Large Malignant Phyllodes Tumor of the Breast: Case Report of a Young Female and Review of Literature

Background: Phyllodes tumors are rare fibroepithelial neoplasm of the breast, representing 0.3 to 0.5% of all female breast neoplasms. The term ‘‘phyllodes tumor” by the World Health Organization (WHO) categorizes it into benign, borderline, and malignant tumors based on histopathological characteristics. Malignant phyllodes tumor is an uncommon but aggressive breast malignancy and accounts for approximately 25% of all phyllodes tumors.Case Presentation: A 23-year-old female patient Gravida 0 Para 0, previously healthy, with no family history of breast or ovarian cancer was referred to our institution for managing a right breast mass increasing in size over a period of 1 month associated with reddish-brown discoloration of the skin. Breast ultrasound showed an isodense oval mass measuring approximately 16x14x12cm in the right lower outer quadrant of her breast. Core biopsy and FNA done revealed a low grade phyllodes tumor. MRI of breasts showed a huge mass of the right breast occupying all quadrants, measuring 15x14.5 cm in its greatest axis with involvement of the pectoralis major muscle, with no evidence of suspicious axillary lymphadenopathy. Distant metastatic work-up with CT scan of chest abdomen and pelvis and a PET scan did not show distant metastasis. Hence, the patient underwent right total mastectomy with a final pathology compatible with malignant phyllodes tumor. She is on regular follow up and 18 months post-surgery is still disease free.Conclusion: Management of malignant phyllodes tumor remains debatable, especially when it comes to the effect of adjuvant radiotherapy and chemotherapy. From a surgical perspective, whether phyllodes tumors should be considered as epithelial breast cancers or as soft tissue sarcoma is another debate. On the other hand, although challenging, accurate identification of phyllodes tumor initially may aid in decreased recurrence.

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Effective Treatment of a Malignant Breast Phyllodes Tumor with Doxorubicin-Ifosfamide Therapy

Case Reports in Oncological Medicine ◽

10.1155/2019/2759650 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Shinya Yamamoto ◽

Shigeru Yamagishi ◽

Toshiro Kohno ◽

Ryosuke Tajiri ◽

Toshikazu Gondo ◽

...

Keyword(s):

Pleural Effusion ◽

Left Lung ◽

Phyllodes Tumor ◽

Lung Mass ◽

Malignant Phyllodes Tumor ◽

Phyllodes Tumors ◽

Malignant Breast ◽

One Year ◽

The Right ◽

Chemotherapy Strategy

Malignant phyllodes tumors of the breast occur infrequently and are difficult to treat with chemotherapy. Here, we present an effective chemotherapy strategy for recurrent malignant breast phyllodes tumors. A 48-year-old woman was diagnosed with a malignant phyllodes tumor in her right breast and underwent total right mastectomy. One year later, the tumor recurred in the right (a 2.2 cm mass) and left (a 10 cm mass) lungs; pleural effusion was also observed in the left lung. Eight courses of doxorubicin-ifosfamide (AI) therapy were administered. After treatment, the right lung mass and pleural effusion regressed completely and the left lung mass regressed to 2 cm. In conclusion, AI therapy is useful for treating recurrent malignant breast phyllodes tumors.

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Advance Malignant Phyllodes Tumor with Active Bleeding in Children: A Rare Case

Indonesian Journal of Cancer ◽

10.33371/ijoc.v15i4.797 ◽

2021 ◽

Vol 15 (4) ◽

pp. 208

Author(s):

Dedy Hermansyah ◽

Fernando Silalahi ◽

Albiner Simarmata ◽

Denny Rifsal Siregar

Keyword(s):

Physical Examination ◽

Rare Case ◽

Phyllodes Tumor ◽

Active Bleeding ◽

Breast Lesions ◽

Malignant Phyllodes Tumor ◽

Phyllodes Tumors ◽

Prompt Treatment ◽

The Right ◽

Current Guidelines

Introduction: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, there are only a few large pediatric phyllodes tumor series. Current guidelines do not differentiate treatment recommendations between children and adults.Case Presentation: A 12-year-old girl presented with a lump in her right breast which grew rapidly within a month. On physical examination, we found a mass on the right breast sized ± 10 x 10 cm; the lump was fragile and bled easily. The patient’s condition was getting worse and worse. Due to this deterioration, we performed a mastectomy immediately.Conclusions: The incidence of malignant phyllodes tumor in children is very rare and required prompt treatment in emergency cases.

