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

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.

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Malignant Phyllodes Tumor: Imaging Features With Histopathologic Correlation

Journal of Breast Imaging ◽

10.1093/jbi/wbab065 ◽

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.

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Clinical Application of CT-Guided Percutaneous Microwave Ablation for the Treatment of Lung Metastasis from Colorectal Cancer

Gastroenterology Research and Practice ◽

10.1155/2017/9621585 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9

Author(s):

Lin Li ◽

Ketong Wu ◽

Haiyang Lai ◽

Bo Zhang

Keyword(s):

Colorectal Cancer ◽

Lung Metastasis ◽

Microwave Ablation ◽

Progression Free Survival ◽

Ct Guided ◽

Metastatic Lesions ◽

Local Progression ◽

Invasive Method ◽

Percutaneous Microwave Ablation

Objective. The aim of our research is to explore the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA) for the treatment of lung metastasis from colorectal cancer. Materials and Methods. CT-guided percutaneous MWA was performed in 22 patients (male 14, female 8, mean age: 56.05 ± 12.32 years) with a total of 36 lung metastatic lesions from colorectal cancer between February 2014 and May 2017. Clinical data were retrospectively analyzed with respect to the efficacy, safety, and outcome. Results. Of the 36 lesions, 34 lesions (94.4%) reduced obviously with small cavitations or fibrous stripes formed and had no evidence of recurrence during follow-up. The volume of the other 2 lesions demonstrated local progression after 6 months by follow-up CT. The primary complications included pneumothorax (28%), chest pain (21%), and fever (5%). These symptoms and signs were obviously relieved or disappeared after several-day conservative treatment. The mean follow-up of the patients was 25.54 ± 12.58 months (range 2–41 months). The estimated progression-free survival rate was 94.4%. Conclusion. Our results demonstrate that CT-guided percutaneous MWA appears to be an effective, reliable, and minimally invasive method for the treatment of lung metastasis from colorectal cancer. This trial is registered with ChiCTR-ORC-17012904.

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Malignant phyllodes tumor of the breast with rapid progression: a case report

Surgical Case Reports ◽

10.1186/s40792-020-00986-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hajime Abe ◽

Atsuko Teramoto ◽

Yumiko Takei ◽

Yoshihito Tanaka ◽

Genichiro Yoneda

Keyword(s):

Therapeutic Strategy ◽

Muscle Flap ◽

Skin Grafting ◽

Phyllodes Tumor ◽

Rapid Progression ◽

Total Mastectomy ◽

Latissimus Dorsi Muscle Flap ◽

Case Presentation ◽

Dorsi Muscle ◽

Short Period

Abstract Background Malignant phyllodes tumors (PTs) of the breast occur infrequently and are difficult to treat with adjuvant therapy. Here, we present a case of a female patient with a huge malignant PT with rapid progression in a short period. Case presentation A 44-year-old woman presented to our hospital with a rapid growth mass in her right breast, measuring 20 cm. She was initially diagnosed as having a borderline phyllodes tumor by core needle biopsy and underwent total mastectomy and artificial dermis was grafted, 20 days later, latissimus dorsi muscle flap and free skin grafting were performed. Two courses of doxorubicin–ifosfamide therapy were administered because of recurrence, but the patient died 4 months after the mastectomy. Conclusions A standard therapeutic strategy for malignant PTs is needed in urgently to reduce the risk of tumor recurrence.

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Retroperitoneal pelvic schwannoma in pregnancy: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173515 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3689 ◽

Cited By ~ 1

Author(s):

Nithya J. ◽

Banumathy M. ◽

Radha A.

