SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In 1720, Heister successfully removed a massive tumor of the breast. The lesion was probably a massive cystosarcoma phylloides rather than infiltrating carcinoma of the duct. His thorough description reveals that patients and surgeons have changed little in two and one-half centuries.
Malignant cystosarcoma phylloides (CP) is a relatively rare cancer of the breast. A CP tumor was processed as part of a tumor acquisition, propagation, and preservation program in patient biotherapy. Two tissue culture cell lines were developed from this tumor, one directly from the biopsy, another from a xenograft tumor grown in athymic mice. The two cell lines were similar in character. There was strong immunochemical reactivity with antibodies to vimentin, type I collagen, and type III collagen. There was no reactivity with antibodies to cytokeratin and epithelial membrane antigen. Both cell lines were aneuploid, clonogenic in soft agar, and tumorigenic in nude mice. 5 alpha-dihydrotestosterone and thyroxine added to the culture medium stimulated growth, while testosterone, 17 beta-estradiol, and 4-hydroxytamoxifen were without effect. Dexamethasone and cortisol were inhibitory at high doses (10(-6) M). Dibutyryl cyclic AMP, theophylline, and vitamin C were all inhibitory. The biopsy contained tumor-infiltrating lymphocytes which proliferated in cultures containing interleukin 2. The expanded lymphocytes were activated T cells which had the capacity to lyse tumor cells. These results suggest possibilities in the therapy of cystosarcoma phylloides involving vitamin C, certain hormones, and tumor-infiltrating lymphocytes.
We report the appearance of calcifications on computed tomography (CT) images of pulmonary metastases from a rare breast tumor, malignant cystosarcoma phylloides. Histologic examination of the pulmonary masses revealed malignant spindle cells with osteoid and cartilage components in the cellular stroma. This appearance has not been described previously.
Cystosarcoma phylloides of the breast is a tumor composed of breast ducts and a cellular stromal component that can be benign or malignant. The origin of the stromal cells is controversial. We undertook an immunohistochemical and ultrastructural study of 11 cases of cystosarcoma phylloides to assess the histogenesis of the stromal component. By light microscopy, 4 were diagnosed as benign, and 7 were diagnosed as malignant. Antibodies to vimentin, desmin, actin, high- and low-molecular-weight keratins, and S100 protein were used for immunohistochemical staining. In the 4 benign cases of cystosarcoma phylloides, the stromal cells stained positively only for vimentin. In the malignant tumors, the spindle cell component stained for vimentin in all the cases. In addition, the malignant stromal cells coexpressed desmin in two cases and keratin and S 100 protein in another case. By electron microscopy the stromal component in the benign case and in two of five malignant cases was composed of a mixture of fibroblasts and myofibroblasts. The entire neoplastic stroma in two other malignant cases showed features of smooth-muscle differentiation, whereas in another case all the stromal cells showed myoepithelial differentiation. Thus, in benign and malignant cystosarcoma phylloides, the stromal component consists of a mixture of fibroblasts and myofibroblasts. Leiomyosarcomas and myoepitheliomas can mimic malignant cystosarcoma phylloides, but immunohistochemistry and electron microscopy can differentiate these entities. This is important since their biologic behavior is different.
Antibodies to different intermediate filament proteins can be used to distinguish cells of epithelial, mesenchymal, muscle, glial and neuronal origin. Antibodies to prekeratin which characterize cells of epithelial origin, and antibodies to vimentin which recognize cells of mesenchymal origin have been used to study twenty cases of breast carcinoma (sixteen infiltrating ductal carcinomas and four infiltrating intraductal carcinomas), two cases of cystic breast disease, two fibroadenomas and one case of benign cystosarcoma phylloides. The prekeratin and vimentin were detected using specific antibodies to these proteins by immunofluorescence microscopy using alcohol fixed paraffin-embedded tissues. In eighteen out of the twenty carcinomas the tumor cells were strongly and specifically stained by antibodies to prekeratin. DIfferent tumors gave different patterns of prekeratin staining. In contrast, when the same specimens were tested with the vimentin antibody, the tumor cells were unstained, and instead only the usual strong staining to fibroblasts and blood vessels in the stroma was observed. In cystic breast disease, fibroadenomas, and benign cystosarcoma phylloides, cells of epithelial origin were strongly stained by the prekeratin but not by the vimentin antibody.
