Phyllodes Tumor as a Secondary Neoplasm in Survivors of Childhood Cancer: A Tertiary Care Cancer Centre Experience.

Secondary neoplasms (SNs) are being increasingly identified in long-term survivors of childhood cancer. Phyllodes tumor (PT) form a distinctly uncommon SN. We report a series of 6 female childhood cancer survivors who developed PT as SN. The median age at primary diagnosis was 13 years. Their primary tumors were bone sarcoma (4) and acute leukemia (2), and all were treated with chemotherapy, predominantly with alkylating agents and/or anthracyclines. None had received direct radiotherapy to the chest wall. Subsequently, PT were detected after a median interval of 7.5 years, with 2 patients developing bilateral and malignant PT. The series highlights a rare SN in childhood cancer survivors, underscoring the importance of regular long-term follow-up.

Ultrasound Imaging Characteristics of Breast Lesions Diagnosed During Pregnancy and Lactation.

Background and Objectives: The breast undergoes extensive physiologic changes during pregnancy/lactation. We aimed to review the ultrasound (US) imaging characteristics of breast lesions during pregnancy/lactation and to demonstrate ultrasonography as an excellent imaging modality in this patient population. Materials and Methods: We performed a retrospective study involving 195 patients with 206 pathologically confirmed breast lesions during pregnancy/lactation over the period of January 2010 to December 2018; 51 were diagnosed with breast cancer, including 50 invasive ductal carcinomas and 1 low malignant potential phyllodes tumor, whereas 144 were diagnosed with 155 benign lesions, including 103 mastitis/abscesses, 45 fibroadenomas, 2 intraductal papillomas, 2 sclerosing lesions, and 3 benign phyllodes tumors. The patients' age, lesion diameter, and US characteristics were analyzed. Results: The breast lesions of patients during pregnancy/lactation were compared with those during nonpregnancy/lactation. Patients with breast cancer or fibroadenomas during pregnancy/lactation were younger than those during nonpregnancy/lactation. The average lesion diameter was significantly higher among pregnant/lactating patients compared with controls of childbearing age for fibroadenomas, but not for malignant lesions. The fibroadenomas and mastitis/abscesses during pregnancy/lactation usually have higher BI-RADS categories than those during nonpregnancy/lactation. Conclusions: The imaging features of breast cancer during pregnancy/lactation did not differ much from those of nonpregnancy/lactation; however, some benign lesions had suspicious sonographic features, and US-guided core biopsies were necessary for differentiating benign from malignant lesions.

Does Prophylactic Radiation Therapy to Avoid Gynecomastia in Patients With Prostate Cancer Increase the Risk of Breast Cancer?

PURPOSE: Prostate cancer (PC) patients who undergo antiandrogen monotherapy are offered prophylactic radiation therapy (PRT) to the breast buds to avoid gynecomastia. The aim of the present study was to evaluate whether the risk of breast cancer (BC) in men with PC as their first cancer diagnosis was influenced by PRT. METHODS AND MATERIALS: From the Norwegian Cancer Registry, we collected data from all patients with PC as their first cancer diagnosis from 1997 to 2014. We registered all RT given to the patients in the same period and the occurrence of BC diagnosed ≥3 months after the PC diagnosis. The histopathologic diagnoses of all BC cases were collected. Subdistribution hazard ratios for the risk of BC in the PRT and non-PRT groups were estimated. A standardized incidence ratio for BC was calculated by comparing our cohort to the standard male population. RESULTS: We analyzed 59,169 patients with PC, of whom 7864 (13.3%) had received PRT. The median follow-up time was 4 years. Of the 12 men with a diagnosis of BC, 3 had received PRT, and 2 of the 3 were phyllodes tumors. The risk of BC was not significantly different statistically for the patients given PRT compared with the non-PRT group (subdistribution hazard ratio 1.62, 95% confidence interval 0.41-5.62, adjusted for age and time of diagnosis). The standardized incidence ratio was 0.996 (95% confidence interval 0.57-1.75). CONCLUSIONS: In this registry-based study, we did not find an increased risk of BC in PC patients who received PRT. The number of BC cases in our study was low, and the risk of secondary BC after PRT seems to be negligible. The incidence of BC could, however, increase with additional follow-up. Also, 2 patients who had received PRT developed a malignant phyllodes tumor, an extremely rare type of BC associated with gynecomastia.

