Osteogenic sarcoma of the breast arising in a cystosarcoma phyllodes.
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Breast Neoplasms↗
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[Cystosarcoma phyllodes and sarcoma of the breast].
Altogether 217 phyllode tumours, 28 sarcomas and 5 carcinosarcomas of the mammary gland have been studied in the Institute from 1946 to 1980. Three structural variants of phyllode tumour are distinguished: 1) early stages of formation, 2) classical phyllode tumour, 3) phyllode tumour with sarcomatous stroma. 20 out of 28 sarcomas are linked with phyllode tumours while the morphogenesis of primary sarcomas, which are characterized by a more malignant clinical course, remains unclear. When studied electron-microscopically, classical phyllode tumour reveals marked and peculiar vascular proliferation which not infrequently coincides with cellular stroma. Various directions of functional and structural differentiation of stromal cells are observed. The alternation in the tumour of areas with different morphology found in light microscope is reflected by the dependence of the structure of intercellular substance upon the type of stromal cells observed electron-microscopically.
Breast Neoplasms↗
Cystosarcoma phyllodes and its surgical management.
The purpose of this study is to formulate guidelines for proper surgical management of phyllodes tumor. It is a disease often misdiagnosed by pathologists and undertreated by surgeons. In a private surgical practice from 1956 to 1984, 16 patients were treated for phyllodes tumor. Findings from this retrospective review are compared with other reported series. Eleven benign cases survived 9 to 35 years. Four with malignancies developed metastases. One such patient, however, survives 11 years postmastectomy and two years after removal of a large thigh metastasis. An algorithm is presented for proper management of phyllodes tumor consisting of needle biopsy, tumor excision with testing for margins, and simple mastectomy for tumors > 5 cm and those of any size found to be malignant or borderline on permanent section or on the recommended secondary pathologic review. Surgical removal of a solitary distant metastasis should be considered for this resistant tumor.
Adult↗
Fine-needle aspiration cytology of mesenchymal tumors of the breast.
This report describes the fine-needle aspiration (FNA) cytologic findings of 15 cases of sarcomas involving the breast out of a combined series of 2,064 breast FNA biopsies, including 580 malignancies, thereby accounting for 2.6% of all the malignant breast tumors. The series consisted of 14 women and one man with a mean age of 48.4 yr (range, 29-63). There were eight cases of cystosarcoma phyllodes, including one malignant cystosarcoma phyllodes. Three benign cystosarcoma phyllodes had a significant concomitant atypical epithelial hyperplasia, which lead to a misdiagnosis of carcinoma in two of the cases. The third case was correctly identified as recurrent cystosarcoma phyllodes. In retrospect, features suggestive for cystosarcoma phyllodes and unusual for breast carcinoma include increased numbers of naked nuclei and hypercellular stromal fragments. Sarcomatous patterns in our four metaplastic carcinomas included chondrosarcoma (two cases), malignant fibrous histiocytoma (MFH) (one case), and fibrosarcoma (one case). Two additional pure primary MFHs (both of which had electron microscopic confirmation) and one metastatic fibrosarcoma to the breast were encountered. Recognition of unusual cytologic patterns for breast carcinoma should suggest the possibility of a primary or metastatic sarcoma to the breast. Potential pitfalls for misdiagnosis include the presence of atypical epithelial hyperplasia in some cases of cystosarcoma phyllodes, along with occasional cases having patterns indistinguishable from a fibroadenoma. The pleomorphic and bizarre cellular features can suggest the diagnosis of metaplastic and pure sarcomas of the breast, although the potential exists for confusion with very poorly differentiated carcinoma. FNA diagnosis of sarcomatous lesions of the breast is essential in order to insure proper surgical treatment.
Adult↗
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.
Adult↗
Phyllodes tumours: a clinicopathological review of 30 cases.
