scholarly journals Malignant Phyllodes Tumor of the Breast and Pregnancy: A Rare Case Report and Literature Review

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 36
Author(s):  
Laura Mustață ◽  
Nicolae Gică ◽  
Radu Botezatu ◽  
Raluca Chirculescu ◽  
Corina Gică ◽  
...  
Keyword(s):  
Breast Tumor ◽  
Perioperative Complications ◽  
Phyllodes Tumor ◽  
Breast Mass ◽  
Tumor Board ◽  
Resection Margins ◽  
Premature Delivery ◽  
Pathology Report ◽  
Final Pathology ◽  
Complete Surgical Excision

Phyllodes Tumor (PT) is a rare fibroepithelial breast tumor that can behave differently depending on its biologic features. Traditionally, PTs are classified by their histologic features into benign, borderline, and malignant. In most cases that were reported, all PTs may recur, but only the borderline and malignant PT can metastasize. PT usually occurs as a breast lump or accidental finding on ultrasound (US) examination. The clinical features include a well-defined breast mass, regular or lobulated. The diagnosis is based on the integration of morphology features, but remains challenging, particularly in the distinction from fibroadenomas. We report a case of a 36-year-old patient who presented for a voluminous breast mass, rapidly growing in the past 3–4 months. At presentation, the patient was 19 weeks pregnant. The breast tumor had the clinical and US aspect of PT. A core needle biopsy was obtained, confirming a benign PT, and local excision was performed with no postoperative complications. The final pathology report showed a borderline PT with close resection margins of 1 mm. Immunohistochemistry (IHC) established the diagnosis of malignant PT with heterologous sarcomatous differentiation. The case was discussed in the multidisciplinary tumor board (MDT) and mastectomy was recommended. The patient fully consented but refused surgery at 25 weeks’ gestation, fearing premature delivery. The right breast was closely monitored by US, and at 9 weeks after the first surgery, signs of local recurrence were detected. At 35 weeks’ gestation, right mastectomy was performed, with no perioperative complications. The pregnancy was closely followed up and no complication were found. The final pathology report describes multiples PT recurrences with heterologous sarcomatous differentiation. The pregnancy outcome was uneventful, and the patient delivered a healthy child vaginally at term with no peripartum complication. Postpartum, a computer tomography (CT) examination of the head, thorax, abdomen and pelvis was performed, with no evidence of metastases. Adjuvant chemotherapy and radiotherapy completed the treatment. The follow-up and CT scan showed no metastases or further recurrence 4 years after diagnosis. In conclusion, diagnosis of PT can be difficult, especially because of the easy confusion with fibroadenoma of the breast. There are rare cases when a pathology exam needs further assessment and IHC is recommended for accurate diagnosis. Although malignant PT is rare and accounts for <1% of all breast cancers, the diagnosis and treatment that are recommended are based on the reported cases. Moreover, when complete surgical excision is achieved, the rates of recurrence and distant metastases are low, and adjuvant therapy might not be necessary.

Primary stromal sarcoma of breast: A case report and literature review

2021 ◽  
pp. 1-7
Author(s):  
Mohammad Al-Wiswasy ◽  
Mahmoud Al-Balas ◽  
Raith Al-Saffar ◽  
Hamzeh Al-Balas
Keyword(s):  
Malignant Tumors ◽  
Histopathological Examination ◽  
Prognostic Significance ◽  
Total Duration ◽  
Young Patients ◽  
Soft Tissue Sarcomas ◽  
Breast Mass ◽  
Resection Margins ◽  
Stromal Sarcoma ◽  
First Case

