10-year series

2018 ◽  
Vol 103 (7) ◽  
pp. 976-979 ◽  
Author(s):  
Lindsay A McGrath ◽  
Adam Meeney ◽  
Zanna I Currie ◽  
Hardeep Singh Mudhar ◽  
Jennifer H Tan
Keyword(s):  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Basal Cell ◽  
Significant Proportion ◽  
Surgical Excision ◽  
Lower Eyelid ◽  
Growth Patterns ◽  
Residual Tumour ◽  
Tumour Characteristics

AimsThe aim is to study staged periocular basal cell carcinoma (BCC) excision in a tertiary oculoplastic referral centre in Sheffield, UK. In particular, we examined patients with close or positive margins and no tumour seen on re-excision to identify demographics and tumour characteristics in this population.MethodsA retrospective review of medical records of 437 cases of staged periocular BCC excisions over a 10-year period (2007–2017) was carried out. Patients had surgical excision with 3 mm clinically clear margins. Staged excision was performed for all cases included in this study. Standard reconstruction techniques were employed. Histopathology was analysed for tumour type, subtype and stage.ResultsOver the 10-year period, of the 437 periocular BCCs, 156 had close or involved margins. Residual tumour was found in 29 (18.6%), whereas in 122 eyelids of 120 patients (78.2%) no residual tumour was identified on histological examination. Micronodular (54.1%) and nodular (23.7%) growth patterns of BCC, as well as lower eyelid location (72.1%), were the most prevalent in this population. Two patients (1.6%) had recurrence of BCC over a mean follow-up of 57 months (range 1–125 months).ConclusionsA significant proportion of BCCs transected on initial excision show no residual tumour in the re-excision specimens. In the interval between initial excision and re-excision, there may be eradication of the residual tumour. The exact mechanisms for this are unclear, however, and re-excision remains the appropriate recommended course in the presence of involved surgical margins of periocular BCC, particularly when high-risk tumour subtypes are encountered.

scholarly journals The approach to an isolated close anterior margin in breast conserving surgery

2019 ◽  
Vol 101 (4) ◽  
pp. 268-272
Author(s):  
L O’Connell ◽  
S Walsh ◽  
D Evoy ◽  
A O’Doherty ◽  
C Quinn ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Anterior Margin ◽  
Residual Disease ◽  
Breast Conserving Surgery ◽  
University Hospital ◽  
Single Institution ◽  
Close Margin ◽  
Patient Demographics ◽  
Included Patient ◽  
Tumour Characteristics

Introduction Although close radial margins after breast-conserving surgery routinely undergo re-excision, appropriate management of patients with close anterior margins remains a topic of controversy. An increasing body of literature suggests that re-excision of close anterior margins yields low rates of residual malignancy and may only be necessary in selected patients. The aim of this study was to examine the management of close anterior margins after breast conserving surgery in a single institution and to analyse the rate of residual disease in re-excised anterior margins. Methods All patients having breast conserving surgery at St Vincent’s University Hospital from January 2008 to December 2012 were reviewed retrospectively. Data collected included patient demographics, tumour characteristics, margin positivity, re-excision rates and definitive histology of the re-excision specimens. A close margin was defined as les than 2 mm. Results A total of 930 patients were included with an average age of 65 years (range 29–94 years). Of these, 121 (13%) had a close anterior margin. Further re-excison of the anterior margin was carried out in 37 patients (30.6%) and a further 16 (13.2%) proceeded to mastectomy. Residual disease was found in 18.5% (7/36) of those who underwent re-excision and 7/16 (43.75%) of those who underwent mastectomy. Overall, 11.57% (14/121) of patients with close anterior margins were subsequently found to have residual disease. Conclusion The low yield of residual disease in re-excised anterior margins specimens supports the concept that routine re-excision of close anterior margins is not necessary. Further research is required to definitively assess its influence on the risk of local recurrence.

