Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 459
Filtrar
2.
Med. leg. Costa Rica ; 37(1): 146-153, ene.-mar. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1098382

RESUMO

Resumen El tumor phyllodes de mama es un tumor fibroepitelial raro, pero clínicamente importante, que representa menos del 1% de las neoplasias de mama. Histológicamente, los tumores phyllodes se clasifican en tres; como: benignos, limítrofes o malignos, basándose en una combinación de criterios histológicos y patológicos. Esta clasificación del tumor phyllodes de mama es precisamente relevante en su clínica. Si bien la recurrencia local del tumor phyllodes puede ocurrir en todos los grados, la metástasis se limita principalmente a casos malignos y pocos casos limítrofes, por lo general siendo estos dos últimos los que presentan un peor pronóstico de la enfermedad. El tratamiento es principalmente quirúrgico ya que los tumor phyllodes no responden bien a la terapia sistémica. Esta revisión del tumor phyllodes de mama permite orientar a toda la comunidad médica, con base en la evidencia más reciente, a diagnosticar y así poder manejar esta patología, evitando sus complicaciones.


Abstract Phyllodes tumor of the breast is a rare, but clinically important fibroepithelial tumor, accounting for <1% of breast tumors. Histologically, phyllodes tumor is classified into three; as: benign, borderline or malignant, based on a combination of histological and pathological criteria. This classification of the phyllodes breast tumor is precisely relevant in the clinic. While local recurrence of phyllodes tumor may occur in all grades, metastasis is mostly limited to malignant and few borderline cases, usually the latter two types having a worse prognosis of the disease. Treatment is mainly surgical as phyllodes tumor doesn´t respond well to systemic therapy. This review of the phyllodes tumor allows to guide the entire medical community based on the most recent evidence to diagnose and thus be able to manage this pathology, avoiding its complications.


Assuntos
Humanos , Feminino , Neoplasias da Mama/cirurgia , Tumor Filoide/diagnóstico , Neoplasias Fibroepiteliais
3.
Anticancer Res ; 40(2): 1095-1100, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014959

RESUMO

BACKGROUND/AIM: Fibroepithelial lesions (FEL) of the breast include fibroadenomas and phyllodes tumors (PT). Their histologic characteristics on core needle biopsy can overlap, while their clinical management is different. The aim of this study was to develop and to validate a pre-operative score for the diagnosis of PT with surgical decision rules. PATIENTS AND METHODS: We developed a pre-operative score for the diagnosis of PT by performing logistic regression on 217 FEL of the Rene Huguenin Hospital. This score and the surgical decision rules were validated on 87 FEL of the Lariboisiere Hospital. RESULTS: Three variables were independently and significantly associated with PT: age ≥40 years, mammography's tumor size ≥3 cm and PT diagnosed by CNB. The pre-operative score was based on these three criteria with values ranging from 0 to 10. Surgical decision rules were created: the low-risk group of PT (score≤2) had a sensitivity of 92.6% and a LR- of 0.2, the high-risk group (score>7) had a specificity of 93.5% and a LR+ of 4.4. In the validation sample, surgical decision rules were applied. CONCLUSION: These surgical decision rules may prove useful in deciding which FEL needs surgical resection.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/patologia , Fibroadenoma/diagnóstico , Neoplasias Fibroepiteliais/diagnóstico , Tumor Filoide/diagnóstico , Adulto , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/cirurgia , Tomada de Decisão Clínica , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Fibroadenoma/cirurgia , Humanos , Mamografia , Pessoa de Meia-Idade , Neoplasias Fibroepiteliais/cirurgia , Tumor Filoide/cirurgia , Curva ROC , Estudos Retrospectivos , Adulto Jovem
4.
J Surg Res ; 249: 205-215, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31991330

