Objective: To investigate the pathological features and the clinicopathological significance of TERT detection in those tumors that were difficult to diagnosis. Methods: A total of 93 cases of fibroepithelial tumors without definite diagnosis were collected from the Affiliated Hospital of Qigndao University between 2013 and 2021. The clinical details such as patients' age and tumor size were collected. All slides were re-reviewed and the pathologic parameters, including stromal cellularity, stromal cell atypia, stromal cell mitoses, and stromal overgrowth were re-interpreted. Sanger sequencing was used to detect TERT promoter status, and immunohistochemistry was performed to detect TERT protein expression. The relationship between TERT promoter mutation as well as protein expression levels and the clinicopathological parameters were also analyzed. Results: The patients' ages ranged from 30 to 71 years (mean of 46 years); the tumor size ranged from 1.2 to 8.0 cm (mean 3.8 cm). These tumors showed the following morphologic features: leafy structures in the background of fibroadenoma, or moderately to severely abundant stromal cells. The interpretations of tumor border status were ambiguous in some cases. The incidence of TERT promoter mutation was high in patients of age≥50 years, tumor size≥4 cm, and stromal overgrowth at ×4 or ×10 objective, and these clinicopathologic features were in favor of diagnosis of phyllodes tumors. TERT protein expression levels was not associated with the above clinicopathologic parameters and its promoter mutation status. Conclusions: The diagnostic difficulty for the breast fibroepithelial tumors is due to the difficulty in recognition of the leafy structures or in those cases with abundant stromal cells. A comprehensive evaluation combined with morphologic characteristics and molecular parameters such as TERT promoter may be helpful for the correct diagnosis and better evaluating recurrence risk.
Humans ; Adult ; Middle Aged ; Aged ; Female ; Neoplasms, Fibroepithelial/pathology* ; Phyllodes Tumor/genetics* ; Stromal Cells ; Fibroadenoma/pathology* ; Breast Neoplasms/pathology* ; Mutation ; Telomerase/genetics*

Phyllodes tumors are breast tumors accounting for about 1% of all breast neoplasms in women and are rare in males. Reported here is a case of a 45-year-old male presenting with a rapidly enlarging right breast mass with invasion of the anterior chest wall. Core Needle Biopsy revealed Malignant Phyllodes Tumor. He underwent wide excision and chest wall resection. Reconstruction was performed using polyropelene mesh, a latissimus dorsi flap and split thickness skin grafting. Patient was discharged on the 33rd post-operative day due to delayed expansion of the right lung from splinting and subsequent near-complete loss of the split thickness skin graft over the latissimus muscle flap. On the recommendation of the plastic surgeon, the wound was allowed to heal by secondary intention. This report draws attention to the rarity of malignant phyllodes tumor in males, and the difficulty of recognizing a malignant pathology in males presenting with breast mass. It also highlights a cost-effective treatment option in the management of these tumors.
Malignant Phyllodes tumor ; breast

Breast/pathology* ; Breast Neoplasms/surgery* ; Female ; Humans ; Phyllodes Tumor/surgery*

Non-islet cell tumor-induced hypoglycemia (NICTH) secondary to phyllodes tumor is extremely rare but potentially life threatening if not treated promptly. We report a case of a 46-year-old Indian female without underlying diabetes mellitus who presented with a large breast tumor and recurrent severe symptomatic hypoglycemia. Investigations supported the diagnosis of NICTH. The hypoglycemia only resolved after corticosteroids and mastectomy. This case highlights the importance of considering NICTH in the evaluation of patients with voluminous tumor and hypoglycemia.
Hypoglycemia ; Insulin-Like Growth Factor II ; Phyllodes Tumor ; Mastectomy ; Adrenal Cortex Hormones

No abstract available.
Breast ; Nasolacrimal Duct ; Neoplasm Metastasis ; Phyllodes Tumor

Cavernous hemangiomas are benign neoplasms of endothelial cells. Although this neoplasm has the potential to develop in all parts of the body, it rarely develops in the axilla; in fact, there are only two case reports of axillary cavernous hemangiomas in the literature. Here, we describe a third case, which occurred in a 30-year-old Korean woman. The patient presented with a palpable mass in the left axilla that was initially thought to be either a phyllodes tumor or a lymphoma based on imaging studies. However, the results of an excisional biopsy led to a diagnosis of cavernous hemangioma. Although uncommon, a cavernous hemangioma can be encountered unexpectedly, presenting as a mass in axilla. Although usually curative, surgery may be challenging not only because of the rarity of the condition, but also because of inconsistent preoperative findings and the involvement of large vessels.
Adult ; Axilla ; Biopsy ; Diagnosis ; Endothelial Cells ; Female ; Hemangioma, Cavernous ; Humans ; Lymphoma ; Phyllodes Tumor ; Ultrasonography ; Vascular Neoplasms

Breast Neoplasms ; pathology ; Female ; Humans ; Lung Neoplasms ; secondary ; Phyllodes Tumor ; secondary

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.
Acoustics ; Adolescent* ; Adult ; Biopsy ; Biopsy, Large-Core Needle ; Breast Diseases ; Breast Neoplasms ; Breast* ; Child* ; Diagnosis* ; Fibroadenoma ; Gynecomastia ; Humans ; Male ; Phyllodes Tumor ; Risk Factors ; Shadowing (Histology) ; Thorax ; Ultrasonography

OBJECTIVE: As there is a dearth of information on phyllodes tumors of the breast in the Philippines yet this ultimately impacts on the management and survival of Filipino patients, the authors reviewed their surgical cases of phyllodes tumors, focusing in this report, for the first time in Philippine literature, on the real risk of distant metastasis from the more common benign variety of phyllodes tumors. They therefore aim to identify case/s and do a review of literature on distant metastasis from benign phyllodes tumors.

METHODS: A review of records of all surgical cases of phyllodes tumor managed at PGH from 2005 - 2014 was done. Data from patients who on follow up were found to have distant metastasis were gathered and further reviewed. A literature search on metastatic phyllodes tumor and its implications was likewise done to complete this study.

RESULTS: A total of 200 patients with phyllodes tumor surgically managed within the study period were reviewed and followed up. One hundred sixty one out of 200 (80.5%) patients were histologically classified as benign. Twelve patients out of 200 (6.0%) developed distant metastasis on follow up, 1 (0.62% of 161 benign phyllodes tumors) of whom had benign phyllodes tumor.

CONCLUSIONS: The authors show that distant metastasis from benign phyllodes tumor can occur here in the Philippines. Therefore, the subtype of phyllodes tumor alone, especially in benign lesions, does not absolutely predict biological behavior and risk of recurrence. A better understanding of the true nature of metastasis in these tumors is highly anticipated.

We present the case of a 31-year-old woman with an inflammatory and ulcerative malignant phyllodes tumor in her right breast. A right modified radical mastectomy and transverse rectus abdominis myocutaneous (TRAM) flap were performed. A month after the initial operation, several masses recurred at the superior margin and deep margin of the TRAM flap. Wide excision was performed, but masses recurred at the inferior margin and in both lung fields 2 weeks after the second operation. Six weeks after the second operation, the patient died due to progression of dyspnea and respiratory failure.
Adult ; Breast ; Breast Neoplasms ; Dyspnea ; Female ; Humans ; Lung ; Mastectomy, Modified Radical ; Phyllodes Tumor* ; Rectus Abdominis ; Respiratory Insufficiency ; Ulcer