Comparing long-term local recurrence rates of surgical and non-surgical management of close anterior margins in breast conserving surgery

2019 ◽  
Vol 176 (2) ◽  
pp. 311-319
Author(s):  
George Boundouki ◽  
Joseph Ryan Wong Sik Hee ◽  
Natalie Croghan ◽  
Katie Stocking ◽  
Andrew Pieri ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Surgical Management ◽  
Breast Conserving Surgery ◽  
Recurrence Rates

Intraoperative versus external beam boost for breast cancer: A matched-pair analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1120-1120 ◽  
Author(s):  
Elena Sperk ◽  
Daniela Astor ◽  
Grit Welzel ◽  
Axel Gerhardt ◽  
Marc Suetterlin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Breast Conserving Surgery ◽  
Matched Pair ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Matched Pair Analysis ◽  
Pair Analysis ◽  
Local Recurrence Free Survival

1120 Background: After breast conserving surgery, radiotherapy leads to a better overall survival. In addition to whole breast radiotherapy (WBRT) a boost to the tumor bed leads to a better local control. The tumor bed boost is usually added after WBRT or can be done intraoperative (IORT). Belletti et al. (Clin Cancer Res., 2008) described positive effects, an antitumoral effect and modulation of microenvironment after IORT with 50kV x-rays. A matched pair analysis was performed to investigate the impact of IORT boost on overall survival compared to standard external beam boost. Methods: Between 2002 – 2009, 370 patients were treated for breast cancer with WBRT + boost (external beam (EBRT) boost n = 146, IORT boost n =224). A matched pair analysis (1:1 propensity score matching for age, TNM, grading, hormonal treatment and chemotherapy) for overall survival and local recurrence free survival could be done for 53 pairs. All patients underwent breast conserving surgery and WBRT with 46-50Gy. 53 patients received an EBRT boost with 16Gy (2Gy/fraction, dedicated linear accelerator) and 53 patients received an IORT boost with 20Gy (INTRABEAM system, 50kV x-rays). Median follow-up was 6 months (range, 1-77 months) for the EBRT boost patients and 56 months (range, 2-97 months) for IORT boost patients. Kaplan Meier estimates were performed for overall survival and local recurrence free survival. Results: IORT boost patients had a longer follow-up than EBRT boost patients. Despite the difference in follow-up times, there was a strong trend towards better overall survival after IORT boost (90.2% vs. 62.3%, p = 0.375). One local recurrence was present in each group (EBRT boost after 15 months, local recurrence free survival 95%; IORT boost after 12 months, local recurrence free survival 98.1%). Conclusions: IORT given as a boost seems to have a positive impact on overall survival in breast cancer patients after breast conserving surgery. To identify such an effect a prospective randomized trial should be conducted.

Nasal haemangiopericytoma: report of two cases with literature review

1999 ◽  
Vol 113 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Rémi Marianowski ◽  
Michel Wassef ◽  
Philippe Herman ◽  
Partice Tran Ba Huy
Keyword(s):  
Local Recurrence ◽  
Literature Review ◽  
Paranasal Sinuses ◽  
Surgical Excision ◽  
Lateral Rhinotomy ◽  
Vascular Tumour ◽  
Wide Surgical Excision ◽  
Incomplete Removal ◽  
Midfacial Degloving

AbstractHaemangiopericytoma (HPC) is a rare vascular tumour produced by proliferation of pericytes. One hundred and thirty-three cases of HPC have been reported in the nose and the paranasal sinuses. We present two more cases. Wide surgical excision via lateral rhinotomy, midfacial degloving, or endonasal removal is the treatment of choice. Radiotherapy has been used post-operatively in cases of incomplete removal. Life-long follow-up is required to evaluate local recurrence and late metastases.

Chondrogenic neoplasms of the nasal cavity

1987 ◽  
Vol 101 (5) ◽  
pp. 500-505 ◽  
Author(s):  
O. E. El-Silimy ◽  
L. Harvey ◽  
M.R.C. Path ◽  
P. J. Bradley
Keyword(s):  
Local Recurrence ◽  
Nasal Cavity ◽  
Initial Treatment ◽  
Distant Metastases ◽  
Surgical Excision ◽  
Natural Course ◽  
Facial Skeleton ◽  
Histological Differentiation

Chondrogenic neoplasms of the nasal cavity are rare. Clinically, presentation is often late, with expansion and destruction of the middle facial skeleton. Local radical surgical excision is the preferred treatment, with regular life-long follow-up. Risk of local recurrence and distant metastases may Qccur many years after initial treatment. All chondrogenic tumours should be carefully followed up because the natural course of the disease may not match the histological differentiation.

