Phyllodes Tumor of the Breast: Stromal Overgrowth and Histological Classification are Useful Prognosis-predictive Factors for Local Recurrence in Patients with a Positive Surgical Margin

ArticleinJapanese Journal of Clinical Oncology 37(10):730-6 · November 2007with22 Reads
DOI: 10.1093/jjco/hym099 · Source: PubMed
Abstract
Background The local recurrence rate of phyllodes tumors is high and ensuring a sufficient surgical margin is considered important for local control. However, the preoperative diagnosis rate of phyllodes tumors is low and we often encounter cases in which a sufficient surgical margin is not achieved, since in routine medical practice the lesion may not be diagnosed as phyllodes tumor until postoperative biopsy of a mammary mass. Furthermore, there are no established therapeutic guidelines for surgical stump-positive phyllodes tumors. We reviewed the outcomes of excision of phyllodes tumors to investigate factors involved in local recurrence and to determine the indication for re-excision in stump-positive cases.
    • "These are in contrast to the NCCN guidelines [8], which do not advocate radiotherapy or axillary staging , but the guidelines assume that a biopsy is performed to cement the diagnosis and do not account for emergent cases. The guidelines admit that the subtype of phyllodes tumor is less important than surgical margins, which has been corroborated by other studies to predict for poorer outcomes [6, 7]. Furthermore, large cohorts analyzed through the SEER database [9] , which showed 15-year cancerspecific survivals (CSS) of 89 %, did not demonstrate radiotherapy to improve CSS, but due to lack of information could not assess radiotherapy's effects on LR, especially with positive margins. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Signs and symptoms of a rapidly enlarging breast mass are not only important for all clinicians to recognize and assess, but also are not uncommon occurrences. We describe a similar but unique case that developed into an enormous, 36 cm exophytic mass. Case presentation: A 51-year-old woman with history of psychiatric conditions presented for signs and symptoms of sepsis. It was determined that the source was an enormous 36 cm mass originating from the breast/chest wall. After stabilizing the patient with antibiotics, she underwent successful resection. Surgical margins were positive, and histopathology demonstrated bland spindle cells with stromal overgrowth. Together with clinical and histopathological information, the patient was diagnosed with a phyllodes tumor. Conclusion: Differential diagnosis of rapidly growing breast masses is discussed, which are not uncommon occurrences in clinical medicine. One etiology, phyllodes tumors, can grow into large, exophytic masses as described. Oncologic treatment is discussed, usually consisting of surgery with postoperative radiotherapy for high-risk features.
    Full-text · Article · Dec 2015
    • "Distant metastasis rates of up to 17% have been reported, mostly from borderline or malignant tumours. Many suggested histological prognostic factors for distant metastases have been evaluated, including stromal overgrowth, infiltrating margins, mixed mesenchymal components, high mitotic rate and stromal atypia [3]. All of these were absent in this patient. "
    Full-text · Article · Jan 2015 · Cancer Treatment Communications
    • "Mastectomy should be considered for recurrent or giant tumors, or tumors for which excision would create a poor cosmetic outcome [2,6,10]. One study proposes a 'wait-and-watch' policy for cases with negative stromal overgrowth and for a benign or borderline tumor as they have a local recurrence rate of 23% [10]. Lymphadenectomy is recommended for palpable lymph nodes, which are present in 10–20% of cases [1,6,13] . "
    [Show abstract] [Hide abstract] ABSTRACT: Phyllodes tumors are extremely uncommon neoplasms that are usually benign. Patients with phyllodes tumors typically present with a well-circumscribed, painless, firm, and mobile mass or nodule characterized by rapid growth in a short period of time. It is recommended that these tumors be excised even though it may look as a fibroademoma. Our patient presented with a left nipple mass with rapid growth. The patient had been previously diagnosed with malignant phyllodes tumor, which was excised with adequate margins, later presenting with an exophytic mass extending from the nipple along with bloody discharge. The patient underwent a complete mastectomy of the left breast without a lymph node dissection, and pathology revealed an additional focus of intramammary myoepithelioma. The aim of this case report is increase awareness of these tumors and their potentially unusual presentations to allow clinicians the ability to recognize these neoplasms earlier as well as recognizing the need for better adjuvant therapy.
    Full-text · Article · Aug 2014
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