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Rare Case of Recurrent Phyllodes Tumor of Bilateral Breasts with Metastasis to the Retroperitoneum and Duodenum

Journal of Clinical Research and Reports ◽

10.31579/2690-1919/035 ◽

2020 ◽

Vol 2 (5) ◽

pp. 01-05

Author(s):

Poya Pourghaderi

Keyword(s):

Rare Case ◽

Malignant Tumors ◽

Left Kidney ◽

Phyllodes Tumor ◽

World Health ◽

Phyllodes Tumors ◽

Common Presentation ◽

History Of ◽

Locally Recurrent ◽

Health Organization

Phyllodes tumors are uncommon fibroepithelial tumors of the breast. These tumors are graded based on the World Health Organization criteria into benign, borderline, and malignant subtypes. While benign phyllodes tumors are by far the most common presentation, borderline and malignant tumors have important clinical implications, as they are more likely to locally recur and metastasize. The most common sites of distant metastasis include the lung, bone, heart, and liver. Rare spread to the small intestines, kidney and pelvis have also been reported. We report a case of a 71 year-old woman with a history of locally recurrent phyllodes tumor of the breasts found to have retroperitoneal and intraperitoneal metastases. The retroperitoneal mass was just below the left kidney, extending into the pelvis, and overlying the psoas and iliacus. The second mass involved the second portion of the duodenum, the proximal transverse colon, and the overlying mesentery. This case of delayed metastatic spread of phyllodes tumor to two sites, seventeen years after first presentation, represent a rare case.

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A Rare Case of Recurrent Phyllodes Tumor of Bilateral Breasts with Metastasis to the Retroperitoneum and Duodenum

10.31487/j.crss.2020.01.05 ◽

2020 ◽

pp. 1-4

Author(s):

Poya Pourghaderi ◽

Andrew M. Nouri ◽

Poya Pourghaderi ◽

Sara E. Chapin ◽

Zoltan Nemeth ◽

...

Keyword(s):

Rare Case ◽

Malignant Tumors ◽

Left Kidney ◽

Phyllodes Tumor ◽

World Health ◽

Phyllodes Tumors ◽

History Of ◽

Locally Recurrent ◽

Health Organization ◽

Iliacus Muscle

Phyllodes tumors are uncommon fibroepithelial tumors of the breast. These tumors are graded based on the World Health Organization criteria into benign, borderline, and malignant subtypes. While benign phyllodes tumors are by far the most common presentation, borderline and malignant tumors have important clinical implications, as they are more likely to locally recur and metastasize. The most common sites of distant metastasis include the lung, bone, heart, and liver. Rare spread to the small intestines, kidney and pelvis have also been reported. We report a case of a 71-year-old woman with a history of locally recurrent phyllodes tumor of the breasts found to have retroperitoneal and intraperitoneal metastases. The retroperitoneal mass was just below the left kidney, extending into the pelvis, and overlying the psoas and iliacus muscle. The second mass involved the second portion of the duodenum, the proximal transverse colon, and the overlying mesentery. This is a rare case of delayed metastatic spread of phyllodes tumor to two sites, seventeen years after first presentation.

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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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Nasopharyngeal Hyalinizing Clear Cell Carcinoma: A Case Report and Review of the Literature

Allergy & Rhinology ◽

10.1177/2152656719889030 ◽

2019 ◽

Vol 10 ◽

pp. 215265671988903 ◽

Cited By ~ 1

Author(s):

Madison J. Malfitano ◽

Meghan N. Norris ◽

Wesley H. Stepp ◽

Griffin D. Santarelli ◽

T. Danielle Samulski ◽

...