Keyword(s):

Spindle Cell ◽

Surgical Excision ◽

Needle Aspiration ◽

Nerve Sheath Tumor ◽

Ct Guided ◽

Spindle Cell Neoplasm ◽

Complete Surgical Excision ◽

S 100 ◽

Needle Aspiration Cytology ◽

In Pregnancy

Solitary nerve sheath tumor such as Benign schwannomas arising in the pelvic retro peritoneum is infrequently reported. Retroperitoneal location accounts for 0.3-3.2% of primary schwannomas. We report a case of benign retroperitoneal pelvic schwannoma in pregnancy that was incidentally diagnosed when it presented with Preterm premature rupture of membranes and mechanical obstruction for labour. She underwent caesarean section and delivered a healthy baby. She was evaluated in the postoperative period by computerized tomography (CT) imaging studies and CT guided fine needle aspiration cytology (FNAC) was not diagnostic. Complete surgical excision of the tumor was achieved in the postpartum period. The adjacent vascular and urinary channels sustained no injuries and she had no neurologic deficit. Histology revealed spindle cell neoplasm composed of interlacing fascicles and sheets of spindle cell with focal areas of nuclear palisading and thick walled blood vessels. Immunohistochemistry was positive for S 100 suggesting schwannoma. Retroperitoneal location of schwannomas is rare and surgery is curative. Prognosis is good, since recurrence is rare.

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Paratesticular Embryonal Rhabdomyosarcoma with Lung Metastasis – A Rare Case Report

Annals of Pathology and Laboratory Medicine ◽

10.21276/apalm.2903 ◽

2020 ◽

Vol 7 (11) ◽

pp. C164-168

Author(s):

Anusha Ganapathi ◽

Thanka J ◽

Lawrence D'Cruze ◽

Barathi G ◽

Natarajan K ◽

...

Keyword(s):

Lung Metastasis ◽

Spermatic Cord ◽

Rare Case ◽

Spindle Cell ◽

Malignant Tumors ◽

Embryonal Rhabdomyosarcoma ◽

Cell Component ◽

Testicular Tumors ◽

Spindle Cell Component ◽

Rare Case Report

Paratesticular rhabdomyosarcomas (RMS) are very rare malignant tumors arising from the mesenchymal tissues of tunica, epididymis or spermatic cord. They present as painless hard masses in inguinoscrotal region, and large tumors can be mistaken for testicular tumors. They can spread to retroperitoneal lymph nodes or hematogenously metastasize to lung, bones and bone marrow. Here, we report a case of Embryonal RMS with spindle cell component presenting with painless scrotal mass and lung metastasis at initial diagnosis.

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Increased CD105 expression is associated with disease progression in phyllodes tumors - A report of a borderline phyllodes tumor with lung metastases and a study of 54 phyllodes tumors

Annals of Diagnostic Pathology ◽

10.1016/j.anndiagpath.2017.04.002 ◽

2018 ◽

Vol 32 ◽

pp. 4-9 ◽

Cited By ~ 2

Author(s):

Kangyu Wang ◽

Qianhua Li ◽

Ranran Shi ◽

Dandan Yang ◽

Wenlu Zou ◽

...

Keyword(s):

Disease Progression ◽

Lung Metastases ◽

Phyllodes Tumor ◽

Phyllodes Tumors

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Malignant Phyllodes Tumor in an Adolescent Female: A Rare Case Report and Review of the Literature

Case Reports in Oncological Medicine ◽

10.1155/2020/1989452 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Gabriel S. Makar ◽

Michael Makar ◽

Joanna Ghobrial ◽

Kathryn Bush ◽

Ryan Allen Gruner ◽

...

Keyword(s):

Breast Neoplasms ◽

Rare Case ◽

Phyllodes Tumor ◽

Adolescent Females ◽

Small Subset ◽

Review Of The Literature ◽

Malignant Phyllodes Tumor ◽

Phyllodes Tumors ◽

Rare Case Report

Primary breast neoplasms are rare in adolescent females, most of which are benign. Phyllodes tumors constitute a remarkably small subset of breast neoplasms (0.3-0.9%) with malignant phyllodes tumors being even more uncommon. Malignant phyllodes tumors tend to progress rapidly though only 1.5% metastasize. They are also associated with a higher rate of recurrence than their benign counterparts, underlying the importance of adequate surgical margins. It is therefore imperative to be able to identify these tumors early allowing for prompt resection and close follow-up. Here, we present the rare case of a 17-year-old female presenting with a rapidly enlarging breast mass, which was ultimately found to be a malignant phyllodes tumor. We further performed a review of the literature to highlight only 22 other cases reported in adolescent females.

