Effect of pregnancy and lactation on a benign phyllodes tumour

Phyllodes tumours occurring in pregnancy are very rare. While most cases presented as rapidly enlarging masses, we present a benign phyllodes tumour which had the most growth in the first half of pregnancy followed by gradual growth in the latter half of pregnancy and lactation, as characterised on ultrasound imaging. This is the first report, to the best of our knowledge, which has objective measurements of the lesion before, during and after pregnancy. It also highlighted the need for a vigilant approach to fibroepithelial lesions in pregnancy, instead of attributing the growth of these lesions solely to hormonal changes.

EP.TH.729Spontaneous Complete Regression of Sacroma: A Case Report And Review of Literature

Spontaneous complete regression (SR) of cancer is complete or partial disappearance of the cancer without any treatment which is very rare(1). Case Report 58 year old female, with a palpable right breast lump from the chest wall at 7o clock position. It was 25mm in size, axillae demonstrated no LAD. Imaging was performed which showed a suspicious lesion with malignant features,core biopsy done. It showed pleomorphic spindled and epitheloid cells. Immunohistochemistry was negative for AE1/AE3,MNF116,CK19,CK7,P63,CK14,CK5/6 was diagnosed as sarcoma with a possibility of phyllodes tumour. Plan was made in MDT to discuss in regional sarcoma meeting and staging CT which was normal. Sarcoma MDT recommended surgery, planned for wide local excision. On the day of surgery patient came for wire localisation, however no tumor noted on imaging and patient also confirmed the same. Patient had CT and MRI which revealed no abnormalities. This was discussed in local and central MDT, advised imaging after 3 and 6 months. Discussion Spontaneous regression of breast sarcoma in Pub med yielded no cases. This process has not been clearly explained yet. Several mechanisms have been suggested for spontaneous regression, including immune modulation, withdrawal of carcinogens, infection, apoptosis, antiangiogenic and maturation mechanisms gene therapy, vaccine-mediated mechanisms among many. Conclusion This is the first case of SA of primary breast sarcoma to our knowledge and our main aim to present this case is due to its rarity.

Aggressive malignant phyllodes tumor of breast with omental metastases – A case report

Distant metastasis from malignant Phyllodes tumour (PT) is rare. They generally metastasize to the lung, bone, pleura, and liver. We present a very rare case of a 25-year-old woman with intraabdominal metastases from malignant phyllodes tumour of the breast. She presented with left breast lump and the biopsy was Phyllodes tumour. She underwent a two staged surgery; left modified radical mastectomy followed by left latissimus dorsi musculocutaneous flap cover. She received adjuvant radiation therapy to left chest wall. Following which she developed intrabdominal mass which was proven to be metastasis from Phyllodes tumour. She was then advised palliative chemotherapy. Malignant Phyllodes with distant metastases has a dismal prognosis. We propose it is preferable to have a CT Thorax and Abdomen as a staging workup for patients with malignant PT to identify those with poor prognosis.

A CASE OF PHYLLODES TUMOUR DONE UNDER CONTINOUS THORACIC EPIDURALANAESTHESIA IN A SIX MONTHS PREGNANT FEMALE

Phyllodes tumor is a rare neoplasm of female breast have its origin from the broepithelial cells of breast. It predominantly occur in females (0.3- 0.5%). Phyllodes in pregnancy are larger in size and rapidly growing may be because of the inuence of pregnancy hormones on the female breast tissues. A 22 year old female with six months of pregnancy with phyllodes tumor of right breast was posted for wide local excision and reconstruction of defect using latissimus dorsi myocutaneous ap. She had presented with swelling of approximately 24cm X10cm X 6cm in her right breast which developed pain since last eight days. She was maintained on the intravenous injection duvadilan (isoxsuprine) 80 mg 8 hourly for three days perioperatively for tocolysis. The case was done using thoracic epidural catheterization at T6-T7 interspace using 0.75% ropivacaine with no perioperative complications. The choice of anesthetic technique for the emergency procedures in pregnancy will depend on the trimester and the type and duration of surgical procedure. Whenever possible, a regional anesthetic technique should be used.

Giant Metastatic Breast Phyllodes Tumour with an Elusive Diagnosis: A Case Report and Literature Review

Background: The term phyllodes tumours, which account for less than 1% of breast neoplasms, describes a spectrum of heterogenous tumours with different clinical behaviours. Less than 30% present as metastatic disease. Complete surgical resection is the standard of care so that recurrence rates are reduced. The role of adjuvant chemotherapy or radiation therapy is controversial. Patients with metastatic disease have a median overall survival of around 30 months. Case description: The authors present the case of a 57-year-old woman with an exuberant left malignant phyllodes tumour with bilateral involvement, as well as lung and axillar metastasis. The patient underwent haemostatic radiation therapy and started palliative chemotherapy with doxorubicin, achieving partial response with significant improvement in quality of life. A posterior simple mastectomy revealed a small residual tumour. Discussion: Metastatic malignant phyllodes tumours are rare, so therapeutic strategies rely on small retrospective studies and guidelines for soft tissue sarcoma. Palliative chemotherapy protocols include anthracycline-based regimens, either as monotherapy with doxorubicin or doxorubicin together with ifosfamide. With few treatment options, management of these patients must rely on a continuum of care

Spindle cell lesions of the breast: a diagnostic approach

Spindle cell lesions of the breast comprise a heterogeneous group of lesions, ranging from reactive and benign processes to aggressive malignant tumours. Despite their rarity, they attract the attention of breast pathologists due to their overlapping morphological features and diagnostic challenges, particularly on core needle biopsy (CNB) specimens. Pathologists should recognise the wide range of differential diagnoses and be familiar with the diverse morphological appearances of these lesions to make an accurate diagnosis and to suggest proper management of the patients. Clinical history, immunohistochemistry, and molecular assays are helpful in making a correct diagnosis in morphologically challenging cases. In this review, we present our approach for the diagnosis of breast spindle cell lesions, highlighting the main features of each entity and the potential pitfalls, particularly on CNB. Breast spindle cell lesions are generally classified into two main categories: bland-appearing and malignant-appearing lesions. Each category includes a distinct list of differential diagnoses and a panel of immunohistochemical markers. In bland-appearing lesions, it is important to distinguish fibromatosis-like spindle cell metaplastic breast carcinoma from other benign entities and to distinguish fibromatosis from scar tissue. The malignant-appearing category includes spindle cell metaplastic carcinoma, stroma rich malignant phyllodes tumour, other primary and metastatic malignant spindle cell tumours of the breast, including angiosarcoma and melanoma, and benign mimics such as florid granulation tissue and nodular fasciitis.

Axillary Mass Turned Out to be A Phyllodes Tumour in An Ectopic Breast Tissue– A Rare Case Report

Background: Phyllodes tumours are rare fibroepithelial lesion, which accounts for less than 1% of all breast neoplasm. However, Phyllodes tumours arising from ectopic breast tissue are even rarer, with less than 15 cases ever reported involving the axilla, vulva, and groin. Case Presentation: A 27-year-old lady presented to the surgical clinic with left axillary swelling measuring 5cm x 6cm. Ultrasound of the axilla revealed heterogenous homogenous mass displacing the left axillary artery and vein medially. Excision was performed, and histopathological examination confirmed the diagnosis of a benign Phyllodes tumour. Conclusion: Phyllodes tumour in ectopic breast tissue over the axilla is a rare occurrence, and our case is the fourth case ever reported. Despite its rarity, diagnosis and treatment modalities are similar to Phyllodes tumour of the breast. Regular follow-up is recommended due to the risk of local recurrence.