Keyword(s):

Case Report ◽

Salivary Glands ◽

Clear Cell ◽

Malignant Tumors ◽

Treatment Strategies ◽

Low Grade ◽

Minor Salivary Glands ◽

Presenting Symptoms ◽

Nasopharyngeal Mass ◽

The Right

Background Hyalinizing clear cell carcinomas (HCCCs) are rare, low-grade, malignant tumors which most often arise from the minor salivary glands primarily in palate and tongue but can arise in any location with minor salivary glands including the nasopharynx. Methods A case report of primary nasopharyngeal HCCC is presented. Because of the rarity of this tumor and location, a literature search was conducted to determine the most common presenting symptoms, treatment strategies, and outcomes. Results A 48-year-old man underwent biopsy of a 4.5 cm mass of the right nasopharynx with pathology suggesting an intermediate grade mucoepidermoid carcinoma. After discussing management with the patient, an endoscopic resection was performed. Final pathology revealed an HCCC which was confirmed after negative Mastermind-like 2 (MAML2) and positive Ewing sarcoma breakpoint region 1 (ESWR1) gene rearrangements on fluorescence in situ hybridization (FISH) studies. Literature review of other nasopharyngeal HCCC cases shows diverse presentation and overall excellent prognosis through surgical and radiation therapy. Conclusion HCCCs are rare, low-grade malignant tumors of the minor salivary glands and can present as a nasopharyngeal mass. Presenting symptoms are diverse but frequently involve otologic and sinonasal disturbances. HCCC is an indolent tumor with an excellent prognostic outcome when treated appropriately with surgical resection and adjuvant radiotherapy.

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Malignant Phyllodes Tumor of the Breast with Metastasis to the Pancreas: A Case Report and Review of Literature

Case Reports in Oncological Medicine ◽

10.1155/2018/6491675 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

R. A. Amir ◽

Rola S. Rabah ◽

S. S. Sheikh

Keyword(s):

Case Report ◽

Breast Neoplasms ◽

Distant Metastasis ◽

Case Reports ◽

Phyllodes Tumor ◽

Pancreatic Metastasis ◽

Rare Tumor ◽

Review Of Literature ◽

Malignant Phyllodes Tumor ◽

Phyllodes Tumors

Phyllodes tumor (PT) is a rare tumor of the breast accounting for approximately 1% of all breast neoplasms. In 1838, J. Muller coined the term “cystosarcoma phyllodes” based on the leaf-like projections of the tumor extending into the cystic spaces and sarcomatous stromal growth. However, seeing as up to 70% of phyllodes tumors are benign, “cystosarcoma” was removed, and the tumor is now recognized simply as phyllodes tumor. It is mainly seen in females between the ages of 35 and 55. Although most phyllodes tumors are benign, malignant cases do uncommonly occur, 22% of which have distant metastasis typically to the lungs and bones. Rarely, this tumor metastasizes to other locations. Herein, we report a case of malignant phyllodes tumor with metastasis to the pancreas. According to our knowledge, only 3 case reports of pancreatic metastasis from malignant phyllodes tumor have been reported in literature thus far. We aim to increase awareness among physicians of this rare metastasic potential of the uncommonly encountered malignant phyllodes tumor.

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Clinicopathologic features of multiple phyllodes tumors of the breast.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1126 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1126-1126

Author(s):

Fumi Yoshidaya ◽

Naoki Hayashi ◽

Atsushi Yoshida ◽

Hiroshi Yagata ◽

Hiroko Tsunoda ◽

...