Thirty cases of phyllodes tumour (cystosarcoma phyllodes) of the breast that presented to the Clinical Oncology Unit at Guy's Hospital were reviewed. Tumours were classified as benign, malignant or borderline according to the following histological criteria: mitotic rate, nuclear pleomorphism, stromal overgrowth and tumour margins. In 14 (46.5%) cases the tumours were considered histologically benign, in 11 (36.5%) malignant, and in five (17%) borderline. Recurrence was seen in a similar proportion of patients with tumours classified as benign (21%) and malignant (18%) according to histological criteria. Malignant lesions tended to recur earlier. Infiltrating tumour margins were noted in all patients and stromal overgrowth in all but one in whom recurrence was observed. Risk of recurrence also appeared to be related to tumour size. Only one patient developed distant metastases and died of her disease. Because of treatment variation no conclusion can be made regarding optimal therapy but the importance of adequate clearance, either through wide excision or mastectomy, is emphasized for all phyllodes tumours irrespective of histological features.
Adult↗
Malignant phyllodes tumor of the breast metastatic to the parotid gland diagnosed by fine needle aspiration biopsy. A case report.
BACKGROUND: Phyllodes tumor (cystosarcoma phyllodes) is a rare fibroepithelial neoplasm of the breast. Malignant phyllodes tumor is characterized by an infiltrative border and marked degree of hypercellular stromal overgrowth with > 5 mitoses per 10 high-power fields. Distant metastasis occurs in 10-20% of patients with malignant phyllodes tumor. The most common sites of distant metastases are the lungs, bone and abdominal viscera. Although theoretically any organ may have metastasis, the parotid gland has not been documented before in the English-language literature. CASE: A 40-year-old, Caucasian woman with a history of malignant phyllodes tumor of the left breast presented with a mass on the right side of the parotid gland. Fine needle aspiration biopsy of the mass revealed abundant discohesive spindle cells showing moderate nuclear pleomorphism with occasional mitoses. No epithelial elements were seen. A diagnosis of malignant spindle cell tumor consistent with metastatic malignant phyllodes tumor was made. Histology confirmed the cytologic diagnosis. CONCLUSION: Fine needle aspiration biopsy is accurate and efficient in conjunction with clinical information in the diagnosis of malignant phyllodes tumor of the breast metastatic to the parotid gland.
Adult↗
In-situ and invasive carcinoma within a phyllodes tumor associated with lymph node metastases.
BACKGROUND: Phyllodes tumors (cystosarcoma phyllodes) are uncommon lesions in the female breast. Rarely, the occurrence of carcinoma within a phyllodes tumor has been reported in the literature, but has never been associated with lymph node metastases. CASE PRESENTATION: A 26-year-old woman presented with a firm, mobile, non-tender mass in the left breast and palpable lymph nodes in the left axilla. The excised lesion appeared well circumscribed and lobulated, with variable fleshy and firm areas. Microscopic examination showed a circumscribed fibroepithelial lesion with a well developed leaf-like architecture, in keeping with a benign phyllodes tumor. The epithelial component showed extensive high grade ductal carcinoma in-situ (DCIS) and invasive carcinoma of no special type, located entirely within the phyllodes tumor. Subsequent axillary lymph node dissection revealed metastatic carcinoma in four lymph nodes. CONCLUSIONS: Although rare, phyllodes tumors may harbor DCIS and invasive carcinoma, with potential for lymph node metastasis.
Journal Article↗
Phyllodes tumour in pregnancy: a case report.
Phyllodes tumour (cystosarcoma phyllodes) is a rare breast tumour that grows rapidly and to a relatively large size, especially during pregnancy. These tumours may be classified as benign, borderline or malignant. They have a high incidence of local recurrence but little tendency to metastasize to distant organs. The question of whether the tumour is hormone dependent remains unresolved. This report describes the case of a patient who had a phyllodes tumour that first became apparent in her 31st week of pregnancy. After enucleation and subsequent wide excision she remained tumour free through a second pregnancy. Although the follow-up period is short, it appears that subsequent pregnancy is not necessarily associated with recurrent or new disease for patients who have had their initial tumour completely excised. The goal for the management of these tumours is complete surgical excision.