A single-center experience and review of the literature: 64 cases of phyllodes tumors to better understand risk factors and disease management.

Phyllodes tumors of the breast are rare fibroepithelial tumors that are characterized as benign, borderline, or malignant based on cellular characteristics such as stromal overgrowth and number of mitoses. Currently, there is a lack of consensus on risk factors and management of patients with phyllodes tumors, which has led to variation in treatment patterns as well as patient outcomes across many institutions. This study seeks to understand the clinicopathologic features, risk factors for local and metastatic recurrence, and clinical outcomes of patients with phyllodes tumors to better define optimal treatment patterns.

De novo phyllodes tumor in an adolescent female after liver transplantation.

Phyllodes tumor of the breast is a rare disease constituting 0.3-0.9% of all breast neoplasms. Occurring mainly in females aged 35 to 55 yr, the disease is especially rare among adolescent females. There is no published literature about de novo phyllodes tumor after liver transplantation. Here we describe a case of de novo phyllodes tumors in an adolescent female after liver transplantation from a living donor for Wilson disease.

A case of a giant phyllodes tumor of the breast with hypoglycemia caused by high-molecular-weight insulin-like growth factor II.

We report the case of a patient who presented with hypoglycemia associated with a giant breast mass and presence of serum high-molecular-weight insulin-like growth factor II (big IGF-II). In July 2005, a 49-year-old woman was admitted because of delirium, transient loss of consciousness, and a giant mass of about 28 cm in diameter on the right breast. She had noticed the mass for more than 2 years, but had refused medical attention at that time. A blood examination indicated hypoglycemia (21 mg/dl) and decreased levels of endogenous insulin. Furthermore, a western blot analysis revealed that big IGF-II (20 kDa) was the predominant serum IGF-II peptide (mature IGF-II is 7.5 kDa). Because we suspected that the big IGF-II was produced by the breast tumor and was likely the cause of the hypoglycemia, a mastectomy was performed. A histological examination determined that the mass was a benign phyllodes tumor. After surgery, the hypoglycemia resolved, and endogenous insulin levels improved. We suspected that the patient had non-islet cell tumor hypoglycemia (NICTH), but the behavioral symptoms of the hypoglycemia caused by NICTH were similar to some mental diseases, which made diagnosis based on the behavior alone difficult. We suggest that co-occurrence of symptoms such as recent appearance of mental disease-like behavior, hypoglycemia, and giant breast tumor may help diagnose NICTH caused by big IGF-II.

Phyllodes tumors of the breast: natural history, diagnosis, and treatment.

Phyllodes tumors of the breast are unusual fibroepithelial tumors that exhibit a wide range of clinical behavior. These tumors are categorized as benign, borderline, or malignant based on a combination of histologic features. The prognosis of phyllodes tumors is favorable, with local recurrence occurring in approximately 15% of patients overall and distant recurrence in approximately 5% to 10% overall. Wide excision with a greater than 1 cm margin is definitive primary therapy. Adjuvant systemic therapy is of no proven value. Patients with locally recurrent disease should undergo wide excision of the recurrence with or without subsequent radiotherapy.