RESUMO

BACKGROUND: Malignant phyllodes tumors of the breast are uncommon in women and rare in children. This study aimed to assess the differences in survival among five specific pathologic groups of breast malignancies and the differences between pediatric and adult breast phyllodes malignancy. MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results database, we collected data on 270 pediatric (aged ≤21 y) female breast malignant tumor patients and 2773 female malignant phyllodes tumor patients between 1976 and 2015. We evaluated survival differences among younger patients with breast malignancy and compared the pediatric and adult groups based on characteristics, treatment patterns, and survival months. Finally, we identified the risk and protective factors for breast phyllodes cases using a multivariable Cox analysis. RESULTS: We collected and analyzed 270 malignant breast cancer patients aged ≤21 y and 2773 malignant phyllodes tumor patients. Pediatric patients with malignant phyllodes tumors (22.2%, n = 60) exhibited better overall survival (OS; log-rank, P = 0.012) and cancer-specific survival (CSS; log-rank, P = 0.005) among the younger patients with malignant breast tumors. Furthermore, pediatric patients with malignant phyllodes tumors showed better OS (log-rank, P = 0.004), and similar CSS (log-rank, P = 0.105), compared with older patients. After adjustments for potential confounding factors, age >21 y, Black race, tumor size of >100 mm, high grade, wider invasion, positive nodal status, larger scope surgery, and no surgery were found to be associated with worse OS. All these factors, except for race, were found to be independent risk factors for CSS. CONCLUSIONS: The prognosis of malignant phyllodes tumors in children is better than that of adults. Appropriate surgical scope and risk of overtreatment should be considered when treating pediatric malignant phyllodes tumor patients.


Assuntos
Neoplasias da Mama/epidemiologia , Mastectomia/normas , Tumor Filoide/epidemiologia , Programa de SEER/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Criança , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Estimativa de Kaplan-Meier , Margens de Excisão , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tumor Filoide/diagnóstico , Tumor Filoide/patologia , Tumor Filoide/cirurgia , Guias de Prática Clínica como Assunto , Prognóstico , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
5.
BMJ Case Rep ; 12(11)2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31712227

RESUMO

A 33-year-old woman presented for a preoperative examination prior to an upcoming operative hysteroscopy. During the examination, a firm 1 cm mass in her right labia minora was noted. The mass was excised in the operating room without difficulty. Pathological examination revealed a benign phyllodes tumour of the vulva. Phyllodes tumours are uncommon fibroepithelial tumours primarily found in the breast although rarely may present as a vulvar lesion. Phyllodes tumours of the vulva are rarely reported in the literature, with only 17 previously reported cases. This case represents the first reported case of a phyllodes tumour occurring in the labia minora. While most of these tumours are benign, it is important to keep these and other rare tumours in the differential diagnosis of vulvar masses. Even with benign tumours, continued surveillance for recurrence should be performed.


Assuntos
Tumor Filoide/diagnóstico , Neoplasias Vulvares/diagnóstico , Adulto , Feminino , Humanos , Achados Incidentais , Resultado do Tratamento
6.
BMC Med Genomics ; 12(1): 142, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31647027

RESUMO

BACKGROUND: Known collectively as breast fibroepithelial lesions (FELs), the common fibroadenomas (FAs) and the rarer phyllodes tumors (PTs) are a heterogenous group of biphasic neoplasms. Owing to limited tissue availability, inter-observer variability, overlapping histological features and heterogeneity of these lesions, diagnosing them accurately on core biopsies is challenging. As the choice management option depends on the histological diagnosis; a novel 16-gene panel assay was developed to improve the accuracy of preoperative diagnosis on core biopsy specimens. METHODS: Using this 16-gene panel, targeted amplicon-based sequencing was performed on 275 formalin-fixed, paraffin-embedded (FFPE) breast FEL specimens, archived at the Singapore General Hospital, from 2008 to 2012. RESULTS: In total, 167 FAs, 24 benign, 14 borderline and 6 malignant PTs, were profiled. Compared to FAs, PTs had significantly higher mutation rates in the TERT promoter (p <  0.001), RARA (p <  0.001), FLNA, RB1 and TP53 (p = 0.002, 0.020 and 0.018, respectively). In addition to a higher mutational count (p <  0.001), TERT promoter (p <  0.001), frameshift, nonsense and splice site (p = 0.001, < 0.001 and 0.043, respectively) mutations were also frequently observed in PTs. A multivariate logistic regression model was built using these as variables and a predictive scoring system was developed. It classifies a FEL at low or high risk (score <  1 and ≥ 1, respectively) of being a PT. This scoring system has good discrimination (ROC area = 0.773, 95% CI: 0.70 to 0.85), calibration (p = 0.945) and is significant in predicting PTs (p <  0.001). CONCLUSION: This novel study demonstrates the ability to extract DNA of sufficient quality and quantity for targeted sequencing from FFPE breast core biopsy specimens, along with their successful characterization and profiling using our customized 16-gene panel. Prospective work includes validating the utility of this promising 16-gene panel assay as an adjunctive diagnostic tool in clinical practice.


