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

OBJECTIVETo explore the prognosis of benign, borderline and malignant phyllodes tumors of the breast.

METHODSData from 246 women with phyllodes tumors of the breast treated in the Cancer Hospital, Chinese Academy of Medical Sciences between January 2002 and December 2012, were collected and analyzed retrospectively. The patients were followed-up for a median of 48 months (range 1-138 months). Kaplan-Meier analysis and Cox proportional hazard model were used to analyze the factors affecting the disease-free survival.

RESULTSAmong the 246 patients, 65 were dropped out from the follow-up. 56 patients had local recurrence, 5 patients had distant metastasis, while one case had both local recurrence and distant metastasis. The median disease-free survival time was 39 months. Kaplan-Meier survival analysis revealed that fibroadenoma history and type of primary surgery were associated to the disease-free survival of phyllodes tumors of the breast (P<0.001, P=0.043), while histological type and primary tumor size had no significant relationship with the disease-free survival (P=0.083, P=0.974). The multivariate Cox proportional hazard model showed that type of primary surgery, fibroadenoma history and histological types are all independent factors affecting the disease-free survival (P=0.009, P=0.001 and P<0.001).

CONCLUSIONPhyllodes tumors of the breast have a relatively good prognosis on the whole. Type of primary surgery, fibroadenoma history and histological type are independent factors predicting the disease-free survival of patients with phyllodes tumors of the breast.

Breast Neoplasms ; mortality ; pathology ; surgery ; Disease-Free Survival ; Female ; Fibroadenoma ; mortality ; pathology ; surgery ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Neoplasm Recurrence, Local ; Phyllodes Tumor ; mortality ; pathology ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Time Factors

A 21-year-old woman underwent bilateral augmentation mammoplasty by injection of an unknown volume of fat obtained via trochanteric and abdominal liposuction. The procedure was performed by a surgeon untrained in plastic surgery, at a clinic not affiliated with a hospital. Six months later, she presented to our clinic with a palpable left breast lump. Physical examination revealed a large firm mass occupying the entire upper outer quadrant of the left breast and a normal right breast. Breast ultrasound showed a large, well-defined isoechoic mass in the left upper outer breast. Considering her age, the patient underwent core needle biopsy, since the mass mimicked a phyllodes tumor on ultrasonography. The 14-gauge core needle biopsy demonstrated multiple lipid droplets with some white-yellowish tissue, caused by liquefaction of the injected fat. Histopathologic examination demonstrated the presence of a pseudocyst with fat necrosis, granulomatous reaction to lipid material, and cystic formations containing oily fluid. No signs of malignancy were detected. Surgical excision was performed, and histopathology revealed findings consistent with fat necrosis.
Biopsy, Large-Core Needle ; Breast* ; Fat Necrosis ; Female ; Femur ; Humans ; Lipectomy ; Mammaplasty ; Phyllodes Tumor ; Physical Examination ; Surgery, Plastic ; Ultrasonography ; Young Adult

Actins ; metabolism ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; metabolism ; pathology ; surgery ; Calcium-Binding Proteins ; metabolism ; Carcinoma ; metabolism ; pathology ; Cyclophosphamide ; therapeutic use ; Desmin ; metabolism ; Diagnosis, Differential ; Female ; Fibrosarcoma ; metabolism ; pathology ; Fluorouracil ; therapeutic use ; Follow-Up Studies ; Humans ; Leiomyosarcoma ; drug therapy ; metabolism ; pathology ; surgery ; Mastectomy, Segmental ; Methotrexate ; therapeutic use ; Microfilament Proteins ; metabolism ; Neurilemmoma ; metabolism ; pathology ; Phyllodes Tumor ; metabolism ; pathology ; Postoperative Period ; Vimentin ; metabolism

OBJECTIVETo study the clinicopathologic features of malignant phyllodes tumors (PT) by histopathologic analyses, immunohistochemical profiling and DNA content assay, and evaluation of the clinical outcome.

METHODSTen patients with malignant PT from 1999 to 2013 who were treated by surgery were enrolled in this study. The morphologic characteristics were studied under light microscope, standard two-step EnVision method of immunohistochemical staining was used to assess the expression of CK5/6, CKpan, 34β E12, desmin, p63, ER-α, PR, Ki-67, CD34, SMA, p53, p16, bcl-2 and CD117 in the tumors. The corresponding paraffin blocks were also used for flow cytometric DNA content assay. These data were correlated with the follow-up results.

RESULTSThe median age of onset was 46.5 years old. The mean tumor size was 7.4 cm (2.0-25.0 cm). At the end of the follow-up period (22 to 125 months), there were tumor recurrences in 3/8 patients and the median time of recurrence was 24 months. Metastasis occurred in 3/8 patients who all died of the tumors. PT had heterogeneous histology, with stromal overgrowth with leaf-like projections, periductal stromal overgrowth, and most commonly, diffuse stromal overgrowth with sarcomatous differentiation. The mean positive index of Ki-67 was 11.4%. The stromal tumor cells were positive for CD34, SMA, p53, p16, and bcl-2 in 3/10, 9/10, 6/10, 8/10, and 4/10 cases, respectively. CD117,ER-α and PR were negative. Interpretable DNA histograms were obtained in nine cases with triploidy in two cases.

CONCLUSIONSThe diagnosis of malignant PT should be considered based on the diversity of growth patterns and heterogeneous histology.Ki-67 and CD34 are valuable diagnostic and prognostic factors in patients with malignant PT. Tumors with diffuse stromal overgrowth, heterologous elements, Ki-67 ≥ 20% or aneuploidy are more likely to metastasize.