Tumor phyllodes de mama. Revisión de 35 casos / No disponible

Introducción y objetivo: el tumor phyllodes es una tumoraciónpoco frecuente de la mama, de comportamiento clínicoimprevisible y cuyo tratamiento es aún objeto de controversia.Presentamos una revisión de 35 casos diagnosticados y tratadosen nuestro centro a lo largo de 10 años, así como una revisiónde los datos publicados en la literatura.Pacientes y métodos: estudio retrospectivo, descriptivo, de35 pacientes portadoras de esta neoplasia estudiadas en la“Unidad de Oncología y Patología Mamaria” (HH.UU. Virgendel Rocío. Sevilla) entre enero de 1998 y enero de 2007.Resultados: la edad al momento del diagnóstico fue de45,02 ± 15 años. El tiempo medio de duración de la sintomatologíafue de 7,8 meses. La forma de presentación en todoslos casos fue la aparición de una tumoración, que en el 11%casos tuvo un crecimiento rápido. La mayoría se localizó enlos cuadrantes supero-externos y el tamaño osciló entre los 2y 20 cm. Las pruebas de imagen orientaron el diagnóstico enel 20% casos; la PAAF/Tru-cut fue positiva en 7 pacientes.De los 35 casos, 54,5% fueron benignos, 27,3% malignos y18,2% borderline. En el 68,6% de las pacientes se realizó tumorectomíaamplia; en cinco pacientes se realizó mastectomíay en un caso se indicó radioterapia adyuvante. Sólo 3 pacientespresentaron recidivas loco-regionales. 2 pacientes evolucionaroncon metástasis a distancia.Conclusiones: la resección con amplios márgenes de seguridades el tratamiento de elección y principal factor que condicionala probabilidad de recidiva local y a distancia de los tumoresphyllodes(AU)

Introduction and objective: the phyllodes tumour is anuncommon breast lesion, with an unpredictable clinical behaviour,which treatment is exposed to controversy. We analyzethe results of 35 patients diagnosed and treatment in ourcenter during 10 years, and also review the dates report onthe literature.Patients and methods: we retrospectively reviewed 35 patientshaving phyllodes tumour, seen at “Unidad de Oncologíay Patología Mamaria” (HH.UU. Virgen del Rocío.Sevilla) between January 1998 and January 2007.Results: the mean age at diagnosis was 45.02 ± 15 years.The mean follow-up was 7.8 months. The appearance of amass was the way of presentation in all cases; in 11% patientsthe tumour’s growth was fast. Tumours predominated on theupper-outer quadrant and the range size was 2-20 cm. Imagingfinding were helpful for diagnosis in 20% cases.PAAF/Tru-cut were positive in 7 patients. Tumours were classifiedas benign in 54.5% cases, malignant (27.3%) and borderline(18.2%). Wide tumorectomy was performed in 68.6%of cases. 5 patients underwent mastectomy, and another onereceived adjuvant external radiation therapy. Only 3 patientshad a recurrence and two had metastases.Conclusions: wide excision with a clear margin may be thepreferable initial therapy. Loco-regional and general spreaddepends on margin surgery(AU)

Retrospective analysis of 25 women with malignant cystosarcoma phyllodes--treatment results.

PURPOSE: Mastectomy without axillary dissection should be the standard treatment in patients with malignant form of cystosarcoma phyllodes. The role of postoperative radiotherapy and chemotherapy remains to be fully established. We evaluate treatment results in a group of patients with cystosarcoma phyllodes (CP) treated at our Institute. PATIENTS AND METHODS: In this report we analyze treatment outcome in 25 patients with malignant cystosarcoma phyllodes treated at Masaryk Memorial Cancer Institute between 1970 and 1995. Mean tumor size was 10 cm in diameter. All patients underwent surgery. Subsequently, 17 patients (68%) received radiotherapy on the breast or chest wall. RESULTS: Median follow-up was 139.5 months. Local recurrence was observed in 16% of all patients and all patients with local recurrence died. Time to local relapse after surgery was 4-11 months. Distant metastases occurred in 5 patients. All patients with local recurrence had distant metastases. Dissemination occurred 3-19 months after local recurrence. Five-year survival of all patients was 80%. CONCLUSION: A specific protocol for the treatment of cystosarcoma phyllodes is missing, probably due to rarity of the disease. The treatment of local recurrent disease remains unsuccessful in most CP patients. We recommend postoperative irradiation on the chest wall in patients with malignant form of CP, because adjuvant radiotherapy decreased the incidence of local relapse in our group of patients.