Assuntos
Neoplasias da Mama/diagnóstico , Fibroadenoma/diagnóstico , Genômica/métodos , Adulto , Mama/metabolismo , Mama/patologia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Fibroadenoma/genética , Fibroadenoma/patologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Modelos Logísticos , Complexo Mediador/genética , Pessoa de Meia-Idade , Mutação , Tumor Filoide/diagnóstico , Tumor Filoide/genética , Tumor Filoide/patologia , Regiões Promotoras Genéticas , Receptor alfa de Ácido Retinoico/genética , Análise de Sequência de DNA , Telomerase/genética
8.
Breast Cancer Res Treat ; 178(1): 51-56, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31332664

RESUMO

PURPOSE: Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC). METHODS: Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified. RESULTS: A core biopsy diagnosis of SC was made only in SC (77%, p = 0.003). The diagnosis "malignant neoplasm" or "atypical spindle cell neoplasm" was made in 100% MP and 23% SC, but no other tumor (p = 0.0001). The diagnosis "phyllodes tumor" was made only in PT (44% BLP, 11% BP, p = 0.06). The diagnosis "fibroepithelial lesion" was made in 44% BLP, 67% BP, and 29% FA. The diagnosis "FA" was made most commonly in FA (57%) (versus 22% BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23%, p = 0.03); adjuvant therapy was given in 46% SC and 13% MP (p = 0.04). CONCLUSIONS: A pre-operative core biopsy diagnosis of "malignant spindle cell neoplasm" separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of "phyllodes tumor" is specific for PT and can guide treatment planning of a wide local excision.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma/diagnóstico , Neoplasias Fibroepiteliais/diagnóstico , Tumor Filoide/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma/patologia , Carcinoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias Fibroepiteliais/patologia , Neoplasias Fibroepiteliais/cirurgia , Tumor Filoide/patologia , Tumor Filoide/cirurgia , Resultado do Tratamento , Adulto Jovem
9.
APMIS ; 127(6): 484-488, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30901115

RESUMO

Phyllodes tumors (PTs) are rare fibroepithelial neoplasms of the breast and constitute 0.3-1% of all primary breast tumors. They should be characterized in to a benign, borderline or malignant category based on a combination of histological features. PTs can show heterologous components, typically sarcomatous, including osteosarcomatous and chondrosarcomatous. Benign heterologous components are exceedingly rare with only one prior reported case in the English literature. This case emphasizes how difficult establishing a correct diagnosis in PTs with heterologous components can be, especially when the tumor consists mainly of a benign heterologous component. We report the case of a 65 year old woman with a recurrent breast tumor initially misdiagnosed as benign osseous metaplasia. The tumor re-occurred as a malignant PT dominated by benign osseous and chondroid metaplasia. Multiple metastases consisting of primarily mature bone and cartilage were seen in the lungs. On microscopic revision and considering the clinical course the primary breast tumor was re-classified as a borderline PT.


Assuntos
Osso e Ossos/patologia , Tumor Filoide/diagnóstico , Idoso , Neoplasias da Mama , Feminino , Humanos , Metaplasia , Recidiva Local de Neoplasia , Tumor Filoide/patologia , Tumor Filoide/cirurgia
10.
Diagn Cytopathol ; 47(6): 599-602, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30829462