INTRODUCTION: Primary breast sarcoma (PBS) was first described in 1887 as a rare heterogeneous neoplasm arising from the mesenchymal tissue of the mammary gland accounting for less than 5% of all body soft-tissue sarcomas and less than 0.1% of all malignant tumors of the breast. CASE PRESENTATION: A 31-year old lady presented with left breast mass which she felt four years before during which the mass increased in size from 1 to 6 cm in the largest diameter, diagnosed clinically as a benign fibroadenoma without any further cytological or histopathological confirmation. Histopathological examination of the excised breast mass reveals undifferentiated, primary stromal sarcoma of the breast (PSSB), which was followed by mastectomy three weeks later with reconstructive breast surgery with a total duration of follow-up of 3 years thereafter. This is the first case of PSSB reported in Jordan. DISCUSSION/CONCLUSION: PSSB is the generic term given to malignant breast tumors thought to arise from the specialized mesenchymal stroma of the breast but lacking an epithelial component with a phylloides pattern. PSSB is difficult to diagnose preoperatively due to its rarity and inadequate imaging methods to establish an exact diagnosis. The histology of the patient mass may be the leading factor for the management of these tumors. Even in very young patients, a progressively growing breast mass should alert the clinician to investigate for malignancy and verify the results by biopsy. Surgery with adequate resection margins represents the only potentially curative modality with prognostic significance. Adjuvant chemotherapy and radiotherapy are not very beneficial. The prognosis is dismal for patients with lymph node involvement and the size of the tumor has a lesser bearing on the outcome.

Discordance Between Intraoperative Consultation by Frozen Section and Final Diagnosis

2016 ◽  
Vol 25 (1) ◽  
pp. 41-50 ◽  
Author(s):  
Sharon B. Sams ◽  
Joshua A. Wisell
Keyword(s):  
Frozen Section ◽  
Cancer Center ◽  
Pathology Report ◽  
Frozen Sections ◽  
Data Set ◽  
Final Pathology ◽  
Root Cause ◽  
Organ Systems ◽  
Standardized Method ◽  
Classification Tool

Discrepancies between intraoperative consultations with frozen section diagnosis and the final pathology report have the potential to alter treatment decisions and affect patient care. Monitoring these correlations is a key component of laboratory quality assurance, however identifying specific areas for improvement can be difficult to attain. Our goal is to develop a standardized method utilizing root cause analysis and a modified Eindhoven classification schematic to identify the source of discrepancies and deferrals and subsequently to guide performance improvement initiatives. A retrospective review of intraoperative consultations performed at a tertiary level hospital and cancer center over a 6-month period identified deferrals and discrepancies between the intraoperative consult report and the final pathology report. We developed and applied a classification tool to identify the process errors and cognitive errors leading to discrepant results. A total of 48 (4.6%) discrepancies and 24 (2.3%) deferrals were identified from the 1042 frozen sections. Within the entire data set of frozen sections, the process errors (n = 26, 54.2%) were due to gross sampling (n = 16, 33.3%), histologic sampling (n = 8, 16.7%), and surgical sampling (n = 2, 4.2%). Interpretation errors (n = 22, 45.8%) included undercalls/false negatives (n=8, 16.7%), overcalls/false positives (n = 10, 20.8%), and misclassification errors (n = 4, 8.3%). Application of our classification tool demonstrated that the root cause of discrepancies and deferrals varied both between organ systems and by specific organs and that classification models may be utilized as a standardized method to identify focused areas for improvement.

scholarly journals Chondrosarcoma of the Nasal Septum—A Rare Subsite: Case Report with Review of Literature

2021 ◽  
Vol 42 (05) ◽  
pp. 506-509
Author(s):  
Nidhi Gupta ◽  
Awadhesh Kumar Pandey ◽  
Kislay Dimri ◽  
Surinder K Singhal ◽  
Neeraj Rathee ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Malignant Tumors ◽  
Surgical Excision ◽  
Metastatic Potential ◽  
Young Female ◽  
Resection Margins ◽  
Diagnostic Dilemma ◽  
Complete Surgical Excision ◽  
Grade Ii ◽  
Common Primary Malignant Bone