Adult↗
Cytogenetic findings in phyllodes tumor and fibroadenomas of the breast.
The cytogenetic data on fibroadenomas and cystosarcoma phyllodes tumor of the breast, which are both biphasic breast tumors composed of epithelial and stromal components, are quite limited. In this study, we report on clonal chromosomal alterations in three fibroadenomas and one cystosarcoma phyllodes analyzed by GTG banding. The fibroadenomas presented mostly numerical abnormalities involving chromosomes 16, 18, and 21. One case presented a deletion on 17p. The cystosarcoma phyllodes presented numerous numerical abnormalities, mostly chromosome gains, and several marker chromosomes.
Adolescent↗
Stromal neoplasms of the breast: a comparative flow cytometric study.
We analyzed 42 mammary spindle cell neoplasms (10 conventional fibroadenomas, 8 giant fibroadenomas, 17 cystosarcoma phyllodes, and 7 stromal sarcomas) by flow cytometry to assess the diagnostic and prognostic relevance of DNA content analysis in the pathologic evaluation of these lesions. Our data indicate that all fibroadenomas were diploid, cystosarcoma phyllodes displayed diploid and aneuploid DNA content irrespective of their histological categorization, and that stromal sarcomas were all aneuploid and clinically aggressive. Diploid cystosarcoma phyllodes were biologically indolent, whereas most of the aneuploid neoplasms killed their hosts (P = 0.03). The present study indicates that a DNA content abnormality it is a reliable marker of malignancy in these neoplasms, and it may identify subsets of patients with variable biologic courses within the histopathologic spectrum of cystosarcoma phyllodes.
Adenofibroma↗
[Management of phyllodes tumors of the breast at the National institute of oncology of Rabat, Morocco].
OBJECTIVES: Phyllodes tumors of the breast (PTB) are rare fibro epithelial tumors. Their terminology, histological classification and their treatment are exposed to controversy. The aim of our work is to underline the epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours through a retrospective study and a review of the literature. PATIENTS AND METHODS: We reviewed at the National Institute of Oncology of Rabat, Morocco, between 1985 and 1998, all the files of patients with histological certainty of PTB, doubtful PTB were excluded. We collected epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours. STATISTICS: quantitative parameters were represented by mean +/- S.D. and qualitative parameters by percentage or effective. RESULTS: We studied nine cases of PTB, which represented 0.09% of all primitive tumors of the breast treated at our institution during the study period. All our patients were female. Mean age was 37.3 +/- 10.07 years. Two of our patients (22.2%) had a history of fibroadenoma and 44.4% were nulliparous. Mean delay before consulting was 60.7 +/- 17.56 months and the median tumour size was 13 +/- 7.47 cm. Pathological findings were six benign or borderline phyllodes tumours (66.7%) and three cystosarcomas phyllodes (33.3%). The treatment consisted in simple mastectomy in seven cases (77.8%) and tumorectomy in two cases (22.2%). All the surgical margins were clear. Two of the three cystosarcomas phyllodes received adjuvant external bean radiation therapy 50 Gy on the thoracic chest wall. After a median outcome of 3 +/- 2 years ranging from 3 to 74 months, we did not note any relapse or metastasis. DISCUSSION AND CONCLUSION: In our series, PTB happened exclusively in females. History of fibroadenoma within 22.2% of the patients suggests the hypothesis of a filiation between these two entities. Their distinctive features were young age in diagnosis, long delay before consulting, important tumor size, predominant benign and borderline histological types, treatment mainly surgical and good local and distant control.
Adult↗
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.
Adolescent↗
[Giant fibroadenoma of the breast. Its clinical picture and differential diagnosis. A report of a clinical case].