RESUMO

A 54-year-old woman presented with a left breast mass, discovered 4 years ago but was static until 2 months before presentation, when it showed a rapid increase in size and became painful. Mammography showed a large lobulated mass with internal cystic components (BI-RADS 4B). A biopsy was performed, followed by modified radical mastectomy. The histologic diagnosis was malignant phyllodes tumor (PT). The patient developed local recurrence 4 months later while on adjuvant radiotherapy and she had a salvage resection. Two months later, she developed massive left pleural effusion. Pleural fluid cytology showed single discohesive markedly atypical cells with hyperchromatic and enlarged nuclei, irregular nuclear membrane, and distinct macronucleoli. Multinucleated forms were also seen. The mononuclear and multinucleated tumor cells cytomorphologically resembled that of the recurrent tumor, indicative of recurrence. Positron emission tomography/computed tomography confirmed recurrence at the left pleura. The patient opted for palliative care and succumbed 1 month later. The current case demonstrated a rare clinical presentation of recurrent malignant PT as massive unilateral malignant pleural effusion. Correlation with previous histologic and cytologic specimens may be useful as similar cytologic features could be identified in subsequent recurrent tumors.


Assuntos
Neoplasias da Mama/diagnóstico , Citodiagnóstico , Tumor Filoide/diagnóstico , Derrame Pleural/diagnóstico , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Tumor Filoide/complicações , Tumor Filoide/diagnóstico por imagem , Tumor Filoide/patologia , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/patologia
12.
J Cancer Res Ther ; 14(5): 1138-1141, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30197364

RESUMO

Phyllodes tumor (PT) is an extremely rare tumor of the breast of mixed mesenchymal and epithelial origin. It may pursue a benign or malignant evolution with distant metastases in the latter case in 3-12% of patients. The most common sites of metastases are the lungs and bones. Although theoretically any organ may have metastasis, it is extremely rare that a PT will metastasize to the bilateral ovaries and present as Krukenberg tumor. Herein, we report such a case.


Assuntos
Neoplasias da Mama/diagnóstico , Tumor de Krukenberg/diagnóstico , Neoplasias Ovarianas/diagnóstico , Tumor Filoide/diagnóstico , Adulto , Neoplasias da Mama/patologia , Feminino , Humanos , Tumor de Krukenberg/patologia , Tumor de Krukenberg/secundário , Metástase Neoplásica , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/secundário , Ovário/patologia , Tumor Filoide/patologia
13.
Korean J Radiol ; 19(5): 978-991, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30174488

RESUMO

Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.


Assuntos
Doenças Mamárias/diagnóstico , Mama/diagnóstico por imagem , Ultrassonografia , Adolescente , Mama/patologia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Criança , Feminino , Ginecomastia/diagnóstico , Ginecomastia/diagnóstico por imagem , Ginecomastia/patologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Tumor Filoide/diagnóstico , Tumor Filoide/diagnóstico por imagem , Tumor Filoide/patologia , Fatores de Risco , Tomografia Computadorizada por Raios X
14.
Medicine (Baltimore) ; 97(31): e11412, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30075507

RESUMO

Phyllodes tumor or cystosarcoma phyllodes is a rare fibroepithelial neoplasm which arises from the periductal stroma of the breast. They are classified as benign, borderline, and malignant based on the histologic features. However, all phyllodes tumor (PT) subtypes are regarded as having malignant potential and correct diagnosis is important for surgical management and optimal care. This study is a retrospective review of 76 women diagnosed as PT with highlights on the imaging characteristics, pathology, and surgical treatment over a 7-year period in a tertiary medical center of urban population in Malaysia. There were 45 benign, 16 borderline, and 15 malignant PT. The median age for benign PT was 43, borderline 48.5, and malignant 42 years. The Malay ethnic group constitute 52.6% of cases, with 27.6% and 18.4% in Chinese and Indian ethnic groups, respectively. On mammograms, most benign (64.3%) and 33.3% of malignant PT showed high-density lesions. Calcifications were only seen in 2 benign PT. On ultrasound, 86% of benign PT was well-circumscribed whilst 50.0% of malignant PT had irregular outline. Cystic spaces were seen in 40.0% of malignant and 9.5% of benign PT. 80% of malignant PT lesions were heterogenous. Malignant PT demonstrates tumor heterogeneity, cystic spaces, and posterior acoustic enhancement on ultrasound. Half of malignant PT showed regular borders on ultrasound and appear well circumscribed on mammogram. A total of 46 patients had wide local excision or excision biopsy whilst 30 underwent mastectomy as primary treatment. The majority of the borderline and malignant PTs in our study (75.0% and 85.7% respectively) and only 5 out of the 43 (11.6%) benign PT underwent mastectomy. There were 2 tumor recurrence in the benign PT group and 1 case in the borderline and malignant group respectively.