AbstractChondrosarcomas are the second most common primary malignant bone tumors. Head and neck chondrosarcomas constitute less than 10% of these tumors, rarely arising from the nasal septum. These are locally aggressive malignant tumors arising from the cartilaginous framework of the nasal septum. Rarity of the tumor coupled with nonspecific symptoms makes it a diagnostic dilemma. Diagnosis requires endoscopy, radiology, and final histopathology for confirmation. Treatment is mainly surgical, requiring complete surgical excision with clear margins. Radiation has a role in unresectable tumors or for tumors with positive margins after surgery. Survival depends on the grade of tumor that predicts the metastatic potential of the tumor. We present a rare case of chondrosarcoma arising from the nasal septum in a 29-year-old young female presenting with complaints of nasal obstruction. Computed tomography was suggestive of a calcified cartilaginous tumor arising from the nasal septum. Endoscopic excision was done and postoperative histopathology showed grade II chondrosarcoma with clear margins. No adjuvant treatment was given to our patient and 2 years post-excision patient is disease free.To conclude, chondrosarcoma of the nasal septum is a rare tumor, with nonspecific symptoms. Surgery with clear margins remains the treatment of choice. Prognosis depends on the extent of tumor at presentation, resection margins, and grade of tumor.

New and Important Changes in the TNM Staging System for Breast Cancer

2018 ◽  
pp. 457-467 ◽  
Author(s):  
Gabriel N. Hortobagyi ◽  
Stephen B. Edge ◽  
Armando Giuliano
Keyword(s):  
Breast Cancer ◽  
Regional Lymph Node ◽  
Staging System ◽  
Distant Metastases ◽  
Tnm Staging ◽  
Pathology Report ◽  
Imaging Evaluation ◽  
Complete Surgical Excision ◽  
Tnm Staging System ◽  
Eighth Edition

Expanded understanding of biologic factors that modulate the clinical course of malignant disease have led to the gradual integration of biomarkers into staging classifications. The American Joint Committee on Cancer (AJCC) TNM staging system is universally used and has largely displaced other staging classifications for most, although not all, cancers. Many of the chapters of the eighth edition of the AJCC TNM staging system integrated biomarkers with anatomic definitions. The Breast Chapter added estrogen receptor (ER) and progesterone receptor (PR) expression, HER2 expression, and/or amplification and histologic grade to the anatomic assessment of tumor size, regional lymph node involvement, and distant metastases (known as TNM). While preserving an anatomic staging system for continuity and for regions where modern biomarkers are not always available, the eighth edition emphasizes the increased prognostic precision of the clinical prognostic stage groups and the pathologic prognostic stage groups. The clinical prognostic stage groups are applicable to all patients with primary breast cancer before any treatment has been implemented, but require a clinical and imaging evaluation as well as a biopsy with grade and available ER, PR, and HER2 results; the pathologic prognostic stage groups are applicable to all patients treated with complete surgical excision as first treatment and also require a complete pathology report, grade, and ER, PR, and HER2. Applying the pathologic prognostic stage groups to a large database of patients staged by basic TNM groupings changed the stage grouping of almost 40% of patients. Grouping by pathologic prognostic stage groups led to a better prognostic distribution of the group and more precise individual prognostication.

scholarly journals Phyllodes tumor masquerading as a fungating breast mass

2017 ◽  
Vol 2017 (12) ◽  
Author(s):  
Nolan R Bruce ◽  
Jacob T Carlson ◽  
Kayla J Barnard ◽  
Ronda Henry-Tillman
Keyword(s):  
Phyllodes Tumor ◽  
Breast Mass

44: Time to PET-CT and final pathology report – delays in the lung cancer pathway

Lung Cancer ◽  
2017 ◽  
Vol 103 ◽  
pp. S20
Author(s):  
A. Hufton ◽  
R. Trafford ◽  
C. Smyth ◽  
M.J. Walshaw ◽  
M. Ledson
Keyword(s):  
Lung Cancer ◽  
Pathology Report ◽  
Final Pathology ◽  
Pet Ct

scholarly journals Giant Benign Mammary Phyllodes Tumor: Report of a Case and Review of the Literature