Keyword(s):

Surgical Procedure ◽

Malignant Tumors ◽

Phyllodes Tumor ◽

Clinicopathological Characteristics ◽

Good Prognosis ◽

Histological Type ◽

Benign Tumors ◽

Borderline Tumor ◽

Phyllodes Tumors ◽

New Findings

1126 Background: Phyllodes tumor of the breast is one of the rare neoplasm accounting for 0.3-0.5% of all breast tumors. It is difficult to diagnose the histological type of phyllodes tumors preoperatively by radiological and even pathological findings. The aim of this study is to clarify the clinicopathological features of phyllodes tumors. Methods: We retrospectively reviewed records from 116 patients with phyllodes tumors who underwent surgery between 2003 and 2011. We determined the clinicopathological characteristics, including the presense of multiple lesions and the type of surgical procedure, of each histological type of phyllodes tumors which were classified as benign, borderline, and malignant. Results: The median follow-up time was 23.3 months. Benign phyllodes tumors were presented in 91 patients (78.4 %), borderline were in 17 patients (14.6 %), and malignant were in 8 patients (6.9 %). Ten patients (8.6 %) had multiple phyllodes tumors; 9 for ipsilateral and one for bilateral breasts. One hundred two patients underwent lumpetcomy and 14 patients underwent mastectomy. No patients received chemotherapy or radiation therapy. Noteworthy, all multiple tumors were diagnosed histologically benign. The median age at operation were 41 years (range, 12-72 years) for benign tumors, 44 years (26-67 years) for borderline, and 47 years (39-60 years) for malignant. The size of malignant tumors was significantly large (a median, 11.3 cm; range, 6-27 cm) compared to benign (a median, 4.4 cm; range 1-21 cm) and borderline (a median, 4.7cm; range 1-16 cm) (p = 0.001, and 0.03, respectively). Local recurrence developed in 14 of the 91 patients (15.4 %) with benign, 2 of the 17 patients (11.8 %) with borderline, and 2 of the 8 patients (25 %) with malignant tumors. Four patients (50 %) with malignant tumors but none with benign and borderline developed distant metastasis. Of the 4 patients, 3 had undergone mastectomy and one had lumpetcomy for initial treatment. No benign and borderline tumor had malignant change when tumors recurred. Conclusions: Our new findings indicated that multiple phyllodes tumors may be histologically benign. Furthermore, patients with benign or borderline phyllodes tumors had good prognosis regardless of surgical procedure.

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Metaplastic Carcinomas of the Breast: Diagnostic Challenges and New Translational Insights

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0166-cr ◽

2012 ◽

Vol 136 (8) ◽

pp. 896-900 ◽

Cited By ~ 26

Author(s):

Shilpa Rungta ◽

Celina G. Kleer

Keyword(s):

Spindle Cell ◽

Malignant Tumors ◽

Wnt Signaling Pathway ◽

Phyllodes Tumor ◽

Low Grade ◽

Cell Component ◽

Pseudoangiomatous Stromal Hyperplasia ◽

Chronic Abscess ◽

Invasive Carcinomas ◽

Metastatic Sarcoma

Comprising less than 1% of invasive carcinomas of the breast, metaplastic carcinomas are a heterogeneous group of malignant tumors in which part or all of the carcinomatous epithelium is transformed into a nonglandular (metaplastic) growth process. Metaplastic carcinomas with a low-grade spindle cell component resembling fibromatosis, as in our present case, are worthy of particular note because they are infrequent, difficult to recognize, and have a high risk of local recurrence. The differential diagnosis of metaplastic carcinomas depends on the degree of atypia observed in the tumor and includes exuberant scars, fibromatosis, nodular fasciitis, myofibroblastomas, pseudoangiomatous stromal hyperplasia, acute and chronic abscess with fat necrosis, malignant phyllodes tumor, and primary or metastatic sarcoma. Limited studies done on the molecular pathology of metaplastic carcinomas show that activation of the Wnt signaling pathway is common in these tumors and that approximately 70% of metaplastic carcinomas show EGFR gene amplification and overexpression. This may have treatment implications because they may lead to targeted treatment for patients with metaplastic carcinomas.

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