Assuntos
Grupo com Ancestrais do Continente Asiático , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Tumor Filoide/diagnóstico , Tumor Filoide/cirurgia , Adulto , Neoplasias da Mama/etnologia , Feminino , Humanos , Malásia , Mamografia , Pessoa de Meia-Idade , Tumor Filoide/etnologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Ann Diagn Pathol ; 35: 85-91, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30029048

RESUMO

Some fibroepithelial lesions (FEL) of the breast are difficult to classify as cellular fibroadenoma (CFA) or benign phyllodes tumor (BPT) due to overlapping histologic features. This indeterminate group is histologically characterized by prominent stromal cellularity, mild atypia, and mitotic activity. The local recurrence potential of cellular FEL (CFEL) has been insufficiently studied. The objective of this study was to evaluate the histologic features, characterize the long-term follow-up and recurrence rate of CFEL, and compare this data with the recurrence rate of definitive BPT. Ninety CFEL that were <4 cm were recovered from the benign breast disease cohort. The control group comprised of 10 randomly selected patients with BPT. Cases were classified based on a combination of mitotic activity, intracanalicular growth, stromal atypia, stromal prominence, and fat infiltration. None of the CFEL was widely excised. Of the 90 CFEL cases, there were 22 BPT-like, 35 CFA, and 33 indeterminate. The mean age of the patients was 40.1 years. The mean tumor size was 2.4 cm. All patients had at least two years of follow-up (median 27). None of the patients with BPT-like CFEL showed ipsilateral recurrence. Five of the 35 patients with CFA had recurrent ipsilateral CFA. This occurred within 1 to 11 years after the initial diagnosis. One of 33 patients with indeterminate type had a recurrent ipsilateral lesion five years after the initial diagnosis with histologic features of CFA. None of the patients in control group had any recurrence. In conclusion, as a group, CFEL have a low proclivity for recurrence, even when enucleated with close or positive margins. The presence of histologic features of BPT did not correlate with an increased potential for recurrence.


Assuntos
Neoplasias da Mama/diagnóstico , Fibroadenoma/diagnóstico , Doença da Mama Fibrocística/diagnóstico , Tumor Filoide/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/patologia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Fibroadenoma/patologia , Doença da Mama Fibrocística/patologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Tumor Filoide/patologia , Adulto Jovem
16.
Breast Cancer Res Treat ; 171(2): 335-344, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29808288

RESUMO

PURPOSE: To identify risk factors for local recurrence (LR) and investigate roles of adjuvant local therapy for malignant and borderline phyllodes tumors of the breast. METHODS: From 1981 to 2014, 362 patients with malignant (n = 235) and borderline (n = 127) phyllodes tumors were treated by breast-conserving surgery (BCS) or total mastectomy (TM) at 10 centers. Thirty-one patients received adjuvant radiation therapy (RT), and those who received adjuvant chemotherapy were excluded from the study. RESULTS: Median follow-up was 5 years. LR developed in 60 (16.6%) patients. Regional recurrence occurred in 2 (0.6%) patients and distant metastasis (DM) developed in 19 (5.2%) patients. Patients receiving BCS (p = 0.025) and those not undergoing adjuvant RT (p = 0.041) showed higher LR rates. For malignant subtypes, local control (LC) rates at 5 years for BCS alone, BCS with adjuvant RT, TM alone, and TM with adjuvant RT were 80.7, 93.3, 92.4, and 100%, respectively (p = 0.033). Multivariate analyses revealed BCS alone, tumor size ≥ 5 cm, and positive margins as independent risk factors for LR. Margin-positive BCS alone showed poorest LC regardless of tumor size (62.5%, p = 0.007). For margin-negative BCS alone, 5-year LC rates for tumors ≥ 5 cm versus those < 5 cm were 71.8% versus 89.5% (p = 0.012). For borderline subtypes, only positive margins (p = 0.044) independently increased the risk of LR. DM developed exclusively in malignant subtypes and a prior LR event increased the risk of DM by sixfold (HR 6.2, 95% CI 1.6-16.1, p = 0.001). CONCLUSIONS: Malignant and borderline phyllodes tumors with positive margins after surgery have high LR rates. After treatment by margin-negative BCS alone, patients with large malignant phyllodes tumors ≥ 5 cm also have heightened risk of LR. Thus, such patients should be considered for additional local therapy.