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A rapid method for testing in vivo the susceptibility of different strains of Trypanosoma cruzi to active chemotherapeutic agents

Memórias do Instituto Oswaldo Cruz ◽

10.1590/s0074-02761984000200008 ◽

1984 ◽

Vol 79 (2) ◽

pp. 221-225 ◽

Cited By ~ 25

Author(s):

Leny S. Filardi ◽

Zigman Brener

Keyword(s):

Trypanosoma Cruzi ◽

Rapid Method ◽

Chemotherapeutic Agents ◽

Prolonged Treatment ◽

Long Term Study ◽

Short Period ◽

Different Strains ◽

Method Show

A method is described which permits to determine in vivo an in a short period of time (4-6 hours) the sensitivity of T. cruzo strains to known active chemotherapeutic agents. By using resistant- and sensitive T. cruzi stains a fairly good correlation was observed between the results obtained with this rapid method (which detects activity against the circulating blood forms) and those obtained with long-term schedules which involve drug adminstration for at least 20 consecutive days and a prolonged period of assessment. This method may be used to characterize susceptibility to active drugs used clinically, provide infomation on the specific action against circulating trypomastigotes and screen active compounds. Differences in the natural susceptibility of Trypanosoma cruzi strains to active drugs have been already reported using different criteria, mostly demanding long-term study of the animal (Hauschka, 1949; Bock, Gonnert & Haberkorn, 1969; Brener, Costa & Chiari, 1976; Andrade & Figueira, 1977; Schlemper, 1982). In this paper we report a method which detects in 4-6 hours the effect of drugs on bloodstream forms in mice with established T. cruzi infections. The results obtained with this method show a fairly good correlation with those obtained by prolonged treatment schedules used to assess the action of drugs in experimental Chagas' disease and may be used to study the sensitivity of T. cruzi strains to active drugs.

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Phyllodes tumor of the breast: a clinic-pathologic study of 77 cases in a Hispanic cohort

Colombia Medica ◽

10.25100/cm.v46i3.1595 ◽

2015 ◽

pp. 104-108 ◽

Cited By ~ 6

Author(s):

Carlos Andres Ossa Gomez ◽

Fernando Herazo ◽

Monica Gil ◽

Carolina Echeverry ◽

Gonzalo Angel ◽

...

Keyword(s):

Breast Cancer ◽

Disease Free Survival ◽

Phyllodes Tumor ◽

Cancer Registries ◽

Local Relapse ◽

Free Survival ◽

Phyllodes Tumors ◽

Mean Size ◽

Reported Data

Introduction: Breast Phyllodes tumors are rare breast tumors present in less than 1% of new cases of breast cancer, usually occurring among middle-aged women (40-50 yrs). Objective: This study shows diagnostic experience, surgical management and follows up of patients with this disease during a period of ten years in a oncology referral center. Methods: Retrospectively, breast cancer registries at the institution were reviewed, identifying 77 patients with Phyllodes tumors between 2002 and 2012, who had been operated on at the Instituto de Cancerología - Clínica Las Américas, in Medellín (Colombia). Clinical and histopathological data belonging to these cases was captured and analyzed and descriptive statistics were used. Results: The follow up median was 22.5 months (IQR: 10.5-60.0), average age was 47.2 yrs (SD: 12.4), mean tumor size was 3.6 cm (SD: 4.6), 88.3% of the patients (68 cases) presented negative margins and none of them received adjuvant chemotherapy. Of the patients with Phyllodes tumors; 33.8% had benign, 31.2% had borderline and 35.0% had malignant tumor. Disease-free survival was 85.8% and overall survival was 94.5%. Discussion: Reported data in this article is in accordance with what has been reported in worldwide literature. In our cohort even the high mean size of the tumors, the risk of local relapse and metastatic disease is low than previously reported in literature. Trials with longer follow up and molecular trials in Phyllodes tumors are necessary to understand the behavior of these tumors in Hispanics population.

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