Adult ; Aged ; Antigens, CD34 ; metabolism ; Bone Neoplasms ; secondary ; Breast Neoplasms ; genetics ; metabolism ; pathology ; surgery ; therapy ; Chemoradiotherapy, Adjuvant ; Diploidy ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; metabolism ; Lung Neoplasms ; secondary ; Mastectomy ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Phyllodes Tumor ; genetics ; metabolism ; pathology ; secondary ; surgery ; therapy ; Triploidy

Phyllodes tumor is a rare breast tumor. A 45-year-old woman who underwent left mastectomy 12 years ago was found to have infiltrates in both lungs in a health examination. Combining histological examinations of the lung and breast samples, the diagnosis of borderline phyllodes tumor metastases to the lung was made. It is the longest interval to our knowledge that the metastases occurred 12 years after primary phyllodes tumor.
Breast Neoplasms ; complications ; surgery ; Female ; Humans ; Lung Neoplasms ; secondary ; Middle Aged ; Phyllodes Tumor ; diagnosis ; secondary

Actins ; metabolism ; Adult ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Calcium-Binding Proteins ; metabolism ; Cell Differentiation ; Desmin ; metabolism ; Diagnosis, Differential ; Female ; Fibroadenoma ; metabolism ; pathology ; surgery ; Hamartoma ; pathology ; Humans ; Hyperplasia ; Leiomyoma ; pathology ; Microfilament Proteins ; metabolism ; Muscle, Smooth ; pathology ; Phyllodes Tumor ; pathology

We report a 65 year-old man with a large cystic phyllodes tumor of the prostate. The patient complained of abdominal discomfort and had a soft palpable mass. Computer tomography showed a solid and cystic mass in the pelvic fossa; the mass was adjacent only to the prostate. We excised the mass. Microscopic findings of the mass showed hyperplastic epithelium lined cysts with leaf-like intraluminal epithelia lined stromal projections, less than 2 mitotic counts/10 HPF, low-to-moderated cellularity, and mild-to-moderate cytoplasm atypia. The pathological findings were consistent with a phyllodes tumor of the prostate, a low-grade tumor. Twenty-eight months after the operation, the patient was well with no recurrence or metastases.
Aged ; Biopsy ; Humans ; Male ; Phyllodes Tumor/*pathology/radiography/*surgery ; Prostatic Neoplasms/*pathology/radiography/*surgery ; Tomography, X-Ray Computed

OBJECTIVETo explore the methods of diagnosis, treatment and prognosis for patients with recurrent breast phyllodes tumor.

METHODSClinicopathological data of 26 patients with pathologically proven recurrent phyllodes tumors treated from March 1972 to June 2006 were retrospectively analyzed.

RESULTSThe mean age of the 26 cases was 45 years, and the median follow-up duration was 83 months. The mean overall survival time of this series was 96 months. The primary breast phyllodes tumor was > or = 5 cm in 10 cases with a recurrence rate of 60.0% (6/10 cases); < 5 cm in 16 cases with a recurrence rate of 31.3% 5/16 cases). After surgical removal of the breast primary tumor, the recurrent tumor was > or = 5 cm in 14 cases with a re-recurrence rate of 35.7% (5/14 cases); < 5 cm was in 12 cases with are-recurrence rate of 50.0% (6/12 cases). There was no statistically significant relationship between the (primary and reccurent) tumor size and recurrence rate (P = 0.094, P = 0.383) or prognosis (P = 0.142, P = 0.486). The benign or malignant nature of the breast phyllodes tumor was significantly correlated with the rate of local re-recurrence (P = 0.046) and prognosis (P = 0.028).

CONCLUSIONThe benign or malignant nature of the breast phyllodes tumor is significantly correlated with the local re-recurrence and prognosis, while the size of the primary breast phyllodes tumor has no significant effect on either re-recrruence or prognosis. The first rescue operation is most important in the treatment of recurrent breast phyllodes tumor. The resection margin should be wide enough. Active surgical treatment can still effectively save the life of the patients with a local re-recurrent tumor.

Adolescent ; Adult ; Breast Neoplasms ; pathology ; surgery ; therapy ; Chemotherapy, Adjuvant ; Child ; Female ; Follow-Up Studies ; Humans ; Mastectomy ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Phyllodes Tumor ; pathology ; surgery ; therapy ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Young Adult

In this study, a recurrent massive phyllodes tumor of the breast was surgically removed and the grafting was used to repair the local skin defects. A 29-y female patient had recurring breast phyllodes tumor of extremely large size in the chest wall after the excision of a previous tumor. The massive phyllodes tumor was eliminated by completely removing the layers of the skin and tissues above the costal bones with incisal margin being 2 cm away from the tumor lesion. The latissimus dorsi myocutaneous flap, lateral thoracic skin flap, and rectus abdominis myocutaneous flap were grafted to replace the lost tissues due to the surgery. Anti-infection and anticoagulation treatments were used after the surgery. The graft flaps had sufficient blood supply and good blood circulation, and the incisions mostly healed. The outcome of the surgery was acceptable. For the surgical treatment of the massive phyllodes tumor in the chest wall, it is an alternative of choice to use latissimus dorsi myocutaneous flap, lateral thoracic skin flap and rectus abdominis myocutaneous flap in combination for skin grafting.
Breast Neoplasms/*surgery ; Mastectomy ; Neoplasm Recurrence, Local/*surgery ; Phyllodes Tumor/*surgery ; Surgical Flaps