Assuntos
Neoplasias da Mama/diagnóstico , Tumor Filoide/diagnóstico , Adolescente , Adulto , Idoso , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia , Tumor Filoide/mortalidade , Tumor Filoide/terapia , Análise de Sobrevida , Falha de Tratamento , Resultado do Tratamento , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-29751600

RESUMO

Introduction: Phylloides tumours (PTs) are rare fibroepithelial neoplasms that account for 0.3⁻0.9% of all breast tumours. These tumours typically occur in women aged 30⁻70 years. The occurrence of these tumours in older children and adolescents poses particular diagnostic and therapeutic problems. However, early diagnosis is mandatory because although most of the cases of PTs in children are benign, the borderline and malignant cases with potential negative outcomes cannot be excluded. Case presentation: A 12-year-old girl presented at the Paediatric Emergency Department for hyperaemia and warmth of the left breast that occurred a few days prior without fever. The girl experienced menarche 8 months previously. She experienced no previous trauma and she had no family history of breast cancer. On physical examination, the left breast was painful, enlarged and tender. The overlying skin was erythematous and warm. A breast ultrasonography (US) revealed a large mass with features of an abscess, including a hyperechoic wall, scattered internal echoes and hypoechoic peripheral lacunae of apparent colliquative nature. After 4 days of unsuccessful antibiotic therapy, surgical drainage was performed due to the suspicion of a mammary abscess. At the surgical incision site, the lesion was not-well circumscribed and lacked a capsule. In addition, purulent material was not detected. Histological examination revealed that the tissue alterations were compatible with benign PT. With this diagnosis, the girl underwent definitive surgical removal of the lesion. The postoperative period passed without negative events. An US performed 6 months later revealed that no new mass was present at this time, suggesting no recurrence of the tumour. Conclusion: This case shows that in the presence of a clinical picture suggesting the inflammation of the breast in adolescent females, PT should be considered as a possible diagnosis and US-guided core biopsy should be considered to confirm this suspicion. Thereafter, when surgical excision is performed, particular attention must be paid to both the preservation of all the normal breast parenchyma and future aesthetic problems.


Assuntos
Neoplasias da Mama/diagnóstico , Tumor Filoide/diagnóstico , Tumor Filoide/fisiopatologia , Criança , Diagnóstico por Imagem , Feminino , Humanos , Pediatria , Tumor Filoide/cirurgia , Resultado do Tratamento , Ultrassonografia
18.
Int J Surg Pathol ; 26(8): 684-692, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29774785

RESUMO

PURPOSE: Surgical excision is recommended for complete evaluation of cellular fibroepithelial lesions identified from core needle biopsy. The purpose of this study was to determine factors associated with phyllodes tumor among cellular fibroepithelial lesions from core biopsies and develop a scoring system to predict the risk of phyllodes tumor. METHODS: We retrospectively reviewed clinical data of 169 breast lesions that were diagnosed as cellular fibroepithelial lesions from core needle biopsy at the Seoul National University Bundang Hospital between March 2005 and January 2013. The clinical, histopathologic, and radiologic characteristics were compared between phyllodes tumors and fibroadenomas during the final diagnosis after surgical excision. RESULTS: Of the 169 lesions, 17 were observed and 152 were surgically removed. After excision, final pathology revealed 60 (39.5%) fibroadenomas and 92 (60.5%) phyllodes tumors. Multivariate analysis demonstrated that age (≥40 years), stromal overgrowth, and stromal cellularity were independent factors associated with phyllodes tumors. A scoring system was developed based on a multivariate logistic regression model, and the area under the receiver operating characteristic curve was 0.828 (95% confidence interval = 0.763-0.893). CONCLUSION: The scoring system will help clinicians make appropriate treatment for patients with cellular fibroepithelial lesions on core needle biopsy.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/patologia , Protocolos Clínicos , Fibroadenoma/diagnóstico , Tumor Filoide/diagnóstico , Adulto , Fatores Etários , Biópsia com Agulha de Grande Calibre , Mama/citologia , Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Diagnóstico Diferencial , Feminino , Fibroadenoma/patologia , Fibroadenoma/terapia , Humanos , Tumor Filoide/patologia , Tumor Filoide/terapia , Estudos Retrospectivos , Células Estromais/patologia
19.
J Pediatr Surg ; 53(6): 1123-1128, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29605260