A case of unilateral phylloides tumor of breast with sudden enlargement during pregnancy has been presented with successful pregnancy outcome followed by complete surgical excision (simple mastectomy) in the puerperium.
Three cases of cystosarcoma phylloides of the breast are presented. The different microscopic presentations are discussed. The therapeutic and prognostic importance of the histologic differences are discussed. Even after excision of the tumour in what appears to be benign types, recurrence must be expected. The recurrent tumour often shows a higher degree of atypia. The same conclusion is reached in other cases in the literature. An excision of the tumor can only be considered to be sufficient treatment if the microscopic findings show a benign well incapsulated tumour with few cells and the excision has been done well in healthy tissue. This should only take place in young women. Since cystosarcoma phylloides can usually not be differentiated clinically or mammographically from fibro-adenomas not even by cytology all fibroadenomas of the breast must be removed and subjected to microscopic evaluation. A mistake in the microscopic evaluation may arise if not several areas of the tumours are examined. The treatment of choice in cystosarcoma phylloides is removal of the breast especially if there is a marked epithelial component to the carcinosarcoma, axillary lymphadenectomy and possibly postoperative radiation may be necessary.
The results of xeroradiography, thermography, and ultrasonic gray scale echography in a case of cystosarcoma phylloides are presented. Echography better described the lesion than the other techniques. Gray scale echography displays the infrastructure of the breast tissues and differentiates between types of soft tissue.
The case of a 72-year-old woman with a high-partially located tumor grown within a half year to a magnitude of 8.5 x 11 x 11 cm is reported. The patient remembered a mastectomy and axillary lymphadenectomy followed by chemotherapy and radiation 8 years ago. Therefore we assumed a skeletal metastasis of a breast cancer. After wide excision, an unusual morphology was found, allowing only a classification as a pleomorphic sarcoma. Searching for the pathohistological evaluation of the former breast tumor, a cystosarcoma phylloides malignum could be found out. The tumor described here can be identified as a metastasis of this rare neoplasm.
The clinical and pathological findings and therapeutic options in 18 patients with cystosarcoma phylloides were retrospectively studied and analysed. Painless breast lump was the most common clinical penetration. An accurate pre-operative diagnosis was obtained in only six patients (33.3%). Intraoperative frozen section examination was performed in nine patients and the diagnosis was cystosarcoma phylloides in five patients, benign breast tumor in four patients with a 55.5% yield. The final pathological results revealed benign form cystosarcoma phylloides in 17 patients and malignant form in one patient. Seven patients, including the one with malignant form tumor, underwent wide excision with an adequate margin of normal breast tissue. One patient underwent subcutaneous mastectomy due to the huge size of tumor. The remaining 11 patients with presumed diagnosis of fibroadenoma or breast cancer underwent simple excision. There was no local recurrence or distant metastasis in any of the 18 patients, with a mean follow-up time of 31.5 months. On the basis of this data, wide excision with an adequate margin of normal breast tissue may be the preferred initial therapy for cystosarcoma phylloides. For those patients undergoing simple excision, the follow-up option may be acceptable if microscopic examination reveals no unrecognised amputation of tumor.