An 18-year-old girl came to our Institute with a large tumefaction at the right breast, that during the last year had risen slowly but continuously. She underwent some clinical and instrumental exams that allow us to diagnose a giant adenofibroma or cystosarcoma phyllodes without excluding either of them. Then she undergoes a subcutaneous mastectomy with an application of a prosthesis. From the histologic point of view it is a giant adenofibroma. Giant adenofibroma is a rare breast pathology, always benign. Nowadays we have some difficulties distinguishing it from cystosarcoma phyllodes, which has both a benign and malignant form. It is important to distinguish the two pathologies before operation as they have a different therapeutic approach and a different follow-up. Cystosarcoma phyllodes can in fact relapse and when malignant can cause metastasis.
Adolescent↗
Surgical management of primary breast sarcoma.
Primary sarcoma constitutes less than one per cent of breast malignancies. A retrospective review of this disease at our institution was undertaken to assess the effect of different treatment modalities on outcome. Over a 24-year period 28 patients were identified. Follow-up ranged from one to 228 months. Partial mastectomy was done in seven patients, whereas ten underwent total mastectomy and nine had modified radical mastectomy. Two refused surgery. All margins of resection were negative. In total ten axillary lymph node dissections were done with no positive nodes identified. Pathologic analysis of tumors revealed a variety of sarcomas including high-grade malignant cystosarcoma phyllodes in 13. Recurrence of disease occurred in two women, both with malignant cystosarcoma phyllodes. One was a local recurrence in a patient who had undergone partial mastectomy. This was successfully treated with a total mastectomy. The second recurrence involved a distant metastasis in a patient treated with modified radical mastectomy that eventually led to her death. For the entire group the disease-free survival was 75 per cent at 10 years whereas overall survival was 87.5 per cent. In conclusion an adequate margin of resection is the single most important determinant of long-term survival. Axillary lymph node dissection is not necessary for the treatment of these tumors.
Adolescent↗
[Non-epitherial malignant neoplasms of the breast--a clinicopathological study of 4 cases].
Between 1972 and 1981, 4 women with breast sarcoma underwent treatment at our department; they accounted for 1.1% (4 of 355) of all female breast malignancies. There was one case of malignant lymphoma and liposarcoma each, and 2 cases of malignant cystosarcoma phyllodes. The patients averaged 31.0 years of age. Of the two cases of cystosarcoma phyllodes, one had coexisting lobular carcinoma in situ arising in a fibroadenoma of the contralateral breast, the other had a coexisting lung cancer. Mastectomy was performed in 3 cases, irradiation in one (malignant lymphoma). All patients received concurrent chemotherapy. The regional lymph nodes were not involved, and 2 patients are alive and well without recurrence.
Adolescent↗
Cathepsin B in human breast tumor tissue and cancer cells.
The cysteine proteinase cathepsin B (EC 3.4.22.1) has been proposed to play an important role in the proteolytic mechanism of the ability of breast cancer cells to invade into and through normal tissues during metastasis. In this study, activity of cathepsin B was measured with a fluorometric microtiter plate assay in human breast tumors as well as in mammary gland dysplasias and in four human breast cancer cell lines (BT-20, MDA-MB-231, PMC42 and T47D). It was found that primary breast carcinomas and cystosarcomas phyllodes contain significantly higher levels of cathepsin B activity than mammary dysplasias; the activity of cathepsin B in cystosarcomas phyllodes was comparable with that in breast carcinomas. The enzyme from breast carcinoma tissue exhibited properties of a mature form of cathepsin B. All investigated breast cancer cell lines display positive cytochemical staining for cathepsin B activity with granular pattern of distribution of the final reaction product. Biochemically, the breast cancer cell lines differed significantly from each other in the level of cathepsin B activity decreasing in the following order: T47D, PMC42, MDA-MB-231 and BT-20.
Breast Neoplasms↗