RESUMO

BACKGROUND: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, few large pediatric phyllodes tumor series exist. Current guidelines do not differentiate treatment recommendations between children and adults. We examined national guideline adherence for children and adults. METHODS: We queried the NCDB (2004-2014) for female patients with phyllodes tumor histology, excluding patients with missing age or survival data. Patients were stratified by age (pediatric <21, adult ≥21), and compared based on patient characteristics, treatment patterns, and survival. RESULTS: We identified 2787 cases of phyllodes tumor (2725 adult, 62 pediatric). Median age was 17years in children and 52years in adults. Margin positivity rates and median tumor size were similar between adults and children. Treatment was discordant with NCCN guidelines in 28.6% of adults and 14.5% of children through use of axillary staging, chemotherapy, adjuvant endocrine therapy, and radiotherapy. Five-year and ten-year survival were comparable between both groups. CONCLUSION: Children and adults present with similarly sized phyllodes tumors. Trends reveal high margin positivity rates, and overtreatment with regional axillary staging and systemic adjuvant therapies. Particularly in children, treatment decisions must consider risks of adjuvant therapy including radiation-related second primary cancers, given uncertain benefit. TYPE OF STUDY: Retrospective Comparative Study. LEVEL OF EVIDENCE: Level III.


Assuntos
Neoplasias da Mama/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Tumor Filoide/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Criança , Terapia Combinada , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Tumor Filoide/diagnóstico , Tumor Filoide/patologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
20.
Cancer Med ; 7(4): 1030-1042, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29479819

RESUMO

The aim of this study was to explore the independent prognostic factors related to postoperative recurrence-free survival (RFS) in patients with breast phyllodes tumors (PTBs). A retrospective analysis was conducted in Fudan University Shanghai Cancer Center. According to histological type, patients with benign PTBs were classified as a low-risk group, while borderline and malignant PTBs were classified as a high-risk group. The Cox regression model was adopted to identify factors affecting postoperative RFS in the two groups, and a nomogram was generated to predict recurrence-free survival at 1, 3, and 5 years. Among the 404 patients, 168 (41.6%) patients had benign PTB, 184 (45.5%) had borderline PTB, and 52 (12.9%) had malignant PTB. Fifty-five patients experienced postoperative local recurrence, including six benign cases, 26 borderline cases, and 22 malignant cases; the three histological types of PTB had local recurrence rates of 3.6%, 14.1%, and 42.3%, respectively. Stromal cell atypia was an independent prognostic factor for RFS in the low-risk group, while the surgical approach and tumor border were independent prognostic factors for RFS in the high-risk group, and patients receiving simple excision with an infiltrative tumor border had a higher recurrence rate. A nomogram developed based on clinicopathologic features and surgical approaches could predict recurrence-free survival at 1, 3, and 5 years. For high-risk patients, this predictive nomogram based on tumor border, tumor residue, mitotic activity, degree of stromal cell hyperplasia, and atypia can be applied for patient counseling and clinical management. The efficacy of adjuvant radiotherapy remains uncertain.


Assuntos
Neoplasias da Mama/mortalidade , Tumor Filoide/mortalidade , Adolescente , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Criança , Terapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Nomogramas , Tumor Filoide/diagnóstico , Tumor Filoide/terapia , Prognóstico , Recidiva , Estudos Retrospectivos , Carga Tumoral , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...