Phyllodes tumor of the breast: case series of 40 patients.

Cystosarcoma phyllodes is a rare, uncommon fibroepithelial tumor of the breast. We analyzed the clinical situation in relation to the histopathologic findings. Forty types of surgery, recurrences, histopathologic diagnosis and follow-up of patients were studied retrospectively. Histopathologic examination results were evaluated by logistic regression analysis. Surgery was performed on all patients as the initial treatment. At the first examination 38 cases were evaluated as benign and the remaining two as malignant. Recurrent tumors were seen in nine (22.5%) cases during follow-up with a mean recurrence time of 30.1 months. Five of the recurrent cases were evaluated as malign. The total number of malignant cases reached seven (17.5%). In statistical analysis evidence of tumor necrosis, stromal atypism, stromal cellularity, number of mitoses and stromal overgrowth were found to be significantly correlated with malignancy (p < 0.05). Recurrences were also significantly correlated with stromal cellularity, stromal overgrowth, necrosis and malignancy (p < 0.05). Cystosarcoma phyllodes recur with a high incidence and may transform to malignant disease. The patients should be followed strictly in order to detect recurrence earlier.

Phyllodes tumours.

Phyllodes tumours are rare fibroepithelial lesions that account for less than 1% of all breast neoplasms. With the non-operative management of fibroadenomas widely adopted, the importance of phyllodes tumours today lies in the need to differentiate them from other benign breast lesions. All breast lumps should be triple assessed and the diagnosis of a phyllodes tumour considered in women, particularly over the age of 35 years, who present with a rapidly growing "benign" breast lump. Treatment can be by either wide excision or mastectomy provided histologically clear specimen margins are ensured. Nodal metastases are rare and routine axillary dissection is not recommended. Few reliable clinical and histological prognostic factors have been identified. Local recurrence occurs in approximately 15% of patients and is more common after incomplete excision. It can usually be controlled by further surgery. Repeated local recurrence has been reported without the development of distant metastases or reduced survival. Approximately 20% of patients with malignant phyllodes tumours develop distant metastases. Long term survival with distant metastases is rare. The role of chemotherapy, radiotherapy, and hormonal manipulation in both the adjuvant and palliative settings remain to be defined.

Tumor filodes: correlación clínica, radiológica y anatomopatológica en 50 casos / Phyllodes tumor: clinical, radiological and pathological correlation in 50 cases

Objetivos: Revisar los hallazgos radiológicos de tumores filodes, correlacionándolos con su presentación clínica, tipo histológico y respuesta al tratamiento.Materiales y métodos: Se analizan de forma retrospectiva 50 tumores filodes en 29 pacientes con edades comprendidas entre 16 y 59 años (media 41 años). Se incluyen 12 recidivas, un tumor bilateral y seis múltiples. Se evaluaron mamográficamente 45 y ecográficamente 36. En ocho casos se realizó estudio citológico tras punción aspiración guiada clínicamente. El diagnóstico anatomopatológico se obtuvo en todos los tumores mediante biopsia quirúrgica (31 benignos y 19 malignos). Se realizó seguimiento clínico-radiológico tras tratamiento quirúrgico a 24 pacientes, durante un período medio de 32 meses.Resultados: Mamográficamente se detectó nódulo o masa en 42 casos, densidad asimétrica en dos, y aumento de densidad generalizada en uno. En seis casos la presentación fue multifocal. El tamaño fue muy variable, demostrando los nódulos > 5 cm mayor probabilidad de malignidad (p 5 cm han sido los dos únicos signos radiológicos asociados estadísticamente a malignidad. El índice de recurrencia ha sido mayor en lesiones malignas que benignas sobre todo en el grupo tratado con tumorectomía (AU)