2021 ◽  
pp. 123-133
Author(s):  
Ricardo Fernández-Ferreira ◽  
Andrés Arroyave-Ramírez ◽  
Daniel Motola-Kuba ◽  
Gabriela Alvarado-Luna ◽  
Ileana Mackinney-Novelo ◽  
...  
Keyword(s):  
Case Reports ◽  
Standard Of Care ◽  
Phyllodes Tumor ◽  
Surgical Excision ◽  
Axillary Lymph Node Metastasis ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Phyllodes Tumors ◽  
Complete Surgical Excision ◽  
Mexican Woman

Phyllodes tumor of the breast is an infrequently encountered fibroepithelial neoplasm, which accounts for 0.3–1% of all tumors. Few case reports have described the occurrence of giant phyllodes tumor. To our knowledge, about 20% of phyllodes tumors would be considered giant benign. Complete surgical excision is the standard of care for giant benign phyllodes tumors; axillary lymph node metastasis is rare, and dissection should be limited to patients with pathologic evidence of tumor in the lymph nodes. We report the case of a 40-year-old Mexican woman with giant mammary tumor who underwent a right total mastectomy. The pathology results showed a benign phyllodes tumor 4,857 g in weight and 40.2 × 36.3 × 15 cm in size. We do not suggest adjuvant radiation therapy for patients with benign phyllodes tumors that are widely excised. A review of the pertinent literature was performed.

scholarly journals Giant lipoma of breast-a diagnostic dilemma

2021 ◽  
Vol 8 (2) ◽  
pp. 752
Author(s):  
D. J. Balsarkar ◽  
Sachin A. Suryawanshi ◽  
Muna Shaikh ◽  
Sudhir Dhobale
Keyword(s):  
Phyllodes Tumor ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Left Breast ◽  
Normal Breast ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Common Benign Tumor ◽  
Complete Surgical Excision ◽  
Giant Lipoma

Lipoma is the most common benign tumor of adipose tissue. Giant lipoma of breast is very rare.Majority of them are small in size, slow growing and asymptomatic until they reach large size. Most patients seek medical advice due to asymmetry in the breast and due to fear of malignancy. Breast lipomas pose a diagnostic challenge due to similarity of their texture to normal breast parenchyma and make it difficult to distinguish from other common breast lesions. The clinical and radiographic identification of breast lipoma remains challenging. Complete surgical excision with the capsule is essential to prevent recurrence. Breast reconstruction may require, to prevent asymmetry following surgical excision of giant breast lipoma. High degree of clinical suspicion and histolopathological correlation will help in preopertaive diagnosis of this clinical condition. Here, we report a case 50- year -old woman with left breast lump which clinically, radiologically and on fine needle aspiration cytology was diagnosed as phyllodes tumor, but after surgical excision it was reported as breast lipoma on final histopathology.

scholarly journals Periductal Stromal Sarcoma of the Breast: A Case Report

2021 ◽  
Author(s):  
Elham Nazar ◽  
Zohre Shabanzadeh
Keyword(s):  
Breast Cancer ◽  
Radical Mastectomy ◽  
Phyllodes Tumor ◽  
Pathology Report ◽  
Low Grade ◽  
Case Presentation ◽  
Adjuvant Therapies ◽  
Stromal Sarcoma ◽  
Spindle Cells

Introduction: Periductal Stromal Sarcoma (PSS), especially spindle and epithelioid types, is a rare subtype of the malignant fibroepithelial tumor with benign ductal elements and a sarcomatous stroma composed of spindle cells. The therapeutic management of PSS is based on wide surgery with free margins, and adjuvant therapies are not required. Case Presentation: This report describes a 37-year-old woman who presented to Shariati hospital with a right breast mass for review and a second opinion pathology report. The patient had undergone a radical mastectomy in another hospital three months previously. Histological and immunohistochemical examinations revealed PSS and all dissected lymph nodes were free of tumor. Based on the diagnosis, the patient received no adjuvant treatment (such as chemotherapy or radiotherapy). After nine months of close follow-up examinations, no recurrence was observed. Conclusion: PSS is an extremely rare disease with low-grade sarcomatous behavior, which may evolve into a phyllodes tumor or an entity of breast cancer. Therefore, frequent follow-up examinations are required.

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