ABSTRACT
Pulmonary adenofibroma is an extremely rare benign primary tumor of the lung,with characteristic bi-phasic differential pattern.They are usually sub-pleural solid pulmonary nodules with clear margins.The tumor is composed of glands and peri-gland stroma.The glands are often quite simple,forming long and narrow tubules,with uniformly monolayer lining cells.Combined papillary or phyllodes structures were reported in some cases.The stromal cells are spindle-shaped and look mild,mixed with the collagen bands.Up till now,only a few cases of pulmonary adenofibroma have been reported all over the world.And because of the limited recognition,this tumor is easily misinterpreted as malignancy in frozen section or biopsy specimens.We reported a new case of pulmonary adenofibroma.The mass peripherally located in the left lobe of the lung,found by chance in a 74-year-old woman.The patient underwent a wedge resection of the left lung by the thoracoscope,because of the slowly gradual enlargement of the mass annually.An oval grayish-white nodule was sub-pleural located in the specimen,with solid and rubbery texture,but without a distinct capsule.Two distinct components of simple glands and mild spindle cell stroma were found to mix together uniformly under the microscope.Collagen bands of various widths evenly surrounded each stromal cell.A few small coarse papillae or phyllodes structures were randomly distributed in some area.The immunohistochemical staining pattern of the glandular cells was accordant with type Ⅱ alveolar epithelium.Stromal cells were positive with CD34,B-cell lymphoma-2 (Bcl-2),CD99and estrogen receptor (ER),while S-100,smooth muscle actin (SMA) and all the mesothelium markers were negative.The patient was disease free after the surgery,although the follow-up time was only one year.Besides the new case above,we also reviewed all the reported cases,and tentatively discussed the probable histological origin of pulmonary adenofibroma.
ABSTRACT
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.
Introducción: Los tumores phyllodes mamarios son Tumores infrecuentes en la mama presentes en menos del 1% de los casos nuevos de cáncer mamario, por lo general ocurre en mujeres de mediana edad (40-50 años) Objetivo: Este estudio muestra la experiencia de diagnóstico, tratamiento quirúrgico y seguimiento de los pacientes con esta variedad de tumor durante un período de diez años en un centro de referencia oncológico. Métodos: Retrospectivamente, los registros de cáncer de mama en la institución fueron revisados, se identificaron 77 pacientes con tumores phyllodes entre 2002 y 2012, que habían sido operados en el Instituto de Cancerología - Clínica Las Américas, en Medellín (Colombia). Los datos clínicos e histopatológicos pertenecientes a estos casos fueron recolectados y analizados utilizando técnicas de estadística descriptivas. Resultados: La mediana de seguimiento fue de 22.5 meses (RIC: 10.5-60.0), la Media de edad fue de 47.2 años (DE: 12.4), tamaño medio del tumor fue de 3.6 cm (DE: 4.6), 88.3% de los pacientes (68 casos) presentaron márgenes negativos y ninguno de ellos recibieron quimioterapia adyuvante. De los pacientes con tumores phyllodes; 33.8% fueron benignos, 31.2% Borderline y 35.0% phyllodes maligno. Supervivencia libre de enfermedad fue 85.8% y la supervivencia global fue de 94.5%. Discusión: Los datos reportados en este artículo están acordes con lo que se ha reportado en la literatura mundial. En nuestra cohorte, a pesar de que el tamaño promedio de los tumores fue mayor, el riesgo de recidiva local y las tasas de enfermedad metastásica es menor que el reportado previamente en la literatura. Los ensayos con seguimiento más prolongado, y los ensayos moleculares en tumores phyllodes son necesarios para comprender de una manera mas precisa el comportamiento de estos tumores en la población hispana.
Subject(s)
Adult , Female , Humans , Middle Aged , Breast Neoplasms/pathology , Phyllodes Tumor/pathology , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Colombia , Disease-Free Survival , Follow-Up Studies , Phyllodes Tumor/diagnosis , Phyllodes Tumor/surgery , Retrospective Studies , Survival RateABSTRACT
El tumor Phyllodes de mama es un tumor poco frecuente que se engloba dentro de los tumores fibroepiteliales de mama, con un amplio abanico de presentación clínica y comportamiento biológico. Se clasifican en benignos, borderline o malignos, en base a factores histológicos. Las formas menos agresivas o benignas presentan un comportamiento similar al de los fibroadenomas, sin embargo las formas malignas suelen presentar un comportamiento más agresivo. El pronóstico de este tipo de tumor es favorable, con una recurrencia local del 15 por ciento de forma global y recurrencia a distancia entre 5-10 por ciento. El tratamiento se basa en la escisión quirúrgica de la lesión, acompañada de radioterapia e incluso quimioterapia en las formas más agresivas. Presentamos la revisión de 13 casos clínicos de esta entidad diagnosticados en nuestro centro entre 2001-2009.
Phyllodes tumor of the breast is a rare tumor, which is part of fibroepithelial breast tumors with a wide range of clinical presentation and biological behavior. They are classified into benign, borderline or malignant based on histologic factors. The less aggressive or benign forms show a more behavior to that of fibroade-nomas, but malignant forms usually show a more aggressive behavior. The prognosis of this tumor is favorable, with local recurrence in 15 percent overall and distant recurrence between 5-10 percent globally. The treatment relies on surgical excision of the lesion accompanied by radiotherapy and chemotherapy even in the most aggressive. We present a review of 13 cases of this entity diagnosed in our center between 2001-2009.
Subject(s)
Humans , Adult , Female , Middle Aged , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Phyllodes Tumor/diagnosis , Phyllodes Tumor/therapy , Biopsy , Diagnosis, Differential , Fibroadenoma/diagnosis , Mammography , Breast Neoplasms/pathology , Prognosis , Retrospective Studies , Survival Analysis , Phyllodes Tumor/pathologyABSTRACT
Phyllodes tumors are an infrequent breast tumor presentation. A phyllodes tumor with a synchronous invasive ductal carcinoma is rarely described and has never been reported with lobular carcinoma in situ component. A 53-year-old female presented with a nine-year history of twice core biopsy proven fibroadenoma. After an increase in the tumor's growth velocity it was decided upon to undergo an excisional biopsy. Microscopic examination of the well-circumscribed pale-tan mass found focal areas of leaf like architecture with variable number of mitoses present, representing a phyllodes tumor of borderline malignant potential. Incidentally, at one edge of the mass was found a tubular carcinoma and lobular carcinoma in situ components. Thorough, routine follow-up of patients with biopsy proven benign breast masses is important to finding a masked malignant component.