BACKGROUND: Cystosarcoma phylloides is a rare, mostly benign tumor of the breast. In most cases curative treatment is possible with complete surgical excision of the lesions. However, there is a high local recurrence rate up to 46%. There are only few reported successful treatments with radiotherapy in cystosarcoma phylloides. Radiotherapy is indicated in patients with locoregional recurrent disease and those with symptomatic metastases. PATIENT: We present a case of a 54-year-old woman with a painless mass in the right breast. Clinical examination showed a large, firm tumor and axillary lymph node metastases. The patient underwent mastectomy and axillary lymph node dissection. Histopathology showed a cystosarcoma phylloides measuring 30 x 25 x 19 cm as well as lymph node metastases measuring 9.5 cm. Despite a R0 resection the patient developed 4 thoracic wall recurrences within 2 years. At 18 months there were additional multiple pulmonary and pleural lesions with a maximum diameter of 6.5 cm. Subsequently the patient received polychemotherapy. There was a significant response of the thoracic wall disease as well as of the pulmonary and pleural lesions. Six months later there was further progress of the thoracic wall disease and the pulmonary lesions. Following this the patient underwent radiation therapy of her right thoracic wall with 50 Gy which lead clinically to a quick response. For the past 5 months there has been no evidence of thoracic wall disease recurrence. CONCLUSION: This is an unusual case of cystosarcoma phylloides and response to different therapeutic modalities. Cystosarcoma phylloides showed to be a radiosensitive tumor. Thus postopertive radiation therapy is indicated to prevent local recurrences.
Nine cases of cystosarcoma phylloides in adolescent female patients are reported along with an additional 35 cases collected from the literature. Analysis of these 44 cases revealed 37 (84.1 percent) benign lesions, 6 (13.6 percent) malignant tumors, and 1 borderline lesion. Excision was the most common operative procedure and was performed in 35 patients. Nine patients underwent mastectomy. There were three recurrent lesions (one benign and two malignant) for a recurrence rate of 6.8 percent. Wide excision was successful in the treatment of recurrent lesions. On the basis of these data, excision is the preferred initial therapy of cystosarcoma phylloides in the adolescent patient regardless of the histologic classification of the lesion. Malignant cystosarcoma is more likely to recur than a benign lesion but a recurrence can be managed with reexcision. Sacrifice of the adolescent breast at the initial procedure is strongly discouraged.
Treatment of a breast lesion should never be undertaken without a precise histologic diagnosis, which means careful examination of multiple sections of tissue embedded in paraffin and appropriately stained. The author described the clinical and histologic features of lobular and medullary cancers; cystosarcoma phylloides; carcinosarcoma; Paget's disease; adenoid cystic carcinoma; mucinous, tubular, and papillary cancers; and other unusual lesions that can originate elsewhere in the body. For each, treatment suggestions are offered.
A review of pediatric breast disorders is provided, with particular attention given to the topics of fibroadenoma, cystosarcoma phylloides, breast infections, breast cancer, and benign breast disease. The pediatric clinician is strongly encouraged to include the breast system as part of a complete examination and educational process.
Metastatic malignancies of the hand are infrequent and seldom initially diagnosed and often taken for infections. They usually occur at the late stage of metastatic generalization and indicate an ominous prognosis and justify surgical amputation. A case of metastasis to the distal phalanx of the left ring finger of a woman who had undergone radical mastectomy for breast cystosarcoma phylloides is reported. The evolution of this lesion, initially taken for a whitlow, lasted 45 days and eventually was treated by amputation. A review of literature confirms the rarity of the lesion, and reveals the pathological, clinical and radiographic characteristics.
Two cases of cystosarcoma phylloides in the adolescent female are presented and the literature reviewed. This lesion is usually benign. Even when malignant, simple excision has been curative in 2 or 3 cases. Therapy recommended is local excision with a small margin of normal tissue.
Malignant cystosarcoma phylloides is a rare breast cancer which frequently recurs locally before metastasizing. Local recurrence of cystosarcoma phylloides is unlike adenocarcinoma of the breast since it does not necessarily indicate systemic metastases; and, therefore, aggressive surgery can cure a number of patients with locally recurrent tumor. The present report is an extreme example of a patient with locally recurrent malignant cystosarcoma phylloides, and it illustrates the value of radical surgery in controlling this disease which had previously recurred 21 times. Fifteen months following sternal resection, the patient enjoys her longest tumor-free interval in 16 years.
Cystosarcoma phylloides is an exceedingly rare breast lesion in adolescent females. The tumour contains both stromal and epithelial elements. Benign, malignant and intermediate forms have been described. Complete simple excision is adequate for therapy in all variants. An additional case treated by wide local excision is presented and treatment is discussed.