Tumor filodes de mama. Análisis de 22 casos / Phyllodes tumor of the breast. Analysis of 22 cases

Introducción y objetivos. El tumor filodes es una neoplasia infrecuente de la mama cuyo tratamiento, en lo que se refiere a la extensión de la exéresis, es aún objeto de controversia. Se analizan los resultados obtenidos en una serie de pacientes portadoras de esta neoplasia que hemos tenido oportunidad de tratar. Pacientes y método. Entre 1986 y 1997 fueron diagnosticadas y remitidas al servicio de cirugía de nuestro centro 22 pacientes portadoras de tumor filodes de mama. Retrospectivamente, fueron analizados los datos correspondientes a edad, localización y dimensiones del tumor, así como las características histológicas de benignidad o malignidad, el tratamiento efectuado (exéresis local frente a mastectomía) y el período libre de la enfermedad tras la intervención. Resultados. La edad media fue de 48 años (rango, 36-77). El tumor se localizó más frecuentemente en los cuadrantes superoexternos (15 casos) y sus dimensiones eran inferiores a 5 cm en 7 pacientes; entre 5-10 cm en 13 pacientes y mayor de 10 cm en 2 casos. Fueron clasificados como benignos 14 nódulos y como malignos 7 casos, no pudiéndose determinar en un caso. Fueron practicadas 12 exéresis locales (11 benignos y uno maligno) y 10 mastectomías (6 malignos, 3 benignos y uno indeterminado). Solamente una paciente falleció durante el seguimiento, a los 5 meses de habérsele practicado una mastectomía. El carácter de benignidad o malignidad se relacionó con el tamaño (p = 0,03). Sin embargo, no se encontraron diferencias significativas entre la recidiva y la histología y el tratamiento efectuado (tumorectomía frente a mastectomía). Conclusiones. Los tumores filodes de mama, independientemente del tipo de exéresis practicada, presentan un pronóstico bueno a largo plazo. Se hace necesaria la realización de estudios controlados prospectivos para evaluar el tipo de cirugía ideal (AU)

Malignant phyllodes tumor following irradiation of the breast.

This is a case report of malignant phyllodes tumor (cystosarcoma phyllodes) which appeared 15 years following medical irradiation of the breast for presumable carcinoma which had not been histologically or cytologically confirmed prior to treatment. Histology of the phyllodes tumor disclosed remnant of fibroadenoma in one area, and it is believed that the latter gave rise to the malignant phyllodes tumor within the field of irradiation. In view of recent popularity of the limited surgery and postoperative irradiation in treatment of breast carcinoma the possibility of malignant transformation of fibroadenoma left in situ is raised.

[Development of aggressive cystosarcoma phyllodes after conservative treatment of breast adenocarcinoma]. / Développement d'une tumeur phyllode agressive après traitement conservateur d'un adénocarcinome mammaire.

The case report is that of patient who underwent tumorectomy plus X-ray therapy for mammary invasive ductal carcinoma. Eight years later a large cystosarcoma phyllodes, developed and quickly recurred after conservative surgery. Reviewing previous mammograms, the authors discovered that at the time of irradiation, there was a small lump which had the appearance of fibroadenoma. It may be that heavy X-ray therapy on a benign epithelial and stromal tumour of the breast, played a major role in the later development of cystosarcoma phyllodes.

Cystosarcoma phyllodes. Diagnosis and management.

The diagnosis and management of cystosarcoma phyllodes is analyzed by reviewing the literature and presenting cases from our institution. This rare neoplasm of the female breast represents less than 1% of all breast tumors. Most patients present in the fourth and fifth decades of life. The predominant complaint is a palpable mass in the breast. Systemic manifestations occur after metastases have developed. Treatment is surgical excision. There is some controversy, however, over which type of surgical procedure should be performed. We recommend total mastectomy. Local recurrence and metastases do occur and have been related to inadequate surgery and various histological characteristics (mitotic activity, tumor margin, and stromal cellular atypia).