Outcome at 8 Years After Breast-Conserving Surgery and Radiation Therapy for Invasive Breast Cancer: Influence of Margin Status and Systemic Therapy on Local Recurrence

2000 ◽  
Vol 18 (8) ◽  
pp. 1668-1675 ◽  
Author(s):  
Catherine C. Park ◽  
Michihide Mitsumori ◽  
Asa Nixon ◽  
Abram Recht ◽  
James Connolly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Systemic Therapy ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Positive Margins

PURPOSE: To examine the relationship between pathologic margin status and outcome at 8 years after breast-conserving surgery and radiation therapy. PATIENTS AND METHODS: The study population comprised 533 patients with International Union Against Cancer/American Joint Committee on Cancer clinical stage I or II breast cancer who had assessable margins, who received at least 60 Gy to the primary tumor bed, and who had more than 8 years of potential follow-up. Each margin was scored (according to the presence of invasive or in situ disease that touched the inked surgical margin) as one of the following: negative, close, focally positive, or extensively positive. Outcome at 8 years was calculated using crude rates of first site of failure. A polychotomous logistic regression analysis was performed. Median follow-up time was 127 months. RESULTS: At 8 years, patients with close margins and those with negative margins both had a rate of local recurrence (LR) of 7%. Patients with extensively positive margins had an LR rate of 27%, whereas patients with focally positive margins had an intermediate rate of LR of 14%. In the polychotomous logistic regression model, margin status and the use of systemic therapy were the only two variables that had significant effects on the risk ratio of LR to remaining alive and free of disease. Among the 45 patients with focally positive margins who received systemic therapy, the crude LR rate was 7% at 8 years (95% confidence interval, 1% to 20%). CONCLUSION: Pathologic margin status and the use of adjuvant systemic therapy are the most important factors associated with LR among patients treated with breast-conserving surgery and radiation therapy.

Method of detection of local recurrence in patients following breast conserving surgery and its utility for surveillance

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 611-611
Author(s):  
B. Taback ◽  
N. Hansen ◽  
K. Conway ◽  
A. Giuliano
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Conclusive Evidence ◽  
Breast Cancer Patients ◽  
Asymptomatic Patients

611 Background: It is estimated that approximately 10% of all breast cancer patients will develop local recurrence (LR) at 10 years. Routine surveillance for detection of early breast cancer recurrence is widely performed despite lack of conclusive evidence for an improvement in patient quality of life or potential for cure. A number of historical studies evaluating the effectiveness of routine screening for LR following treatment for early-stage breast cancer have suggested that the diagnosis of LR is more frequent during a routine visit and occurring in asymptomatic patients. However, differentiating the method of detection is not often elucidated. In this study we evaluated the manner in which patients presented with an isolated LR in clinical practice. Methods: Our routine patient follow-up consists of physical exam and mammogram every 6 mos for the first 2 years following breast conserving surgery (BCS) and yearly thereafter. We queried our prospectively collected breast cancer database (1632 patients from July 1986 - July 2004) for patients with an isolated LR following BCS (n=59 (3.6%); two patients had bilateral LRs). Medical records were not available for three patients. Results: At a median follow-up of 45 mos (range: 5–122 mos) there were 58 evaluable LRs: 15 DCIS, 31 infiltrating ductal carcinoma (IDC), 6 infiltrating lobular (ILC), 2 mixed IDC/ILC, 3 invasive cancers NOS and 1 unknown. Patient presentation was as follows: 25 were diagnosed by self-exam, 28 on screening mammogram, 2 were diagnosed by physician (includes one referral), and 3 unknown. Mammogram detected recurrences were more frequent among patients with DCIS whereas self-detected recurrences were more common in patients with IDC (79% vs 33% and 21% vs 67%, respectively; P<0.2). Mean tumor size was larger in self-presentation (2.1 cm; range: 0.8–4.5 cm) than in mammogram detected group (1.6 cm; range 0.4–6 cm). Conclusions: These findings demonstrate the value of mammography as compared to patient detected LRs. Whether a survival advantage exists remains uncertain. Nevertheless routine physician examination in this setting is highly insensitive and its further utility must be considered when devising cost-effective strategies for surveillance of breast cancer patients. No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document